WorldWideScience

Sample records for arthroplasty register association

  1. The Nordic Arthroplasty Register Association

    DEFF Research Database (Denmark)

    Havelin, Leif I; Fenstad, Anne M; Salomonsson, Roger

    2009-01-01

    Background and purpose The possibility of comparing results and of pooling the data has been limited for the Nordic arthroplasty registries, because of different registration systems and questionnaires. We have established a common Nordic database, in order to compare demographics and the results...... collaboration has shown differences between the countries concerning demographics, prosthesis fixation, and survival. The large number of patients in this database significantly widens our horizons for future research....... of total hip replacement surgery between countries. In addition, we plan to study results in patient groups in which the numbers are too small to be studied in the individual countries. Material and methods Primary total hip replacements (THRs) from 1995-2006 were selected for the study. Denmark, Sweden......, and Norway contributed data. A common code set was made and Cox multiple regression, with adjustment for age, sex, and diagnosis was used to calculate prosthesis survival with any revision as endpoint. Results 280,201 operations were included (69,242 from Denmark, 140,821 from Sweden, and 70,138 from Norway...

  2. A Scandinavian Experience of Register Collaboration: The Nordic Arthroplasty Register Association (NARA)

    DEFF Research Database (Denmark)

    Havelin, Leif I; Robertsson, Otto; Fenstad, Anne M;

    2011-01-01

    The Nordic (Scandinavian) countries have had working arthroplasty registers for several years. However, the small numbers of inhabitants and the conformity within each country with respect to preferred prosthesis brands and techniques have limited register research....

  3. Arthroplasty register for Germany

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2009-10-01

    Full Text Available Scientific background: The annual number of joint replacement operations in Germany is high. The introduction of an arthroplasty register promises an important contribution to the improvement of the quality of patient’s care. Research questions: The presented report addresses the questions on organization and functioning, benefits and cost-benefits as well as on legal, ethical and social aspects of the arthroplasty registers. Methods: A systematic literature search was conducted in September 2008 in the medical databases MEDLINE, EMBASE etc. and was complemented with a hand search. Documents describing arthroplasty registers and/or their relevance as well as papers on legal, ethical and social aspects of such registers were included in the evaluation. The most important information was extracted and analysed. Results: Data concerning 30 arthroplasty registers in 19 countries as well as one international arthroplasty register were identified. Most of the arthroplasty registers are maintained by national orthopedic societies, others by health authorities or by their cooperation. Mostly, registries are financially supported by governments and rarely by other sources.The participation of the orthopedists in the data collection process of the arthroplasty registry is voluntary in most countries. The consent of the patients is usually required. The unique patient identification is ensured in nearly all registers.Each data set consists of patient and clinic identification numbers, data on diagnosis, the performed intervention, the operation date and implanted prostheses. The use of clinical scores, patient-reported questionnaires and radiological documentation is rare. Methods for data documentation and transfer are paper form, electronic entry as well as scanning of the data using bar codes. The data are mostly being checked for their completeness and validity. Most registers offer results of the data evaluation to the treating orthopedists and

  4. Inferior outcome after hip resurfacing arthroplasty than after conventional arthroplasty. Evidence from the Nordic Arthroplasty Register Association (NARA) database, 1995 to 2007

    DEFF Research Database (Denmark)

    Johanson, Per-Erik; Fenstad, Anne Marie; Furnes, Ove;

    2010-01-01

    The reported outcomes of hip resurfacing arthroplasty (HRA) vary. The frequency of this procedure in Denmark, Norway, and Sweden is low. We therefore determined the outcome of HRA in the NARA database, which is common to all 3 countries, and compared it to the outcome of conventional total hip...

  5. Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database

    DEFF Research Database (Denmark)

    Mäkelä, Keijo T; Matilainen, Markus; Pulkkinen, Pekka

    2014-01-01

    Background and purpose An earlier Nordic Arthroplasty Register Association (NARA) report on 280,201 total hip replacements (THRs) based on data from 1995-2006, from Sweden, Norway, and Denmark, was published in 2009. The present study assessed THR survival according to country, based on the NARA .......36-0.98) year of follow-up. Interpretation The differences in THR survival rates were considerable, with inferior results in Finland. Brand-level comparison of THRs in Nordic countries will be required....

  6. The Danish Hip Arthroplasty Register

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Varnum, Claus; Pedersen, Alma Becic

    2016-01-01

    through the DHR. Approximately 9,000 primary THAs and 1,500 revisions are reported to the register annually. CONCLUSION: The DHR is important for monitoring and improvement of treatment with THA and is a valuable tool for research in THA surgery due to the high quality of prospective collected data....... All Danish orthopedic departments - both public and private - report to the register, and registration is compulsory. MAIN VARIABLES: The main variables in the register include civil registration number, indication for primary and revision surgery, operation date and side, and postoperative...... complications. Completeness of primary and revision surgery is evaluated annually and validation of a number of variables has been carried out. DESCRIPTIVE DATA: A total of 139,525 primary THAs and 22,118 revisions have been registered in the DHR between January 1, 1995 and December 31, 2014. Since 1995...

  7. Validation of the diagnosis 'prosthetic joint infection' in the Danish Hip Arthroplasty Register

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Pedersen, A B; Schønheyder, HC;

    2016-01-01

    AIMS: The purpose of this study was to validate the diagnosis of periprosthetic joint infection (PJI) in the Danish Hip Arthroplasty Register (DHR). PATIENTS AND METHODS: We identified a cohort of patients from the DHR who had undergone primary total hip arthroplasty (THA) since 1 January 2005 an...

  8. Shoulder Arthroplasty Trials Are Infrequently Registered: A Systematic Review of Trials

    Science.gov (United States)

    Sanchez, Zachary Carter; Herrington, James Murphy; Hensel, James Barrett; Henning, Nolan Michael; Scheckel, Caleb Josiah; Vassar, Matt

    2016-01-01

    Introduction With the intent of improving transparency in clinical research, the International Committee of Medical Journal Editors (ICMJE) established guidelines in 2005 regarding prospective clinical trial registration. This action worked to address bias related to selective outcome reporting in the medical literature. The objective of this study was to assess and characterize the quality of registration of clinical trials appearing in shoulder arthroplasty-related medical journals. Methods All randomized trials involving human subjects, pertaining to shoulder arthroplasty, published between July 1, 2005 and December 31, 2015, and indexed in either PubMed or SportDISCUS were analyzed. We assessed the prevalence of registration, the timing of registration relative to patient enrollment periods, and the variable rates of orthopedic journal compliance with ICMJE and Food and Drug Administration clinical registration standards for our study. Results Of the 382 articles identified, 345 (90.3%) were excluded due to failure to meet inclusion criteria. From the remaining 37, only 12 (32.4%) studies were found to be registered in a trial registry. Ten (10/12, 83.3%) of these provided their registration information within the body of the article. None of the included studies from ICMJE-recognized journals were registered. From 34 included studies from non-ICMJE recognized journals, 12 (35.3%) were registered. Conclusion The level of compliance with clinical trial registration guidelines in the decade since their release among shoulder arthroplasty trials in orthopedic journals is poor. Given the importance of the issue, the prevalence of the problem, and the fact that many other medical specialties have already made efforts to improve ICMJE compliance, further work on the part of orthopedic surgery journal authors and editors is needed to ensure the publication of unbiased results. Trial Registration UMIN000022487 PMID:27764210

  9. Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register

    Science.gov (United States)

    Koivu, Helka; Eskelinen, Antti; Ikävalko, Mikko; Paavolainen, Pekka; Remes, Ville

    2010-01-01

    Background and purpose Although total ankle replacement (TAR) is a recognized procedure for treatment of the painful arthritic ankle, the best choice of implant and the long-term results are still unknown. We evaluated the survival of two TAR designs and factors associated with survival using data from the nationwide arthroplasty registry in Finland. Methods 573 primary TARs were performed during the period 1982–2006 because of rheumatic, arthritic, or posttraumatic ankle degeneration. We selected contemporary TAR designs that were each used in more than 40 operations, including the S.T.A.R. (n = 217) and AES (n = 298), to assess their respective survival rates. The mean age of the patients was 55 (17–86) years and 63% of operations were performed in women. Kaplan-Meier analysis and the Cox regression model were used for survival analysis. The effects of age, sex, diagnosis, and hospital volume were also studied. Results The annual incidence of TAR was 1.5 per 105 inhabitants. The 5-year overall survivorship for the whole TAR cohort was 83% (95% CI: 81–86), which agrees with earlier reports. The most frequent reasons for revision were aseptic loosening of one or both of the prosthesis components (39%) and instability (39%). We found no difference in survival rate between the S.T.A.R. and AES designs. Furthermore, age, sex, diagnosis, and hospital volume ( 100 replacements in each of 17 hospitals) did not affect the TAR survival. Interpretation Based on our findings, we cannot conclude that any prosthesis was superior to any other. A high number of technical errors in primary TARs suggests that this low-volume field of implant arthroplasty should be centralized to fewer units. PMID:20180720

  10. The association between metal allergy, total knee arthroplasty, and revision

    DEFF Research Database (Denmark)

    Münch, Henrik J; Jakobsen, Stig Storgaard; Olesen, Jens T;

    2015-01-01

    Background and purpose - It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction ...

  11. Gluteal tendon reconstruction in association with hip arthroplasty.

    Science.gov (United States)

    Bajwa, Ali S; Campbell, David G; Comely, Andrew S; Lewis, Peter L

    2011-01-01

    We studied a prospective cohort of patients in whom gluteal tendon reconstruction was undertaken in association with hip arthroplasty. Over the course of 10 years, 24 patients had gluteal tendon reconstruction performed either at the time of hip arthroplasty or post-operatively, using the Ligament Augment and Reconstruction System (LARS), suture anchors, direct suture to bone, or a combination of these techniques. All patients were assessed clinically and by patient-centred outcome measures, including the hip disability and osteoarthritis score (HOOS). The mean post-operative HOOS was significantly better than pre-operative score (p pain, activities of daily living (ADL), sports and quality of life (QoL) was 72 (SD 12.8), 73 (SD 15.9), 71 (SD 11.8), 54 (SD 22.6) and 57 (SD 21.76) respectively. There were two failures of gluteal tendon reconstruction which required revision using LARS. One patient died of an unrelated cause. Surgical intervention should be considered in gluteal tendinopathy at the time of hip arthroplasty or when symptoms occur following arthroplasty.

  12. Nationwide review of mixed and non-mixed components from different manufacturers in total hip arthroplasty A Dutch Arthroplasty Register study

    NARCIS (Netherlands)

    Peters, Rinne M.; van Steenbergen, Liza N.; Bulstra, Sjoerd K.; Zeegers, Adelgunde V. C. M.; Stewart, Roy E.; Poolman, Rudolf W.; Hosman, Anton H.

    2016-01-01

    Background and purpose - Combining components from different manufacturers in total hip arthroplasty (THA) is common practice worldwide. We determined the proportion of THAs used in the Netherlands that consist of components from different manufacturers, and compared the revision rates of these mixe

  13. Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty,

    OpenAIRE

    Carlos Roberto Schwartsmann; Felipe Loss; Leandro de Freitas Spinelli; Roque Furian; Marcelo Faria Silva; Júlia Mazzuchello Zanatta; Leonardo Carbonera Boschin; Ramiro Zilles Gonçalves; Anthony Kerbes Yépez

    2014-01-01

    OBJECTIVE: this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty.METHODS: sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically.RESULTS: there were 35 female patients (56.5%) and 27 male patients (43.5%), with a mean age of 65 years (±11). Trochanteric bursitis was conformed histo...

  14. Delayed Femoral Nerve Palsy Associated with Iliopsoas Hematoma after Primary Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Sandeep Kumar

    2016-01-01

    Full Text Available Femoral nerve neuropathy after total hip arthroplasty is rare but catastrophic complication. Pain and quadriceps muscle weakness caused by this complication can significantly affect the functional outcome. Here we present a case report, describing delayed onset femoral nerve palsy associated with iliopsoas hematoma following pseudoaneurysm of a branch of profunda femoris artery after 3 months of primary total hip arthroplasty in an 80-year-old female patient with single kidney. Hip arthroplasty was done for painful primary osteoarthritis of left hip. Diagnosis of femoral nerve palsy was made by clinical examination and computed tomography imaging of pelvis. Patient was managed by surgical evacuation of hematoma and physiotherapy. The patient’s clinical symptoms were improved after surgical evacuation of hematoma. This is the first case report of its kind in English literature regarding delayed onset femoral nerve palsy after primary total hip arthroplasty due to pseudoaneurysm of a branch of profunda femoris artery without any obvious precipitating factor.

  15. Association between trochanteric bursitis, osteoarthrosis and total hip arthroplasty,

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann

    2014-06-01

    Full Text Available OBJECTIVE: this was an epidemiological study on trochanteric bursitis at the time of performing total hip arthroplasty.METHODS: sixty-two sequential patients who underwent total hip arthroplasty due to osteoarthrosis, without any previous history of trochanteric bursitis, were evaluated. The bursas were collected and evaluated histologically.RESULTS: there were 35 female patients (56.5% and 27 male patients (43.5%, with a mean age of 65 years (±11. Trochanteric bursitis was conformed histologically in nine patients (14.5%, of whom six were female (66.7% and three were male (33.3%.CONCLUSIONS: 14.5% of the bursas analyzed presented inflammation at the time that the primary total hip arthroplasty due to osteoarthrosis was performed, and the majority of the cases of bursitis were detected in female patients.

  16. Increasing Resistance of Coagulase-Negative Staphylococci in Total Hip Arthroplasty Infections: 278 THA-Revisions due to Infection Reported to the Norwegian Arthroplasty Register from 1993 to 2007

    Directory of Open Access Journals (Sweden)

    Olav Lutro

    2014-01-01

    Full Text Available We investigated bacterial findings from intraoperative tissue samples taken during revision due to infection after total hip arthroplasty (THA. The aim was to investigate whether the susceptibility patterns changed during the period from 1993 through 2007. Reported revisions due to infection in the Norwegian Arthroplasty Register (NAR were identified, and 10 representative hospitals in Norway were visited. All relevant information on patients reported to the NAR for a revision due to infection, including bacteriological findings, was collected from the medical records. A total of 278 revision surgeries with bacterial growth in more than 2 samples were identified and included. Differences between three 5-year time periods were tested by the chi-square test for linear trend. The most frequent isolates were coagulase-negative staphylococci (CoNS (41%, 113/278 and Staphylococcus aureus (19%, 53/278. The proportion of CoNS resistant to the methicillin-group increased from 57% (16/28 in the first period, 1993–1997, to 84% (52/62 in the last period, 2003–2007 (P = 0.003. There was also significant increase in resistance for CoNS to cotrimoxazole, quinolones, clindamycin, and macrolides. All S. aureus isolates were sensitive to both the methicillin-group and the aminoglycosides. For the other bacteria identified no changes in susceptibility patterns were found.

  17. The association between metal allergy, total hip arthroplasty, and revision

    DEFF Research Database (Denmark)

    Thyssen, Jacob Pontoppidan; Jakobsen, Stig Storgaard; Engkilde, Kåre;

    2009-01-01

    in general with THA. Furthermore, we compared the prevalence of metal allergy in dermatitis patients with and without THA. MATERIALS AND METHODS: The Danish Hip Arthroplasty Registry (DHAR) contained detailed information on 90,697 operations. The Gentofte patch-test database contained test results...

  18. Mortality after shoulder arthroplasty

    DEFF Research Database (Denmark)

    Amundsen, Alexander; Rasmussen, Jeppe Vejlgaard; Olsen, Bo Sanderhoff

    2016-01-01

    BACKGROUND: The primary aim was to quantify the 30-day, 90-day, and 1-year mortality rates after primary shoulder replacement. The secondary aims were to assess the association between mortality and diagnoses and to compare the mortality rate with that of the general population. METHODS: The study...... included 5853 primary operations reported to the Danish Shoulder Arthroplasty Registry between 2006 and 2012. Information about deaths was obtained from the Danish Cause of Death Register and the Danish Civil Registration System. Age- and sex-adjusted control groups were retrieved from Statistics Denmark...

  19. The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, environmental registers and administrative registers

    DEFF Research Database (Denmark)

    Kirkeskov, Lilli; Kristiansen, Eva; Bøggild, Henrik

    2010-01-01

    Kirkeskov L, Kristiansen E, Bøggild H, von Platen-Hallermund F, Sckerl H, Carlsen A, Larsen MJ, Poulsen S. The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, environmental registers and administrative registers. Community...... Dent Oral Epidemiol 2010. (c) 2010 John Wiley & Sons A/S Abstract - Objectives: To study the association between fluoride concentration in drinking water and dental caries in Danish children. Methods: The study linked registry data on fluoride concentration in drinking water over a 10-year period...... with data on dental caries from the Danish National Board of Health database on child dental health for 5-year-old children born in 1989 and 1999, and for 15-year-old children born in 1979 and 1989. The number of children included in the cohorts varied between 41.000 and 48.000. Logistic regression was used...

  20. The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, environmental registers and administrative registers

    DEFF Research Database (Denmark)

    Kirkeskov, Lilli; Kristiansen, Eva; Bøggild, Henrik;

    2010-01-01

    to assess the correlations, adjusting for gender and taxable family income as a proxy variable for socioeconomic status. Results: Fluoride concentration in drinking water varied considerably within the country from very low (1 mg/l), a reduction of approximately 50% was found. Similar findings were found......Kirkeskov L, Kristiansen E, Bøggild H, von Platen-Hallermund F, Sckerl H, Carlsen A, Larsen MJ, Poulsen S. The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, environmental registers and administrative registers. Community...... Dent Oral Epidemiol 2010. (c) 2010 John Wiley & Sons A/S Abstract - Objectives: To study the association between fluoride concentration in drinking water and dental caries in Danish children. Methods: The study linked registry data on fluoride concentration in drinking water over a 10-year period...

  1. Survival rates and causes of revision in cemented primary total knee replacement: a report from the Norwegian Arthroplasty Register 1994-2009.

    Science.gov (United States)

    Gøthesen, O; Espehaug, B; Havelin, L; Petursson, G; Lygre, S; Ellison, P; Hallan, G; Furnes, O

    2013-05-01

    We evaluated the rates of survival and cause of revision of seven different brands of cemented primary total knee replacement (TKR) in the Norwegian Arthroplasty Register during the years 1994 to 2009. Revision for any cause, including resurfacing of the patella, was the primary endpoint. Specific causes of revision were secondary outcomes. Three posterior cruciate-retaining (PCR) fixed modular-bearing TKRs, two fixed non-modular bearing PCR TKRs and two mobile-bearing posterior cruciate-sacrificing TKRs were investigated in a total of 17 782 primary TKRs. The median follow-up for the implants ranged from 1.8 to 6.9 years. Kaplan-Meier 10-year survival ranged from 89.5% to 95.3%. Cox's relative risk (RR) was calculated relative to the fixed modular-bearing Profix knee (the most frequently used TKR in Norway), and ranged from 1.1 to 2.6. The risk of revision for aseptic tibial loosening was higher in the mobile-bearing LCS Classic (RR 6.8 (95% confidence interval (CI) 3.8 to 12.1)), the LCS Complete (RR 7.7 (95% CI 4.1 to 14.4)), the fixed modular-bearing Duracon (RR 4.5 (95% CI 1.8 to 11.1)) and the fixed non-modular bearing AGC Universal TKR (RR 2.5 (95% CI 1.3 to 5.1)), compared with the Profix. These implants (except AGC Universal) also had an increased risk of revision for femoral loosening (RR 2.3 (95% CI 1.1 to 4.8), RR 3.7 (95% CI 1.6 to 8.9), and RR 3.4 (95% CI 1.1 to 11.0), respectively). These results suggest that aseptic loosening is related to design in TKR.

  2. Associations between rates of unassisted inpatient falls and levels of registered and non-registered nurse staffing

    OpenAIRE

    Staggs, Vincent S.; Dunton, Nancy

    2013-01-01

    Objective To enhance understanding of how nurse staffing relates to unassisted falls by exploring non-linear associations between unassisted fall rates and levels of registered nurse (RN) and non-RN staffing on 5 nursing unit types, thereby enabling managers to improve patient safety by making better-informed decisions about staffing. Design Cross-sectional analysis of routinely collected data using hierarchical negative binomial regression. Settings 8069 nursing units in 1361 U.S. hospitals ...

  3. Late recurrent hemarthrosis following knee arthroplasty associated with epithelioid angiosarcoma of bone.

    Science.gov (United States)

    Drexler, M; Dolkart, O; Amar, E; Pritsch, T; Dekel, S

    2010-10-01

    We report a case of recurrent hemarthrosis 1 year following total knee arthroplasty in a patient with no bleeding diathesis, the hemarthrosis was found to be related to, and led to the diagnosis of high grade sarcoma of the proximal tibia. Twenty five years earlier, he sustained a lateral tibial plateau fracture and was treated with open reduction and plating. Sarcoma developing in association with a metallic orthopedic prosthesis or hardware is an uncommon, but well-recognized complication. Sarcomas that occur adjacent to orthopaedic prostheses or hardware are of varied types, but are usually osteosarcoma or malignant fibrous histiocytoma.

  4. Early failures among 7,174 primary total knee replacements: a follow-up study from the Norwegian Arthroplasty Register 1994-2000.

    Science.gov (United States)

    Furnes, Ove; Espehaug, Birgitte; Lie, Stein Atle; Vollset, Stein Emil; Engesaeter, Lars Birger; Havelin, Leif Ivar

    2002-04-01

    We studied primary total knee replacements (TKRs), reported to the Norwegian Arthroplasty Register, operated on between 1994 and 2000. A Cox multiple regression model was used to evaluate differences in survival among the prosthesis brands, their types of fixation, and whether or not the patella was resurfaced. In Norway in 1999, the incidence of knee prosthesis operations was 35 per 100,000 inhabitants. Cement was used as fixation in 87% of the knees, 10% were hybrid and 2% uncemented implants. Bicompartmental (not resurfaced patella) prostheses were used in 65% of the knees. With all revisions as endpoint, no statistically significant differences in the 5-year survival were found among the cemented tricompartmental prostheses brands: AGC 97% (n 279), Duracon 99% (n 101), Genesis I 95% (n 654), Kinemax 98% (n 213) and Tricon 96% (n 454). The bicompartmental LCS prostheses had a 5-year survival of 97% (n 476). The type of meniscal bearing in LCS knees had no effect on survival. Survival with revision for all causes as endpoint showed no differences among types of fixation, or bi- or tricompartmental prostheses. Pain alone was the commonest reason for revision of cemented bicompartmental prostheses. The risk of revision because of pain was 5.7 times higher (p < 0.001) in cemented bicompartmental prostheses than cemented tricompartmental ones, but the revisions mainly involved insertion of a patellar component. In tricompartmental prostheses the risk of revision because of infection was 2.5 times higher than in bicompartmental ones (p = 0.03). Young age (< 60) and the sequelae after a fracture increased the risk of revision. The 5-year survival of the 6 most used cemented tricompartmental knee prostheses brands varied between 95% and 99%, but the differences were not statistically significant. There were more revisions because of pain in bicompartmental than in tricompartmental knees. In tricompartmental knees, however, there were more revisions because of an

  5. Transfemoral amputation after failed knee arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. With use of individual data linkage, 92,785 primary knee arthroplasties performed from 1997 to 2013 were identified. Of these, 258...... for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed...

  6. Psoas abscess associated with infected total hip arthroplasty: a case report.

    Science.gov (United States)

    Plaza, R; Soriano, A; Tomas, X; Gallart, X; Garcia, S

    2006-01-01

    Psoas abscess (PA) is an uncommon disease and its diagnosis is difficult. It can be primary or secondary. Primary abscesses are of unknown origin and are presumably caused by haematogenous or lymphatic spread from a distant infectious focus. Secondary PA is caused by spreading from a contiguous infected structure, such as vertebrae (espondilodiscitis) or mesenteric abscesses (Crohns disease). PA infrequently has been associated with an infection of total hip arthroplasty (ITHA). The correct diagnosis in these cases is difficult due to the clinical similarities between PA and ITHA. Since connection between PA and ITHA is established through the acetabulum, we consider that computed tomography (CT) is the most accurate radiological test because of its efficacy in evaluating the bone structure, and the optimum therapeutic strategy is two-stage replacement surgery. We report one case of PA associated with ITHA and a review of the previous literature.

  7. Bariatric Surgery Prior to Total Knee Arthroplasty is Associated With Fewer Postoperative Complications.

    Science.gov (United States)

    Werner, Brian C; Kurkis, Gregory M; Gwathmey, F Winston; Browne, James A

    2015-09-01

    This study used a national database to compare 90-day postoperative complication rates between three groups of patients who underwent total knee arthroplasty (TKA): (1) non-obese patients (n=66,523), (2) morbidly obese patients who did not have bariatric surgery (n=11,294) and (3) morbidly obese patients who underwent bariatric surgery prior to TKA (n=219). Morbidly obese patients who underwent bariatric surgery prior to TKA had reduced rates of major (OR 0.45, P=0.001) and minor (OR 0.61, P=0.01) complications compared to morbidly obese patients who did not have bariatric surgery. Bariatric surgery prior to TKA appears to be associated with less risk of postoperative complications, although not to the same level as non-obese patients.

  8. No bias of ignored bilaterality when analysing the revision risk of knee prostheses: Analysis of a population based sample of 44,590 patients with 55,298 knee prostheses from the national Swedish Knee Arthroplasty Register

    Directory of Open Access Journals (Sweden)

    Ranstam Jonas

    2003-02-01

    Full Text Available Abstract Background The current practice of the Swedish Knee Register is not to take into consideration if one or both knees in a patient are subject to surgery when evaluating risk of revision after arthroplasty. Risk calculations are typically done by statistical methods, such as Kaplan-Meier analyses and Cox's proportional hazards models, that are based on the assumption that observed events are independent, and this is rarely appreciated. The purpose of this study was to investigate if ignoring bilateral operations when using these methods biases the results. Methods The bias of not taking bilateral operations into account was investigated by statistically analysing 55 298 prostheses in 44 590 patients, undergoing knee arthroplasty surgery in Sweden during 1985–1999, using traditional proportional hazards analysis, which assumes that all observations are independent, and a shared gamma frailty model, which allows patients to contribute repeated observations. Results The effect of neglecting bilateral prostheses is minute, possibly because bilateral prosthesis failure is a rare event. Conclusion We conclude that the revision risk of knee prostheses in general can be analysed without consideration for subject dependency, at least in study populations with a relatively low proportion of subjects having experienced bilateral revisions.

  9. Biofeedback relaxation for pain associated with continuous passive motion in Taiwanese patients after total knee arthroplasty.

    Science.gov (United States)

    Wang, Tsae-Jyy; Chang, Ching-Fen; Lou, Meei-Fang; Ao, Man-Kuan; Liu, Chiung-Chen; Liang, Shu-Yuan; Wu, Shu-Fang Vivienne; Tung, Heng-Hsing

    2015-02-01

    Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f = 29.70, p biofeedback relaxation, a non-invasive and non-pharmacological intervention, as a complementary treatment option for pain management in this population.

  10. Lower Limbs Function and Pain Relationships after Unilateral Total Knee Arthroplasty

    Science.gov (United States)

    Tali, Maie; Maaroos, Jaak

    2010-01-01

    The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was…

  11. Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association

    DEFF Research Database (Denmark)

    Pedersen, A B; Mehnert, F; Havelin, L I;

    2014-01-01

    to Norway, Sweden and Finland. Conclusions: Uncemented implants perform better in relation to long-term risk of aseptic loosening, whereas both uncemented and hybrid rather than cemented implants in patients younger than 55 years had more short-term revisions because problems due to dislocation......, periprosthetic fracture and infection has not yet been completely solved. The vast majority of cup-stem combinations were used in very few operations. (C) 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved....

  12. Improvements in knee biomechanics during walking are associated with increased physical activity after total knee arthroplasty.

    Science.gov (United States)

    Arnold, John B; Mackintosh, Shylie; Olds, Timothy S; Jones, Sara; Thewlis, Dominic

    2015-12-01

    Total knee arthroplasty (TKA) in people with knee osteoarthritis increases knee-specific and general physical function, but it has not been established if there is a relationship between changes in these elements of functional ability. This study investigated changes and relationships between knee biomechanics during walking, physical activity, and use of time after TKA. Fifteen people awaiting TKA underwent 3D gait analysis before and six months after surgery. Physical activity and use of time were determined in free-living conditions from a high resolution 24-h activity recall. After surgery, participants displayed significant improvements in sagittal plane knee biomechanics and improved their physical activity profiles, standing for 105 more minutes (p=0.001) and performing 64 min more inside chores on average per day (p=0.008). Changes in sagittal plane knee range of motion (ROM) and peak knee flexion positively correlated with changes in total daily energy expenditure, time spent undertaking moderate to vigorous physical activity, inside chores and passive transport (r=0.52-0.66, p=0.005-0.047). Restoration of knee function occurs in parallel and is associated with improvements in physical activity and use of time after TKA. Increased functional knee ROM is required to support improvements in total and context specific physical activity.

  13. Association of schizophrenia and autoimmune diseases: linkage of Danish national registers

    DEFF Research Database (Denmark)

    Eaton, William W.; Byrne, Majella; Ewald, Henrik

    2006-01-01

    the association of schizophrenia with these disorders as well as a range of other autoimmune diseases in a single large epidemiologic study. METHOD: The Danish Psychiatric Register, the National Patient Register, and a register with socioeconomic information were linked to form a data file that included all 7......,704 persons in Denmark diagnosed with schizophrenia from 1981 to 1998 and their parents along with a sample of matched comparison subjects and their parents. The data linkage required that the autoimmune disease occur before the diagnosis of schizophrenia. RESULTS: A history of any autoimmune disease...... was associated with a 45% increase in risk for schizophrenia. Nine autoimmune disorders had higher prevalence rates among patients with schizophrenia than among comparison subjects (crude incidence rate ratios ranging from 1.9 to 12.5), and 12 autoimmune diseases had higher prevalence rates among parents...

  14. Knee Arthrodesis after failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...... in a nationwide population. METHODS: Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. A total of 92,785 primary knee arthroplasties performed in Denmark from 1997 to 2013 were identified by linking the data using....... Differences in cumulative incidence were compared with the Gray test. RESULTS: A total of 164 of the 165 arthrodeses were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of arthrodesis was 0.26% (95% confidence interval, 0.21% to 0.31%). The 5-year cumulative...

  15. Pre-Operative Patient Education is Associated With Decreased Risk of Arthrofibrosis After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Livbjerg, Anna Emilie; Frøkjær, Sara; Simonsen, Ole

    2013-01-01

    The purpose was to investigate risk factors for postoperative stiffness and long-term outcome following manipulation under anaesthesia (MUA). In one of the five Danish regions, all patients in a 4-year period who received MUA following total knee arthroplasty (N=36) were included in two case-cont...

  16. The BCL2 -938C>A Promoter Polymorphism Is Associated with Risk for and Time to Aseptic Loosening of Total Hip Arthroplasty.

    Science.gov (United States)

    Stelmach, Patrick; Wedemeyer, Christian; Fuest, Lena; Kurscheid, Gina; Gehrke, Thorsten; Klenke, Stefanie; Jäger, Marcus; Kauther, Max D; Bachmann, Hagen S

    2016-01-01

    Aseptic loosening is a major cause of revision surgery of total hip arthroplasty (THA). Only few host factors affecting aseptic loosening have been identified until now, although they are urgently needed to identify and possibly treat those patients at higher risk for aseptic loosening. To determine whether the functional single nucleotide polymorphism (SNP) c.-938C>A (rs2279115), located in the promoter region of the BCL2 gene has an impact on aseptic loosening of THA we genotyped and analyzed 234 patients suffering from aseptic loosening and 231 patients after primary THA. The polymorphism is associated with risk for aseptic loosening with the CC genotype at highest risk for aseptic loosening, Odds Ratio CC vs. AA 1.93, 95%CI 1.15-3.25, p = 0.013. In contrast, low risk AA genotype carriers that still developed aseptic loosening showed a significantly shorter time to aseptic loosening than patients carrying the C allele (p = 0.004). These results indicate that the BCL2 -938C>A polymorphism influences the occurrence and course of aseptic loosening and suggests this polymorphism as an interesting candidate for prospective studies and analyses in THA registers.

  17. The BCL2 -938C>A Promoter Polymorphism Is Associated with Risk for and Time to Aseptic Loosening of Total Hip Arthroplasty.

    Directory of Open Access Journals (Sweden)

    Patrick Stelmach

    Full Text Available Aseptic loosening is a major cause of revision surgery of total hip arthroplasty (THA. Only few host factors affecting aseptic loosening have been identified until now, although they are urgently needed to identify and possibly treat those patients at higher risk for aseptic loosening. To determine whether the functional single nucleotide polymorphism (SNP c.-938C>A (rs2279115, located in the promoter region of the BCL2 gene has an impact on aseptic loosening of THA we genotyped and analyzed 234 patients suffering from aseptic loosening and 231 patients after primary THA. The polymorphism is associated with risk for aseptic loosening with the CC genotype at highest risk for aseptic loosening, Odds Ratio CC vs. AA 1.93, 95%CI 1.15-3.25, p = 0.013. In contrast, low risk AA genotype carriers that still developed aseptic loosening showed a significantly shorter time to aseptic loosening than patients carrying the C allele (p = 0.004. These results indicate that the BCL2 -938C>A polymorphism influences the occurrence and course of aseptic loosening and suggests this polymorphism as an interesting candidate for prospective studies and analyses in THA registers.

  18. Position statement. Restructuring, work redesign, and the job and career security of registered nurses. American Nurses Association.

    Science.gov (United States)

    1996-01-01

    The American Nurses Association (ANA) is committed to safeguarding the public, protecting and advancing the careers of professional nurses, supporting individual and collective efforts by registered nurses to protect their clients and enhancing the professional development and job security of registered nurses. As the nation's health care system is restructured, ANA is actively engaged in initiatives to strengthen the economic and general welfare of registered nurses, the safety and care for the public, and, in partnership with the state nurses associations (SNAs), oppose efforts to replace registered nurses with inappropriate substitutes.

  19. The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality

    DEFF Research Database (Denmark)

    Zerwas, Stephanie; Tidselbak Larsen, Janne; Petersen, Liselotte;

    2015-01-01

    Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark...... between 1989 and 2006 were included (N = 966,141, 51.3% male). Eating disorders diagnoses (AN, broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish National Patient Register (NPR). Suicide attempts and deaths were captured in the NPR, the PCRR......, and the Danish Civil Registration System (CRS). In females, AN had a peak hazard at approximately age 15 years, BN at 22 years, and EDNOS had an extended peak that spanned 18 years–22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent...

  20. Distraction Arthroplasty

    Science.gov (United States)

    ... arthroplasty? The major goal of this treatment is healing of damaged tissue that occurs from arthritis. Unloading the ankle, along with the use of range of motion activity, is believed to help restore some of the ...

  1. [The profile of fragility and associated factors among the elderly registered in a Family Health Unit].

    Science.gov (United States)

    Santos, Patrícia Honório Silva; Fernandes, Marcos Henrique; Casotti, Cezar Augusto; Coqueiro, Raildo da Silva; Carneiro, José Ailton Oliveira

    2015-06-01

    The scope of this study was to identify the profile of fragility and associated factors among the elderly registered in a Family Health Unit. It involved an observational, exploratory, household -based and cross-sectional study conducted with 139 elderly individuals. The data were collected using a structured questionnaire requesting the following information: personal history, family and self-reported diseases, socio-demographic information, level of physical activity, behavior variables, number of falls in the last year, depressive symptoms, unintentional weight loss and fatigue. Anthropometric measurements (weight and height) were also taken and the body mass index (BMI) was calculated. Descriptive analyses and Pearson's chi-square test or Fisher's exact test were performed, with a significance level of p fragility among the elderly was: frail (16.9%), pre-frail (61.8%) and non-frail (21.3%), respectively. The fragility profile was associated with: age (p factors associated with this syndrome.

  2. The knee adduction moment during gait is associated with the adduction angle measured during computer-assisted total knee arthroplasty.

    Science.gov (United States)

    Roda, Richard D; Wilson, Janie L Astephen; Wilson, David A J; Richardson, Glen; Dunbar, Michael J

    2012-06-01

    Computer-assisted surgery can be used to measure 3-dimensional knee function during arthroplasty surgery; however, it is unknown if the movement of the knee measured during surgery is related to the in vitro, dynamic state of the knee joint, specifically the knee adduction moment during gait, which has been related to implant migration. The purpose of this study was to determine if the preoperative adduction moment is correlated with the knee abduction/adduction angle measured intraoperatively. A statistically significant correlation was found between the mean (r(2) = 0.59; P = .001) and peak (r(2) = 0.53; P = .003) preoperative knee adduction moment and the mean abduction/adduction angle measured intraoperatively. The association found in this study suggests the potential for incorporating functional information that relates to surgical outcome into surgical decision making using computer-assisted surgery.

  3. Joint association of sleep problems and psychosocial working conditions with registered long-term sickness absence

    DEFF Research Database (Denmark)

    Madsen, Ida E. H.; Larsen, Ann D.; Thorsen, Sannie V.

    2016-01-01

    questionnaire response. We defined sleep problems by self-reported symptoms and/or register data on hypnotics purchases of hypnotics. Psychosocial working conditions included quantitative and emotional demands, influence, supervisor recognition and social support, leadership quality, and social support from......Objectives: Sleep problems and adverse psychosocial working conditions are associated with increased risk of long-term sickness absence. Because sleep problems affect role functioning they may also exacerbate any effects of psychosocial working conditions and vice versa. We examined whether sleep...... problems and psychosocial working conditions interact in their associations with long-term sickness absence. Methods: We linked questionnaire data from participants to two surveys of random samples of the Danish working population (N=10 752) with registries on long-term sick leave during five years after...

  4. Failure of cervical arthroplasty in a patient with adjacent segment disease associated with Klippel-Feil syndrome

    Directory of Open Access Journals (Sweden)

    Ioannis D Papanastassiou

    2011-01-01

    Full Text Available Cervical arthroplasty may be justified in patients with Klippel-Feil syndrome (KFS in order to preserve cervical motion. The aim of this paper is to report an arthroplasty failure in a patient with KFS. A 36-year-old woman with KFS underwent two-level arthroplasty for adjacent segment disc degeneration. Anterior migration of the cranial prosthesis was encountered 5 months postoperatively and was successfully revised with anterior cervical fusion. Cervical arthroplasty in an extensively stiff and fused neck is challenging and may lead to catastrophic failure. Although motion preservation is desirable in KFS, the special biomechanical features may hinder arthroplasty. Fusion or hybrid constructs may represent more reasonable options, especially when multiple fused segments are present.

  5. Total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Slavković Nemanja

    2012-01-01

    Full Text Available Total hip arthroplasty is most common reconstructive hip procedure in adults. In this surgery we replace some parts of the upper femur and acetabulum with biocompatible materials. The main goal of this surgery is to eliminate pain and regain full extent of joint motion, maintaining hip stability. Surgical technique, biomaterials, design of the prosthesis and fixation techniques have evolved with time adjusting to each other. After total hip arthroplasty patients’ quality of life should be improved. There are many various postoperative complications. Some of them are fatal, and some are minor, which may become manifested years after surgery. Each next surgical procedure following previous hip surgery is associated with considerably lower chances to be successful. Therefore, in primary total hip arthroplasty, preoperative evaluation and preparation of patients are essential. Every orthopaedic surgeon needs to improve already adopted surgical skills applying them with precision and without compromise, with the main goal to achieve long-term durability of the selected implant. The number of total hip arthroplasties will also increase in future, and newer and higher quality materials will be used.

  6. Danish register-based study on the association between specific cardiovascular drugs and fragility fractures

    DEFF Research Database (Denmark)

    Torstensson, Maia; Hansen, Annette Højmann; Leth-Møller, Katja;

    2015-01-01

    OBJECTIVE: To determine whether drugs used in treatment of cardiovascular diseases (CVD-drugs), including hypertension, increase the risk of fragility fractures in individuals above the age of 65 years. DESIGN: Retrospective nationwide cohort study. SETTING: Danish nationwide national registers....... PARTICIPANTS: All individuals in Denmark ≥65 years who used specified CVD-drugs in the study period between 1999 and 2012. MAIN OUTCOMES MEASURES: Time-dependent exposure to CVD-drugs (nitrates, digoxin, thiazides, furosemide, ACE inhibitors, angiotensin receptor antagonists, β-blockers, calcium antagonists...... and statins) was determined by prescription claims from pharmacies. The association between use of specific CVD-drugs and fragility fractures was assessed using multivariable Poisson regression models, and adjusted incidence rate ratios (IRRs) were calculated. RESULTS: Overall, 1 586 554 persons were included...

  7. Free flap transfer for closure and interposition-arthroplasty in noma defects of the lateral face associated with bony ankylosis.

    Science.gov (United States)

    Giessler, Goetz A; Schmidt, Andreas B; Deubel, Ute; Cornelius, C-Peter

    2004-09-01

    Noma defects of the anterolateral face are often associated with fibrous or bony ankylosis fusing the mandibula to the skull base. According to the extent of the ankylosis, the temporomandibular joint mobility can be restricted or even completely frozen. In third world conditions the surgical approach to severe forms of bony ankylosis consists of a single linear opening osteotomy (trismus release) and the closure of the noma defect with locoregional flaps. Relapse of jaw immobility is common and may be caused by minor bone resection, the lack of adequate postoperative physiotherapy, or even the scarring of the defect coverage. In 4 years the authors have gained increasing experience with folded free flaps for simultaneous closure of outer and inner lining of large noma defects and the maintenance and training of re-established jaw function by the use of a dynamic external distractor fixed between the zygoma and the mandibular body. The authors report the bony reankylosis can be reduced by extended wedge osteotomies of the bony bridge and tip-like shaping of the ascending mandibular ramus. To preclude the reossification of the osteotomy site and fibrous scar formation, a dermofatty or muscular tail of the free flap is interposed into the bone gap. Two cases were treated according to this concept with a free parascapular and a latissimus dorsi flap in combination with simultaneous arthroplasty. During a 6-month follow-up period, no signs of a recurrent reduction of mandibular movement were noted in either case.

  8. Midterm results of resection arthroplasty for forefoot deformities in patients with rheumatoid arthritis and the risk factors associated with patient dissatisfaction.

    Science.gov (United States)

    Matsumoto, Takumi; Kadono, Yuho; Nishino, Jinju; Nakamura, Kozo; Tanaka, Sakae; Yasui, Tetsuro

    2014-01-01

    We investigated the midterm results of resection arthroplasty of all 5 metatarsal heads in patients with rheumatoid arthritis and forefoot deformity and analyzed the factors that affect patient satisfaction levels. Of 64 patients (1 male, 63 females), 107 feet were treated with resection arthroplasty for forefoot deformity at our hospital from January 1992 to December 2005. The mean follow-up period was 5.8 ± 3.1 years, with all patients having at least 1 year of follow-up. Of the 64 patients, 75% were satisfied with the surgery. The mean score for the postoperative Japanese Society for Surgery of the Foot lesser metatarsophalangeal-interphalangeal scale was 75.0 ± 15.8 points. Multivariate logistic regression analysis showed that patient-reported dissatisfaction was significantly associated with the recurrence of hammer toe deformity (odds ratio 2.66, 95% confidence interval 1.07 to 6.97), shortening of the resection arthroplasty space (odds ratio 0.85 for a 1-unit increase, 95% confidence interval 0.74 to 0.96), and the recurrence of hallux valgus (odds ratio 1.04 for a 1-unit increase, 95% confidence interval 1.00 to 1.09) during the postoperative period. From our results, interventions to prevent recurrence of hammer toe deformity, especially in toes with preoperative metatarsophalangeal joint dislocations, have been shown to be important in preventing complications and patient dissatisfaction after resection arthroplasty.

  9. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    Directory of Open Access Journals (Sweden)

    Andrew Cook

    2014-01-01

    Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  10. Preoperative factors and early complications associated with hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures.

    Science.gov (United States)

    Miller, Christopher P; Buerba, Rafael A; Leslie, Michael P

    2014-06-01

    Displaced femoral neck fractures are common injuries in the elderly individuals. There is controversy about the best treatment with regard to total hip arthroplasty (THA) versus hemiarthroplasty. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to evaluate the preoperative risk factors associated with the decision to perform THA over hemiarthroplasty. We also evaluate the risk factors associated with postoperative complications after each procedure. Patients older than 50 years undergoing hemiarthroplasty or THA after fracture in the NSQIP database from 2007 to 2010 were compared to each other in terms of preoperative medical conditions, postoperative complications, and length of stay. Multivariate logistic regression models were used to adjust for preoperative risk factors for undergoing a THA versus a hemiarthroplasty and for complications after each procedure. In all, 783 patients underwent hemiarthroplasty and 419 underwent THA for fracture. Hemiarthroplasty patients had longer hospital stays. On multivariate logistic regression, the only significant predictor for having a THA after fracture over hemiarthroplasty was being aged 50 to 64 years. The patient characteristics/comorbidities that favored having a hemiarthroplasty were age >80 years, hemiplegia, being underweight, having a dependent functional status, being on dialysis, and having an early surgery. High body mass index, American Society of Anesthesiologists (ASA) class, gender, and other comorbidities were not predictors of having one procedure over another. Disseminated cancer and diabetes were predictive of complications after THA while being overweight, obese I, or a smoker were protective. High ASA class and do-not-resuscitate status were significant predictors of complications after a hemiarthroplasty. This study identified clinical factors influencing surgeons toward performing either THA or hemiarthroplasty for elderly patients

  11. Association between Serum IGF-I levels and Postoperative Delirium in Elderly Subjects Undergoing Elective Knee Arthroplasty.

    Science.gov (United States)

    Yen, Timothy E; Allen, John C; Rivelli, Sarah K; Patterson, Stephanie C; Metcalf, Meredith R; Flink, Benjamin J; Mirrakhimov, Aibek E; Lagoo, Sandhya A; Vail, Thomas P; Young, Christopher C; Moon, Richard E; Trzepacz, Paula T; Kwatra, Madan M

    2016-02-05

    Evidence is mixed for an association between serum insulin-like growth factor-I (IGF-I) levels and postoperative delirium (POD). The current study assessed preoperative serum IGF-I levels as a predictor of incident delirium in non-demented elderly elective knee arthroplasty patients. Preoperative serum levels of total IGF-I were measured using a commercially available Human IGF-I ELISA kit. POD incidence and severity were determined using DSM-IV criteria and the Delirium Rating Scale-Revised-98 (DRS-R98), respectively. Median IGF-I levels in delirious (62.6 ng/ml) and non-delirious groups (65.9 ng/ml) were not significantly different (p = 0.141). The ratio (95% CI) of geometric means, D/ND, was 0.86 (0.70, 1.06). The Hodges-Lehmann median difference estimate was 7.23 ng/mL with 95% confidence interval (-2.32, 19.9). In multivariate logistic regression analysis IGF-I level was not a significant predictor of incident POD after correcting for medical comorbidities. IGF-I levels did not correlate with DRS-R98 scores for delirium severity. In conclusion, we report no evidence of association between serum IGF-I levels and incidence of POD, although the sample size was inadequate for a conclusive study. Further efforts to investigate IGF-I as a delirium risk factor in elderly should address comorbidities and confounders that influence IGF-I levels.

  12. Probability and heritability estimates on primary osteoarthritis of the hip leading to total hip arthroplasty

    DEFF Research Database (Denmark)

    Skousgaard, Søren Glud; Hjelmborg, Jacob; Skytthe, Axel;

    2015-01-01

    INTRODUCTION: Primary hip osteoarthritis, radiographic as well as symptomatic, is highly associated with increasing age in both genders. However, little is known about the mechanisms behind this, in particular if this increase is caused by genetic factors. This study examined the risk and heritab......INTRODUCTION: Primary hip osteoarthritis, radiographic as well as symptomatic, is highly associated with increasing age in both genders. However, little is known about the mechanisms behind this, in particular if this increase is caused by genetic factors. This study examined the risk...... and heritability of primary osteoarthritis of the hip leading to a total hip arthroplasty, and if this heritability increased with increasing age. METHODS: In a nationwide population-based follow-up study 118,788 twins from the Danish Twin Register and 90,007 individuals from the Danish Hip Arthroplasty Register...... not have had a total hip arthroplasty at the time of follow-up. RESULTS: There were 94,063 twins eligible for analyses, comprising 835 cases of 36 concordant and 763 discordant twin pairs. The probability increased particularly from 50 years of age. After sex and age adjustment a significant additive...

  13. Total Ankle Arthroplasty: An Imaging Overview.

    Science.gov (United States)

    Kim, Da-Rae; Choi, Yun Sun; Potter, Hollis G; Li, Angela E; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  14. Total ankle arthroplasty: An imaging overview

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)

    2016-06-15

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  15. Fast track in total hip and knee arthroplasty--experiences from Hvidovre University Hospital, Denmark

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte

    2006-01-01

    This study investigated whether unselected patients operated on with total hip arthroplasty (THA) or total knee arthroplasty (TKA) could accomplish a self-developed accelerated track, ANORAK-HH, with a planned length of stay (LOS) of maximum 5 days and patient satisfaction at all parts of the track...... and a planned LOS of maximum 5 days. 22 patient characteristics and 11 satisfaction parameters were registered as well as readmissions within 3 months. 95% of patients had a LOS of maximum 5 days with a mean of 3.9 days. Median and mean values of satisfaction for the entire track were 10 and 9.4 out of 10......, respectively. Participation in patient clinic did not influence LOS or satisfaction. Operations at the beginning of the week and lack of blood transfusion were associated with shorter LOS. Finally, ANORAK-HH could be effectively accomplished in unselected THA and TKA patients without having an adverse effect...

  16. Unexpected wear of an unicompartimental knee arthroplasty in oxidized zirconium.

    Science.gov (United States)

    Luyet, Anais; Fischer, Jean-François; Jolles, Brigitte M; Lunebourg, Alexandre

    2015-12-01

    Unicompartimental knee arthroplasty is a successful procedure for the treatment of localized osteoarthritis to one compartment of the knee with good long-term results. However, several modes of failure of unicompartimental knee arthroplasty have been described, namely aseptic or septic loosening, progression of disease, wear, and instability. Metallosis after unicompartimental knee arthroplasty is rarely reported and is most often related with polyethylene wear or break. We report on a case of rapid failure of unicompartimental knee arthroplasty in oxidized zirconium associated with metallosis secondary to the dislocation of the polyethylene.

  17. SHOULDER ARTHROPLASTY RECORDS

    Science.gov (United States)

    Filho, Geraldo Motta; Galvão, Marcus Vinicius; Monteiro, Martim; Cohen, Marcio; Brandão, Bruno

    2015-01-01

    The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation. PMID:26998463

  18. Association of antipsychotic polypharmacy with health service cost: a register-based cost analysis

    DEFF Research Database (Denmark)

    Baandrup, Lone; Lublin, Henrik Kai Francis; Nordentoft, Merete;

    2012-01-01

    OBJECTIVE: To investigate the association of antipsychotic polypharmacy in schizophrenia with cost of primary and secondary health service use. METHOD: Comparative analysis of health service cost for patients prescribed antipsychotic polypharmacy versus antipsychotic monotherapy. Resource......, disease duration, psychiatric inpatient admissions, and treatment site as covariates. RESULTS: The sample consisted of 736 outpatients with a diagnosis in the schizophrenia spectrum. Antipsychotic polypharmacy was associated with significantly higher total health service costs compared with monotherapy...

  19. Hip resurfacing arthroplasty

    OpenAIRE

    2010-01-01

    Background and purpose Hip resurfacing arthroplasty is claimed to allow higher activity levels and to give better quality of life than total hip arthroplasty. In this literature review, we assessed the therapeutic value of hip resurfacing arthroplasty as measured by functional outcome. Methods An extensive literature search was performed using the PubMed, Embase, and Cochrane databases. Results 9 patient series, 1 case-control study, and 1 randomized controlled trial (RCT) were included. Clin...

  20. Trends in suicide risk associated with hospitalized psychiatric illness: a case-control study based on danish longitudinal registers

    DEFF Research Database (Denmark)

    Qin, Ping; Nordentoft, Merete; Hansen Høyer, Eyd;

    2006-01-01

    OBJECTIVE: In light of the consistent reduction in suicide rate during the past 20 years in Denmark, this study aims to investigate trends in suicide risk associated with hospitalized psychiatric illness and to explore differences in the changes with regard to clinical phases of illness, sex, age...... longitudinal registers. Data were analyzed using conditional logistic regression. RESULTS: This study shows that the reduction in suicide rate is generally faster among individuals with a history of psychiatric admission than among individuals without such a history. However, this substantial reduction...... at the time of suicide or the index date, the reduction in suicide rate is relatively slower. Such trends hold for all diagnostic groups. Further analyses stratified by age indicate that the faster reduction in suicide rate associated with history of hospitalized psychiatric illness is more pronounced among...

  1. Forensic Psychiatric Perspective on Criminality Associated with Intellectual Disability: A Nationwide Register-Based Study

    Science.gov (United States)

    Mannynsalo, L.; Putkonen, H.; Lindberg, N.; Kotilainen, I.

    2009-01-01

    Background: Contrasting views exist over the association of intellectual disability (ID) and criminal offending. This nationwide study attempts to shed further light to expand understanding to substantiate the relation between socio-demographic characteristics, psychiatric co-morbidity and criminal behaviour among the Finnish forensic population…

  2. Joint associations of smoking and physical activity with disability retirement: a register-linked cohort study

    OpenAIRE

    Lallukka, Tea; Rahkonen, Ossi; Lahelma, Eero; Lahti, Jouni

    2015-01-01

    Objectives We examined the risk of disability retirement by smoking and physical activity, and particularly whether the risk due to smoking is affected by the level of physical activity. Additionally, the contribution of baseline health, sociodemographic and work-related factors to the joint associations of smoking and physical activity with disability retirement was considered. Design Cohort study. Setting Helsinki, Finland. Participants Employees of the City of Helsinki, aged 40–60 years at...

  3. Do Associate Degree Registered Nurses Fare Differently in the Nurse Labor Market Compared to Baccalaureate-Prepared RNs?

    Science.gov (United States)

    Auerbach, David I; Buerhaus, Peter I; Staiger, Douglas O

    2015-01-01

    Roughly 40% of the nearly 3 million registered nurses (RNs) in the United States have an associate's degree (ADN) as their highest level of nursing education. Yet even before the recent Institute of Medicine report on The Future of Nursing, employers of RNs have increasingly preferred baccalaureate-prepared RNs (BSNs), at least anecdotally. Data from the American Community Survey (2003-2013) were analyzed with respect to employment setting, earnings, and employment outcomes of ADN and BSN-prepared RNs. The data reveal a divergence in employment setting: the percentage of ADN-prepared RNs employed in hospitals dropped from 65% to 60% while the percentage of BSN-prepared RNs employed in hospitals grew from 67% to 72% over this period. Many ADNs who would have otherwise been employed in hospitals seem to have shifted to long-term care settings.

  4. Adherence to guidelines for avoiding drug interactions associated with warfarin--a Nationwide Swedish Register Study.

    Directory of Open Access Journals (Sweden)

    Jonatan D Lindh

    Full Text Available PURPOSE: To investigate the extent to which clinicians avoid well-established drug-drug interactions associated with warfarin. We hypothesised that clinicians would avoid combining non-steroidal anti-inflammatory drugs (NSAIDs, tramadol and sulfamethoxazole with warfarin. METHODS: A cross-sectional analysis of nationwide dispensing data was performed in Swedish individuals 18 years or older (n =  7,563,649. Odds ratios of interacting NSAIDs, tramadol and sulfamethoxazole versus respective prevalence of comparator drugs codeine, and ciprofloxacin in patients co-dispensed interacting warfarin versus patients unexposed was calculated. RESULTS: The odds of receiving an interacting NSAID versus the comparator codeine was markedly lower in patients with warfarin than in the remaining population (adjusted OR 0.21; 95% CI 0.20 - 0.22. Also, the interacting drugs tramadol and sulfamethoxazole were less common among patients dispensed warfarin as compared to the remaining population, although the decrease was much more modest (adjusted OR 0.83; CI 0.80-0.87 and 0.81; CI 0.73 - 0.90. CONCLUSIONS: In conclusion, Swedish doctors in the vast majority of cases refrain from prescribing NSAIDs to patients already on warfarin. Tramadol and sulfamethoxazole are however rarely avoided.

  5. Unicompartmental knee arthroplasty

    NARCIS (Netherlands)

    Kort, Nanne Pieter

    2007-01-01

    This thesis concerns technical aspects of unicompartmental knee arthroplasty. Recent years have witnessed a resurgence of interest in unicompartmental arthroplasty, particularly with the introduction of the minimally invasive technique. In the light of the excellent long-term results of the total kn

  6. Knee arthroplasty in Denmark, Norway and Sweden

    Science.gov (United States)

    Bizjajeva, Svetlana; Fenstad, Anne Marie; Furnes, Ove; Lidgren, Lars; Mehnert, Frank; Odgaard, Anders; Pedersen, Alma Becic; Havelin, Leif Ivar

    2010-01-01

    Background and purpose The number of national arthroplasty registries is increasing. However, the methods of registration, classification, and analysis often differ. Methods We combined data from 3 Nordic knee arthroplasty registers, comparing demographics, methods, and overall results. Primary arthroplasties during the period 1997–2007 were included. Each register produced a dataset of predefined variables, after which the data were combined and descriptive and survival statistics produced. Results The incidence of knee arthroplasty increased in all 3 countries, but most in Denmark. Norway had the lowest number of procedures per hospital—less than half that of Sweden and Denmark. The preference for implant brands varied and only 3 total brands and 1 unicompartmental brand were common in all 3 countries. Use of patellar button for total knee arthroplasty was popular in Denmark (76%) but not in Norway (11%) or Sweden (14%). Uncemented or hybrid fixation of components was also more frequent in Denmark (22%) than in Norway (14%) and Sweden (2%). After total knee arthroplasty for osteoarthritis, the cumulative revision rate (CRR) was lowest in Sweden, with Denmark and Norway having a relative risk (RR) of 1.4 (95% CI: 1.3–1.6) and 1.6 (CI: 1.4–1.7) times higher. The result was similar when only including brands used in more than 200 cases in all 3 countries (AGC, Duracon, and NexGen). After unicompartmental arthroplasty for osteoarthritis, the CRR for all models was also lowest in Sweden, with Denmark and Norway having RRs of 1.7 (CI: 1.4–2.0) and 1.5 (CI: 1.3–1.8), respectively. When only the Oxford implant was analyzed, however, the CRRs were similar and the RRs were 1.2 (CI: 0.9–1.7) and 1.3 (CI: 1.0–1.7). Interpretation We found considerable differences between the 3 countries, with Sweden having a lower revision rate than Denmark and Norway. Further classification and standardization work is needed to permit more elaborate studies. PMID:20180723

  7. Revision Total Hip Arthroplasty Using a Modular Tapered Stem With Distal Fixation Good Short-Term Results in 125 Revisions

    DEFF Research Database (Denmark)

    Ovesen, Ole; Emmeluth, Claus; Hofbauer, Christian;

    2009-01-01

    After 2 to 7 years we reviewed 125 prosthetic hip arthroplasty stem revisions using a modular tapered stem with distal fixation. Median age of these patients was 68 (33-92) years. Baseline and follow-up data were registered prospectively according to the Danish Hip Arthroplasty Registry. Survival...

  8. Association between ongoing pain intensity, health-related quality of life, disability and quality of sleep in elderly people with total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    María Dolores Herrero-Sánchez

    2014-06-01

    Full Text Available The scope of this paper was to study the relationship between pain intensity, health-related quality of life, disability, sleep quality and demographic data in elderly people with total knee arthroplasty (TKA. 24 subjects who had been subjected to TKA the previous month (4 females; 66 ± 9years and 21 comparable controls (8 male; 70 ± 9years participated in the study. Intensity of pain, and highest and lowest pain intensity experienced in the preceding week were collected. The Western Ontario and McMaster Universities index function, quality of life (Medical Outcomes Study Short Form 36, and Pittsburgh Sleep Quality Index were assessed. Age, gender, weight, height, body mass index were also collected. Individuals with TKA presented worse physical function (P < 0.01, social role (P = 0.01, physical performance (P < 0.01, pain (P = 0.04, disability (P = 0.04 and sleep quality (P = 0.03 than the controls. Higher intensity of pain was associated with lower physical function, social role, mental health, vitality and general health, and with higher disability and sleep quality. Disability and sleep quality were negatively associated with several quality of life domains. The associations between the intensity of pain, disability, quality of life and sleep reveal the multidimensional experience of TKA.

  9. A MRI classification of periprosthetic soft tissue masses (pseudotumours) associated with metal-on-metal resurfacing hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Hauptfleisch, Jennifer; Ostlere, Simon [Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Department of Radiology, Oxford (United Kingdom); Pandit, Hemant; Grammatopoulos, George; Gill, Harinderjit S.; Murray, David W. [Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Oxford (United Kingdom)

    2012-02-15

    Metal-on-metal hip resurfacing arthroplasty (MoMHRA) has become a popular option for young patients requiring hip replacement. A recognised complication is the formation of a symptomatic reactive periprosthetic soft tissue mass (pseudotumour). We present a radiological classification system for these reactive masses, dividing them into three groups: Type I are thin-walled cystic masses (cyst wall <3 mm), Type II are thick-walled cystic masses (cyst wall >3 mm, but less than the diameter of the cystic component) and Type III are predominantly solid masses. We reviewed all MRI performed over a 4-year period in patients with primary MoMHRA referred to our institution. In all cases the masses were assessed on MRI according to size, anatomical position, signal intensity and involvement of bone, muscle or neighbouring neurovascular bundles. Periprosthetic masses were seen in 33 hips in 17 female (7 bilateral) and 8 male patients (1 bilateral). The Type I lesions were the most common and more likely to be posterior to the hip joint. The Type III masses were significantly larger than the cystic lesions and were more likely to be located anterior to the hip joint. To date 22 patients have undergone revision surgery with conversions to total hip replacement. Severity of symptoms and revision rates were lowest in the Type I group and highest in the Type III group. Solid anterior pseudotumours were most likely to have the more severe symptoms and require revision surgery. (orig.)

  10. Imaging evaluation of complications of hip arthroplasty: review of current concepts and imaging findings.

    Science.gov (United States)

    Awan, Omer; Chen, Lina; Resnik, Charles S

    2013-11-01

    Total hip arthroplasty has evolved along with improvements in component materials and design. The radiologist must accurately diagnose associated complications with imaging methods and stay informed about newer complications associated with innovations in surgical technique, prosthetic design, and novel materials. This pictorial essay presents clinical and imaging correlation of modern hip arthroplasty complications, with an emphasis on the most common complications of instability, aseptic loosening, and infection as well as those complications associated with contemporary metal-on-metal arthroplasty.

  11. [Consideration of Rehabilitation within High Class Quality Guidelines, Registered by the German Association of the Scientific Medical Professional Societies (AWMF)].

    Science.gov (United States)

    Jäckel, W H; Beindorf, G; Glattacker, M

    2013-10-01

    Clinical practice guidelines are systematically developed documents aiming at guiding decisions in specific areas of health care. Therefore, incorporating rehabilitation in guidelines adressing chronic diseases is of major importance. As information regarding consideration of rehabilitation in guidelines is lacking, the intention of our study was to analyse to what degree rehabilitation experts participated in guideline development and whether guidelines for chronic diseases include relevant information and recommendations concerning rehabilitation.In order to answer these questions we investigated 97 guidelines of high class quality, registered by the German Association of the Scientific Medical Professional Societies (AWMF). 36 out of these guidelines addressed chronic health conditions in which rehabilitation may be of relevance. Guidelines identified were analysed using a set of defined criteria.In 11 out of the 36 guidelines one or more medical rehabilitation societies participated in the development process, 17 include a chapter on rehabilitation issues, and 20 information concerning indication for rehabilitation processes. 24 guidelines consider rehabilitation in their recommendations.There is substantial variance concerning inclusion of rehabilitation in German guidelines on chronic diseases. Rehabilitation societies are encouraged to strive for stronger integration of rehabilitation into guidelines of other societies.

  12. Psychological quality of life and its association with academic employability skills among newly-registered students from three European faculties

    Directory of Open Access Journals (Sweden)

    Ionescu Ion

    2011-04-01

    Full Text Available Abstract Background In accord with new European university reforms initiated by the Bologna Process, our objectives were to assess psychological quality of life (QoL and to analyse its associations with academic employability skills (AES among students from the Faculty of Language, Literature, Humanities, Arts and Education, Walferdange Luxembourg (F1, mostly vocational/applied courses; the Faculty of Social and Human Sciences, Liege, Belgium (F2, mainly general courses; and the Faculty of Social Work, Iasi, Romania (F3, mainly vocational/professional courses. Method Students who redoubled or who had studied at other universities were excluded. 355 newly-registered first-year students (145 from F1, 125 from F2, and 85 from F3 were invited to complete an online questionnaire (in French, German, English or Romanian covering socioeconomic data, the AES scale and the QoL-psychological, QoL-social relationships and QoL-environment subscales as measured with the World Health Organisation Quality of Life short-form (WHOQoL-BREF questionnaire. Analyses included multiple regressions with interactions. Results QoL-psychological, QoL-social relationships and QoL-environment' scores were highest in F1 (Luxembourg, and the QoL-psychological score in F2 (Belgium was the lower. AES score was higher in F1 than in F3 (Romania. A positive link was found between QoL-psychological and AES for F1 (correlation coefficient 0.29, p Conclusions Psychological quality of life is associated with acquisition of skills that increase employability from the faculties offering vocational/applied/professional courses in Luxembourg and Romania, but not their academically orientated Belgian counterparts. In the context of developing a European Higher Educational Area, these measurements are major indicators that can be used as a guide to promoting programs geared towards counseling, improvement of the social environment, and services to assist with university work and facilitate

  13. Imaging of hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T., E-mail: millertt@hss.edu [Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (United States)

    2012-12-15

    The imaging evaluation of the prosthetic hip begins with radiography, but arthrography, aspiration, scintigraphy, sonography, CT and MR imaging all have roles in the evaluation of the painful prosthesis. This article will review the appearance of normal hip arthroplasty including hemiarthroplasty, total arthroplasty, and hip resurfacing, as well as the appearances of potential complications such as aseptic loosening and osteolysis, dislocation, infection, periprosthetic fracture, hardware failure, and soft tissue abnormalities.

  14. Imaging of knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T. [Department of Radiology, North Shore University Hospital, 825 Northern Blvd., Great Neck, NY 11021 (United States)]. E-mail: TMiller@NSHS.edu

    2005-05-01

    Knee replacement surgery, either with unicompartmental or total systems, is common. The purpose of this manuscript is to review the appearance of normal knee arthroplasty and the appearances of complications such as infection, polyethylene wear, aseptic loosening and particle-induced osteolysis, patellofemoral abnormalities, axial instability, and periprosthetic and component fracture. Knowledge of the potential complications and their imaging appearances will help the radiologist in the diagnostic evaluation of the patient with a painful knee arthroplasty.

  15. Partial sick leave associated with disability pension: propensity score approach in a register-based cohort study

    OpenAIRE

    Kausto, Johanna; Solovieva, Svetlana; Virta, Lauri J.; Viikari-Juntura, Eira

    2012-01-01

    Objectives To support sustainability of the welfare society enhanced work retention is needed among those with impaired work ability. Partial health-related benefits have been introduced for this target. The aim was to estimate the effects of partial sick leave on transition to disability pension applying propensity score methods. Design Register-based cohort study. Setting Sample from the national sickness insurance registers representative of the Finnish working population (full-time worker...

  16. Relationship of Academic Variables to National Council for Licensure Examination for Registered Nurse Performance of Graduates in a Selected Associate Degree Nursing Program.

    Science.gov (United States)

    Naron, Rosarica G.; Widlak, Frederic

    This report addresses the unstable and unsatisfactory performance of Chicago, Illinois' Olive-Harvey College's (OHC) associate degree nursing (ADN) graduates on the National Council Licensure Examination for Registered Nurses (NCLEX-RN). An ex post facto correlation study was designed to determine the worthiness of pre-nursing admission course…

  17. Importância do registo nacional de artroplastias na identificação médico-legal Importance of a national arthroplasty register for identification by medical examiner

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Durão

    2012-10-01

    establishes who the manufacturer was and the serial number can be compared with the clinical process or with a prosthesis register, as has been implemented in several countries. The information in the database should include the patient's name, the implant model and its serial number, for consultation only in cases of forensic identification, while obviously respecting ethical issues of privacy. This article highlights the importance of creating a national prosthesis register.

  18. The Danish Shoulder Arthroplasty Registry

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe; Jakobsen, John; Brorson, Stig

    2012-01-01

    The Danish Shoulder Arthroplasty Registry (DSR) was established in 2004. Data are reported electronically by the surgeons. Patient-reported outcome is collected 10-14 months postoperatively using the Western Ontario osteoarthritis of the shoulder index (WOOS). 2,137 primary shoulder arthroplasties......% reverse shoulder arthroplasties, and 3% total arthroplasties. Median WOOS was 59% (IQR: 37-82). 5% had been revised by the end of June 2010. The most frequent indications for revision were dislocation or glenoid attrition....

  19. Prevalence and Factors Associated with Needle Stick Injuries among Registered Nurses in Public Sector Tertiary Care Hospitals of Pakistan '

    Directory of Open Access Journals (Sweden)

    Haris Habib

    2011-02-01

    Full Text Available Background: Needle stick injuries remain the main cause of Hep B, Hep C and HIV which lead to mortality and morbidity in health care providers especially in nurses all over the world. Although needle stick injuries have been well studied in developed countries, data from developing countries is limited.Aim & Objectives: To estimate the prevalence of needle stick injuries among nurses and its associated factors in public sector tertiary care hospitals of Pakistan. Methods: This cross sectional survey was conducted in 3 major tertiary care hospitals of Rawalpindi, Pakistan. Study duration was from March 2010 to May 2010 (3 months. Two Hundred and Sixteen (216 nurses were selected by simple random sampling with proportionate sampling. All those registered nurses who were working in allied hospitals of Rawalpindi and involved in clinical work were included, while all those who were on administrative positions, students, retired or on maternity leave were excluded from the study. Pre structured questionnaire was used and data was collected by questionnaire having optional choices and few open ended questions. The questionnaire was piloted among thirty nurses in a tertiary care hospital and their comments were incorporated accordingly to redesign the final questionnaire. The data was analysed using SPSS 16.Results: Sixty Seven (67% of nurses got needle stick injury during job. Almost all (99% nurses said that they didn’t report their injury because of no reporting system in their hospital (p value < 0.05. Injection and needles (72% are the most injury causing instrument and needle stick injuries mostly occurred (81% at bedside and ward (p value < 0.05. Sixty six percent (66% of nurses said that they didn’t attended any educational session, seminar or workshop related to needle stick injuries during their job. Conclusion: The frequency of needle stick injuries among nurses is quite high in public sector hospitals of Rawalpindi Pakistan. Non

  20. Registered partnerships

    CERN Multimedia

    Staff Association

    2015-01-01

    In recent decades, family patterns have changed significantly. National laws have taken these changes into account, recognizing new forms of unions, different to heterosexual marriage. Indeed, recently some countries have given the possibility to same-sex couples to enter into various forms of unions. Staff regulations of international organizations are not directly affected by national laws, but in the context of diversity policies, the lack of recognition of these new forms of unions, may appear to discriminate based on sexual orientation and to limit the freedom of choosing marital status. A study by the International Service for Remunerations and Pensions (iSRP) of the OECD in January 2015 (PROS Report (1015) 04) shows that in comparison with other international organizations, CERN offers the least favorable social conditions for its Staff with in a registered partnership. As part of the Five-year review in 2015, it is important that CERN aligns itself with the practice of these other organizations...

  1. Associations between patients' risk attitude and their adherence to statin treatment - a population based questionnaire and register study

    DEFF Research Database (Denmark)

    Barfoed, Benedicte Marie Lind; Paulsen, Maja Skov; Christensen, Palle Mark;

    2016-01-01

    -based study on a sample of 6393 persons of the general. Danish population aged 20-79. Data on risk attitude were based on 4 items uncovering health-related as well as financial dimensions of risk attitude. They were collected through a web-based questionnaire and combined with register data on redeemed statin...

  2. Analysis of 127 peripartum hypoxic brain injuries from closed claims registered by the Danish Patient Insurance Association

    DEFF Research Database (Denmark)

    Bock, J.; Christoffersen, J.K.; Hedegaard, M.;

    2008-01-01

    BACKGROUND: One of the most feared complications in medicine is hypoxic brain damage to a newborn. The authors investigated the circumstances of registered peripartum hypoxic brain injuries in order to identify potential opportunities to improve patient safety and prevent injuries. METHODS: The a...

  3. Cattle Housing at the Registered Farms under Cattle Breeders’ Association in Ödemiş, İzmir.

    Directory of Open Access Journals (Sweden)

    Erdal Yaylak

    2015-02-01

    Full Text Available The objective of this study was to determine barning conditions of dairy farms registered to Cattle Breeders Association (CBA Ödemiş district of İzmir. The 92 farms were selected among members of the CBA by proportional sampling method. The farms were divided into three groups according to the number of cattle: group 1 from 5 to 20, group 2 from 21 to 40 and group 3 with over 41 heads, respectively. The farms were divided into three groups according to the number of cattle: 5-20; 21-40 and over 41 heads, respectively. The research results indicated that 76.1% of the barns were shed type, 15.2% were corral, 8.7% were completely closed-up. The flooring types of these barns were a mixed of concrete and soil (73.9%, concrete (19.6% and soil (6.5%. The stocking density for group 1, 2 and 3 were 22.2 m2, 19.5 m2 and 18.2 m2 per cow, respectively. The barns had a range of full cattle capacity from 12.5 m2 to 15 m2 per cow. But none of the farms surveyed did not use fully capacity of the barn. The present running capacity of farms were between 55% and 80%. It was observed that 19.6% of farms had a individual calf section, 82.6% had a night lighting at the barn, and 64.1% had a seperate concenrated feed store. All the farms were milked with milking machines. The percentage of farms with bucked milking machine was 47.8%, those with an air pipeline system was 37% and those with parlour system was 15.2%. None of farms had manure pit. Consequently, as herd size grow, the presence of free barn, calving pen, feed store and milk cooling tank increase. It can be concluded that improving the housing conditions is much more related with increasing the herd size per farm.

  4. Readmissions after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B;

    2010-01-01

    With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been s...... speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA)....

  5. The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study.

    Science.gov (United States)

    Czurda, Thomas; Fennema, Peter; Baumgartner, Martin; Ritschl, Peter

    2010-07-01

    Previous studies have noted an adverse relationship between implant malalignment during total knee arthroplasty (TKA) and post-operative pain. Although some evidence exists indicating that computer-assisted surgical navigation for TKA can improve the accuracy of component alignment, its impact on clinical outcomes is currently unknown. The dual goals of the present cohort/nested case-control study were to (1) compare self-reported responses to the Western Ontario-McMaster Osteoarthritis Index (WOMAC) questionnaire between computer-assisted TKA (123 patients) using the imageless PiGalileo navigation system and conventional TKA (207 patients) [cohort analysis], and (2) to investigate a potential association between malalignment and post-operative pain in 19 painful knees and 19 asymptomatic knees obtained from the cohort analysis using matched sampling [nested case-control study]. In the cohort analysis, a relevant but non-significant (P = 0.06) difference in the occurrence of chronic pain was observed between the navigated (12%) and conventional arms (20%). Median post-operative WOMAC pain score was 100 (range, 50-100) in the conventional group and 100 (range, 65-100) in the navigated group. However, the Mann-Whitney test revealed a significant difference in favor of the navigated group (P = 0.01). In the nested case-control analysis, radiological outcomes and computer tomography (CT) measurements of femoral rotation were compared between the groups. The CT rotation measurements yielded evidence of a relationship between post-operative pain and incorrect rotational alignment of the femoral component of more than 3 degrees (OR: 7; 95% CI: 1.2-42; P = .033). In conclusion, there was no clinical benefit to computer-assisted navigation; however, a statistically significant relationship was observed between incorrect rotational alignment of the femoral component and symptoms of post-operative pain following TKA.

  6. Rural vs. urban utilization of total joint arthroplasty.

    Science.gov (United States)

    Banerjee, Devraj; Illingworth, Kenneth David; Novicoff, Wendy M; Scaife, Steven L; Jones, Braden K; Saleh, Khaled J

    2013-06-01

    The purpose of this study was to analyze the association between patient demographics and hospital demographics on utilization of total joint arthroplasty in rural and urban populations from the National Inpatient Sample database. Any patient that was discharged after a primary total hip or primary total knee arthroplasty was included in this study. Results showed that rural patients living in a Northeastern hospital region compared to West, less than 65 years of age, females, Blacks and Hispanics were less likely to undergo total joint arthroplasty compared to their urban counterparts. Rural patient were more likely to undergo total joint arthroplasty compared to their urban counterparts if they were in the Midwest and had Medicare as their primary payer provider.

  7. Poor 10-year survivorship of hip resurfacing arthroplasty

    Science.gov (United States)

    Seppänen, Matti; Karvonen, Mikko; Virolainen, Petri; Remes, Ville; Pulkkinen, Pekka; Eskelinen, Antti; Liukas, Antti; Mäkelä, Keijo T

    2016-01-01

    Background and purpose In a previous registry report, short-term implant survival of hip resurfacing arthroplasty (HRA) in Finland was found to be comparable to that of total hip arthroplasty (THA). Since then, it has become evident that adverse reactions to metal debris (ARMDs) may also be associated with HRA, not only with large-diameter head metal-on-metal THA. The aim of the study was to assess medium- to long-term survivorship of HRA based on the Finnish Arthroplasty Register (FAR). Patients and methods 5,068 HRAs performed during the period 2001–2013 in Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities and their 95% confidence intervals (CIs). Cox multiple regression, with adjustment for age, sex, diagnosis, femoral head size, and hospital volume was used to analyze implant survival of HRA devices with revision for any reason as endpoint. The reference group consisted of 6,485 uncemented Vision/Bimetric and ABG II THAs performed in Finland over the same time period. Results The 8-year survival, with any revision as an endpoint, was 93% (CI: 92–94) for Birmingham Hip Resurfacing (BHR), 86% (CI: 78–94) for Corin, 91% (CI: 89–94) for ReCap, 92% (CI: 89–96) for Durom, and was 72% (CI: 69–76) for the Articular Surface Replacement (ASR). The 10-year survival, with any revision as an endpoint, for reference THAs was 92% (CI: 91–92) and for all HRAs it was 86% (CI: 84–87%). Female HRA patients had about twice the revision risk of male patients. ASR had an inferior outcome: the revision risk was 4-fold higher than for BHR, the reference implant. Interpretation The 10-year implant survival of HRAs is 86% in Finland. According to new recommendations from NICE (The National Institute for Health and Care Excellence), an HRA/THA should have a revision rate of 5% or less at 10 years. None of the HRAs studied achieved this goal. PMID:27759474

  8. Stiffness after total knee arthroplasty.

    Science.gov (United States)

    Manrique, Jorge; Gomez, Miguel M; Parvizi, Javad

    2015-04-01

    Stiffness after total knee arthroplasty (TKA) adversely affects outcome and impacts patient function. Various risk factors for stiffness after TKA have been identified, including reduced preoperative knee range of motion, history of prior knee surgery, etiology of arthritis, incorrect positioning or oversizing of components, and incorrect gap balancing. Mechanical and associated causes, such as infection, arthrofibrosis, complex regional pain syndrome, and heterotopic ossification, secondary gain issues have also been identified. Management of stiffness following TKA can be challenging. The condition needs to be assessed and treated in a staged manner. A nonsurgical approach is the first step. Manipulation under anesthesia may be considered within the first 3 months after the index TKA, if physical therapy fails to improve the range of motion. Beyond this point, consideration should be given to surgical intervention such as lysis of adhesions, either arthroscopically or by open arthrotomy. If the cause of stiffness is deemed to be surgical error, such as component malpositioning, revision arthroplasty is indicated. The purpose of this article is to evaluate the various aspects of management of stiffness after TKA.

  9. Associations between follow-up screening after gestational diabetes and early detection of diabetes – a register based study

    DEFF Research Database (Denmark)

    Nielsen, Jane Hyldgård; Rebecca Olesen, Christinna; Nørmark Mortensen, Rikke;

    2014-01-01

    Background: Women whose pregnancy was complicated by gestational diabetes have a 7-fold higher risk of developing diabetes, primarily type 2. Early detection can prevent or delay the onset of late complications, for which follow-up screening is important. This study investigated the extent...... of participation in follow-up screening and the possible consequences of nonattendance in the Region of North Jutland, Denmark. Method: In Danish national registers covering the years 1994–2011 we identified 2171 birthing women whose pregnancy was complicated by first-time gestational diabetes. Control visits...... and treatment after gestational diabetes than women not attending. The results for women attending testing at biochemical departments also showed an increased risk of initiation of treatment. Women attending at least one general practitioners control had a significantly higher risk of early diabetes diagnosis...

  10. Large volume TENAX {sup registered} extraction of the bioaccessible fraction of sediment-associated organic compounds for a subsequent effect-directed analysis

    Energy Technology Data Exchange (ETDEWEB)

    Schwab, K.; Brack, W. [UFZ - Helmholtz Centre or Environmental Research, Leipzig (Germany). Dept. of Effect-Directed Analysis

    2007-06-15

    Background, Aim and Scope: Effect-directed analysis (EDA) is a powerful tool for the identification of key toxicants in complex environmental samples. In most cases, EDA is based on total extraction of organic contaminants leading to an erroneous prioritization with regard to hazard and risk. Bioaccessibility-directed extraction aims to discriminate between contaminants that take part in partitioning between sediment and biota in a relevant time frame and those that are enclosed in structures, that do not allow rapid desorption. Standard protocols of targeted extraction of rapidly desorbing, and thus bioaccessible fraction using TENAX {sup registered} are based only on small amounts of sediment. In order to get sufficient amounts of extracts for subsequent biotesting, fractionation, and structure elucidation a large volume extraction technique needs to be developed applying one selected extraction time and excluding toxic procedural blanks. Materials and Methods: Desorption behaviour of sediment contaminants was determined by a consecutive solid-solid extraction of sediment using TENAX {sup registered} fitting a tri-compartment model on experimental data. Time needed to remove the rapidly desorbing fraction trap was calculated to select a fixed extraction time for single extraction procedures. Up-scaling by about a factor of 100 provided a large volume extraction technique for EDA. Reproducibility and comparability to small volume approach were proved. Blanks of respective TENAX {sup registered} mass were investigated using Scenedesmus vacuolatus and Artemia salina as test organisms. Results: Desorption kinetics showed that 12 to 30 % of sediment associated pollutants are available for rapid desorption. t{sub r}ap is compound dependent and covers a range of 2 to 18 h. On that basis a fixed extraction time of 24 h was selected. Validation of large volume approach was done by the means of comparison to small method and reproducibility. The large volume showed a good

  11. An association between initiation of selective serotonin reuptake inhibitors and suicide - a nationwide register-based case-crossover study.

    Directory of Open Access Journals (Sweden)

    Charlotte Björkenstam

    Full Text Available BACKGROUND: Treatment with selective serotonin reuptake inhibitors (SSRI is one of the most common treatments for depression. It is however not clear whether or not there is an increased short-term suicide risk during initiation with SSRI. METHODS: A register-based nationwide case-crossover study including 5,866 suicides, 1,698 women and 4,168 men, from the Death Register 2007-2010 in Sweden. SSRI initiation was defined as a dispensed prescription of SSRI within 28 days prior to the date of suicide with no previous dispensed prescription of SSRI within 4 months prior that prescription. The control period took place one year earlier. Odds ratio (OR was estimated using conditional logistic regression. RESULT: During the 28 day period prior to suicide 48 women and 138 men were exposed to SSRI initiation (while not being exposed in the control period and 22 women and 43 men were exposed in the control period (while not being exposed in the case period. The OR for suicide after initiation with SSRI was 2.7 (95% CI: 1.6-44 for women, and 4.3 (95% CI: 3.0-6.1 for men. The highest OR was found 8-11 days after initiation with SSRI 9.7 (95% CI: 3.0-31.7 for women and men combined. CONCLUSION: The main limitation in this study is confounding by indication, but the descriptive question is however not confounded by indication. Together with plausible biological mechanisms and previous clinical and epidemiological observations our findings, linking initiation of SSRI to increased short-term suicide risk, deserve further attention specifically in the clinical setting.

  12. Primary total elbow arthroplasty

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2013-01-01

    Full Text Available Background: Primary total elbow arthroplasty (TEA is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years. The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80° and average pronation was 70° (range 60-80°. Average flexion was 135° (range 130-135°. However, in 5 cases, there was loss of 15 to 35° (average 25° of extension (45° out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100. Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18% out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head

  13. Cervical Total Disc Arthroplasty

    OpenAIRE

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc...

  14. Biometrics-based service marketing issues: exploring acceptability and risk factors of iris scans associated with registered travel programmes.

    Science.gov (United States)

    Smith, Alan D

    2008-01-01

    The marketability and viability of biometric technologies by companies marketing their own versions of pre-approved registered travel programmes have generated a number of controversies. Data were collected and analysed to formulate graphs, run regression and correlation analyses, and use Chi-square to formally test basic research propositions on a sample of 241 professionals in the Pittsburgh area. It was found that there was a significant relationship between the respondents' familiarity with new technology (namely web-enabled and internet sophistication) and knowledge of biometrics, in particular iris scans. Participants who frequently use the internet are more comfortable with innovative technology; although individuals with higher income levels have less trust in the government, it appeared that virtually everyone is concerned about trusting the government with their personal information. Healthcare professionals need to document the safety, CRM-related factors, and provide leadership in the international collaboration of biometric-related personal identification technologies, since they will be one of the main beneficiaries of the implementation of such technologies.

  15. Thromboembolism prophylaxis practices in orthopaedic arthroplasty patients.

    LENUS (Irish Health Repository)

    Cawley, D

    2010-10-01

    Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.

  16. Infected primary knee arthroplasty: Risk factors for surgical treatment failure

    Directory of Open Access Journals (Sweden)

    Joao Gabriel Duarte Paes Pradella

    2013-09-01

    Full Text Available OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days or unfavorable (arthrodesis or death infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016 and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032 were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis and diabetics had higher odds of death after infection of primary knee arthroplasties.

  17. Preoperative Strength Training for Elderly Patients Awaiting Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    D. M. van Leeuwen

    2014-01-01

    Full Text Available Objective. To investigate the feasibility and effects of additional preoperative high intensity strength training for patients awaiting total knee arthroplasty (TKA. Design. Clinical controlled trial. Patients. Twenty-two patients awaiting TKA. Methods. Patients were allocated to a standard training group or a group receiving standard training with additional progressive strength training for 6 weeks. Isometric knee extensor strength, voluntary activation, chair stand, 6-minute walk test (6MWT, and stair climbing were assessed before and after 6 weeks of training and 6 and 12 weeks after TKA. Results. For 3 of the 11 patients in the intensive strength group, training load had to be adjusted because of pain. For both groups combined, improvements in chair stand and 6MWT were observed before surgery, but intensive strength training was not more effective than standard training. Voluntary activation did not change before and after surgery, and postoperative recovery was not different between groups (P>0.05. Knee extensor strength of the affected leg before surgery was significantly associated with 6-minute walk (r=0.50 and the stair climb (r−=0.58, P<0.05. Conclusion. Intensive strength training was feasible for the majority of patients, but there were no indications that it is more effective than standard training to increase preoperative physical performance. This trial was registered with NTR2278.

  18. Which patients need critical care intervention after total joint arthroplasty? : a prospective study of factors associated with the need for intensive care following surgery.

    Science.gov (United States)

    Courtney, P M; Melnic, C M; Gutsche, J; Hume, E L; Lee, G-C

    2015-11-01

    Older patients with multiple medical co-morbidities are increasingly being offered and undergoing total joint arthroplasty (TJA). These patients are more likely to require intensive care support, following surgery. We prospectively evaluated the need for intensive care admission and intervention in a consecutive series of 738 patients undergoing elective hip and knee arthroplasty procedures. The mean age was 60.6 years (18 to 91; 440 women, 298 men. Risk factors, correlating with the need for critical care intervention, according to published guidelines, were analysed to identify high-risk patients who would benefit from post-operative critical care monitoring. A total of 50 patients (6.7%) in our series required critical care level interventions during their hospital stay. Six independent multivariate clinical predictors were identified (p 1000 mL (OR 17.36, 95% CI 5.36 to 56.19), chronic obstructive pulmonary disease (13.90, 95% CI 4.78 to 40.36), intra-operative use of vasopressors (OR 8.10, 95% CI 3.23 to 20.27), revision hip arthroplasty (OR 2.71, 95% CI 1.04 to 7.04) and body mass index > 35 kg/m(2) (OR 2.70, 95% CI 123 to 5.94). The model was then validated against an independent, previously published data set of 1594 consecutive patients. The use of this risk stratification model can be helpful in predicting which high-risk patients would benefit from a higher level of monitoring and care after elective TJA and aid hospitals in allocating precious critical care resources.

  19. Association between antipsychotic/antidepressant drug treatments and hospital admissions in schizophrenia assessed using a mental health case register

    Science.gov (United States)

    Cardinal, Rudolf N; Savulich, George; Mann, Louisa M; Fernández-Egea, Emilio

    2015-01-01

    Background: The impact of psychotropic drug choice upon admissions for schizophrenia is not well understood. Aims: To examine the association between antipsychotic/antidepressant use and time in hospital for patients with schizophrenia. Methods: We conducted an observational study, using 8 years’ admission records and electronically generated drug histories from an institution providing secondary mental health care in Cambridgeshire, UK, covering the period 2005–2012 inclusive. Patients with a coded ICD-10 diagnosis of schizophrenia were selected. The primary outcome measure was the time spent as an inpatient in a psychiatric unit. Antipsychotic and antidepressant drugs used by at least 5% of patients overall were examined for associations with admissions. Periods before and after drug commencement were compared for patients having pre-drug admissions, in mirror-image analyses correcting for overall admission rates. Drug use in one 6-month calendar period was used to predict admissions in the next period, across all patients, in a regression analysis accounting for the effects of all other drugs studied and for time. Results: In mirror-image analyses, sulpiride, aripiprazole, clozapine, and olanzapine were associated with fewer subsequent admission days. In regression analyses, sulpiride, mirtazapine, venlafaxine, and clozapine–aripiprazole and clozapine–amisulpride combinations were associated with fewer subsequent admission days. Conclusions: Use of these drugs was associated with fewer days in hospital. Causation is not implied and these findings require confirmation by randomized controlled trials. PMID:27336041

  20. Postoperative pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Højer Karlsen, Anders Peder; Geisler, Anja; Petersen, Pernille Lykke

    2015-01-01

    Treatment of postoperative pain should rely on results from randomized controlled trials and meta-analyses of high scientific quality. The efficacy of a particular intervention may depend on the type of surgical procedure, which supports the reporting of "procedure-specific" interventions. The aim...... of this systematic review was to document the procedure-specific evidence for analgesic interventions after total hip arthroplasty (THA). This PRISMA-compliant and PROSPERO-registered review includes randomized placebo-controlled trials (RCTs) of medication-based analgesic interventions after THA. Endpoints were......, and lumbar plexus block reduced nausea and pruritus. The GRADE-rated quality of evidence ranged from low to very low throughout the analyses. This review demonstrated, that some analgesic interventions may have the capacity to reduce mean opioid requirements and/or mean pain intensity compared with controls...

  1. RUSSIAN EXPERIENCE WITH USING MONOCLONAL ANTIBODIES TO B-LYMPHOCYTES (RITUXIMAB IN SYSTEMIC VASCULITIDES ASSOCIATED WITH NEUTROPHIL CYTOPLASMIC ANTIBODIES (PRELIMINARY RESULTS OF THE RUSSIAN REGISTER NORMA

    Directory of Open Access Journals (Sweden)

    T. V. Beketova

    2014-01-01

    Full Text Available In 2013, Russia registered officially the indications for the use of monoclonal antibodies to B-lymphocytes (rituximab, RTM in systemic vasculitides associated with antineutrophil cytoplasmic antibodies (ANCA-SV. This communication presents the preliminary results of the Russian register of the RTM application in autoimmune diseases (NORMA that has included 50 patients with ANCA-SV treated in 14 cities of the Russian Federation. Twenty-five of 50 (50% patients received repeated courses of RTM. RTM has demonstrated a high efficacy and a good profile of treatment safety in patients with ANCA-SV in real-life national clinical practice. Among 25 patients who had been followed up for over 12 months, the remission was achieved in 92% of cases, a decrease in the ANCA-SV activity was observed in 8%. The efficacy of RTM increased when performing repeated courses, while it has been noted that the positive results can be obtained by prescribing a repeated course of RTM at a reduced dose (500–1000 mg. Prescription of the repeated courses was primarily required in patients with granulomatosis and polyangiitis affecting the lungs. Care should be taken when combining RTM treatment with cytostatics (primarily with cyclophosphamide because of the risk of secondary immunodeficiency and infectious adverse events (AE, which have been the most frequent serious AE (12% in patients with ANCA-SV.

  2. Danish register-based study on the association between specific antipsychotic drugs and fractures in elderly individuals

    DEFF Research Database (Denmark)

    Torstensson, Maia; Leth-Møller, Katja; Andersson, Charlotte

    2017-01-01

    %) experienced a fracture. Associations were for all APs highest in the initial treatment period (0-30 days) with IRRs for risperidone 1.97 (95% CI: 1.70-2.28), olanzapine 2.31 (95% CI: 1.96-2.73), quetiapine 2.09 (95% CI: 1.73-2.52), zuclopenthixol 2.19 (95% CI: 1.82-2.63), chlorprothixen 1.62 (95% CI: 1...

  3. Association between antipsychotic/antidepressant drug treatments and hospital admissions in schizophrenia assessed using a mental health case register

    OpenAIRE

    2015-01-01

    This is the final version of the article. It first appeared from Nature Publishing Group via http://dx.doi.org/10.1038/npjschz.2015.35 Background: The impact of psychotropic drug choice upon admissions for schizophrenia is not well understood. Aims: To examine the association between antipsychotic/antidepressant use and time in hospital for patients with schizophrenia. Methods: We conducted an observational study, using 8 years? admission records and electronically gene...

  4. Inflammatory pseudotumor of the hip: a complication of arthroplasty to be recognized by the radiologist

    Directory of Open Access Journals (Sweden)

    Raquel de Melo Santos Vilas Boas

    2015-10-01

    Full Text Available AbstractSoft tissue complications following hip arthroplasty may occur either in cases of total hip arthroplasty or in hip resurfacing, a technique that has become popular in cases involving young patients. Both orthopedic and radiological literatures are now calling attention to these symptomatic periprosthetic soft tissue masses called inflammatory pseudotumors or aseptic lymphocytic vasculites-associated lesions. Pseudotumors are associated with pain, instability, neuropathy, and premature loosening of prosthetic components, frequently requiring early and difficult reoperation. Magnetic resonance imaging plays a relevant role in the evaluation of soft tissue changes in the painful hip after arthroplasty, ranging from early periprosthetic fluid collections to necrosis and more extensive tissue damage.

  5. Large differences in incidences of overt hyper- and hypothyroidism associated with a small difference in iodine intake: A prospective comparative register-based population survey

    DEFF Research Database (Denmark)

    Pedersen, I.B.; Knudsen, N.; Jorgensen, T.

    2002-01-01

    Around 3-4 billion people in the world are covered by iodine supplementation programs to prevent developmental brain damage and other iodine deficiency (ID) disorders. Mild ID is associated with more hyperthyroidism and less hypothyroidism in the population than a high iodine intake. Knowledge...... of the iodine intake levels where the shifts in incidences occur is important for planning of iodine supplementation programs. A computer-based register linked to thyroid diagnostic laboratories was used to continuously identify all new cases of overt hyper- and hypothyroidism in two population cohorts...... that iodine supplementation of a population may increase the incidence of overt hypothyroidism, even if the population is moderately iodine-deficient. In such a population, the increase in risk of hypothyroidism should be weighed against the risk of ID disorders such as hyperthyroidism due to multinodular...

  6. Shoulder arthroplasty. Part 1: Prosthesis terminology and classification

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: bdsheridan@hotmail.com [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom); Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P. [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom)

    2012-07-15

    Shoulder arthroplasty is the third most common joint replacement procedure in the UK, and there are a number of different implant options available to surgeons to treat a variety of shoulder disorders. With an increasing burden placed on clinical follow-up, more patients are remaining under the care of their general practitioners and musculoskeletal triage assessment services and are not necessarily being seen by specialists. Referrals to orthopaedic specialists are therefore often prompted by radiological reports describing evidence of implant failure. This article is the first of two reviews on shoulder arthroplasty, concentrating on implant features and the indications for their use. The second article will address the modes of failure of shoulder arthroplasty and describe the relevant associated radiological features.

  7. Stemless shoulder arthroplasty-current results and designs.

    Science.gov (United States)

    Churchill, R Sean; Athwal, George S

    2016-03-01

    Stemless shoulder arthroplasty was originally introduced in 2004 by a single manufacturer. Now, over a decade later, numerous designs are available outside the USA, but as yet, only one implant has been cleared by the Food and Drug Administration (FDA) and is available for use within the USA. Often referred to as "canal sparing," these implants are designed for metaphyseal fixation to minimize humeral bone removal, avoid intraoperative and postoperative humeral fracture complications, and to decrease morbidity associated with revision operations. Recently, the second generation of stemless arthroplasty, a convertible implant allowing use in either anatomic or reverse arthroplasty configuration, was released for use outside the USA. This paper will review the available designs, reported results, and raise potential concerns for this emerging technology.

  8. Shoulder arthroplasty. Part 2: Normal and abnormal radiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: bdsheridan@hotmail.com [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom); Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P. [Department of Orthopaedic Surgery, Bristol Royal Infirmary, Bristol (United Kingdom)

    2012-07-15

    Frequently, the decision made by general practitioners or musculoskeletal triage assessment services to refer patients for specialist review is initiated by a radiological report. Following shoulder arthroplasty it is important to ensure that any patient with asymptomatic evidence of a failing prosthesis is referred for review so that revision surgery can be contemplated and planned before the situation becomes unsalvageable. The first paper in this series described the various types of shoulder arthroplasty and indications for each. This follow-up paper will concentrate on their modes of failure and the associated radiographic features, and is aimed at radiology trainees and non-musculoskeletal specialist radiologists.

  9. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    OpenAIRE

    Sporer, Scott M.; Bernard R. Bach, Jr

    2009-01-01

    DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Sc...

  10. National Register Historic Districts

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — The National Register Historic District layer is a shape file showing the boundaries of Historic Districts that are listed on the National Register of Historic Places.

  11. Transfusion-related mortality after primary hip arthroplasty - an analysis of mechanisms and confounders

    DEFF Research Database (Denmark)

    Jans, O; Kehlet, H; Johansson, P I

    2012-01-01

    Background and Objectives Bleeding and postoperative anaemia after total hip arthroplasty (THA) may trigger transfusion of red blood cells (RBC). However, large observational studies have reported associations between RBC transfusion and increased postoperative morbidity and mortality. As major b...

  12. Fast track in total hip and knee arthroplasty--experiences from Hvidovre University Hospital, Denmark

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte

    2006-01-01

    . 307 patients who sustained 329 hip and knee arthroplasties were included in the study with the main material constituted from 243 primary unilateral THA and TKA arthroplasties. ANORAK-HH includes pre-operative patient clinic, patient motivation, dedicated staff, unchanged criteria for discharge...... and a planned LOS of maximum 5 days. 22 patient characteristics and 11 satisfaction parameters were registered as well as readmissions within 3 months. 95% of patients had a LOS of maximum 5 days with a mean of 3.9 days. Median and mean values of satisfaction for the entire track were 10 and 9.4 out of 10...

  13. Periprosthetic osteolysis after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Herzberg, Guillaume

    2014-01-01

    Background and Literature Review Periprosthetic osteolysis (PPO) after second- or third-generation total wrist arthroplasty (TWA), with or without evident loosening of the implant components, has previously been reported in the literature, but rarely in a systematic way. Purpose The purpose....... Conclusion Periprosthetic loosening is frequent following a TWA. In our series it was not necessarily associated with implant loosening and seemed to stabilize within 3 years. Close and continued observation is, however, recommended. Level of Evidence Therapeutic IV....

  14. Total Hip Arthroplasty in Mucopolysaccharidosis Type IH

    Directory of Open Access Journals (Sweden)

    S. O'hEireamhoin

    2011-01-01

    Full Text Available Children affected by mucopolysaccharidosis (MPS type IH (Hurler Syndrome, an autosomal recessive metabolic disorder, are known to experience a range of musculoskeletal manifestations including spinal abnormalities, hand abnormalities, generalised joint stiffness, genu valgum, and hip dysplasia and avascular necrosis. Enzyme therapy, in the form of bone marrow transplantation, significantly increases life expectancy but does not prevent the development of the associated musculoskeletal disorders. We present the case of a 23-year-old woman with a diagnosis of Hurler syndrome with a satisfactory result following uncemented total hip arthroplasty.

  15. Registered Nurse Education and the Registered Nurse Job Market.

    Science.gov (United States)

    Hunt, Howard Allan

    This effort compares the graduates of the three types of Registered Nurse (RN) education programs (three-year Diploma in Nursing, two-year Associate Degree in Nursing (ADN), and four-year Bachelor of Science Degree in Nursing). The basic objective is to determine whether they are perfect substitutes, especially whether ADN graduates can adequately…

  16. THERAPEUTIC STRATEGY IN THE REHABILITATION OF THE DYSPLASTIC HIP THROUGH ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Liliana SAVIN

    2012-07-01

    Full Text Available Total hip arthroplasty in degenerative pathology secondary to congenital dysplasia differentiates itself amongtotal arthroplasties by the frequent technical difficulties it poses and the site where it is performed. The existence of aform of congenital dysplasia that remained untreated or insufficiently treated in childhood leads to irreversibledeformities in adulthood. Partial or total loss of joint congruence causes, in time, degenerative changes with theimpairment of hip mobility and is associated with a number of progressive deformations (limb length discrepancy,abnormal rotation, asymmetric lesions, periarticular muscle failure, which gradually reduce the quality of the patient’slife. This study aims at investigating the incidence of prosthetic hip arthroplasty for osteoarthritis secondary todysplastic hip in the total number of arthroplasties, the age when surgery is performed, the type of deformity andprosthetic components used, and the postoperative and long-term functional results. The study was conducted on 110patients who received total hip arthroplasty due to osteoarthritis secondary to hip dysplasia, between 1994 and 2011, inthe Orthopaedics Trauma Department of the Rehabilitation Hospital of Iasi, the incidence being of 3.34% of the totalnumber of arthroplasties, with a prevalence of 65% under the age of 50 years. The functional results were assessed,according to the Harris-hip-score parameters, as good or very good in proportion of 82%. The complexity of the areawhere the total hip arthroplasty is performed requires a good management consisting of thorough preoperativeplanning, determining the operatory indication, and specialized and individualized medical recovery.

  17. Risk of pneumonia and urinary tract infection within the first week after total hip arthroplasty and the impact on survival

    Science.gov (United States)

    Glassou, Eva N; Hansen, Torben B; Pedersen, Alma B

    2017-01-01

    Background Pneumonia and urinary tract infections (UTIs) increase morbidity and mortality. There is little epidemiological evidence from large population-based studies on risk factors for these infections and subsequent mortality in total hip arthroplasty (THA) patients. Aim To examine the risk factors of postoperative pneumonia and UTI after THA and their impact on survival. Patients and methods We used the Danish Hip Arthroplasty Register to identify THAs due to osteoarthritis registered from 2000 to 2013. We collected data about comorbidities, mortality and infections in relation to primary hospitalization and potential predictive variables from administrative databases. Regression models were used to estimate associations between potential risk factors and infection, and subsequently, between infection and mortality. Results In total 84,812 THAs were included. The cumulative incidence of pneumonia and UTI within 7 days of the primary procedure were 0.21 (95% confidence interval [CI]: 0.18–0.25) and 0.29 (95% CI: 0.26–0.33), respectively. Patient-related risk factors for infection were being 80 years or older, gender and a comorbidity burden at time of surgery. The hazard ratio (HR) of dying within 90 days of the primary THA was 10.67 (95% CI: 5.79–19.57) compared to patients without pneumonia. For patients with UTIs, the HR was 1.64 (95% CI: 0.41–6.59) compared to those without a UTI. Conclusion Pneumonia was associated with an increased short-term risk of dying, despite adjustment for coexisting comorbidity and other potential confounders. Age, gender and comorbidity were the most important risk factors for pneumonia and UTIs. Individual initiatives to reduce the risk of pneumonia in select patient groups may be essential to the effort to optimize outcomes after a THA. PMID:28176979

  18. The Danish Twin Register

    DEFF Research Database (Denmark)

    Kyvik, K O; Christensen, Kaare; Skytthe, A;

    1996-01-01

    BACKGROUND: Population based twin registers represent a valuable tool for genetic epidemiological research, since twin studies aim at separating the effect of genes and environment for complex traits. The Danish Twin Register's history, size, ascertainment and completeness of data, as well as data...... accessibility and availability are described. RESULTS: The Danish Twin Register comprises 14,051 twin pairs born 1870-1930, representing all twins surviving to age six years, and 20,888 twin pairs born 1953-1982, representing 75% of those born 1953-1967 and 95% of those born 1968-1982. The birth cohorts 1931......-1952 og 1983-1993 are being ascertained at the moment. The register is available for research given certain conditions are fulfilled. CONCLUSION: This register will in a few years be the most comprehensive twin register in the world. It is a very valuable Danish research resource....

  19. Tratamento do cotovelo rígido com artroplastia de interposição associada ao fixador externo articulado Stiff elbow treatment by interposing arthroplasty associated to hinged external fixator

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2009-01-01

    Full Text Available OBJETIVO: Avaliar os resultados da técnica de artroplastia de interposição do cotovelo com fascia lata associada ao uso de fixador externo articulado no tratamento do cotovelo rígido. MÉTODOS: Entre 2001 e 2006 foram operados e acompanhados cinco casos de cotovelo rígido pelo Grupo de Ombro e Cotovelo da Faculdade de Ciências Médicas da Santa Casa Misericórdia de São Paulo, tendo como critérios de inclusão: pacientes com arco de movimento do cotovelo menor que o funcional associado a degeneração dessa articulação que não tiveram indicação de prótese total. A idade dos pacientes variou entre 21 e 55 anos (média de 38. Houve predomínio do sexo masculino (quatro casos e, em todos, o membro dominante foi o operado. Quanto à etiologia, houve dois casos de sequela de artrite infecciosa, um de sequela pós-traumática e dois de artrite reumatoide. O arco de movimento no período pré-operatório variou em torno de 20 a 30º de flexoextensão; em dois casos existia contratura fixa em flexão em 30º e 65º. Os pacientes foram avaliados segundo os critérios da AMA modificados por Bruce. RESULTADOS: O seguimento médio foi de 54 meses. Todos os pacientes obtiveram melhora no índice de Bruce, que no pré-operatório era de 43,5 e foi para 88,2 no pós-operatório. Houve dois casos excelentes, um bom, um regular e um ruim. CONCLUSÃO: A artroplastia de interposição com fascia lata associada ao uso de fixador externo dinâmico no cotovelo rígido é uma alternativa viável para pacientes que não têm indicação de artroplastia total de cotovelo.OBJECTIVE: Assess the results of the elbow/ fascia lata interposing arthroplasty technique associated to the use of a hinged external fixator in the treatment of stiff elbow. METHODS: Between 2001 and 2006, five cases of stiff elbow were operated and followed up by the Shoulder and Elbow Group of the Santa Casa Misericórdia de São Paulo Medical Sciences School, establishing the following

  20. Total elbow arthroplasty: a radiographic outcome study

    Energy Technology Data Exchange (ETDEWEB)

    Bai, Xue Susan [University of Washington, Department of Radiology, Box 357115, Seattle, WA (United States); Petscavage-Thomas, Jonelle M. [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Ha, Alice S. [University of Washington, Department of Radiology, Box 354755, Seattle, WA (United States)

    2016-06-15

    Total elbow arthroplasty (TEA) is becoming a popular alternative to arthrodesis for patients with end-stage elbow arthrosis and comminuted distal humeral fractures. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TEA and to correlate with clinical symptoms such as pain. This is an IRB-approved retrospective review from 2005 to 2015 of all patients with semiconstrained TEA. All available elbow radiographs and clinical data were reviewed. Data analysis included descriptive statistics and Kaplan-Meier survival curves for radiographic and clinical survival. A total of 104 total elbow arthroplasties in 102 patients were reviewed; 75 % were in women and the mean patient age was 63.1 years. Mean radiographic follow-up was 826 days with average of four radiographs per patient. Seventy TEAs (67 %) developed radiographic complications, including heterotopic ossification (48 %), perihardware lucency (27 %), periprosthetic fracture (23 %), hardware subluxation/dislocation (7 %), polyethylene wear (3 %), and hardware fracture/dislodgement (3 %); 56 patients (55 %) developed symptoms of elbow pain or instability and 30 patients (30 %) underwent at least one reoperation. In patients with radiographic complications, 66 % developed elbow pain, compared to 19 % of patients with no radiologic complications (p = 0.001). Of the patients with radiographic complications, 39 % had at least one additional surgery compared to 0 % of patients without radiographic complications (p = 0.056). Radiographic complications are common in patients after total elbow arthroplasty. There is a strong positive association between post-operative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist. (orig.)

  1. Disability Pension at the Time of Coronary Revascularisation Is Associated with Higher Five-Year Mortality; A Swedish Nationwide, Register-Based Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Katharina Zetterström

    Full Text Available Although coronary revascularisation by coronary artery bypass grafting (CABG and percutaneous coronary intervention (PCI are common procedures, little is known regarding disability pension (DP at the time of coronary revascularisation and its association with mortality. The aim was to investigate the five-year mortality following a first coronary revascularisation among women and men on DP, compared with those not on DP at the time of intervention, accounting for socio-demographic and medical factors.A nationwide prospective population-based cohort study was conducted, using national registers including 70,040 patients (80% men, aged 30-64 years, with a first CABG (n = 24,987; 36% or PCI (n = 45,053; 64% during 1994-2006 in Sweden, who were alive 30 days after the intervention. The main outcome was all-cause and cause-specific mortality within five years or through 31 December 2006, following CABG and PCI, and the exposure was DP at the time of a first coronary revascularisation. Information on DP, patient characteristics, date and cause of death was obtained from nationwide registers. Hazard ratios (HR with 95% confidence intervals (CI for the outcome were estimated, using Cox proportional hazard regression analyses. All analyses were stratified by type of intervention and gender.Four percent died following coronary revascularisation. Cardiovascular disease was the most common cause of death (54%, followed by neoplasms (25%. Regardless of type of intervention, gender and after multivariable adjustments, patients on DP had a higher HR for five-year mortality compared with those not on DP at time of revascularisation (CABG: women HR 2.14; 95% CI 1.59-2.89, men HR 2.09; 1.84-2.38, PCI: women HR 2.25; 1.78-2.83, men HR 1.95; 1.72-2.21. Young women on DP at the time of PCI had a substantially higher HR (HR 4.10; 95% CI: 2.25-7.48.Patients on DP at the time of first coronary revascularisation had a higher five-year risk of mortality compared with

  2. The Danish Pathology Register

    DEFF Research Database (Denmark)

    Bjerregaard, Beth; Larsen, Ole B

    2011-01-01

    The National Board of Health, Denmark in 1997 published guidelines for reporting of pathology data and the Danish Pathology Register (DPR) was established.......The National Board of Health, Denmark in 1997 published guidelines for reporting of pathology data and the Danish Pathology Register (DPR) was established....

  3. The Danish Adoption Register

    DEFF Research Database (Denmark)

    Petersen, Liselotte; Sørensen, Thorkild I A

    2011-01-01

    The Danish Adoption Register was established in 1963-1964 to explore the genetic and environmental contribution to familial aggregation of schizophrenia.......The Danish Adoption Register was established in 1963-1964 to explore the genetic and environmental contribution to familial aggregation of schizophrenia....

  4. Risk of pneumonia and urinary tract infection within the first week after total hip arthroplasty and the impact on survival

    Directory of Open Access Journals (Sweden)

    Glassou EN

    2017-01-01

    Full Text Available Eva N Glassou,1,2 Torben B Hansen,1,3 Alma B Pedersen2 1University Clinic of Hand, Hip and Knee Surgery, Department of Orthopedic Surgery, Regional Hospital West Jutland, Aarhus University, 2Department of Clinical Epidemiology, Aarhus University Hospital, 3The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Aarhus University, Aarhus, Denmark Background: Pneumonia and urinary tract infections (UTIs increase morbidity and mortality. There is little epidemiological evidence from large population-based studies on risk factors for these infections and subsequent mortality in total hip arthroplasty (THA patients.Aim: To examine the risk factors of postoperative pneumonia and UTI after THA and their impact on survival.Patients and methods: We used the Danish Hip Arthroplasty Register to identify THAs due to osteoarthritis registered from 2000 to 2013. We collected data about comorbidities, mortality and infections in relation to primary hospitalization and potential predictive variables from administrative databases. Regression models were used to estimate associations between potential risk factors and infection, and subsequently, between infection and mortality.Results: In total 84,812 THAs were included. The cumulative incidence of pneumonia and UTI within 7 days of the primary procedure were 0.21 (95% confidence interval [CI]: 0.18–0.25 and 0.29 (95% CI: 0.26–0.33, respectively. Patient-related risk factors for infection were being 80 years or older, gender and a comorbidity burden at time of surgery. The hazard ratio (HR of dying within 90 days of the primary THA was 10.67 (95% CI: 5.79–19.57 compared to patients without pneumonia. For patients with UTIs, the HR was 1.64 (95% CI: 0.41–6.59 compared to those without a UTI.Conclusion: Pneumonia was associated with an increased short-term risk of dying, despite adjustment for coexisting comorbidity and other potential confounders. Age, gender and comorbidity were the most

  5. Nationwide trends in total shoulder arthroplasty and hemiarthroplasty for osteoarthritis.

    Science.gov (United States)

    Trofa, David; Rajaee, Sean S; Smith, Eric L

    2014-04-01

    Recent literature reports an increase in the rate of shoulder arthroplasties, particularly total shoulder arthroplasties (TSAs), being performed in the United States. However, the national epidemiology of use of hemiarthroplasty (HA) and TSA as treatments for glenohumeral osteoarthritis has not been elucidated. We conducted a study to analyze trends in using HA and TSA as treatments for glenohumeral osteoarthritis from 2000 to 2010, and to compare patient characteristics and inpatient complications. US Nationwide Inpatient Sample patients with a primary inpatient diagnosis of shoulder arthritis and a principal procedure of HA or TSA were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedural codes. From 2000 to 2010 the nationally adjusted population rate of shoulder arthroplasty performed for osteoarthritis increased 3.7-fold. Specifically, the population rate of TSA increased 5.0-fold, and that of HA increased 1.9-fold. In 2010, 80.3% of patients having shoulder arthroplasty for arthritis underwent TSA. TSA patients were older (P < .0001) and had a higher mean number of chronic illnesses (P = .034). TSA-associated discharges had a higher rate of surgical and medical care complications (P = .011) and blood transfusions (P = .041) after adjusting for comorbidities.

  6. Breast cancer and early retirement: Associations with disease characteristics, treatment, comorbidity, social position and participation in a six-day rehabilitation course in a register-based study in Denmark

    DEFF Research Database (Denmark)

    Damkjae, Lars Henrik; Deltour, Isabelle; Suppli, Nis Palm

    2011-01-01

    The purpose of this register-based study was to identify factors related to disease, treatment, sociodemographics and comorbidity associated with taking early retirement among women treated for breast cancer, and to evaluate the risk for taking early retirement among breast cancer survivors who...

  7. Differential Drug Survival of Biologic Therapies for the Treatment of Psoriasis: A Prospective Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR).

    Science.gov (United States)

    Warren, Richard B; Smith, Catherine H; Yiu, Zenas Z N; Ashcroft, Darren M; Barker, Jonathan N W N; Burden, A David; Lunt, Mark; McElhone, Kathleen; Ormerod, Anthony D; Owen, Caroline M; Reynolds, Nick J; Griffiths, Christopher E M

    2015-11-01

    Drug survival reflects a drug's effectiveness, safety, and tolerability. We assessed the drug survival of biologics used to treat psoriasis in a prospective national pharmacovigilance cohort (British Association of Dermatologists Biologic Interventions Register (BADBIR)). The survival rates of the first course of biologics for 3,523 biologic-naive patients with chronic plaque psoriasis were compared using survival analysis techniques and predictors of discontinuation analyzed using a multivariate Cox proportional hazards model. Data for patients on adalimumab (n=1,879), etanercept (n=1,098), infliximab (n=96), and ustekinumab (n=450) were available. The overall survival rate in the first year was 77%, falling to 53% in the third year. Multivariate analysis showed that female gender (hazard ratio (HR) 1.22; 95% confidence interval (CI): 1.09-1.37), being a current smoker (HR 1.19; 95% CI: 1.03-1.38), and a higher baseline dermatology life quality index (HR 1.01; 95% CI: 1.00-1.02) were predictors of discontinuation. Presence of psoriatic arthritis (HR 0.82; 95% CI: 0.71-0.96) was a predictor for drug survival. As compared with adalimumab, patients on etanercept (HR 1.63; 95% CI: 1.45-1.84) or infliximab (HR 1.56; 95% CI: 1.16-2.09) were more likely to discontinue therapy, whereas patients on ustekinumab were more likely to persist (HR 0.48; 95% CI: 0.37-0.62). After accounting for relevant covariates, ustekinumab had the highest first-course drug survival. The results of this study will aid clinical decision making when choosing biologic therapy for psoriasis patients.

  8. Wedged tibial components for total knee arthroplasty.

    Science.gov (United States)

    Jeffery, R S; Orton, M A; Denham, R A

    1994-08-01

    Severe coronal deformity of the knee is frequently associated with erosion of one tibial condyle. This can cause problems with fixation and alignment during total knee arthroplasty. If the tibia is cut to the level of the more worn side, valuable bone is sacrificed; if the less worn side is chosen, the deficiency must be filled with bone--graft, cement, or a prosthesis. Tibial components with an integral polyethylene wedge on the undersurface were introduced in 1980 for use in patients with a bony deficit on one tibial condyle. The authors believe that the Denham prosthesis (Biomet, Wales, U.K.) was the first knee arthroplasty to offer such spacers. Twenty-six patients with preoperative varus deformity in whom a wedged component was used were compared with 29 historic control subjects. None of the wedged components loosened after a median follow-up period of 8 years compared with loosening in five of the control subjects (P = .01). In three of the control subjects a fractured triangle of cement was present on the radiographs. Use of the wedges was not accompanied by an improvement in postoperative alignment. The authors conclude that the wedges resulted in improved fixation that was independent of postoperative alignment.

  9. The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Lau Rick L

    2012-12-01

    Full Text Available Abstract Background A number of factors have been identified as influencing total knee arthroplasty outcomes, including patient factors such as gender and medical comorbidity, technical factors such as alignment of the prosthesis, and provider factors such as hospital and surgeon procedure volumes. Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of total joint arthroplasty to higher volume centers, and adoption of volume standards. To contribute to the discussions concerning the optimization of provider factors and proposals to regionalize total knee arthroplasty practices, we undertook a systematic review to investigate the association between surgeon volume and primary total knee arthroplasty outcomes. Methods We performed a systematic review examining the association between surgeon volume and primary knee arthroplasty outcomes. To be included in the review, the study population had to include patients undergoing primary total knee arthroplasty. Studies had to report on the association between surgeon volume and primary total knee arthroplasty outcomes, including perioperative mortality and morbidity, patient-reported outcomes, or total knee arthroplasty implant survivorship. There were no restrictions placed on study design or language. Results Studies were variable in defining surgeon volume (‘low’: 5 to >70 total knee arthroplasty per year. Mortality rate, survivorship and thromboembolic events were not found to be associated with surgeon volume. We found a significant association between low surgeon volume and higher rate of infection (0.26% - 2.8% higher, procedure time (165 min versus 135 min, longer length of stay (0.4 - 2.13 days longer, transfusion rate (13% versus 4%, and worse patient reported outcomes. Conclusions Findings suggest a trend towards better outcomes for higher volume surgeons, but results must be interpreted with caution.

  10. Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Scher, Courtney [Michigan State University Osteopathic Radiology Residency, Henry Ford Macomb Hospital, Warren, MI (United States); Craig, Joseph [Department of Radiology, Henry Ford Hospital, Detroit, MI (United States); Nelson, Fred [Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI (United States)

    2008-07-15

    The purpose of this study was to determine if a correlation exists between magnetic resonance imaging (MRI) findings of bone marrow edema (BME) in osteoarthrosis (OA) of the knee joint and need for total knee arthroplasty (TKA) within a follow-up period of 3 years. The entire database of knee MR studies over a 3-year period was used to select individuals with knee OA. A chart review was conducted to identify and include only those who had a 3-year follow-up appointment from the time of the initial MR study. There were 25 patients in the OA-only group (four men and 21 women; age range, 28-75; average age, 49.3 years). The OA and BME group had 48 patients (23 men and 25 women; average age, 55.5 years). The MRs were reviewed and interpreted by a musculoskeletal radiologist and were classified into one of four patterns of BME: none, focal, global, or cystic pattern. Meniscal tear and degree of cartilage loss were also assessed. Subjects who had BME of any pattern type were 8.95 times as likely to progress rapidly to a TKA when compared to subjects with no BME (p=0.016). Subjects with a global pattern of BME were 5.45 times as likely to have a TKA compared to subjects with focal, cyst, or no BME (p<0.05). Subjects with a global edema pattern were 13.04 times as likely to have a TKA than subjects with no marrow edema in the knee (p<0.01). There was no correlation of TKA with meniscal tear or cartilage loss. The group of subjects who had a TKA were 12.6 years older than those who did not have a TKA (p<0.001). However, the BME results were still significant after accounting for the age difference. Our classification of patterns into global, focal, cystic, and absence of BME is an attempt to further define edema in osteoarthrosis and how it relates to clinical progression. Patients with BME and OA have an increased risk of TKA as opposed to OA and no marrow edema. The BME pattern with the worst prognosis for the knee is the global pattern. (orig.)

  11. Nursing: Registered Nurses

    Science.gov (United States)

    ... a diploma from an approved nursing program. Registered nurses also must be licensed. Education In all nursing education programs, students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology, and other social and ...

  12. Intraoperative Hypothermia in Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Frisch, Nicholas B; Pepper, Andrew M; Rooney, Edward; Silverton, Craig

    2016-10-25

    Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common and successful orthopedic procedures, and as their frequency continues to increase substantially, the focus on limiting perioperative complications heightens. Intraoperative normothermia is recommended to minimize additional complications, but limited evidence exists regarding the effect of hypothermia on orthopedic patients. The purpose of this retrospective study was to determine the incidence of perioperative hypothermia in the setting of TKA and THA, and to evaluate its impact on complications and outcomes. The clinical records of 2580 consecutive patients who underwent TKA or THA at a single institution between January 1, 2011, and December 31, 2013 were reviewed. After excluding patients with complex or revision procedures, a total of 2397 patients comprised the study population. Patient demographic data, surgery-specific data, postoperative complications, length of hospital stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis evaluated associations with hypothermia and the effect on complications and outcomes. The incidence of mean intraoperative hypothermia was 37%, 43.9%, and 32.6% for arthroplasty, THA, and TKA, respectively. General anesthesia was significantly associated with hypothermia (P<.001). Women and THA patients were at higher risk for hypothermia. In the arthroplasty and THA cohorts, longer operating room time and re-warmer use were associated with hypothermia (P=.010). Overall, hypothermia was associated with increased estimated blood loss, but no increase in associated transfusion was demonstrated (P=.006). Hypothermia was not associated with postoperative complications. [Orthopedics. 201x; xx(x):xx-xx.].

  13. IT Risk register

    OpenAIRE

    2011-01-01

    The theoretical part of the thesis analyzes several selected methodologies and best-practices related to information technology risks management, with focus on documents and guidance developed by ISACA. It builds a set of ideas and basic requirements for effective model of an IT risk register. Strong emphasis is placed on mapping CobiT 4.1 based Risk IT to COBIT 5. The practical part describes implementation of an exploratory web-based IT risk register in Python programming language utilizing...

  14. Extensor mechanism disruption after total knee arthroplasty.

    Science.gov (United States)

    Bates, Michael D; Springer, Bryan D

    2015-02-01

    Extensor mechanism disruption is a rare and potentially devastating complication associated with total knee arthroplasty. Disruption can occur at the quadriceps or patellar tendons or, in the setting of a fracture, at the patella. Recognition of the risk factors for disruption and prevention via meticulous surgical technique are critical to avoid this complication. Various management techniques and the challenges associated with treatment have been described. Nonsurgical management consists of the use of walking aids and/or knee braces, which may not be acceptable for the active patient. Surgical options include primary repair and reconstructive techniques using allograft, autograft, synthetic material, and gastrocnemius rotational flaps. However, no single method has reliably demonstrated satisfactory outcomes. Although research on reconstructive procedures with synthetic materials has been promising, further study is need to assess the use of these materials.

  15. A Case Study of Connecticut Community Colleges Nursing Programs to Describe Gerontological Content Inclusion in Associate Degree Registered Nursing Programs Using an Educational Curriculum Framework

    Science.gov (United States)

    Harris, Leslie J.

    2013-01-01

    The population of adults over age 65 must have competently prepared registered nurses to meet their current and future health care needs. There is a societal component in nursing to ensure that all nurses have the content, skills, and strategies, which includes a focus on basic gerontology preparation. Therefore, the purpose of this descriptive…

  16. Low infection rate after tumor hip arthroplasty for metastatic bone disease in a cohort treated with extended antibiotic prophylaxis

    DEFF Research Database (Denmark)

    Hettwer, Werner H; Horstmann, Peter Frederik; Hovgaard, Thea Bechmann;

    2015-01-01

    Background. Compared to conventional hip arthroplasty, endoprosthetic reconstruction after tumor resection is associated with a substantially increased risk of periprosthetic joint infection (PJI), with reported rates of around 10% in a recent systematic review. The optimal duration of antibiotic...

  17. Autologous platelet gel and fibrin sealant enhance the efficacy of total knee arthroplasty : improved range of motion, decreased length of stay and a reduced incidence of arthrofibrosis

    NARCIS (Netherlands)

    Everts, Peter A. M.; Devilee, Roger J. J.; Oosterbos, Cornelis J. M.; Mahoney, Christine Brown; Schattenkerk, Maarten Eeftinck; Knape, Johannes T. A.; van Zundert, Andre

    2007-01-01

    In this study we describe the potential role of autologous platelet gel and fibrin sealant in unilateral total knee arthroplasty to improve the postoperative range of motion and to reduce the incidence of arthrofibrosis. Total knee arthroplasty is often associated with a considerable amount of post-

  18. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Scott M. Sporer

    2009-03-01

    Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer

  19. Gait and postural control after total knee arthroplasty

    OpenAIRE

    Bjerke, Joakim

    2014-01-01

    The aim of the thesis was to investigate deficits and compensatory strategies after total knee arthroplasty (TKA) in different conditions during gait and quiet standing. Although TKA is considered the gold standard treatment for end-stage knee osteoarthritis, it is associated with a number of implications. Reduced physical function after osteoarthritis is partly, but apparently not fully, remedied by surgery. The two most common deficits are reduced knee muscle strength and limited range of k...

  20. Association Between Prepartum Maternal Iron Deficiency and Offspring Risk of Schizophrenia: Population-Based Cohort Study With Linkage of Danish National Registers

    DEFF Research Database (Denmark)

    2010-01-01

    Recent findings suggest that maternal iron deficiency may increase the risk of schizophrenia-spectrum disorder in offspring. We initiated this study to determine whether maternal prepartum anemia influences offspring risk of schizophrenia. We conducted a population-based study with individual...... a 1.60-fold (95% confidence interval = 1.16-2.15) increased risk of schizophrenia. Although the underlying mechanisms are unknown and independent replication is needed, our findings suggest that maternal iron deficiency increases offspring risk of schizophrenia....... record linkage of the Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Register. In a cohort of 1 115 752 Danish singleton births from 1978 to 1998, cohort members were considered as having a maternal history of anemia if the mother had received...

  1. Association Between Prepartum Maternal Iron Deficiency and Offspring Risk of Schizophrenia: Population-Based Cohort Study With Linkage of Danish National Registers

    DEFF Research Database (Denmark)

    Sørensen, Holger J; Nielsen, Philip R; Pedersen, Carsten B;

    2011-01-01

    Recent findings suggest that maternal iron deficiency may increase the risk of schizophrenia-spectrum disorder in offspring. We initiated this study to determine whether maternal prepartum anemia influences offspring risk of schizophrenia. We conducted a population-based study with individual...... a 1.60-fold (95% confidence interval = 1.16-2.15) increased risk of schizophrenia. Although the underlying mechanisms are unknown and independent replication is needed, our findings suggest that maternal iron deficiency increases offspring risk of schizophrenia....... record linkage of the Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Register. In a cohort of 1 115 752 Danish singleton births from 1978 to 1998, cohort members were considered as having a maternal history of anemia if the mother had received...

  2. Processor register error correction management

    Science.gov (United States)

    Bose, Pradip; Cher, Chen-Yong; Gupta, Meeta S.

    2016-12-27

    Processor register protection management is disclosed. In embodiments, a method of processor register protection management can include determining a sensitive logical register for executable code generated by a compiler, generating an error-correction table identifying the sensitive logical register, and storing the error-correction table in a memory accessible by a processor. The processor can be configured to generate a duplicate register of the sensitive logical register identified by the error-correction table.

  3. Fracture Blisters After Primary Total Knee Arthroplasty.

    Science.gov (United States)

    Halawi, Mohamad J

    2015-08-01

    Fracture blisters are tense vesicles that arise on markedly swollen skin overlying traumatized soft tissue. While this relatively uncommon complication has been well described in the trauma literature, this article reports for the first time a case of fracture blisters after primary total knee arthroplasty. The fracture blisters developed within 36 hours of surgery and were associated with profound swelling and erythema. There was no evidence of vascular injury, compartment syndrome, iatrogenic fracture, or deep venous thrombosis. The patient was treated with leg elevation, loosely applied nonadhesive dressings, and a short course of oral antibiotics after skin desquamation. Blood-filled blisters required longer time to reepithelialization than fluid-filled blisters. Knee stiffness developed because of pain and fear of participation with physical therapy, but the patient was able to resume intensive rehabilitation after resolution of the blisters. Patient factors, surgical factors, and review of the literature are discussed.

  4. [Uncemented arthroplasty of the hip].

    Science.gov (United States)

    von Schulze Pellengahr, C; Fottner, A; Utzschneider, S; Schmitt-Sody, M; Teske, W; Lichtinger, T; Esenwein, S A

    2009-05-01

    Prognosis of cemented total hip replacement seems to be excellent for elderly patients. In younger age the outcome is less favourable and early revision is more common. Thus, different concepts with better prognosis and preservation of bone stock for possible revisions were needed. After more than 30 years of application with excellent short-term and long-term results, uncemented total hip arthroplasty is nowadays generally regarded as the standard procedure for younger patients. New bone-preserving implants, such as surface replacement or short-stemmed femoral shaft prostheses, have been introduced especially for younger patients. Some of these new procedures are still under development, and the long-term results of new implant concepts have to be evaluated over the next decades. Regarding recently published scientific studies an overview about non-cemented total hip arthroplasty is given and current concepts and developments are presented.

  5. Register file soft error recovery

    Science.gov (United States)

    Fleischer, Bruce M.; Fox, Thomas W.; Wait, Charles D.; Muff, Adam J.; Watson, III, Alfred T.

    2013-10-15

    Register file soft error recovery including a system that includes a first register file and a second register file that mirrors the first register file. The system also includes an arithmetic pipeline for receiving data read from the first register file, and error detection circuitry to detect whether the data read from the first register file includes corrupted data. The system further includes error recovery circuitry to insert an error recovery instruction into the arithmetic pipeline in response to detecting the corrupted data. The inserted error recovery instruction replaces the corrupted data in the first register file with a copy of the data from the second register file.

  6. Revision of hip resurfacing arthroplasty.

    Science.gov (United States)

    Wera, Glenn D; Gillespie, Robert J; Petty, Carter; Petersilge, William J; Kraay, Matthew J; Goldberg, Victor M

    2010-08-01

    Metal-on-metal (MOM) hip resurfacing has become an increasingly popular treatment for young, active patients with degenerative disease of the hip, as bearing surfaces with better wear properties are now available. One proposed advantage of resurfacing is its ability to be successfully revised to total hip arthroplasty (THA). In addition, radiographic parameters that may predict failure in hip resurfacing have yet to be clearly defined. Seven MOM resurfacing arthroplasties were converted to conventional THAs because of aseptic failure. Using Harris Hip Scores (HHS) and Short Form 12 (SF-12) questionnaire scores, we compared the clinical outcomes of these patients with those of patients who underwent uncomplicated MOM hip resurfacing. In addition, all revisions were radiographically evaluated. Mean follow-up periods were 51 months (revision group) and 43 months (control group). There was no significant difference between the 2 groups' HHS or SF-12 scores. There was no dislocation or aseptic loosening after conversion of any resurfacing arthroplasty. Valgus neck-shaft angle (P hip resurfacing. Conversion of aseptic failure of hip resurfacing to conventional THA leads to clinical outcomes similar to those of patients who undergo uncomplicated hip resurfacing. The orientation of the femur and the components placed play a large role in implant survival in hip resurfacing. More work needs to be done to further elucidate these radiographic parameters.

  7. Humeral windows in revision total elbow arthroplasty

    Science.gov (United States)

    Salama, Amir; Stanley, David

    2016-01-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery. PMID:27583011

  8. The Danish Education Registers

    DEFF Research Database (Denmark)

    Jensen, Vibeke Myrup; Rasmussen, Astrid Würtz

    Collection of systematic information on education is a long established practice in Denmark. Since 1910, the Danish Ministry of Education's annual reports collects information about individual-level test scores in e.g. compulsory schooling. Today, several registers from compulsory schooling...

  9. The Danish Heart Register

    DEFF Research Database (Denmark)

    Abildstrom, S. Z.; Madsen, Mette

    2011-01-01

    Introduction: The Danish Heart Register (DHR) is a clinical database of invasive procedures within cardiology. Content: All providers of these procedures have been obliged to report to DHR since 2000. DHR is used to monitor the activity and quality of the procedures and serves as a data source...

  10. Register for Suicide Attempts

    DEFF Research Database (Denmark)

    Christiansen, Erik; Jensen, Børge Frank

    2004-01-01

    The Register for Suicide Attempts (RSA) is a product of the WHO research project "WHO/Euro Multicentre Study on Parasuicide", which, among other things, had the purpose of collecting data on suicide attempts from 13 European countries. Data is collected in order to calculate trends and identify...

  11. The Danish Education Registers

    DEFF Research Database (Denmark)

    Jensen, Vibeke Myrup; Würtz Rasmussen, Astrid

    Collection of systematic information on education is a long established practice in Denmark. Since 1910, the Danish Ministry of Education’s annual reports collects information about individual-level test scores in e.g. compulsory schooling. Today, several registers from compulsory schooling to ad...... of missing information on immigrants, the level is still low in an international context....

  12. Hello! Are You Registered?

    Science.gov (United States)

    Institute for Political/Legal Education, Sewell, NJ.

    Organizational procedures and appropriate forms for high school students to conduct a community survey of non-registered voters are provided. Duties for student coordinator, field staff, and clerical staff are described and a flow chart depicts the relationship of personnel to one another and to the community. Students are instructed to notify…

  13. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    of the hospital stay (I); how to optimize analgesia by using a compression bandage in total knee arthroplasty (II); the clinical and organizational set-up facilitating or acting as barriers for early discharge (III); safety aspects following fast-track in the form of few readmissions in general (IV) and few...... thromboembolic complications in particular (V); feasibility studies showing excellent outcomes following fast-track bilateral simultaneous total knee arthroplasty (VI) and non-septic revision knee arthroplasty (VII); how acute pain relief in total hip arthroplasty is not enhanced by the use of local infiltration......Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...

  14. Use of register data to assess the association between use of antimicrobials and outbreak of Postweaning Multisystemic Wasting Syndrome (PMWS) in Danish pig herds

    DEFF Research Database (Denmark)

    Vigre, Håkan; Dohoo, Ian R; Stryhn, Henrik

    2010-01-01

    of antimicrobials prescribed to weaners (prescribed by 347 practitioners) and finishers (prescribed by 522 practitioners), respectively. The estimation of the effect of PMWS was done by comparing the amount of antimicrobials (measured as Animal Defined Daily Doses (ADDkg) used per pig-day at risk each month in each......In 2001, the first case of Postweaning Multisystemic Wasting Syndrome (PMWS) was reported in the Danish pig population. During subsequent years, the number of affected farms increased exponentially. The aim of this study was to determine how this increase influenced the use of antimicrobials...... between 2002 and 2004. We used national register data of herd characteristics, antimicrobial usage and disease occurrence. The analysis included data on antimicrobial usage in 3371 pig herds with weaners and 7434 pig herds with finishers, which accounted for 56 and 82% of the national amount...

  15. Identifying the procedural gap and improved methods for maintaining accuracy during total hip arthroplasty.

    Science.gov (United States)

    Gross, Allan; Muir, Jeffrey M

    2016-09-01

    Osteoarthritis is a ubiquitous condition, affecting 26 million Americans each year, with up to 17% of adults over age 75 suffering from one variation of arthritis. The hip is one of the most commonly affected joints and while there are conservative options for treatment, as symptoms progress, many patients eventually turn to surgery to manage their pain and dysfunction. Early surgical options such as osteotomy or arthroscopy are reserved for younger, more active patients with less severe disease and symptoms. Total hip arthroplasty offers a viable solution for patients with severe degenerative changes; however, post-surgical discrepancies in leg length, offset and component malposition are common and cause significant complications. Such discrepancies are associated with consequences such as low back pain, neurological deficits, instability and overall patient dissatisfaction. Current methods for managing leg length and offset during hip arthroplasty are either inaccurate and susceptible to error or are cumbersome, expensive and lengthen surgical time. There is currently no viable option that provides accurate, real-time data to surgeons regarding leg length, offset and cup position in a cost-effective manner. As such, we hypothesize that a procedural gap exists in hip arthroplasty, a gap into which fall a large majority of arthroplasty patients who are at increased risk of complications following surgery. These complications and associated treatments place significant stress on the healthcare system. The costs associated with addressing leg length and offset discrepancies can be minor, requiring only heel lifts and short-term rehabilitation, but can also be substantial, with revision hip arthroplasty costs of up to $54,000 per procedure. The need for a cost-effective, simple to use and unobtrusive technology to address this procedural gap in hip arthroplasty and improve patient outcomes is of increasing importance. Given the aging of the population, the projected

  16. Dislocation following revision total hip arthroplasty.

    Science.gov (United States)

    Gioe, Terence J

    2002-04-01

    Dislocation is a relatively common complication following revision total hip arthroplasty. Risk factors include surgical approach, gender, underlying diagnosis, comorbidities, surgical experience, and previous surgery; for later dislocations, risk factors include wear/deformation of polyethylene, trauma, and decreased muscle strength. Prevention and precaution are the watchwords for dislocations following revision total hip arthroplasty. For dislocations that do occur, treatment rests first on identifying the source of instability. Most dislocations can be managed by closed reduction. Constrained components may increase success rates, but only for appropriate indications. Prevention and treatment of dislocations following revision total hip arthroplasty are discussed in this article.

  17. Similar range of motion and function after resurfacing large-head or standard total hip arthroplasty

    DEFF Research Database (Denmark)

    Penny, Jeannette Østergaard; Ovesen, Ole; Varmarken, Jens-Erik

    2013-01-01

    BACKGROUND AND PURPOSE: Large-size hip articulations may improve range of motion (ROM) and function compared to a 28-mm THA, and the low risk of dislocation allows the patients more activity postoperatively. On the other hand, the greater extent of surgery for resurfacing hip arthroplasty (RHA) c...... for large articulations did not improve the clinical and patient-perceived outcomes. The more extensive surgical procedure of RHA did not impair the rehabilitation. This project is registered at ClinicalTrials.gov under # NCT01113762.......BACKGROUND AND PURPOSE: Large-size hip articulations may improve range of motion (ROM) and function compared to a 28-mm THA, and the low risk of dislocation allows the patients more activity postoperatively. On the other hand, the greater extent of surgery for resurfacing hip arthroplasty (RHA...

  18. Register-based studies of cardiovascular disease

    DEFF Research Database (Denmark)

    Abildstrøm, Steen Z; Torp-Pedersen, Christian; Madsen, Mette

    2011-01-01

    Introduction: The use of the unique personal identification number in the Nordic database systems enables the researchers to link the registers at the individual level. The registers can be used for both defining specific patient populations and to identify later events during follow-up. This rev...... the hospitalisation rate and treatment of cardiovascular disease. The risk of unmeasured factors affecting the results calls for cautious interpretation of the results.......-up. This review gives three examples within cardiovascular epidemiology to illustrate the use of the national administrative registers available to all researchers upon request. Research topics: The hospitalisation rate of acute myocardial infarction (AMI) was expected to be increased and case-fatality rate......-based treatment increased significantly over time and adherence to treatment was high. Finally, use of specific nonsteroidal antiinflammatory drugs by healthy subjects was associated with a dose-dependent increase in cardiovascular risk. CONCLUSION: The nationwide registers have proven very useful in monitoring...

  19. The Danish Education Registers

    DEFF Research Database (Denmark)

    Jensen, Vibeke Myrup; Rasmussen, Astrid Würtz

    2011-01-01

    Collection of systematic information on education is a long established practice in Denmark. Since 1910, the Danish Ministry of Education’s annual reports collects information about individual-level test scores in e.g. compulsory schooling. Today, several registers from compulsory schooling...... to adults continuing education and training stem from administrative education reports. Therefore, for cohorts born 1945-1990, 97 percent of the Danish population has a valid education identifier. For the immigrant population born in the same cohorts the coverage is 85-90 percent. Despite a higher level...

  20. Register / Andri Ksenofontov

    Index Scriptorium Estoniae

    Ksenofontov, Andri, 1962-

    2007-01-01

    Näitused: Eesti Kujundusgraafikute Liidu aastanäitus "Register 2007" Kunstihoone galeriis, Signe Kivi "Võimuvaibad ja vaimukleidid" Arhitektuuri- ja Disainigaleriis, "Kehaturg / Sex market" (Dagmar Kase, Eveli Variku tööd) Tallinna Kunstihoones, Andrei Maksimjuki "Surematu klassika" Ühispanga galeriis, Katrin Veegeni "Varsti" A-galeriis, Eda Lõhmuse "Ülespoole" ja Rein Kelpmani "Grosso modo" ArtDepoo Galeriis, Jaan Elkeni "Valge valgus" Galeriis 008, Paul Rodgersi "Transplants" Hobusepea galeriis, Masayo Ave "Haptic Interface Design" Arhitektuuri- ja Disainigaleriis ja workshop Eesti Kunstiakadeemias

  1. Analysis of deaths related to anesthesia in the period 1996-2004 from closed claims registered by the Danish Patient Insurance Association

    DEFF Research Database (Denmark)

    Hove, Lars Dahlgaard; Steinmetz, Jacob; Christoffersen, Jens Krogh

    2007-01-01

    Anesthesia is associated with complications, and some of them may be fatal. The authors investigated the circumstances under which deaths were associated with anesthesia. In Denmark, the specialty anesthesiology encompasses emergency medicine, chronic and acute pain medicine, anesthetic procedure...

  2. Total Knee Arthroplasty in Patients with Blount Disease or Blount-Like Deformity.

    Science.gov (United States)

    Natoli, Roman M; Nypaver, Chrissy M; Schiff, Adam P; Hopkinson, William J; Rees, Harold W

    2016-01-01

    Blount disease is associated with complex deformity of the proximal tibia, and some patients will develop knee osteoarthritis. Five patients (eight knees) with Blount disease or Blount-like deformity underwent total knee arthroplasty. Mean proximal tibial metaphyseal-diaphyseal angle was 20.75°. Each patient had substantial posteromedial tibial bony defects and six knees required extensive medial releases. Two knees required increased constraint at index procedure. One patient has undergone bilateral revision surgery with rotating hinge prostheses. Mean WOMAC scores were 13.5 and Knee Society scores were 212.5 at average 75.2 month follow-up. Despite technical challenges, patients with these deformities can have successful outcomes after total knee arthroplasty. Surgeons should be prepared to address posteromedial tibial bony defects and consider constrained arthroplasty at the index procedure.

  3. Revision of failed humeral head resurfacing arthroplasty

    Directory of Open Access Journals (Sweden)

    Philipp N Streubel

    2016-01-01

    Conclusion: Outcomes of revision of HHR arthroplasty in this cohort did not improve upon those reported for revision of stemmed humeral implants. A comparative study would be required to allow for definitive conclusions to be made.

  4. Total Knee Arthroplasty Complicated by a Severe Heterotopic Ossification: A Case Report

    Directory of Open Access Journals (Sweden)

    Antonio Spinarelli

    2016-05-01

    Full Text Available Introduction Total knee arthroplasty (TKA associated with heterotopic ossifications (HOs are rare occurrences despite the relatively frequent surgery procedure of the hip arthroplasty. Up to present, different types of treatment were described in the literature. Case Presentation We report an unusual case of TKA in a 70-year-old woman, which was early complicated by development of HO. It was successfully treated with a second surgery and a selective cyclooxygenase (COX-2 inhibitor (celecoxib with good clinical results. Conclusions This case illustrates that early operative and medical treatment can be used to optimally resolve stiffness caused by HO after total knee replacement.

  5. Total Ankle Arthroplasty: A Brief Review

    OpenAIRE

    Mann, Roger A.; Harrison, Matthew J.

    2012-01-01

    Ankle fusion has long been the standard of treatment for end-stage ankle arthritis, and a successful arthroplasty has been a long sought alternative. It is a motion sparing procedure and may greatly reduce the potential for adjacent level degeneration as seen with arthrodesis. The typical candidate for arthroplasty is a healthy low demand patient, although the indications are widening as the success of the procedure has increased. Nevertheless, it is not fail-safe, technical expertise and exp...

  6. Wear debris in cemented total hip arthroplasty.

    Science.gov (United States)

    Huo, M H; Salvati, E A; Buly, R L

    1991-03-01

    One of the most prevalent clinical problems in long-term follow up of total hip arthroplasty patients is loosening of prosthetic fixation. Factors contributing to mechanical failure of total hip reconstruction are complex and multiple. It has become increasingly apparent that wear debris from the prosthetic components may contribute significantly to this process. The authors summarize some of the current concepts concerning the detrimental effects of metallic debris in total hip arthroplasty.

  7. Osteolysis of the Greater Trochanter Caused by a Foreign Body Granuloma Associated with the Ethibond® Suture after Total Hip Arthroplasty.

    Science.gov (United States)

    Kamo, Keiji; Kijima, Hiroaki; Okuyama, Koichiro; Seki, Nobutoshi; Yamada, Shin; Miyakoshi, Naohisa; Shimada, Yoichi

    2017-01-01

    The present case shows a case of progression of osteolysis of the greater trochanter caused by a foreign body granuloma associated with the number 5 Ethibond suture in cementless THA with the direct lateral approach that was completely healed by removal of the Ethibond suture. A 55-year-old Japanese woman with secondary osteoarthritis caused by acetabular dysplasia underwent left cementless THA with the direct lateral approach. After setting of the total hip prosthesis, the gluteus medius muscle and vastus lateralis muscle were reattached to the greater trochanter through two bone tunnels using number 5 Ethibond EXCEL sutures. The left hip pain disappeared after surgery, but the bone tunnels enlarged gradually and developed osteolysis at 10 weeks. The removal of the Ethibond sutures and debridement improved the osteolysis. Histological examination showed the granuloma reaction to a foreign body with giant cell formation. The Ethibond suture has the lowest inflammatory tissue reaction and relatively high tension strength among nonabsorbable suture materials. However, number 5 Ethibond has the potential to cause osteolysis due to a foreign body granuloma, as in the present case.

  8. Efficacy and safety of rivaroxaban thromboprophylaxis after arthroplasty of the hip or knee: retrospective cohort study.

    Science.gov (United States)

    Loganathan, L; Hua, A; Patel, S; Gibbons, C; Vizcaychipi, M P

    2016-09-01

    Introduction Venous thromboembolism (VTE) is a potentially fatal complication of hip arthroplasty and knee arthroplasty. The National Institute for Health and Care Excellence recommend rivaroxaban for VTE prevention. Amid concerns over bleeding complications, the modified thromboprophylaxis policy of Chelsea and Westminster Hospital (CWH; London, UK) advises enoxaparin given after surgery in the inpatient setting followed by rivaroxaban upon hospital discharge. This retrospective study investigated the efficacy and safety of rivaroxaban in this novel, modified venous-prophylaxis regimen in a surgical orthopaedic cohort at CWH. Methods A total of 479 patients who received modified thromboprophylaxis treatment at CWH after hip arthroplasty or knee arthroplasty between April 2013 and October 2014 formed the study cohort. Seven outcomes based on efficacy and safety while undergoing treatment with rivaroxaban were investigated: symptomatic deep-vein thrombosis (DVT), pulmonary embolism (PE), death, stroke, myocardial infarction (MI), major bleeding episodes (MBEs) and non-major bleeding episodes (NMBEs). Median follow-up was 369 days. Fisher's exact and Mann-Whitney U-tests were adopted to identify associations with these outcomes. Results Prevalence of symptomatic PE, DVT, death, stroke and MI during treatment was zero. One (0.2%) MBE and nine (1.9%) NMBEs occurred. The MBE (a wound haematoma) required a return to theatre for aspiration. Off-treatment VTEs occurred in four (0.8%) patients after completion of a course of rivaroxaban, and were associated with known risk factors. Conclusions Rivaroxaban is an effective and safe anticoagulant for thromboprophylaxis after hip arthroplasty or knee arthroplasty if used in a modified regimen involving enoxaparin administered in the inpatient setting followed by rivaroxaban upon hospital discharge.

  9. Revision total elbow arthroplasty with the linked Coonrad-Morrey total elbow arthroplasty

    DEFF Research Database (Denmark)

    Plaschke, Hans Christian; Thillemann, Theis; Belling-Sørensen, Anne Kathrine;

    2013-01-01

    In this retrospective study we evaluated the short- to medium-term results after 20 Coonrad-Morrey revision total elbow arthroplasties (TEAs).......In this retrospective study we evaluated the short- to medium-term results after 20 Coonrad-Morrey revision total elbow arthroplasties (TEAs)....

  10. Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial

    DEFF Research Database (Denmark)

    Lunn, Troels; Kristensen, Billy Bjarne; Andersen, Lasse;

    2011-01-01

    Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied....

  11. No evidence of a clinically important effect of adding local infusion analgesia administrated through a catheter in pain treatment after total hip arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Leonhardt, Jane Schwartz; Revald, Peter

    2011-01-01

    Background and purpose Postoperative analgesia after primary total hip arthroplasty (THA) using opioids is associated with troublesome side effects such as nausea and dizziness, and epidural analgesic means delayed mobilization. Thus, local infiltration analgesia (LIA) during surgery prolonged...

  12. Modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov external fixator as a salvage method in the management of severely infected total hip replacement

    Directory of Open Access Journals (Sweden)

    Nikolai M Kliushin

    2016-01-01

    Conclusion: The modified Girdlestone arthroplasty and hip arthrodesis using the Ilizarov apparatus results in sufficient ability for ambulation and good infection control in cases of failed THR associated with severe infection.

  13. Lubrication regimes in lumbar total disc arthroplasty.

    Science.gov (United States)

    Shaheen, A; Shepherd, D E T

    2007-08-01

    A number of total disc arthroplasty devices have been developed. Some concern has been expressed that wear may be a potential failure mode for these devices, as has been seen with hip arthroplasty. The aim of this paper was to investigate the lubrication regimes that occur in lumbar total disc arthroplasty devices. The disc arthroplasty was modelled as a ball-and-socket joint. Elastohydrodynamic lubrication theory was used to calculate the minimum film thickness of the fluid between the bearing surfaces. The lubrication regime was then determined for different material combinations, size of implant, and trunk velocity. Disc arthroplasties with a metal-polymer or metal-metal material combination operate with a boundary lubrication regime. A ceramic-ceramic material combination has the potential to operate with fluid-film lubrication. Disc arthroplasties with a metal-polymer or metal-metal material combination are likely to generate wear debris. In future, it is worth considering a ceramic-ceramic material combination as this is likely to reduce wear.

  14. Clinical outcome after treatment of infected primary total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jensen, Tim Toftgaard

    2002-01-01

    Twenty-six consecutive cases of infected primary total knee arthroplasties were treated at our institution from 1989 through 2000. Eleven patients had debridement and irrigation performed within 2 months of index arthroplasty or hematogenous spread; only one infection was eradicated. Twenty......-five patients had their prostheses removed; 17 had two-stage revision arthroplasty, following which infection was eradicated in 15; one had a permanent spacer, 7 had arthrodesis (following failed revision arthroplasty in one) and 2 had a femur amputation (following failed revision arthroplasty in one) at follow......-up of mean 24 months. Infections were cured equally well with revision arthroplasty and arthrodesis. Among the 15 patients who ended up with revision arthroplasty, 11 had a better range of motion compared to the index arthroplasty, but 8 had daily pain. We present our treatment protocol, which eradicated 15...

  15. Joint Line Reconstruction in Navigated Total Knee Arthroplasty Revision

    Science.gov (United States)

    2012-05-16

    Revision Total Knee Arthroplasty Because of; Loosening; Instability; Impingement; or Other Reasons Accepted as Indications for TKA Exchange.; The Focus is to Determine the Precision of Joint Line Restoration in Navigated vs. Conventional Revision Total Knee Arthroplasty

  16. Effect of adductor canal block on pain in patients with severe pain after total knee arthroplasty

    DEFF Research Database (Denmark)

    Grevstad, Jens Ulrik; Mathiesen, Ole; Lind, T;

    2014-01-01

    BACKGROUND: Total knee arthroplasty (TKA) is associated with varying degrees of pain. A considerable proportion (25-40%) of patients experience severe pain, despite a comprehensive multimodal analgesic regimen. We hypothesized that adductor canal block (ACB) would reduce pain in this patient...

  17. Intraoperative periprosthetic fractures associated with uncemented stems in primary total hip arthroplasty%初次全髋关节置换术中与生物柄相关的假体周围骨折

    Institute of Scientific and Technical Information of China (English)

    林龙泉; 丁真奇; 陈智彪; 刘国俊; 陈卫; 陆成武

    2015-01-01

    Objective To analyze the incidence management and outcomes of intraoperative periprosthetic fractures associated with the insertion of uncemented stems around primary total hip arthroplasty( THA) . Methods 623 stem-med implants in 559 cases of THA were analyzed retrospectively. Results 43 patients of 559 cases who sustained in-traoperative periprosthetic fractures were classified according to the Vancouver system:5 cases type A1 fractures, 3 type B1, 13 type B2, 6 type A2L, 6 type A2G, 8 type A3L, 2 type A3G were recognized in the study. All the patients were used cerclage wiring or conservative treatment and healed uneventfully. 43 patients were completed review with 12~37 months and none of them were found implant migration loosening until the end of the review. The Harris score ranged from 77~91 points. Conclusions Most of the intraoperative periprosthetic fracture are non- or minimally displaced. Female gender is absolutely associated ( P =0. 002 ) and diameter of implant is significantly associated with intraoperative periprosthetic fractures ( P=0. 031 ) , cerclage wiring can be used to treated type A3 L and A3 G fractures in the operation and bear weight postponed for 2~3 months until fracture healing and obtain a favorable cur-ative effect.%目的 分析初次全髋关节置换术( THA)术中与植入生物柄相关的假体周围骨折的因素及处理方法.方法 对559例THA术中使用的623个植入假体进行回顾性研究. 结果 559例中43例发生术中假体周围股骨骨折,按Vancouver型标准进行分类:A1型5例,B1型3例,B2型13例,A2L 型6例,A2G型6例,A3L 型8例,A3 G 型2例. 分别用钢丝环扎固定、术后卧床等治疗,均愈合良好. 43 例均获得随访,时间12 ~37 个月. 均未见假体松动,Harris评分为77~91分. 结论 THA术中与生物柄相关的假体周围骨折多为轻微骨折. 假体周围骨折与性别为女性存在绝对相关( P=0. 002 ) ,与假体直径的相关性较明显( P=0. 031 ). Van

  18. Health-related quality of life in veterans with prevalent total knee arthroplasty and total hip arthroplasty

    OpenAIRE

    Singh, J.A.; Sloan, J.A.

    2008-01-01

    Objective. To study the HRQOL in veterans with prevalent total knee arthroplasty (TKA) or total hip arthroplasty (THA) and compare them with age- and gender-matched US population and control veteran population without these procedures.

  19. ARTHROFIBROSIS FOLLOWING TOTAL KNEE ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Ravi B. Solanki

    2014-11-01

    Full Text Available Arthrofibrosis following total knee arthroplasty is an uncommon complication defined as less than 80 degrees of knee flexion 6-8 weeks post operatively. It is characterized by abnormal scarring of the joint in which the formation of dense fibrous tissue and tissue metaplasia prevent normal range of motion. Clinical features include limited knee Range of motion with extension deficit, pain with activities of daily living and unusual amount of pain and swelling post operatively in the absence of infection, bleeding or mechanical complications. We present case of 55 years old female who undergone for total knee replacement before 3 months and presented to our department with complain of knee pain and swelling with activities of daily living. She was diagnosed on the basis of clinical examination. Her detailed evaluation was carried out and Physiotherapy treatment was started.

  20. Traditions and myths in hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Gromov, Kirill; Malchau, Henrik

    2014-01-01

    of future research. Results - We present traditions and evaluate them against the published evidence. Preoperative removal of hair, urine testing for bacteria, use of plastic adhesive drapes intraoperatively, and prewarming of the operation room should be abandoned-as should use of a tourniquet, a space......Background and purpose - Traditions are passed on from experienced surgeons to younger fellows and become "the right way to do it". Traditions associated with arthroplasty surgery may, however, not be evidence-based and may be potentially deleterious to both patients and society, increasing...

  1. Breast cancer and early retirement: Associations with disease characteristics, treatment, comorbidity, social position and participation in a six-day rehabilitation course in a register-based study in Denmark

    DEFF Research Database (Denmark)

    Damkjaer, L. H.; Deltour, I.; Suppli, N. P.

    2011-01-01

    Introduction. The purpose of this register-based study was to identify factors related to disease, treatment, sociodemographics and comorbidity associated with taking early retirement among women treated for breast cancer, and to evaluate the risk for taking early retirement among breast cancer...... information on receipt of unemployment benefits, sickness benefits and early retirement pension for each of the years 1996-2007. Multivariate cox-regression models were used to analyze disease-specific, treatment-related, comorbidity and sociodemographics factors associated with early retirement after breast...... cancer and to evaluate the effect of attending a rehabilitation course on taking early retirement. Results. The rate of retirement was higher for women with somatic comorbidity (hazard ratio [HR], 1.91; 95% CI, 1.3; 2.9 for score 1, and HR 1.42; 95% CI, 0.7; 2.7 for score >= 2), previous depression (HR...

  2. Removal versus preservation of the posterior longitudinal ligament in Bryan cervical disc arthroplasty

    Institute of Scientific and Technical Information of China (English)

    YANG Da-long; DING Wen-yuan; ZHANG Ying-ze; ZHANG Wei; XU Jia-xin; SHEN Yong

    2013-01-01

    Background Bryan cervical disc arthroplasty can be used to restore and maintain the mobility and function of the involved cervical spinal segments.The efficiency of posterior longitudinal ligament (PLL) resection in anterior cervical decompression and fusion has been demonstrated.However,no clinical reports have compared PLL removal with preservation in Bryan cervical disc arthroplasty.This study aimed to assess the role of removal of PLL in Bryan cervical disc arthroplasty at an 18-month follow-up.Methods We performed a prospective investigation of clinical and radiological outcomes in patients after Bryan cervical disc arthroplasty.Sixty patients who underwent Bryan cervical disc arthroplasty were included.The PLL was removed in 35 patients (investigational group) and preserved in 25 patients (control group).All of the patients were followed up for more than 18 months.Clinical (Japanese Orthopedic Association score and Visual Analogue Scale pain score) and radiological (functional spinal unit (FSU) angle,range of movement (ROM),and diameter of the spinal cord) parameters were compared between the two groups before and after surgery (18 months).Results Clinical outcomes in the investigational group were significantly superior to those in the control group.There were no significant differences in the FSU angle and ROM (P=-0.41 and 0.16,respectively) between the two groups.However,the increase in diameter of the spinal cord in the investigational group was significantly greater than that in the control group (P <0.01).Conclusions Removal of the PLL can improve the clinical outcomes of Bryan cervical disc arthroplasty.This procedure does not have a large effect on imbalance and motion of the cervical spine.

  3. Antibiofilm and Antimicrobial Efficacy of DispersinB (registered trademark)-KSL-W Peptide-Based Wound Gel Against Chronic Wound Infection Associated Bacteria

    Science.gov (United States)

    2014-01-21

    16, 21–23]. The DispersinB-KSL-W wound gel exhibited a sus- tained antibacterial activity over a period of 72 h against all the chronic wound...Antibiofilm and Antimicrobial Efficacy of DispersinB-KSL-W Peptide-Based Wound Gel Against Chronic Wound Infection Associated Bacteria Purushottam V...and Acinetobacter baumannii. In addition, the wound gel formulation comprising DispersinB, KSL-W peptide, and a gelling agent Pluronic F-127 showed a

  4. Postoperative blood loss prevention in total knee arthroplasty.

    Science.gov (United States)

    Banerjee, Samik; Kapadia, Bhaveen H; Issa, Kimona; McElroy, Mark J; Khanuja, Harpal S; Harwin, Steven F; Mont, Michael A

    2013-12-01

    Blood loss is a serious concern during lower extremity total joint arthroplasty with the estimated reduction in hemoglobin concentration known to vary between 2 and 4 g/dL after total knee arthroplasty (TKA). Allogeneic transfusions are commonly used to treat the acute blood loss and postoperative anemia to diminish the potential cardiovascular risks in up to 50% of such cases with a high volume of blood loss. However, these transfusions are associated with the risks of immunologic reactions, immunosuppression, and infection transmission. Multiple blood-saving strategies have been developed to minimize blood loss, to reduce transfusion rates, to decrease complications, and to improve outcomes in the postoperative period. Currently, there are no clear guidelines on the blood management strategies adopted to lessen the blood loss associated with TKA. The aim of this study was to review the literature and provide a broad summary of the efficacy and complications associated with several blood-saving measures that are currently used in the postoperative period. Evidence suggests that simple techniques such as limb elevation, cryotherapy, compression dressings, and drain clamping may reduce external drainage, however, whether these techniques lead to less allogeneic transfusions is currently debatable. Further research on using a combination of these strategies and their cost-effectiveness are needed.

  5. Implementación de guías de buenas prácticas clínicas elaboradas por Registered Nurses Association of Ontario (RNAO en el curriculum de Enfermería Universidad de Chile / Implementation of Clinical Best Practice Guidelines Done by The Registered Nurses’ Association of Ontario (RNAO in the Nursing Curriculum at Universidad de Chile / Implementação de manuais de boas práticas clínicas desenvolvidas por Registered Nurses Association of Ontario (RNAO no currículo de Enfermagem da Universidade do Chile

    Directory of Open Access Journals (Sweden)

    Amalia Silva-G, Lic. en Enf. y Obstetricia, Mg., PhD. (c

    2015-03-01

    Full Text Available Introducción: La investigación desarrollada en enfermería en el último tiempo ha permitido generar conocimientos que aportan a mejorar el cuidado de salud que otorgan los profesionales, se han confeccionado protocolos y guías clínicas con la finalidad de ofrecer a los profesionales de la salud la mejor evidencia para la práctica clínica, viéndose beneficiadas con ello, principalmente, las personas que requieren cuidados y también las instituciones al disminuir sus costos. Para llegar a esta meta es indispensable la capacitación continua de los profesionales de la salud y la inclusión de la formación de estos contenidos en los programas de las instituciones formadoras. Objetivo: Este artículo presenta la experiencia de implementación de cuatro guías de buena práctica clínica elaboradas por Registered Nurses’ Association of Ontario (RNAO en dos planes de formación que se encontraba desarrollando en el Departamento / Escuela de Enfermería de la Universidad de Chile para los profesionales de enfermería. Metodología: Para la metodología de implementación se consideró como marco de referencia el material elaborado para este fin por parte de la organización RNAO denominado “Recursos para el Docente”, se apoya en modelos de desarrollo y progresión del aprendizaje como el modelo de Patricia Benner para la elaboración de la hipótesis de progresión de los contenidos en el curriculum de Enfermería, como también la pirámide de Miller para la evaluación de las competencias. Conclusiones: se espera que los estudiantes una vez terminada su formación cuenten con las herramientas implementadas bajo esta metodología, las cuales les permitan un desempeño profesional fundamentado en cuidados de enfermería basados en la evidencia científica. [Silva-G A. Implementación de guías de buenas prácticas clínicas elaboradas por Registered Nurses Association of Ontario (RNAO en el curriculum de Enfermería Universidad de Chile

  6. Analgesic drug consumption increases after knee arthroplasty: a pharmacoepidemiological study investigating postoperative pain.

    Science.gov (United States)

    Fuzier, Régis; Serres, Isabelle; Bourrel, Robert; Palmaro, Aurore; Montastruc, Jean-Louis; Lapeyre-Mestre, Maryse

    2014-07-01

    Knee arthroplasty remains the gold standard in the treatment of severe osteoarthritis. Chronic postoperative pain has been reported with a prevalence ranging from 15% to 47%. The aim of this study was to compare analgesic drug consumption before and after surgery as an indicator of pain after knee surgery. A pharmacoepidemiological method comparing analgesics and antineuropathic issues 1 year before and 1 year after surgery was used. All patients who underwent knee arthroplasty in the Midi-Pyrenees region (2.5 million inhabitants) were identified through the Health Insurance System Database. Increase of drug issues (all analgesics, antineuropathic drugs, strong opioids) was calculated and compared between several periods surrounding the surgery (12 months, 2 months, and 10 months before and after the knee arthroplasty). A multivariate logistic regression model was used to identify factors associated with chronic postoperative pain. The study included 1939 patients. An increase in analgesic, antineuropathic, and opioid drug consumption was observed the year after the surgery in 47.3%, 8.6%, and 5.6% of patients, respectively. Multivariate analysis found a significant association between type of surgery (total knee vs unicompartmental arthroplasty) and analgesic consumption 1 year after surgery, and between preoperative pain and psychiatric vulnerability and increase in neuropathic drug dispensing. Conversely, older age was considered as a protective factor. This study revealed that an increase in the issue of different analgesic drugs is present in half of patients 1 year after knee arthroplasty. Several associated factors of drug consumption (preoperative pain, type of surgery, and psychiatric disorder) were identified.

  7. Imaging patellar complications after knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: pmelloni@cspt.es; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2008-03-15

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.

  8. Primary total hip arthroplasty for acetabular fracture

    Institute of Scientific and Technical Information of China (English)

    WANG Zi-ming; SUN Hong-zhen; WANG Ai-min; DU Quan-yin; WU Siyu; ZHAO Yu-feng; TANG Ying

    2006-01-01

    Objective: To explore the operative indications and operative methods of primary total hip arthroplasty for acetabular fracture and to observe the clinical curative effect.Methods: We retrospectively summarized and analyzed the traumatic conditions, fracture types, complications,operative time, operative techniques, and short-term curative effect of 11 patients( 10 males and 1 female, with a mean age of 42. 4 years ) with acetabular fracture who underwent primary total hip arthroplasty.Results: The patients were followed up for 6-45 months ( mean = 28 months). Their average Harris score of postoperative hip joint was 78.Conclusion: Under strict mastery of indications,patients with acetabular fracture may undergo primary total hip arthroplasty, but stable acetabular components should be made.

  9. Total Ankle Arthroplasty: A Brief Review

    Directory of Open Access Journals (Sweden)

    Roger A. Mann

    2012-12-01

    Full Text Available Ankle fusion has long been the standard of treatment for end-stage ankle arthritis, and a successful arthroplasty has been a long sought alternative. It is a motion sparing procedure and may greatly reduce the potential for adjacent level degeneration as seen with arthrodesis. The typical candidate for arthroplasty is a healthy low demand patient, although the indications are widening as the success of the procedure has increased. Nevertheless, it is not fail-safe, technical expertise and experience are necessary to achieve a successful result. We have been treating ankle arthritis with the Scandinavian Total Ankle Replacement (STAR ankle replacement prosthesis for over ten years. We believe that arthroplasty will surpass arthrodesis as the standard of care for severe ankle arthritis.

  10. Registering Researchers in Authority Files

    Science.gov (United States)

    Smith-Yoshimura, Karen; Altman, Micah; Conlon, Michael; Cristán, Ana Lupe; Dawson, Laura; Dunham, Joanne; Hickey, Thom; Hook, Daniel; Horstmann, Wolfram; MacEwan, Andrew; Schreur, Philip; Smart, Laura; Wacker, Melanie; Woutersen, Saskia

    2014-01-01

    Written by OCLC Research Program Officer Karen Smith-Yoshimura and the 13 members of the Registering Researchers in Authority Files Task Group comprised of specialists from the US, UK, and the Netherlands, this report summarizes their research into approaches to providing authoritative researcher identifiers. Registering researchers in some type…

  11. The Danish National Patient Register

    DEFF Research Database (Denmark)

    Lynge, Elsebeth; Sandegaard, Jakob Lynge; Rebolj, Matejka

    2011-01-01

    The Danish National Patient Register (NPR) was established in 1977, and it is considered to be the finest of its kind internationally.......The Danish National Patient Register (NPR) was established in 1977, and it is considered to be the finest of its kind internationally....

  12. Implant survival after total elbow arthroplasty

    DEFF Research Database (Denmark)

    Plaschke, Hans Christian; Thillemann, Theis M; Brorson, Stig

    2014-01-01

    with the linked design. Fracture sequelae was associated with a relative risk of revision of 1.9 (95% CI, 1.05-3.45). CONCLUSIONS: We found acceptable implant survival rates after 5 and 10 years, with a higher revision rate for the unlinked design and primary TEA due to fracture sequelae. Patient-related outcome...... was to evaluate implant survival and risk factors for revision of TEAs inserted in patients in the eastern part of Denmark in the period from 1980 until 2008. MATERIAL AND METHODS: The Danish National Patient Register provided personal identification numbers for patients who underwent TEA procedures from 1980...... until 2008. On the basis of a review of medical reports and linkage to the National Patient Register, we calculated revision rates and evaluated potential risk factors for revision, including, age, sex, period, indication for TEA, and implant design. RESULTS: We evaluated 324 primary TEA procedures...

  13. The effectiveness and safety of tranexamic acid in bilateral total knee arthroplasty

    Science.gov (United States)

    Weng, Kedi; Zhang, Xingen; Bi, Qing; Zhao, Chen

    2016-01-01

    Abstract Objective: A meta-analysis was performed to investigate the effectiveness and safety of tranexamic acid (TXA) for the treatment of blood loss after a bilateral total knee arthroplasty (TKA). Methods: Patients prepared for bilateral TKA and intervention including TXA versus placebo were comprehensively retrieved from MEDLINE (PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from the time of the establishment of these databases to January 2016. The outcomes were all calculated by Stata 12.0 software. The continuous endpoints (total blood loss and blood loss in drainage) were calculated as mean difference (MD) and 95% confidence intervals (CIs). Binary variables (the need for transfusion, and the occurrence of deep venous thrombosis [DVT]) were calculated as relative risk (RR) with 95% CIs. Results: Pooled results revealed that treatment with TXA associated with less need for transfusion (P = 0.000) and the value of Hb drop postoperatively (P = 0.290) after bilateral TKA. The results also indicated that TXA can decrease the total blood loss and blood loss in drainage after bilateral TKA (P < 0.05). Meanwhile, TXA can decrease the blood units transfused per patient by 1.23 U (P = 0.001). There is no statistically significant difference in terms of the occurrence of DVT between the 2 groups (P = 0.461). Conclusion: Based on the current evidence, TXA can decrease the need for transfusion and the total blood loss without increasing the occurrence of DVT, and its administration is recommended routinely in bilateral TKA. PMID:27684841

  14. Proprioception and Knee Arthroplasty: A Literature Review.

    Science.gov (United States)

    Wodowski, Andrew J; Swigler, Colin W; Liu, Hongchao; Nord, Keith M; Toy, Patrick C; Mihalko, William M

    2016-04-01

    Proprioceptive mechanoreceptors provide neural feedback for position in space and are critical for three-dimensional interaction. Proprioception is decreased with osteoarthritis of the knees, which leads to increased risk of falling. As the prevalence of osteoarthritis increases so does the need for total knee arthroplasty (TKA), and knowing the effect of TKA on proprioception is essential. This article reviews the literature regarding proprioception and its relationship to balance, aging, osteoarthritis, and the effect of TKA on proprioception. Knee arthroplasty involving retention of the cruciate ligaments is also reviewed, as well the evidence of proprioception in the posterior cruciate ligament after TKA.

  15. Total hip arthroplasty after previous fracture surgery.

    Science.gov (United States)

    Krause, Peter C; Braud, Jared L; Whatley, John M

    2015-04-01

    Total hip arthroplasty can be a very effective salvage treatment for both failed fracture surgery and hip arthritis that may occur after prior fracture surgery. The rate of complications is significantly increased including especially infection, dislocation, and loosening. Complications are more likely to occur after failed open reduction and internal fixation than after posttraumatic arthritis. Adequately ruling out infection before hip arthroplasty can be difficult. The best predictor of infection is a prior infection. Long-term outcomes can be comparable to outcomes in other conditions if complications are avoided.

  16. Changes of Hemoglobin and Hematocrit in Elderly Patients Receiving Lower Joint Arthroplasty without Allogeneic Blood Transfusion

    Institute of Scientific and Technical Information of China (English)

    Qi Zhou; Yiqin Zhou; Haishan Wu; Yuli Wu; Qirong Qian; Hui Zhao; Yunli Zhu

    2015-01-01

    Background:It has rarely been reported about the changes of hemoglobin (Hb) and hematocrit (Hct) in elderly patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA).This study aimed to evaluate the changes of Hb and Hct after TKA or THA in elderly patients,and analyze its relationship with sex and type of arthroplasty.Methods:This is a prospective cohort study,including 107 patients receiving TKA or THA without allogeneic blood transfusion.There were 54 males and 53 females,with a mean age of 69.42 years.Levels of Hb and Hct were examined preoperatively and during the 6 months follow-up after operation.Results:Levels of Hb and Hct decreased postoperatively and reached their minimum points on postoperative day 4.Thereafter,Hb and Hct recovered to their preoperative levels within 6-12 weeks.No significant differences in the levels of Hb and Hct were noticed between different sexes.THA patients showed significantly greater drop in Hb and Hct than TKA patients in the first 4 days postoperatively (P < 0.05).Conclusions:Levels of Hb and Hct decreased during the first 4 days after arthroplasty and gradually returned to their normal levels within 6-12 weeks postoperatively.THA may be associated with higher postoperative blood loss than TKA.

  17. Which Are the Most Frequently Used Outcome Instruments in Studies on Total Ankle Arthroplasty?

    Science.gov (United States)

    Impellizzeri, Franco M.; Rippstein, Pascal F.

    2009-01-01

    The number of studies reporting on outcomes after total ankle arthroplasty is continuously increasing. As the use of valid outcome measures represents the cornerstone for successful clinical research, we aimed to identify the most frequently used outcome instruments in ankle arthroplasty studies and to analyze the evidence to support their use in terms of different quality criteria. A systematic review of the literature identified 15 outcome instruments reported in 79 original studies. The most commonly used measures were the American Orthopaedic Foot and Ankle Society hindfoot score (n = 41), the Kofoed ankle score (n = 21), a visual analog scale assessing pain (n = 15), and the generic SF-36 (n = 6). Eight additional instruments were used only once or twice. The American Orthopaedic Foot and Ankle Society and Kofoed instruments include a clinical examination and score up to 100 points. Evidence to support their use in terms of validity, reliability, responsiveness, and interpretability is limited, raising the question whether their use is justified. Self-reported questionnaires related to ankle osteoarthritis or arthroplasty are rather disregarded in the current literature, and only the Foot Function Index is associated with evidence in terms of the above-mentioned quality criteria. Future research is warranted to improve the outcome assessment after total ankle arthroplasty. PMID:19672670

  18. Total elbow arthroplasty in the United States: evaluation of cost, patient demographics, and complication rates

    Directory of Open Access Journals (Sweden)

    Hanbing Zhou

    2016-03-01

    Full Text Available Total elbow arthroplasty (TEA is utilized in the treatment of rheumatoid and post-traumatic elbow arthritis. TEA is a relatively low volume surgery in comparison to other types of arthroplasty and therefore little is known about current surgical utilization, patient demographics and complication rates in the United States. The purpose of our study is to evaluate the current practice trends and associated inpatient complications of TEA at academic centers in the United States. We queried the University Health Systems Consortium administrative database from 2007 to 2011 for patients who underwent an elective TEA. A descriptive analysis of demographics was performed which included patient age, sex, race, and insurance status. We also evaluated the following patient clinical benchmarks: hospital length of stay (LOS, hospital direct cost, inhospital mortality, complications, and 30-day readmission rates. Our cohort consisted of 3146 adult patients (36.5% male and 63.5% female with an average age of 58 years who underwent a total elbow arthroplasty (159 academic medical centers in the United States. The racial demographics included 2334 (74% Caucasian, 285 (9% black, 236 (7.5% Hispanic, 16 (0.5% Asian, and 283 (9% other patients. The mean LOS was 4.2±5 days and the mean total direct cost for the hospital was 16,300±4000 US Dollars per case. The overall inpatient complication rate was 3.1% and included mortality <1%, DVT (0.8%, re-operation (0.5%, and infection (0.4%. The 30-day readmission rate was 4.4%. TEA is a relatively uncommon surgery in comparison to other forms of arthroplasty but is associated with low in-patient and 30-day perioperative complication rate. Additionally, the 30-day readmission rate and overall hospital costs are comparable to the traditional total hip and knee arthroplasty surgeries.

  19. Short term outcomes of revision total knee arthroplasty.

    Science.gov (United States)

    Dieterich, James D; Fields, Adam C; Moucha, Calin S

    2014-11-01

    Few studies have assessed postoperative complications in revision total knee arthroplasty (rTKA). The aim of this study was to assess which preoperative factors are associated with postoperative complications in rTKA. Using the National Surgical Quality Improvement (NSQIP) database, we identified patients undergoing rTKA from 2010 to 2012. Patient demographics, comorbidities, and complications within thirty days of surgery were analyzed. A total of 3421 patients underwent rTKA. After adjusted analysis, dialysis (P = 0.016) was associated with minor complications. Male gender (P = 0.03), older age (P = 0.029), ASA class >2 (P = 0.017), wound class >2 (P < 0.0001), emergency operation (P = 0.038), and pulmonary comorbidity (P = 0.047) were associated with major complications.

  20. Inflammatory pseudotumor causing deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty.

    LENUS (Irish Health Repository)

    Memon, Adeel Rasool

    2013-01-01

    Metal-on-metal hip resurfacings have recently been associated with a variety of complications resulting from adverse reaction to metal debris. We report a case of extensive soft tissue necrosis associated with a huge pelvic mass causing extensive deep vein thrombosis of the lower limb secondary to mechanical compression of the iliac vein. This is a rare and unusual cause of deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty.

  1. Door Opening Affects Operating Room Pressure During Joint Arthroplasty.

    Science.gov (United States)

    Mears, Simon C; Blanding, Renee; Belkoff, Stephen M

    2015-11-01

    Many resources are expended to ensure a sterile operating room environment. Efforts are made to prevent exposure of patients to personnel and to achieve positive room pressure to keep out airborne contaminants. Foot traffic into and out of the operating room during surgery can undermine these efforts. The authors investigated the number and duration of operating room door openings during hip and knee arthroplasty procedures and the effect of the door openings on room pressure. They tested the hypothesis that door openings defeat positive pressure, permitting air flow into the room. Room pressure and door status were monitored electronically during 191 hip and knee arthroplasty procedures. Operating room staff were unaware that data were being collected. The authors evaluated the data with regression analysis to determine whether the number and duration of door openings had an effect on room pressure. Significance was set at Poperating room. Total time with the door open significantly affected the minimum pressure recorded in the room (Poperating room sterility. The causes of excessive operating room traffic must be evaluated to identify ways to reduce this traffic and the associated risks.

  2. Total Hip Arthroplasty in Systemic Lupus Erythematosus: A Systematic Review

    Directory of Open Access Journals (Sweden)

    John W. Kennedy

    2015-01-01

    Full Text Available The prognosis of systemic lupus erythematosus (SLE has greatly improved in recent years, resulting in an increased number of patients reporting musculoskeletal complications such as osteonecrosis of the femoral head. Total hip arthroplasty (THA can be utilised to alleviate the pain associated with this; however postoperative outcomes in patients with SLE are uncertain. A systematic review of the literature was conducted to identify articles presenting results of THA in SLE, and nine suitable papers were found. All papers were level IV evidence. Pooling the results, a total of 162 patients underwent 214 total hip arthroplasties. Mean follow-up was 72.5 months. The mean Harris Hip Score improved from 45.5 preoperatively to 88.6 and last follow-up. Seventeen percent of patients experienced at least one complication. Superficial wound infection occurred in 3.3%. Revision was required in 2.8% of cases. The mortality rate was 18.5% however no deaths were attributable to undergoing THA. Given the paucity of data present in the literature, more studies are required to adequately assess the postoperative outcomes of THA in patients with SLE, particularly complication rates.

  3. Ninety day mortality and its predictors after primary shoulder arthroplasty: an analysis of 4,019 patients from 1976-2008

    Directory of Open Access Journals (Sweden)

    Singh Jasvinder A

    2011-10-01

    Full Text Available Abstract Background Examine 90-day postoperative mortality and its predictors following shoulder arthroplasty Methods We identified vital status of all adults who underwent primary shoulder arthroplasty (Total shoulder arthroplasty (TSA or humeral head replacement (HHR at the Mayo Clinic from 1976-2008, using the prospectively collected information from Total Joint Registry. We used univariate logistic regression models to assess the association of gender, age, body mass index, American Society of Anesthesiologist (ASA class, Deyo-Charlson comorbidity index, an underlying diagnosis and implant fixation with odds of 90-day mortality after TSA or HHR. Multivariable models additionally adjusted for the type of surgery (TSA versus HHR. Adjusted Odds ratio (OR with 95% confidence interval (CI were calculated. Results Twenty-eight of the 3, 480 patient operated died within 90-days of shoulder arthroplasty (0.8%. In multivariable-adjusted analyses, the following factors were associated with significantly higher odds of 90-day mortality: higher Deyo-Charlson index (OR, 1.54; 95% CI:1.39, 1.70; p Conclusions 90-day mortality following shoulder arthroplasty was low. An underlying diagnosis of tumor, higher comorbidity and higher ASA class were risk factors for higher 90-day mortality, while higher BMI was protective. Pre-operative comorbidity management may impact 90-day mortality following shoulder arthroplasty. A higher unadjusted mortality in patients undergoing TSA versus HHR may indicate the underlying differences in patients undergoing these procedures.

  4. Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer

    Science.gov (United States)

    Saito, Hidetomo; Aizawa, Toshiaki; Miyakoshi, Naohisa; Shimada, Yoichi

    2016-01-01

    One component of conventional total knee arthroplasty is removal of the anterior cruciate ligament, and the knee after total knee arthroplasty has been said to be a knee with anterior cruciate ligament dysfunction. Bicruciate stabilized total knee arthroplasty is believed to reproduce anterior cruciate ligament function in the implant and provide anterior stability. Conventional total knee arthroplasty was performed on the right knee and bicruciate stabilized total knee arthroplasty was performed on the left knee in the same patient, and a triaxial accelerometer was fitted to both knees after surgery. Gait analysis was then performed and is reported here. The subject was a 78-year-old woman who underwent conventional total knee arthroplasty on her right knee and bicruciate stabilized total knee arthroplasty on her left knee. On the femoral side with bicruciate stabilized total knee arthroplasty, compared to conventional total knee arthroplasty, there was little acceleration in the x-axis direction (anteroposterior direction) in the early swing phase. Bicruciate stabilized total knee arthroplasty may be able to replace anterior cruciate ligament function due to the structure of the implant and proper anteroposterior positioning. PMID:27648328

  5. Registering Researchers in Authority Files

    NARCIS (Netherlands)

    Altman, M.; Conlon, M.; Cristan, A.L.; Dawson, L.; Dunham, J.; Hickey, T.; Hook, D.; Horstmann, W.; MacEwan, A.; Schreur, P.; Smart, L.; Smith-Yoshimura, K.; Wacker, M.; Woutersen, S.

    2014-01-01

    Registering researchers in some type of authority file or identifier system has become more compelling as both institutions and researchers recognize the need to compile their scholarly output. The report presents functional requirements and recommendations for six stakeholders: researchers, funders

  6. Recurrent hemarthrosis after total knee arthroplasty.

    Science.gov (United States)

    Rukavina, Alexander; Kerkhoffs, Gino M M J; Schneider, Philipp; Kuster, Markus S

    2010-07-01

    This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result and good knee joint function. Hemarthrosis has not recurred since embolization.

  7. Recurrent hemarthrosis after total knee arthroplasty

    OpenAIRE

    Rukavina, A.; Kerkhoffs, G. M. M. J.; Schneider, P.; Kuster, M S

    2010-01-01

    This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result and good knee joint function. Hemarthrosis has not recurred since embolization.

  8. Recurrent hemarthrosis after total knee arthroplasty

    NARCIS (Netherlands)

    Rukavina, A.; Kerkhoffs, G.M.M.J.; Schneider, P.; Kuster, M.S.

    2010-01-01

    This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed usin

  9. SOFT TISSUE BALANCING IN TOTAL HIP ARTHROPLASTY.

    Directory of Open Access Journals (Sweden)

    Pencho Kosev

    2015-03-01

    Full Text Available We present our experience with the soft tissue balancing in total hip arthroplasty. Detailed indications, planning and surgical technique are presented. The described procedures are performed on 278 hips for a period of 6 years (2008-2014. We conclude that the outcome of a THA can be improved by balancing the stability, ROM, muscle strength and limb length equality.

  10. Dilemmas in Uncemented Total Hip Arthroplasty

    NARCIS (Netherlands)

    Goosen, J.H.M.

    2009-01-01

    In this thesis, different aspects that are related to the survivorship and clinical outcome in uncemented total hip arthroplasty are analysed. In Chapter 2, the survival rate, Harris Hip score and radiographic features of a proximally hydroxyapatite coated titanium alloy femoral stem (Bi-Metric, Bio

  11. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B;

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...

  12. Comparison of Acetabular Bone Resection, Offset, Leg Length and Post Operative Function Between Hip Resurfacing Arthroplasty and Total Hip Arthroplasty.

    Science.gov (United States)

    Parry, Michael C; Povey, James; Blom, Ashley W; Whitehouse, Michael R

    2015-10-01

    Controversy exists regarding the amount of acetabular bone resection, biomechanics and function of patients receiving either total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA). A cohort of patients undergoing 36 mm ceramic-on-ceramic THA (89) or metal-on-metal HRA (86) were compared. No difference was observed when the ratio of native femoral head size was compared to the implanted acetabular component size (1.15 ± 0.1 HRA c.f. 1.13 ± 0.1 THA). No difference was observed in acetabular offset, vertical centre of rotation or function (OHS mean 47 in both groups) but leg length discrepancy (1.8 mm c.f. 5.5 mm) and femoral offset did differ (0.6 mm c.f. 4.1 mm). This demonstrates that 36 mm ceramic-on-ceramic THA is not associated with more bone resection than HRA and achieves equivalent function whilst avoiding the problems of metal-on-metal bearings.

  13. Hip arthroplasty in patients with complex femoral deformity after surgical treatment of dysplasia

    Directory of Open Access Journals (Sweden)

    V. V. Bliznyukov

    2014-01-01

    Full Text Available Objective - based on the analysis of remote results of total hip arthroplasty in patients with complex deformities of the femur to compare the effectiveness of operations with standard cases and identify the factors that determine the surgery effectiveness. Material and methods. in Vreden clinic 73 patients with complex deformities of the femur underwent surgical treatment between 2001 and 2013 by various surgical interventions: arthroplasty without femoral osteotomy (23; arthroplasty accompanied by great trochanteric slide osteotomy or Paavilainen technigue (37, arthroplasty with femoral osteotomy below the lesser trochanter (13, including 4 - at the level of deformation, 4 - with double two-stage osteotomy and 5 - with one-stage double osteotomy. all patients were assessed with Harris scale before and after surgery. the results obtained in the course of the study data were processed using statistical methods, including correlation analysis using Pearson's coefficients and Gamma. Results. in assessing the long-term results the Harris hip score improved from a preoperative average of 40.2 (95% Ci 38.2 to 45.6 to 78.4 (95% Ci 76.7 to 83.5. the analysis of various factors influencing on operation efficiency showed that maximum results are achieved with good initial function and a small level of pain (Harris score of 40-45 points, residual femoral deformation should not exceed 5 degrees, the rotation center displacement - no more than 30 mm, the offset increasing - no more than 20 mm and of limb length increasing - no more than 25-30 mm. Conclusion. Hip arthroplasty in patients with coxarthrosis associated with complex femoral deformities is technically challenging, but the using the algorithm presented by authors allows achieve the best possible results.

  14. Computer-assisted navigation in knee arthroplasty: a critical appraisal.

    Science.gov (United States)

    Venkatesan, Muralidharan; Mahadevan, Devendra; Ashford, Robert U

    2013-10-01

    The purpose of this review was to appraise the use of computer-assisted navigation in total knee arthroplasty and to assess whether this technology has improved clinical outcomes. Studies were identified through searches in MEDLINE, Embase, and PubMed. Numerous studies have shown improved leg and component alignment using navigation systems. However, the better alignment achieved in navigated knee arthroplasty has not been shown to lead to better clinical outcomes. Navigated knee arthroplasty had lower calculated blood loss and lower incidence of fat embolism compared with conventional knee arthroplasty using intramedullary jigs. It may be most valued when dealing with complex knee deformities, revision surgery, or minimally invasive surgery. Navigated knee arthroplasty, however, is only cost-effective in centers with a high volume of joint replacements. Overall, computer-assisted navigated knee arthroplasty provides some advantages over conventional surgery, but its clinical benefits to date are unclear and remain to be defined on a larger scale.

  15. Postoperative morbidity and mortality in type-2 diabetics after fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Madsbad, Sten; Kehlet, Henrik

    2015-01-01

    BACKGROUND: Diabetes is a risk factor for postoperative morbidity, which includes total hip and knee arthroplasty. However, no previous studies have been done in a fast-track setting with optimized perioperative care, including spinal anesthesia, multimodal opioid-sparing analgesia, early...... mobilization, and discharge to home, which improved postoperative outcome. METHODS: We performed an observational cohort study using prospective data in primary total hip and total knee arthroplasty with a standardized fast-track approach. Eight hundred ninety type 2 diabetics were successfully propensity......-∞) and 115 (35-∞), respectively. Insulin-treated type 2 diabetes was associated with increased risk of specific "diabetes-related" morbidity (1.95 [1.13-3.35]; P = 0.016). CONCLUSIONS: Type 2 diabetes per se has limited influence on postoperative morbidity in fast-track total hip and knee arthroplasty....

  16. Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty.

    Science.gov (United States)

    Moucha, Calin Stefan; Weiser, Mitchell C; Levin, Emily J

    2016-02-01

    Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia--incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods--can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.

  17. Total joint arthroplasties: current concepts of patient outcomes after surgery.

    Science.gov (United States)

    Jones, C Allyson; Beaupre, Lauren A; Johnston, D W C; Suarez-Almazor, Maria E

    2007-02-01

    Total hip and knee arthroplasties are effective surgical interventions for relieving hip pain and improving physical function caused by arthritis. Although the majority of patients substantially improve, not all report gains or are satisfied after receiving total joint arthroplasty. This article reviews the literature on patient outcomes after total hip and knee arthroplasties for osteoarthritis, and the evidence pertaining to factors that affect these patient-centered outcomes. Mounting evidence suggests that no single patient-related or perioperative factor clearly predicts the amount of pain relief or functional improvement that will occur following total hip or knee arthroplasty.

  18. Femoral component loosening after hip resurfacing arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Zustin, Jozef; Sauter, Guido [University Medical Centre Hamburg-Eppendorf, Institute of Pathology, Hamburg (Germany); Hahn, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); Morlock, Michael M. [TUHH Hamburg University of Technology, Biomechanics Section, Hamburg (Germany); Ruether, Wolfgang [University Medical Centre Hamburg-Eppendorf, Department of Orthopaedics, Hamburg (Germany); Amling, Michael [University Medical Centre Hamburg-Eppendorf, Center for Biomechanics and Skeletal Biology, Hamburg (Germany); University Medical Centre Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany)

    2010-08-15

    Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral

  19. Management of Medial Collateral Ligament Injury During Primary Total Knee Arthroplasty: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Paul Della Torre, MD

    2014-07-01

    Full Text Available Medial collateral ligament injury during primary total knee arthroplasty is a recognised complication potentially resulting in valgus instability, suboptimal patient outcomes and a higher rate of revision or reoperation. Options for management include primary repair with or without augmentation, reconstruction or immediate conversion to prosthesis with greater constraint, in conjunction with various postoperative rehabilitation protocols. Inconsistent recommendations throughout the orthopaedic literature have made the approach to managing this complication problematic. The objective of this study was to review the available literature to date comparing intraoperative and postoperative management options for primary total knee arthroplasty complicated by recognised injury to the medial collateral ligament. This systematic literature review was prospectively registered with PROSPERO (#CRD42014008866 and performed in accordance with PRISMA guidelines including a PRISMA flow diagram. Five articles satisfied the inclusion criteria. Each was a retrospective, observational cohort or case series with small numbers reported, inconsistent methodology and incompletely reported outcomes. Four of the five studies managing medial collateral ligament injury during total knee arthroplasty (47/84 patients with direct repair with or without autograft augmentation reported good outcomes with no revision or reoperation required for symptomatic instability over a follow-up period of 16 months to almost 8 years. The fifth study with a follow-up to 10 years and a high rate of conversion to unlinked semi constrained total knee arthroplasty implant (30/37 patients reported a greater incidence of revision due to instability, in patients in whom the medial collateral ligament injury was directly repaired without added constraint. Overall balance of evidence is in favour of satisfactory outcomes without symptomatic instability following direct repair with or without

  20. Knee Muscles Power Evolution in Patients with Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Ileana Monica BORDA

    2012-09-01

    Full Text Available Purpose: To measure changes in muscle power from before to 6 months after total knee arthroplasty and to compare outcomes with those from a control group of healthy adults. Material and Methods: 26 patients who underwent a total knee replacement were compared with 12 healthy age-matched adults in a prospective cohort study. Patients’ assessment was performed preoperatively, as well as at 1, 2 and 6 months postoperatively, by the isokinetic method. Healthy adults were assessed once by the same method. Isokinetic evaluation of knee extensor and flexor muscles was performed using a Gimnex Iso 2 dynamometer. After a warm-up protocol, measurements were done at angular velocities of 90 and 180°/sec. Results: Compared to healthy adults, patients performed significantly worse at all evaluation times, for both extensors and flexors of the knee, except for the 6-month evaluation at 180°/sec. One month postoperatively losses from preoperative levels were registered in patients, but without statistically significance, except for extension at 180°/sec. At 6 months postoperatively patients surpassed the preoperative levels, with statistical significance at 180°/sec. Conclusions: Power is an important parameter to follow after TKA, in parallel with peak torque. Increasing muscle power should be one of the central issues to address during postoperative rehabilitation.

  1. Prescription trajectories and effect of total hip arthroplasty on the use of analgesics, hypnotics, antidepressants, and anxiolytics: results from a population of total hip arthroplasty patients.

    Science.gov (United States)

    Blågestad, Tone; Nordhus, Inger H; Grønli, Janne; Engesæter, Lars B; Ruths, Sabine; Ranhoff, Anette H; Bjorvatn, Bjørn; Pallesen, Ståle

    2016-03-01

    Total hip arthroplasty (THA) has been shown to reduce pain and improve function. In addition, it is suggested that THA improves sleep and alleviates symptoms of anxiety and depression. Patients with chronic pain are frequent users of analgesic and psychotropic drugs and thereby risk adverse drug events. The impact of THA on such drug use has not been thoroughly investigated. Based on merged data from the Norwegian Prescription Database and the Norwegian Arthroplasty Register, this study sought to investigate redeemed medications in a complete population (N = 39,688) undergoing THA in 2005 to 2011. User rates and redeemed drug volume of analgesics (nonsteroid anti-inflammatory drugs (NSAIDs), opioids, and nonopioids) and psychotropics (hypnotics, anxiolytics, and antidepressants) were calculated for 4 quarters before and 4 quarters after surgery. We analysed preoperative prescription trends (Q1 vs Q4), postoperative prescription (Q4 vs Q5), and long-term effect of surgery (Q4 vs Q8). Before surgery, use of all drug groups increased from Q1 to Q4. Use of opioids, nonopioids, and hypnotics dramatically increased from Q4 to Q5. Long-term (Q4 vs Q8) surgery reduced prescriptions of analgesics, hypnotics, and anxiolytics, but not antidepressants. Overall, the present results extend the positive effects of THA to include reduced reliance on medication to alleviate symptoms.

  2. Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Mobilization, and Pain After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Grevstad, Jens Ulrik; Mathiesen, Ole; Valentiner, Laura Risted Staun;

    2015-01-01

    BACKGROUND AND OBJECTIVES: Total knee arthroplasty (TKA) is often associated with severe pain. Different regional anesthetic techniques exist, all with varying degrees of motor blockade. We hypothesized that pain relief provided by the adductor canal block (ACB) could increase functional muscle....... CONCLUSION: Adductor canal block provides a clinically relevant and statistically significant increase in quadriceps muscle strength for patients in severe pain after TKA....

  3. Effects of adductor-canal-blockade on pain and ambulation after total knee arthroplasty

    DEFF Research Database (Denmark)

    Jenstrup, M T; Jæger, P; Lund, J;

    2012-01-01

    Total knee arthroplasty (TKA) is associated with intense post-operative pain. Besides providing optimal analgesia, reduction in side effects and enhanced mobilization are important in this elderly population. The adductor-canal-blockade is theoretically an almost pure sensory blockade. We...... hypothesized that the adductor-canal-blockade may reduce morphine consumption (primary endpoint), improve pain relief, enhance early ambulation ability, and reduce side effects (secondary endpoints) after TKA compared with placebo....

  4. Abductor weakness and stresses around acetabular components of total hip arthroplasty: a finite element analysis

    OpenAIRE

    Sutherland, A. G.; D’Arcy, S.; Smart, D; Ashcroft, G. P.

    1999-01-01

    Abductor weakness, and the resulting Trendelenburg gait, after total hip arthroplasty is believed to be associated with a poor long-term outcome. We have constructed a two-dimensional finite element analysis using load cases to mimic this abductor weakness. The finite element analysis demonstrates slightly increased stresses, particularly at the bone-cement interface in the DeLee-Charnley zone I, which does not seem sufficient to explain the adverse effect of abductor weakness.

  5. Stop of loss of cognitive performance during rehabilitation after total hip arthroplasty-Prospective controlled study

    OpenAIRE

    Matthias H. Brem, MD, MHBA; Siegfried Lehrl, PhD; Anna K. Rein, MD; Sylvia Massute, BS; Stefan Schulz-Drost, MD; Kolja Gelse, MD; Phillip M. Schlechtweg, MD, MHBA; Friedrich F. Hennig, MD, PhD; Alexander Olk, MD; Harald J. Jacob, MD; Johannes Gusinde, MD

    2010-01-01

    Prolonged hospitalization is known to be associated with a loss of cognitive performance. Does playing video games (VGs) developed to improve cognitive properties delay this loss or even lead to an increase in cognitive performance? We performed a 10-day longitudinal study of patients who received total hip arthroplasty. We compared 16 patients (6 male) aged 66 ± 9 years (mean ± standard deviation) who played Dr. Kawashima's Brain Training: How Old Is Your Brain? (Nintendo; Redmond, Washingto...

  6. The effect of malnutrition on patients undergoing elective joint arthroplasty.

    Science.gov (United States)

    Huang, Ronald; Greenky, Max; Kerr, Glenn J; Austin, Matthew S; Parvizi, Javad

    2013-09-01

    Malnutrition has been linked to serious complications in patients undergoing elective total joint arthroplasty (TJA). This study prospectively evaluated 2,161 patients undergoing elective TJA for malnutrition as defined by either an abnormal serum albumin or transferrin. The overall incidence of malnutrition was 8.5% (184 of 2,161) and the rate of overall complications in the malnourished group was 12% as compared to 2.9% in patients with normal parameters (PMalnutrition predicted serious complications involving hematoma formation, infection, renal and cardiac complications. Obesity, defined by a body mass index (BMI) of 30kg/m(2) was present in 42.9% of malnourished patients with a significantly higher complication rate in this cohort. Malnutrition remains prevalent in patients >55years-old undergoing TJA and is associated with a significant increase in post-operative complications.

  7. Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nevzat Dabak

    2014-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

  8. Heterotopic bone formation following total shoulder arthroplasty

    DEFF Research Database (Denmark)

    Kjaersgaard-Andersen, P.; Frich, Lars Henrik; Sjøbjerg, J.O.

    1989-01-01

    The incidence and location of heterotopic bone formation following total shoulder arthroplasty were evaluated in 58 Neer Mark-II total shoulder replacements. One year after surgery, 45% had developed some ectopic ossification. In six shoulders (10%) the ossifications roentgenographically bridged...... the glenohumeral and/or the glenoacromial space. There was no correlation between shoulder pain and the development of ossification. Shoulders with grade III heterotopic bone formation had a limited range of active elevation compared with shoulders without or with only a milder lesion. Men and patients...... with osteoarthritis of the shoulder joint were significantly disposed to the development of heterotopic bone. Heterotopic bone formation following total shoulder arthroplasty is frequent, but disabling heterotopic ossifications seem to be rare....

  9. Cost Analysis in Shoulder Arthroplasty Surgery

    Directory of Open Access Journals (Sweden)

    Matthew J. Teusink

    2012-01-01

    Full Text Available Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved. Given its reproducible nature, shoulder arthroplasty is ideally situated to become a model for an episode of care. Currently, there is little research into cost in shoulder arthroplasty surgery. The current analyses do not provide surgeons with a method for determining the cost and outcomes of their interventions, which is necessary to the success of bundled payment. Surgeons are ideally positioned to become leaders in ACOs, but in order for them to do so a methodology must be developed where accurate costs and outcomes can be determined for the episode of care.

  10. Sleep Apnea and Total Joint Arthroplasty under Various Types of Anesthesia

    Science.gov (United States)

    Memtsoudis, Stavros G.; Stundner, Ottokar; Rasul, Rehana; Sun, Xuming; Chiu, Ya-Lin; Fleischut, Peter; Danninger, Thomas; Mazumdar, Madhu

    2014-01-01

    Background and Objectives The presence of sleep apnea (SA) among surgical patients has been associated with significantly increased risk of perioperative complications. Although regional anesthesia has been suggested as a means to reduce complication rates among SA patients undergoing surgery, no data are available to support this association. We studied the association of the type of anesthesia and perioperative outcomes in patients with SA undergoing joint arthroplasty. Methods Drawing on a large administrative database (Premier Inc), we analyzed data from approximately 400 hospitals in the United States. Patients with a diagnosis of SA who underwent primary hip or knee arthroplasty between 2006 and 2010 were identified. Perioperative outcomes were compared between patients receiving general, neuraxial, or combined neuraxial-general anesthesia. Results We identified 40,316 entries for unique patients with a diagnosis for SA undergoing primary hip or knee arthroplasty. Of those, 30,024 (74%) had anesthesia-type information available. Approximately 11% of cases were performed under neuraxial, 15% under combined neuraxial and general, and 74% under general anesthesia. Patients undergoing their procedure under neuraxial anesthesia had significantly lower rates of major complications than did patients who received combined neuraxial and general or general anesthesia (16.0%, 17.2%, and 18.1%, respectively; P = 0.0177). Adjusted risk of major complications for those undergoing surgery under neuraxial or combined neuraxial-general anesthesia compared with general anesthesia was also lower (odds ratio, 0.83 [95% confidence interval, 0.74–0.93; P = 0.001] vs odds ratio, 0.90 [95% confidence interval, 0.82–0.99; P = 0.03]). Conclusions Barring contraindications, neuraxial anesthesia may convey benefits in the perioperative outcome of SA patients undergoing joint arthroplasty. Further research is needed to enhance an understanding of the mechanisms by which neuraxial

  11. The Pediatric Cataract Register (PECARE)

    DEFF Research Database (Denmark)

    Haargaard, Birgitte; Nyström, Alf; Rosensvärd, Annika;

    2015-01-01

    examination with a pencil light at age 5 weeks, whereas newborn red reflex examination using a handheld ophthalmoscope is routine protocol in Swedish maternity wards. Data regarding age of referral were derived from the Pediatric Cataract Register (PECARE). All children operated on before 1 year of age...

  12. Proximal humeral fractures treated with arthroplasty

    Institute of Scientific and Technical Information of China (English)

    QIAN Qi-rong; WU Hai-shan; ZHOU Wei-jiang; LI Xiao-hua; WU Yu-li

    2005-01-01

    Objective: To explore arthroplasty in treating 3- and 4-part fractures of the proximal humerus.Methods: A total of 132 patients with proximal humeral fractures were treated in our hospital from July 1997 to February 2003. According to Neer's classification, the fractures of 45 patients (14 males and 31 females, aged 31-78 years, 56.1 years±7.8 years on an average) belonged to 3- or 4-part fractures (10 patients with 4-part fracture and 35 with 3-part comminuted fracture) and they were treated with shoulder joint arthroplasty. Unipolar prosthesis replacement of the head of humerus was made in 28 cases, while bipolar prosthesis replacement in 2 cases and total shoulder joint replacement in 15 cases. Results: During the follow-up period (range: 12-72 months, mean: 37.3 months±4.1 months), among the 45 patients who suffered from fractures of the proximal humerus and underwent arthroplasty surgery, 44 patients (97.8%) had no postoperative pain and were satisfied with the active range of motion and with the whole treatment results. And radiography showed that the prostheses were at their good position. One patient had postoperative pain because he had so narrow medullary cavity that the humeral prosthesis could not be put deeply enough and the prosthesis head was a little higher over the anatomic level. He did not have good postoperative active range of motion, either. Then he received a review surgery and got satisfied results. Temporary shoulder stiffness was observed in one patient. Manual release of these adhesions improved the shoulder function. No evidence of nonunion of the fracture segments around the humeral prosthesis stem was found. Conclusions: Shoulder arthroplasty is a dependable method to restore the comfort and function of the should joints of the patients with 3- or 4-part fractures of the proximal humerus.

  13. Imaging of hip arthroplasty; Bildgebung bei Hueftprothesen

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, M.J. [Abteilung fuer Osteologie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Klinische Abteilung fuer Radiodiagnostik chirurgischer Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Ludwig-Boltzmann-Institut fuer Radiologische Tumordiagnostik, Wien (Austria); Mayerhoefer, M. [Klinische Abteilung fuer Radiodiagnostik chirurgischer Faecher, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Gottsauner-Wolf, F. [Universitaetsklinik fuer Orthopaedie, Wien (Austria); Abteilung fuer Orthopaedie, Allgemeines oeffentliches KH, Krems (Austria); Krestan, C.; Imhof, H. [Abteilung fuer Osteologie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Toma, C.D. [Universitaetsklinik fuer Orthopaedie, Wien (Austria)

    2002-06-01

    Hip arthroplasty has become a common and still increasing procedure for the treatment of osteoarthritis, advanced head necrosis, post-inflammatory arthritis or rheumatoid arthritis.Radiography is the most important imaging modality for monitoring the normal, asymptomatic hip arthroplasty. Radiographs are obtained at the end of a surgical treatment, to exclude complications like fracture or component misplacement. In the follow-up radiographs are used for the diagnosis of loosening and infection of the hip arthroplasty as well as soft tissue ossification. Together with the history and clinical information, the analysis of morphological findings allows to find the grade of loosening. MRI has been advocated in the diagnosis of infection, in particular in the localisation of soft tissue involvement.Imaging, especially by radiographs, is used for the evaluation of the normal and complicated follow-up of hip arthroplasty. (orig.) [German] Die Implantation einer Hueftgelenkprothese ist eine immer haeufiger verwendete medizinische Massnahme bei Erkrankungen des Hueftgelenks wie Koxarthrose, Hueftkopfnekrose, postentzuendliche Arthrose oder rheumatoide Arthritis.Von den bildgebenden Methoden ist das konventionelle Roentgen die wichtigste Untersuchung, um den normalen Behandlungsverlauf einer Hueftprothese zu monitieren. Das Roentgen kann fruehzeitige Komplikationen wie Fraktur oder Fehlposition intraoperativ oder eine Luxation postoperativ erfassen. Im laengerfristigen Verlauf ist das Roentgen zur Diagnose von Infektion, Prothesenlockerung und Weichteilverknoecherung geeignet. In Zusammenschau mit der Klinik ermoeglicht die Analyse morphologisch-radiologischer Details, die Wahrscheinlichkeit einer Lockerung abzuschaetzen. Bei Protheseninfektionen ermoeglicht die MRT die Lokalisation von Weichteilentzuendungen.Die Methoden der Bildgebung, besonders das Roentgen, haben in der Beurteilung des normalen und in der Diagnose des komplizierten Verlaufes einen hohen Stellenwert

  14. Stemless shoulder arthroplasty: a literature review

    OpenAIRE

    PETRICCIOLI, DARIO; BERTONE, CELESTE; MARCHI, GIACOMO

    2015-01-01

    The design of humeral implants for shoulder arthroplasty has evolved over the years. The new-generation modular shoulder prostheses have an anatomical humeral stem that replicates the three-dimensional parameters of the proximal humerus. An anatomical reconstruction is the best way to restore stability and mobility of the prosthetic shoulder and improve implant durability. However, a perfect anatomical match is not always possible in, for example, patients with post-traumatic osteoarthritis o...

  15. Dilemmas in Uncemented Total Hip Arthroplasty

    OpenAIRE

    Goosen, J. H. M.

    2009-01-01

    In this thesis, different aspects that are related to the survivorship and clinical outcome in uncemented total hip arthroplasty are analysed. In Chapter 2, the survival rate, Harris Hip score and radiographic features of a proximally hydroxyapatite coated titanium alloy femoral stem (Bi-Metric, Biomet) was evaluated. In conclusion, at an average follow-up of 8 years, this proximally HA-coated femoral component showed favorable clinical and radiological outcome and excellent survivorship. In ...

  16. New concepts in revision total knee arthroplasty.

    Science.gov (United States)

    Vince, Kelly G; Droll, Kurt; Chivas, Dan

    2008-01-01

    Revision knee arthroplasty should be regarded as a discipline separate from primary surgery. A disciplined approach to diagnosis is mandatory in which the following categories for failure are useful: (a) sepsis, (b) extensor mechanism rupture, (c) stiffness, (d) instability, (e) periprosthetic fracture, (f) aseptic loosening and osteolysis, (g) patellar complications and malrotation, (h) component breakage, and (i) no diagnosis. In the event of no coherent explanation for pain and disability, the possibilities of chronic regional pain syndrome, hip or spine pathology, and inability of current technology to meet patient expectations should be considered and revision surgery should be avoided. Revision arthroplasty cannot be performed as if it were a primary procedure and indeed will be eight (or more) different surgeries depending on the cause of failure. Though perhaps counterintuitive, there is a logical rationale and empirical evidence to support complete revision in virtually every case. In general, revision implant systems are required. The early dependence on the "joint line" is inadequate, failing as it does to recognize that the level of the articulation is a three-dimensional concept and not simply a "line." The key to revision surgery technique is that the flexion gap is determined by femoral component size and the extension gap by proximal distal component position. Accordingly, a general technical pathway of three steps can be recommended: 1) tibial platform; 2) stabilization of the knee in flexion with (a) femoral component rotation and (b) size selected with evaluation of (c) patellar height as an indication of "joint line" in flexion only; and 3) stabilization of the knee in extension, an automatic step. Stem extensions improve fixation and, if they engage the diaphysis, may be used as a guide for positioning. Porous metals designed as augments for bone defects may prove more important as "modular fixation interfaces." It is postulated that with the

  17. Recurrent hemarthrosis after unicompartmental knee arthroplasty.

    Science.gov (United States)

    Asanuma, Kunihiro; Ito, Haruo; Ogawa, Akito; Asanuma, Yumiko; Yoshikawa, Tomoaki; Hasegawa, Masahiro; Sudo, Akihiro

    2011-09-09

    Recurrent hemarthrosis after knee arthroplasty can be disabling, requiring adequate and immediate diagnosis and treatment for recovery of symptoms and joint function. The most commonly reported cause is impingement of proliferative synovium between prosthetic components. Although various procedures for hemarthrosis have been reported after knee arthroplasty for patients who do not respond to conservative treatment, the recommended first-line therapy is open surgery or embolization. Although hyperplastic synovium was observed during the first and second arthrotomy, in our case, tissue impingement was not detected. We describe a rare case of recurrent hemarthrosis after unicompartmental knee arthroplasty (UKA) and successful treatment by open synovectomy. A 66-year-old woman presented with spontaneous osteonecrosis of the medial femoral condyle in the right leg. She underwent UKA of the right knee of the medial condyle. Eighteen months after UKA, the patient developed recurrent hemarthrosis. Open arthrotomy was performed 22 months after UKA, revealing only hematoma with no obvious hemorrhage or loosening of the prosthesis. No history of trauma or use of anticoagulant medications was present. After a symptom-free period of 8 months, another 2 episodes of hemarthrosis occurred over the course of 8 months. A second open arthrotomy was performed. Hyperplastic synovium with fibrin and hemosiderin pigmentation was observed, again without hemorrhage or loosening. There were no pathological features of pigmented villonodular synovitis. Synovectomy was performed, and no hemarthrosis has recurred for 2 years.

  18. Analysis of the unicompartmental knee arthroplasty results

    Directory of Open Access Journals (Sweden)

    S. A. Firsov

    2015-01-01

    Full Text Available In 2012-2014 total 67 unicompartmental arthroplasty surgeries with use of Oxford knee meniscal bearing were performed. The surgeries were performed by a single surgeon. Minimally invasive approach was used. All patients were evaluated clinically, radiographically and with Oxford Knee score scale, Knee Society score scale and functional scale. Obtained data was processed with nonparametric Mann-Whitney-Wilcoxon test. Results were processed using the statistical analysis application package SPSS, version 10.07. Analysis of of mid-term results showed that the average for Oxford Knee score increased from 16.4 (95% CI 9-23 to 41.3 (95% CI 29-47. Average for Knee Society score scale increased from 42.7 (95% CI 31-55 to 88.6 (95% CI 73-100. No occurrence of early postoperative complications have been reported. Statistically significant improvements of knee function in patients after unicompartmental arthroplasty have been observed. Unicompartmental arthroplasty currently can be considered as an advanced treatment option for medial knee joint pathology. Meniscal bearing cemented prostheses such as Oxford III are preferable.

  19. Perioperative blood saving measures in total hip and knee arthroplasty

    NARCIS (Netherlands)

    Horstmann, W.G.

    2011-01-01

    This dissertation explores and discusses different aspects of blood loss and blood-saving measures in total hip and knee arthroplasty. Background: Worldwide, approximately 1 million total hip and 1 million total knee prostheses are implanted each year. Total hip arthroplasty and total knee art

  20. Patient-reported outcome after fast-track knee arthroplasty

    DEFF Research Database (Denmark)

    Larsen, Kristian; Hansen, Torben B; Søballe, Kjeld;

    2012-01-01

    PURPOSE: The purpose of this study was to describe patient-related functional outcomes after fast-track total knee arthroplasty and unicompartmental knee arthroplasty. Furthermore, we wanted to assess physical areas where an additional need for rehabilitation could be identified, and finally, we...

  1. Hip arthroplasty for treatment of advanced osteonecrosis: comprehensive review of implant options, outcomes and complications

    Directory of Open Access Journals (Sweden)

    Waewsawangwong W

    2016-06-01

    Full Text Available Warit Waewsawangwong, Pirapat Ruchiwit, James I Huddleston, Stuart B Goodman Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA Abstract: Surgical treatment for late stage (post-collapse osteonecrosis of the femoral head is controversial. In these situations, the outcome of joint preservation procedures is poor. There are several arthroplasty options for late-stage disease. The clinical outcomes of hemiarthroplasty and hemiresurfacing are unpredictable because of progressive acetabular cartilage degeneration. Total hip resurfacing may be associated with further vascular insult to the femoral head and early failure of the implant. Total hip replacement with metal-on-conventional polyethylene bearing surfaces has been the gold standard, but implant survivorship is limited in young active patients due to wear and osteolysis. Newer alternative bearing surfaces may have improved wear characteristics, but their durability must be confirmed in longer-term studies. Keywords: hip arthroplasty, advanced osteonecrosis, implant options, outcomes, complications

  2. Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty?

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill;

    2016-01-01

    patients only) was associated with a LOS of >4 days (p = 0.001), but not with re-admission. No such relationship existed for TKA. Interpretation - A fast-track setting resulted in similar length of hospital stay and re-admission rates regardless of BMI, except for very obese and morbidly obese THA patients.......Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality....... Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. Results - Median length of stay (LOS) was 2 (IQR: 2-3) days in all BMI groups. 30...

  3. The Copenhagen School Health Records Register

    DEFF Research Database (Denmark)

    Baker, Jennifer L; Sørensen, Thorkild I A

    2011-01-01

    The Copenhagen School Health Records Register is an electronic register of health examination information on 372,636 children who attended school in Copenhagen, Denmark from 1936 to 2005.......The Copenhagen School Health Records Register is an electronic register of health examination information on 372,636 children who attended school in Copenhagen, Denmark from 1936 to 2005....

  4. [Revision arthroplasty of the ankle joint].

    Science.gov (United States)

    Hintermann, B; Barg, A; Knupp, M

    2011-11-01

    In the last 20 years total ankle replacement has become a viable alternative to arthrodesis for end-stage osteoarthritis of the ankle. Numerous ankle prosthesis designs have appeared on the market in the past and attracted by the encouraging intermediate results reported in the literature, many surgeons have started to perform this procedure. With increased availability on the market the indications for total ankle replacement have also increased in recent years. In particular, total ankle replacement may now be considered even in younger patients. Therefore, despite progress in total ankle arthroplasty the number of failures may increase. Up to now, arthrodesis was considered to be the gold standard for salvage of failed ankle prostheses. Because of extensive bone loss on the talar side, in most instances tibiocalcaneal fusion is the only reliable solution. An alternative to such extended hindfoot fusions would be revision arthroplasty. To date, however, there are no reported results of revision arthroplasty for salvage of a failed ankle replacement.Based on our experience prosthetic components with a flat undersurface are most likely to be able to find solid support on remaining bone stock. The first 83 cases (79 patients, 46 males, 33 females, average age 58.9 years, range 30.6-80.7 years) with a average follow-up of 5.4 years (range 2-11 years) showed excellent to good results in 69 cases (83%), a satisfactory result in 12 cases (15%) and a fair result in 2 cases (2%) and 47 patients (56%) were pain free. Primary loosening was noted in three cases and of these two cases were successfully revised by another total ankle replacement and in one case with arthrodesis. Another case with hematogenous infection was also revised by arthrodesis. At the last follow-up control two components were considered to be loose and the overall loosening rate was thus 6%.This series has proven that revision arthroplasty can be a promising option for patients with failed total

  5. Adjacent-level arthroplasty following cervical fusion.

    Science.gov (United States)

    Rajakumar, Deshpande V; Hari, Akshay; Krishna, Murali; Konar, Subhas; Sharma, Ankit

    2017-02-01

    OBJECTIVE Adjacent-level disc degeneration following cervical fusion has been well reported. This condition poses a major treatment dilemma when it becomes symptomatic. The potential application of cervical arthroplasty to preserve motion in the affected segment is not well documented, with few studies in the literature. The authors present their initial experience of analyzing clinical and radiological results in such patients who were treated with arthroplasty for new or persistent arm and/or neck symptoms related to neural compression due to adjacent-segment disease after anterior cervical discectomy and fusion (ACDF). METHODS During a 5-year period, 11 patients who had undergone ACDF anterior cervical discectomy and fusion (ACDF) and subsequently developed recurrent neck or arm pain related to adjacent-level cervical disc disease were treated with cervical arthroplasty at the authors' institution. A total of 15 devices were implanted (range of treated levels per patient: 1-3). Clinical evaluation was performed both before and after surgery, using a visual analog scale (VAS) for pain and the Neck Disability Index (NDI). Radiological outcomes were analyzed using pre- and postoperative flexion/extension lateral radiographs measuring Cobb angle (overall C2-7 sagittal alignment), functional spinal unit (FSU) angle, and range of motion (ROM). RESULTS There were no major perioperative complications or device-related failures. Statistically significant results, obtained in all cases, were reflected by an improvement in VAS scores for neck/arm pain and NDI scores for neck pain. Radiologically, statistically significant increases in the overall lordosis (as measured by Cobb angle) and ROM at the treated disc level were observed. Three patients were lost to follow-up within the first year after arthroplasty. In the remaining 8 cases, the duration of follow-up ranged from 1 to 3 years. None of these 8 patients required surgery for the same vertebral level during the follow

  6. VISUALIZATION OF REGISTERED SUBSURFACE ANATOMY

    DEFF Research Database (Denmark)

    2010-01-01

    A system and method for visualization of subsurface anatomy includes obtaining a first image from a first camera and a second image from a second camera or a second channel of the first camera, where the first and second images contain shared anatomical structures. The second camera and the secon....... A visual interface displays the registered visualization of the first and second images. The system and method are particularly useful for imaging during minimally invasive surgery, such as robotic surgery....

  7. China's Economy Registered Moderate Slowdown

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    @@ The Chinese economy registered a moderate slowdown over the course of 2011, the World Bank said in its East Asia and Pacific Economic Update.During the first nine months of 2011, growth slowed from 10.6 percent in 2010 to 9.4 percent.The bank estimates that China's economic growth is expected at 9.1 percent in 2011, 8.4 percent in 2012 and roughly similar rates thereafter.

  8. Bisphosphonate treatment for osteolysis in total hip arthroplasty. A report of four cases

    Science.gov (United States)

    Trevisan, Carlo; Nava, Veronica; Mattavelli, Marta; Parra, Cleber Garcia

    2013-01-01

    Summary Aseptic loosening due to wear debris is the most frequent modality of failure in total hip arthroplasty. Bisphosphonates, a class of molecules which inhibit bone resorption showed an inhibitory effects on particles-induced osteolysis in vitro and in animal models. We report the clinical, radiographic and densitometric outcome of four postmenopausal women with total hip arthroplasty affected by peri-prosthetic osteolysis treated with neridronate due to their unwillingness to be operated. After neridronate treatment, there was general improvement in pain and function: VAS decrease 13 points (15%), the Harris Hip Score increase 9 points (15%). An average number of 3.3 x-ray per patients with an average follow-up of 23 months (range 12–34) were collected and evaluated. In all the patients except one, serial radiographs didn’t show any progression of radioluciencies lines or periprosthetic osteolysis. Bone density was evaluated by Dual energy X-ray absorptiometry after an average follow-up of 21 months (range 6–46 mo): periprosthetic BMD around the whole stem and the cup increased respectively 2.4% and 7.1%. Treatment was well tolerated and no significant side effects were registered. This retrospective collection of a small group of patients suggest that bisphosphonates should be clinically useful in preventing periprosthetic wear debris mediated osteolysis and claim for dedicated clinical trials. PMID:23858314

  9. [Case report of a patient with ochronosis and arthroplasty of the hip and both knees].

    Science.gov (United States)

    Moslavac, Aleksandra; Moslavac, Sasa; Cop, Renata

    2003-01-01

    Alkaptonuria is a rare hereditary metabolic disorder characterised by absence of the enzyme homogentisic acid oxidase. As a result of this defect homogentisic acid accumulates and is excreted in the urine. The term ochronosis is used to describe bluish-black pigmentation of connective tissue. Ochronotic arthropathy results from the pigmented deposits in the joints of the appendicular and axial skeleton. Findings simulate those of uncomplicated degenerative joint disease, with effusion, articular space narrowing, and bony sclerosis. Our patient is a 70-year old male with ochronotic arthropathy. He has typical ears and sclera discoloration, and had arthroplasty of knees 7 and 4 years ago, respectively. In year 2002, he had undergone total right hip arthroplasty and has been admitted for rehabilitation 14th postoperative day. Individually designed rehabilitation regimen included kinesitherapy, hydrokinesitherapy, and ambulation training with gradual increase in weight bearing exercises and electro-analgesia of associated low back pain. In course of rehabilitation our patient improved his endurance with satisfying range of motion of right hip (flexion 90 degrees, abduction 40 degrees) and strength of hip and thigh musculature. The patient was able to walk with crutches without limitation. We conclude that joint destruction followed by painful locomotion due to ochronotic arthropathy is best treated by total joint arthroplasty, as described in our patient.

  10. Pulmonary Findings on Computed Tomography in Asymptomatic Total Joint Arthroplasty Patients.

    Science.gov (United States)

    Vigdorchik, Jonathan M; Riesgo, Aldo M; Lincoln, Denis; Markel, David C

    2016-08-01

    An increase in the diagnosis of pulmonary embolus (PE) in the early postoperative period has been attributed to the use of multidetector 64-slice computed tomographic (CT) scans. It was suspected that this finding was the result of marrow or fat emboli that are commonly associated with arthroplasty rather than a true venous thromboembolic phenomenon. The purpose of this study was to determine the baseline pulmonary findings in asymptomatic patients after total joint arthroplasty (TJA). Over a 1-year period, an institutional review board-approved prospective study of 20 asymptomatic patients using a multidetector 64-slice CT scanner was performed. Overall, 15 TKAs and 5 total hip arthroplasties were included for analysis. All of the CT scans were negative for PE. There were no signs of microemboli or fat emboli on any scan. No patient went on to develop a PE at 2 years postoperatively. Despite the fact that emboli are created during TJA, if emboli are seen on a CT scan postoperatively, they should be assumed to be real events with clinical sequelae. If pulmonary symptoms develop postoperatively, they should not simply be assumed to be the result of fat or marrow embolism.

  11. Anteroposterior glide versus rotating platform low contact stress (LCS knee arthroplasty: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Wynn-Jones Charles

    2007-08-01

    Full Text Available Abstract Background Fifty thousand knee replacements are performed annually in the UK at an estimated cost of £150 million. Post-operative improvement depends on a number of factors including implant design and patient associated factors. To our knowledge there are no published study's comparing the results of AP glide and rotating platform designs of LCS knee arthroplasty. Therefore we feel that a study is required to investigate and compare the effects of two types of LCS total knee arthroplasty on joint proprioception and range of motion. Methods/Design Patients will be randomised to receive either a LCS AP glide or Rotating platform prosthesis. Clinical scores (Oxford knee score, American knee society score, EuroQol, range of motion and proprioception will be assessed prior to and at 3,6, 12 and 24 months after the operation. Proprioception will be assessed in terms of absolute error angle (mean difference between the target angle and the response angle. Knee angles will be measured in degrees using an electromagnetic tracking device, Polhemus 3Space Fastrak that detects positions of sensors placed on the test limb. Student's t-test will be used to compare the mean of two groups. Discussion Evidence is lacking concerning the best prosthesis to use for patients undergoing total knee replacement. This pragmatic randomised trial will test the null hypothesis that anteroposterior glide LCS knee arthroplasty does not result in better post operative knee motion and proprioception as compared to rotating platform LCS knee. Trial Registration ISRCTN52943804

  12. Liposomal Bupivacaine vs Interscalene Nerve Block for Pain Control After Shoulder Arthroplasty: A Retrospective Cohort Analysis.

    Science.gov (United States)

    Hannan, Casey V; Albrecht, Matthew J; Petersen, Steve A; Srikumaran, Uma

    The aim of this study was to compare liposomal bupivacaine and interscalene nerve block (ISNB) for analgesia after shoulder arthroplasty. We compared 37 patients who received liposomal bupivacaine vs 21 who received ISNB after shoulder arthroplasty by length of hospital stay (LOS), opioid consumption, and postoperative pain. Pain was the same in both groups for time intervals of 1 hour and 8 to 14 hours postoperatively. Compared with ISNB patients, liposomal bupivacaine patients reported less pain at 18 to 24 hours (P = .001) and 27 to 36 hours (P = .029) and had lower opioid consumption on postoperative days 2 (P = .001) and 3 (P = .002). Mean LOS for liposomal bupivacaine patients was 46 ± 20 hours vs 57 ± 14 hours for ISNB patients (P = .012). Sixteen of 37 liposomal bupivacaine patients vs 2 of 21 ISNB patients were discharged on the first postoperative day (P = .010). Liposomal bupivacaine was associated with less pain, less opioid consumption, and shorter hospital stays after shoulder arthroplasty compared with ISNB.

  13. The Influence of Overweight/Obesity on Patient-Perceived Physical Functioning and Health-Related Quality of Life After Primary Total Hip Arthroplasty

    NARCIS (Netherlands)

    Stevens, Martin; Paans, Nienke; Wagenmakers, Robert; van Beveren, Jan; van Raay, Jos J. A. M.; van der Meer, Klaas; Stewart, Roy; Bulstra, Sjoerd K.; Reininga, Inge H. F.; van den Akker-Scheek, Inge

    2012-01-01

    Overweight/obesity in patients after total hip arthroplasty (THA) is a growing problem and is associated with postoperative complications and a negative effect on functional outcome. The objective of this study is to determine to what extent overweight/obesity is associated with physical functioning

  14. Danish registers on aspects of reproduction

    DEFF Research Database (Denmark)

    Blenstrup, Lene Tølbøll; Knudsen, Lisbeth B.

    2011-01-01

    on births, abortions and assisted reproduction as well as selected characteristics of the women (and men) involved. Validity and Coverage: Both the validity and coverage of each register is considered of high quality. Conclusions: These registers provide, both individually and in combination, unique......Introduction: The establishing of three Danish population based registers, namely the Fertility Database, the Register of Legally Induced Abortions and the In Vitro Fertilisation register aimed at providing data for surveying of reproductive outcome. Content: The registers include information...... opportunities for undertaking detailed and comprehensive research in the field of reproduction....

  15. Registers of multiple sclerosis in Denmark

    DEFF Research Database (Denmark)

    Koch-Henriksen, N; Magyari, M; Laursen, B

    2015-01-01

    There are two nationwide population-based registers for multiple sclerosis (MS) in Denmark. The oldest register is The Danish Multiple Sclerosis Registry (DMSR), which is an epidemiological register for estimation of prevalence and incidence of MS and survival, and for identifying exposures earlier...... between a number of different environmental exposures in the past and the subsequent risk of MS. Some of these studies have been able to exonerate suspected risk factors. The other register, the nationwide Danish Multiple Sclerosis Treatment Register, is a follow-up register for all patients who have...

  16. People who undergo revision arthroplasty report more limitations but no decrease in physical activity compared with primary total hip arthroplasty : an observational study

    NARCIS (Netherlands)

    Stevens, Martin; Hoekstra, Tsjerk; Wagenmakers, Robert; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge

    2009-01-01

    Question: Do people who have had revision arthroplasty report more limitations and less physical activity than those after primary total hip arthroplasty? Can degree of limitation and physical activity be predicted by revision arthroplasty, after adjustment for age, gender, and Charnley classificati

  17. Current trends in total hip arthroplasty.

    Science.gov (United States)

    Eingartner, Christoph

    2007-01-01

    After 20 years of application, with excellent short-term and long-term results, uncemented total hip arthroplasty (THA) is now generally regarded as the standard procedure for younger patients undergoing THA. However, expectations regarding hip replacement are continuously rising, along with the increasing number of young and active patients undergoing hip arthroplasty: a complication rate, including postoperative dislocation, close to zero, faster postoperative rehabilitation, low wear even in active patients, high durability and long term survival, etc. Demographic changes in aging societies are also leading to an increased need for cost-effective THA for the low-demand trauma patient. For high-demand patients, modern THA bearings, such as ceramic-ceramic articulations and other improved PE and metal materials, provide high durability and low wear, if the components are properly aligned. Navigation technology has been introduced in THA to ensure perfect component positioning without outliers and concomitant risk of increased wear and implant failure. Minimally and less invasive approaches are becoming increasingly popular in order to facilitate rehabilitation and fast-track surgery in younger patients. Navigation provides assistance for implant positioning in procedures with limited surgical exposure and visibility. New bone-preserving implants, such as surface replacement or short-stemmed femoral shaft prostheses, have been introduced especially for younger patients. Some of these new procedures are still under development,and the long-term results of new implant concepts have to be evaluated over the next decades. Not every modern concept will likely stand the test of time, but some will be beneficial for patients undergoing total hip arthroplasty in the future.

  18. Lower Limb Ischaemia Complicating Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Shiu-Wai Chan

    2012-06-01

    Full Text Available This article is about two patients having vascular injuries complicating total hip arthroplasty because of intraoperative indirect injuries. One patient had a delayed presentation of acute lower limb ischaemia, in which he required amputation of his left second toe because of ischaemic gangrene. The other patient had acute lower limb ischaemia leading to permanent muscle and nerve damage because of delayed recognition. Both patients had vascular interventions for the indirect vascular injuries. Preoperative workup for suspicious underlying peripheral vascular disease, intraoperative precautions, and perioperative period of vascular status monitoring are essential for prevention and early detection of such sinister events.

  19. Asymptomatic prospective and retrospective cohorts with metal-on-metal hip arthroplasty indicate acquired lymphocyte reactivity varies with metal ion levels on a group basis.

    Science.gov (United States)

    Hallab, Nadim J; Caicedo, Marco; McAllister, Kyron; Skipor, Anastasia; Amstutz, Harlan; Jacobs, Joshua J

    2013-02-01

    Some tissues from metal-on-metal (MoM) hip arthroplasty revisions have shown evidence of adaptive-immune reactivity (i.e., excessive peri-implant lymphocyte infiltration/activation). We hypothesized that, prior to symptoms, some people with MoM hip arthroplasty will develop quantifiable metal-induced lymphocyte reactivity responses related to peripheral metal ion levels. We tested three cohorts (Group 1: n = 21 prospective longitudinal MoM hip arthroplasty; Group 2: n = 17 retrospective MoM hip arthroplasty; and Group 3: n = 20 controls without implants). We compared implant position, metal-ion release, and immuno-reactivity. MoM cohorts had elevated (p metal-reactivity (vs. 5% pre-op, metal-LTT, SI > 2), compared with 76% of Group 2, and 15% of Group 3 controls (patch testing was a poor diagnostic indicator with only 1/21 Group 1 positive). Higher cup-abduction angles (50° vs. 40°) in Group 1 were associated with higher serum Cr (p reactive versus non-reactive Group-1 participants (p metal-reactive versus non-reactive Group 1 participants. Our results showed that lymphocyte reactivity to metals can develop within the first 1-4 years after MoM arthroplasty in asymptomatic patients and lags increases in metal ion levels. This increased metal reactivity was more prevalent in those individuals with extreme cup angles and higher amounts of circulating metal.

  20. The establishment of a polyposis register

    DEFF Research Database (Denmark)

    Bülow, Steffen; Burn, J; Neale, K;

    1993-01-01

    registers are discussed, and the stages of development of a register are reviewed: Ascertainment of probands, construction of pedigrees, identification of family members at risk, and screening of members at risk. The problem of data confidentiality is discussed....

  1. The Danish National Health Service Register

    DEFF Research Database (Denmark)

    Andersen, John Sahl; Olivarius, Niels de Fine; Krasnik, Allan

    2011-01-01

    Abstract Introduction: To describe the Danish National Health Service Register in relation to research. Content: The register contains data collected for administrative and scientific purposes from health contractors in primary health care. It includes information about citizens, providers...

  2. 76 FR 16016 - Sunshine Federal Register Notice

    Science.gov (United States)

    2011-03-22

    .... ] Briefing on Small Modular Reactors (Public Meeting) (Contact: Stephanie Coffin, 301-415-6877) This meeting... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Sunshine Federal Register Notice AGENCY HOLDING THE MEETINGS: Nuclear Regulatory Commission,...

  3. 76 FR 14107 - Sunshine Federal Register Notice

    Science.gov (United States)

    2011-03-15

    .... Briefing on Small Modular Reactors (Public Meeting). (Contact: Stephanie Coffin, 301-415-6877). This... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Sunshine Federal Register Notice AGENCY HOLDING THE MEETINGS: Nuclear Regulatory Commission....

  4. Patellar resurfacing versus nonresurfacing in total knee arthroplasty for osteoarthritis: experience at a tertiary care institution in Pakistan

    Directory of Open Access Journals (Sweden)

    Lakdawala RH

    2012-02-01

    Full Text Available Akil Fazal1, Riaz H Lakdawala21Clinical Fellow, NYU Hospital for Joint Disease, New York, US; 2Associate Professor and Chief, Section of Orthopedics, Department of Surgery, The Aga Khan University Hospital, Karachi, PakistanObjective: To determine the effect of patellar resurfacing in patients offered total knee arthroplasty for osteoarthritis.Design: Randomized control study.Place and duration of study: The Aga Khan University Hospital, Karachi, Pakistan from January 3, 2005 to January 9, 2010.Patients and methods: Patients undergoing primary total knee arthroplasty for osteoarthritis were assigned to either the patellar resurfacing or nonresurfacing arm using systematic sampling. This consisted of patients undergoing unilateral and bilateral knee arthroplasty. Preoperatively, Knee Society Knee and Function Scores were calculated. After a minimum of 3 years postoperatively Knee Society Knee and Function Scores as well as the Clinical Anterior Knee Pain Rating were calculated and analysis done to check for differences.Results: Seventy-five patients were recruited in each arm; 135 patients had bilateral and 15 had unilateral knee arthroplasty. The mean preoperative knee score was 40.4 for the resurfacing group and 40.60 for the nonresurfacing group (P = 0.45. This improved postoperatively to 93.67 and 94.23 respectively, with no difference between the two groups (P = 0.67. The mean preoperative function score was 45.50 for resurfaced patellae and 45.83 for nonresurfaced. This improved to 89.67 and 90.50, respectively, again with no difference (P = 0.51. Postoperative Clinical Anterior Knee Pain Rating was a mean of 0.1 for resurfaced and 0.13 for nonresurfaced patellas, with no difference on analysis (P = 0.06. However, patients who had bilateral knee arthroplasty had a slightly higher Clinical Anterior Knee Pain Rating than those who had single knee surgery (P = 0.046 irrespective of whether the patellar was resurfaced or not.Conclusion: In

  5. Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Jørgensen, Christoffer; Kehlet, Henrik

    2014-01-01

    BACKGROUND: Preoperative anemia has been associated with increased risk of allogeneic blood transfusion and postoperative morbidity and mortality. The prevalence of preoperative anemia and its association with postoperative outcomes has not previously been reported in relation to fast......-track elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). We aimed to evaluate the prevalence of preoperative anemia in elective fast-track THA and TKA and its association with risk of perioperative transfusion, prolonged length of hospital stay (LOS), and postoperative readmission. STUDY...... national databases and patient charts. Adjusted risk estimates for transfusion, prolonged LOS, and all-cause readmission according to preoperative anemia status were obtained by multivariate logistic regression. RESULTS: A total of 5.165 THA or TKA procedures were included with a mean patient age of 67...

  6. Assessment of Bonelike (registered) graft with a resorbable matrix using an animal model

    Energy Technology Data Exchange (ETDEWEB)

    Lobato, J.V. [CHVNG-Servico de Estomatologia, Centro Hospitalar de Vila Nova de Gaia (Portugal); ICBAS-Instituto de Ciencias Biomedicas de Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 2, 4099-003 Porto (Portugal); CECA/ICETA-Centro de Estudos de Ciencia Animal, Instituto de Ciencias e Tecnologias Agrarias e Agro-Alimentares, Campus Agrario de Vairao, Rua Padre Armando Quintas, 4485-661 Vairao (Portugal); Hussain, N. Sooraj [INEB-Instituto de Engenharia Biomedica, Laboratorio de Biomateriais, Rua Campo Alegre, 823, 4150-180, Porto (Portugal); FEUP-Faculdade de Engenharia da Universidade do Porto, DEMM, Rua Dr. Roberto Frias, 4200-465 Porto (Portugal); Botelho, C.M. [INEB-Instituto de Engenharia Biomedica, Laboratorio de Biomateriais, Rua Campo Alegre, 823, 4150-180, Porto (Portugal); FEUP-Faculdade de Engenharia da Universidade do Porto, DEMM, Rua Dr. Roberto Frias, 4200-465 Porto (Portugal); Mauricio, A.C. [ICBAS-Instituto de Ciencias Biomedicas de Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 2, 4099-003 Porto (Portugal); CECA/ICETA-Centro de Estudos de Ciencia Animal, Instituto de Ciencias e Tecnologias Agrarias e Agro-Alimentares, Campus Agrario de Vairao, Rua Padre Armando Quintas, 4485-661 Vairao (Portugal); Afonso, A. [FMDUP-Faculdade de Medicina Dentaria da Universidade do Porto, Rua Dr. Manuel Pereira da Silva, 4200-393 Porto (Portugal); Ali, N. [Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro (Portugal); Santos, J.D. [INEB-Instituto de Engenharia Biomedica, Laboratorio de Biomateriais, Rua Campo Alegre, 823, 4150-180, Porto (Portugal) and FEUP-Faculdade de Engenharia da Universidade do Porto, DEMM, Rua Dr. Roberto Frias, 4200-465 Porto (Portugal)]. E-mail: jdsantos@fe.up.pt

    2006-09-25

    Synthetic bone grafts have been developed to provide an alternative to autografts and allografts. Bonelike (registered) is a patented synthetic osteoconductive bone graft that mimics the mineral composition of natural bone. In the present preliminary animal studies a user-friendly version of synthetic bone graft Bonelike (registered) have been developed by using a resorbable matrix, Floseal (registered) , as a vehicle and raloxifene hydrochloride as a therapeutic molecule, that is known to decrease osteoclast activity and therefore enhanced bone formation. From histological and scanning electron microscopy evaluations, the use of Bonelike (registered) associated with Floseal (registered) and raloxifene hydrochloride showed that new bone was rapidly apposed on implanted granules and also that the presence of the matrix and therapeutic molecule does not alter the proven highly osteoconductivity properties of Bonelike (registered) . Therefore, this association may be one step-forward for the clinical applications of Bonelike (registered) scaffolds since it is much more easy-to-handle when compared to granular materials.

  7. UnconStrained ShoUlder arthroplasty

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To evaluate the results of 36unconstrained shoulder arthroplasties. Methods: In the series, 24 total and 12 hemiarthroplasties of the shoulders were performed with unconstrained shoulder prostheses in 29 patients who suffered from glenohumeral degenerative arthritis, rheumatoid arthritis, avascular necrosis and proximal fracture of humerus, respectively. Follow-up averaged 6.2years. All patients were evaluated pre- and post-operatively using the rating system of the Society of American Shoulder and Elbow Surgeons which assesses the severity of pain,strength of muscles around shoulder, stability, range of motion and functional activities of daily living. Radiolucent line and migration of prostheses were observed postoperatively on X-rays. Results: Postoperatively, the rate of pain relief was 91.3%, and active range of motion increased by 47° inforward flexion, 43° in abduction , 30° in external rotation,and 4 segments in internal rotation. Preoperatively the average points of 6 functional activities patients could perform was 0.8, and postoperatively 3.1. On postoperative X-ray, proximal migration of the humerus was seen in 8 shoulders, 6 of which had either a torn or absent rotator cuff. Radiolucent lines were seen around 1humeral component and 9 glenoid components. Onehumeral and 2 glenoid components loosened. Conclusions: These results suggest that unconstrained shoulder arthroplasty is a satisfactory and safe technique.

  8. Radiographic analysis of shoulder anatomical arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Merolla, Giovanni [Unit of Shoulder and Elbow Surgery, ' D. Cervesi' Hospital, L. Van Beethoven 46 Street, 47841 Cattolica (Italy)], E-mail: gmerolla@shouldertech.it; Di Pietto, Francesco; Romano, Stefania [Department of Diagnostic Imaging, ' A. Cardarelli' Hospital, Naples (Italy); Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe [Unit of Shoulder and Elbow Surgery, ' D. Cervesi' Hospital, L. Van Beethoven 46 Street, 47841 Cattolica (Italy)

    2008-10-15

    Arthroplasty is the standard treatment for advanced shoulder osteoarthritis. Modern prostheses designs have modular features whose size, shaft/head and body morphology can be adjusted. Total Shoulder Arthroplasty (TSA) provides better results. A complete X-ray follow-up is essential to assess the results and evaluate the survival rates of a shoulder prosthesis. Antero-posterior at 40 deg. in both internal and external rotation (true AP view) and axillary view are recommended to assess the following parameters: orientation and translation of the humeral component, offset, size and height of the humeral head, acromio-humeral distance, distribution and fixation of the cement, stress shielding and cortical resorption, radiolucent lines, subsidence and tilt, glenoid wear and 'bone stock', prostheses instability, glenoid component shift. Shoulder hemiarthroplasty can lead to glenoid wear; the true AP film at 40 deg. of internal rotation provides the best profile of gleno-humeral joint to depict glenoid erosion. Shift of the glenoid component in TSA is identified as tilting or medial migration on true AP and axillary views in the early postoperative period (1-2 months) and at minimum of 2 years. An exhaustive radiographic analysis remains essential to monitor the prosthetic implant and detect early and late complications or risk factors of prosthetic loosening.

  9. Extensor mechanism allograft in total knee arthroplasty

    Science.gov (United States)

    Helito, Camilo Partezani; Gobbi, Riccardo Gomes; Tozi, Mateus Ramos; Félix, Alessandro Monterroso; Angelini, Fábio Janson; Pécora, José Ricardo

    2013-01-01

    Objective To analyze the experience with allograft transplantation of the extensor mechanism in total knee arthroplasty and compare results with the international experience. Methods We retrospectively evaluated three cases of extensor mechanism allograft after total knee arthroplasty performed in our hospital with the aid of one of the few tissue banks in Brazil and attempt to establish whether our experiences were similar to others reported in the world literature regarding patient indication, techniques, and outcomes. Results Two cases went well with the adopted procedure, and one case showed bad results and progressed to amputation. As shown in the literature, the adequate tension of the graft, appropriate tibial fixation and especially the adequate patient selection are the better predictors of good outcomes. Previous chronic infection can be an unfavorable predictor. Conclusion This surgical procedure has precise indication, albeit uncommon, either because of the rarity of the problem or because of the low availability of allografts, due to the scarcity of tissue banks in Brazil. Level of Evidence IV, Case Series. PMID:24453688

  10. Reverse Shoulder Arthroplasty for Trauma: When, Where, and How.

    Science.gov (United States)

    Szerlip, Benjamin W; Morris, Brent J; Edwards, T Bradley

    2016-01-01

    Reverse shoulder arthroplasty has become increasingly popular for the treatment of complex shoulder injuries, including proximal humerus fractures and fixed glenohumeral dislocation, in the elderly population. The early to midterm results of reverse shoulder arthroplasty for the treatment of proximal humerus fractures are promising compared with the results of unconstrained humeral head replacement, and patients may have more predictable improvement with less dependence on bone healing and rehabilitation. However, long-term follow-up is needed, and surgeons must be familiar with various complications that are specific to reverse shoulder arthroplasty. To achieve optimal patient outcomes for the management of traumatic shoulder injuries, surgeons must have a comprehensive understanding of the current implant options, indications, and surgical techniques for reverse shoulder arthroplasty.

  11. Resurfacing shoulder arthroplasty for the treatment of severe rheumatoid arthritis

    DEFF Research Database (Denmark)

    Voorde, Pia C Ten; Rasmussen, Jeppe V; Olsen, Bo S

    2015-01-01

    BACKGROUND AND PURPOSE: There is no consensus on which type of shoulder prosthesis should be used in patients with rheumatoid arthritis (RA). We describe patients with RA who were treated with shoulder replacement, regarding patient-reported outcome, prosthesis survival, and causes of revision......, and we compare outcome after resurfacing hemi-arthroplasty (RHA) and stemmed hemi-arthroplasty (SHA). PATIENTS AND METHODS: We used data from the national Danish Shoulder Arthroplasty Registry and included patients with RA who underwent shoulder arthroplasty in Denmark between 2006 and 2010. Patient......-reported outcome was obtained 1-year postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), and rates of revision were calculated by checking revisions reported until December 2011. The patient-reported outcome of RHA was compared to that of SHA using regression analysis...

  12. Recurrent Hemarthrosis Following Knee Arthroplasty Treated with Arterial Embolization.

    Science.gov (United States)

    Weidner, Zachary D; Hamilton, William G; Smirniotopoulos, John; Bagla, Sandeep

    2015-11-01

    Recurrent hemarthrosis is an uncommon but troublesome complication following knee arthroplasty. This study reports the results for 13 patients with spontaneous recurrent hemarthrosis after knee arthroplasty treated with arterial embolization. The average interval between arthroplasty and embolization was 47 months (range, 2-103 months), and the average time from onset of hemarthrosis to embolization was 4.1 months (range, 1-11 months). Geniculate arterial embolization lead to resolution of hemarthrosis in 12 of 13 patients (92.3%). The one clinical failure likely represented a case of misdiagnosed periprosthetic joint infection. Two patients experienced transient cutaneous ischemia related to distal particulate embolization that resolved spontaneously. Selective geniculate arterial embolization is an effective and safe treatment modality for recurrent hemarthrosis after knee arthroplasty.

  13. Myofascial Pain in Patients Waitlisted for Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Richard Henry

    2012-01-01

    Full Text Available BACKGROUND: Knee pain is one of the major sources of pain and disability in developed countries, particularly in aging populations, and is the primary indication for total knee arthroplasty (TKA in patients with osteoarthritis (OA.

  14. Is cold therapy really efficient after knee arthroplasty?

    Directory of Open Access Journals (Sweden)

    Ersin Kuyucu

    2015-12-01

    Conclusion: After knee arthroplasty, the preoperative and postoperative use of cryotherapy is effective in terms of the pain control and functional knee scores without a significant change in surgical blood loss.

  15. Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures.

    Science.gov (United States)

    Chen, Antonia F; Choi, Lisa E; Colman, Matthew W; Goodman, Mark A; Crossett, Lawrence S; Tarkin, Ivan S; McGough, Richard L

    2013-10-01

    Current methods of fixing periprosthetic fractures after total knee arthroplasty (TKA) are variable, and include open reduction and internal fixation (ORIF) via plating, retrograde nailing, or revision using standard revision TKA components or a distal femoral arthroplasty (DFA). The purpose of this study is to compare patients who failed plating techniques requiring subsequent revision to DFA to patients who underwent primary DFA. Of the 13 patients (9.2%) who failed primary ORIF, causes included nonunion (53.8%), infection (30.8%), loosening (7.7%), and refracture (7.7%). There were significantly more surgical procedures for ORIF revision to DFA compared to primary DFA. Complications for patients who underwent primary reconstruction with DFAs included extensor mechanism disruption (8.3%), infection (5.6%), and dislocation (2.8%). Primary reconstruction via ORIF is beneficial for preserving bone stock, but primary DFA may be preferred in osteopenic patients, or those at high risk for nonunion.

  16. Funding source and primary outcome changes in clinical trials registered on ClinicalTrials.gov are associated with the reporting of a statistically significant primary outcome: a cross-sectional study [v2; ref status: indexed, http://f1000r.es/5bj

    Directory of Open Access Journals (Sweden)

    Sreeram V Ramagopalan

    2015-04-01

    Full Text Available Background: We and others have shown a significant proportion of interventional trials registered on ClinicalTrials.gov have their primary outcomes altered after the listed study start and completion dates. The objectives of this study were to investigate whether changes made to primary outcomes are associated with the likelihood of reporting a statistically significant primary outcome on ClinicalTrials.gov. Methods: A cross-sectional analysis of all interventional clinical trials registered on ClinicalTrials.gov as of 20 November 2014 was performed. The main outcome was any change made to the initially listed primary outcome and the time of the change in relation to the trial start and end date. Findings: 13,238 completed interventional trials were registered with ClinicalTrials.gov that also had study results posted on the website. 2555 (19.3% had one or more statistically significant primary outcomes. Statistical analysis showed that registration year, funding source and primary outcome change after trial completion were associated with reporting a statistically significant primary outcome. Conclusions: Funding source and primary outcome change after trial completion are associated with a statistically significant primary outcome report on clinicaltrials.gov.

  17. Saving Tons at the Register

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Karl; Seigel, Jeff; Sherman, Max; Walker, Iain

    1998-05-01

    Duct losses have a significant effect on the efficiency of delivering space cooling to U.S. homes. This effect is especially dramatic during peak demand periods where half of the cooling equipment's output can be wasted. Improving the efficiency of a duct system can save energy, but can also allow for downsizing of cooling equipment without sacrificing comfort conditions. Comfort, and hence occupant acceptability, is determined not only by steady-state temperatures, but by how long it takes to pull down the temperature during cooling start-up, such as when the occupants come home on a hot summer afternoon. Thus the delivered tons of cooling at the register during start-up conditions are critical to customer acceptance of equipment downsizing strategies. We have developed a simulation technique which takes into account such things as weather, heat-transfer (including hot attic conditions), airflow, duct tightness, duct location and insulation, and cooling equipment performance to determine the net tons of cooling delivered to occupied space. Capacity at the register has been developed as an improvement over equipment tonnage as a system sizing measure. We use this concept to demonstrate that improved ducts and better system installation is as important as equipment size, with analysis of pull-down capability as a proxy for comfort. The simulations indicate that an improved system installation including tight ducts can eliminate the need for almost a ton of rated equipment capacity in a typical new 2,000 square foot house in Sacramento, California. Our results have also shown that a good duct system can reduce capacity requirements and still provide equivalent cooling at start-up and at peak conditions.

  18. Preoperative Patient Education for Hip and Knee Arthroplasty: Financial Benefit?

    Science.gov (United States)

    Tait, Mark A; Dredge, Carter; Barnes, C Lowry

    2015-01-01

    Of 904 patients who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) at the same hospital, 802 participated in a preoperative education day called "Joint Academy" (JA). The length of stay of JA participants was 2.12 days (49.5%) less than patients who did not attend a JA (p education program may significantly reduce overall costs for primary TKA and THA procedures.

  19. Intrathecal opioid versus ultrasound guided fascia iliaca plane block for analgesia after primary hip arthroplasty: study protocol for a randomised, blinded, noninferiority controlled trial

    Directory of Open Access Journals (Sweden)

    Kinsella John

    2011-02-01

    Full Text Available Abstract Background Hip replacement surgery is increasingly common due to an ageing population, and rising levels of obesity. The provision of excellent pain relief with minimal side effects is important in order to facilitate patient mobilisation and rehabilitation. Spinal opioids provide excellent analgesia but are associated with adverse effects. The fascia-iliaca block is an alternative technique which provides analgesia to the nerves innervating the hip. The success of fascia iliaca blocks has been demonstrated to be superior when using ultrasound compared to landmark techniques. However, the clinical benefit of this improvement has yet to be investigated. The aim of this study is to compare the efficacy and safety of ultrasound guided fascia iliaca block with spinal morphine for hip replacement surgery. Methods/Design This study is a randomised, blinded, placebo-controlled, noninferiority trial. Patients scheduled to undergo unilateral primary hip arthroplasty will receive a study information sheet and consent will be obtained in keeping with the Declaration of Helsinki. Patients will be randomised to receive either; (i Ultrasound guided fascia iliaca block using levobupivacaine, plus spinal anaesthesia with hyperbaric bupivacaine containing no morphine, or (ii sham ultrasound guided fascia iliaca block performed with sterile saline, and spinal anaesthesia containing hyperbaric bupivacaine and 0.1 mg of spinal morphine. A total of 108 patients will be recruited. Primary outcome is post-operative morphine consumption in a 24 hour period. Secondary outcomes include; pain scores at 3, 6, 12, 24, 36 and 48 hours, episodes of respiratory depression, hypotension, nausea and vomiting, pruritus, sedation, time to first mobilisation and patient satisfaction. Conclusions There are no studies to date comparing ultrasound guided fascia iliaca block with spinal morphine for pain control after hip arthroplasty. If the ultrasound guided fascia iliaca

  20. Endocannabinoids and acute pain after total knee arthroplasty.

    Science.gov (United States)

    Azim, Syed; Nicholson, James; Rebecchi, Mario J; Galbavy, William; Feng, Tian; Reinsel, Ruth; Volkow, Nora D; Benveniste, Helene; Kaczocha, Martin

    2015-02-01

    Osteoarthritis (OA) of the knee is a progressive disease that is associated with inflammation of the joints and lower extremity pain. Total knee arthroplasty (TKA) is a surgical procedure that aims to reduce pain and restore motor function in patients suffering from OA. The immediate postoperative period can be intensely painful leading to extended recovery times including persistent pain. The endocannabinoid system regulates nociception, and the activation of cannabinoid receptors produces antinociceptive effects in preclinical models of OA. To date, the influence of the endocannabinoid tone on pain and disability in OA patients and on acute postoperative pain in humans has not been explored. In this study, we provide the first comprehensive profile of endocannabinoids in serum, cerebrospinal fluid, and synovial fluid of patients with painful end-stage OA undergoing TKA and examine correlations between endocannabinoid levels, interleukin 6, functional disability, acute postoperative pain, and postoperative opioid use. Our results reveal that central (cerebrospinal fluid) and peripheral (synovial fluid) levels of the endocannabinoid 2-arachidonoyl glycerol were significantly elevated in patients who developed higher postoperative pain after TKA. In addition, synovial fluid 2-arachidonoyl glycerol levels were positively correlated with postoperative opioid use. Similarly, synovial fluid levels of the anti-inflammatory lipid palmitoylethanolamide correlated with functional disability in OA. Taken together, our results are the first to reveal associations between central and peripheral endocannabinoid levels and postoperative pain. This suggests that endocannabinoid metabolism may serve as a target for the development of novel analgesics both for systemic or local delivery into the joint.

  1. Efficient sorting using registers and caches

    DEFF Research Database (Denmark)

    Wickremesinghe, Rajiv; Arge, Lars Allan; Chase, Jeffrey S.;

    2002-01-01

    Modern computer systems have increasingly complex memory systems. Common machine models for algorithm analysis do not reflect many of the features of these systems, e.g., large register sets, lockup-free caches, cache hierarchies, associativity, cache line fetching, and streaming behavior...... on sorting performance. We introduce a new cache-conscious sorting algorithm, R-MERGE, which achieves better performance in practice over algorithms that are superior in the theoretical models. R-MERGE is designed to minimize memory stall cycles rather than cache misses by considering features common to many....... Inadequate models lead to poor algorithmic choices and an incomplete understanding of algorithm behavior on real machines.A key step toward developing better models is to quantify the performance effects of features not reflected in the models. This paper explores the effect of memory system features...

  2. RECENT VIEW AT UNICOMPARTMENTAL KNEE ARTHROPLASTY AMONG OTHER SURGICAL APPROACHES TO PATIENTS WITH KNEE OSTEOARTHRITIS

    Directory of Open Access Journals (Sweden)

    N. N. Kornilov

    2012-01-01

    Full Text Available In the article recent publications dedicated to unicompartmental knee arthroplasty are analyzed. Evolution of indications and contraindications, mid- and late term results, difference in functional outcomes in comparison with total knee arthroplasty are discussed. Taking into consideration all relevant information unicompartmental knee arthroplasty may be considered as effective and reliable method of treatment of patients with knee osteoarthrosis and osteonecrosis.

  3. Noise measurement in total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Lukas A Holzer

    2014-01-01

    Full Text Available Few studies have been performed to analyze noise levels produced by various surgical instruments in the operating room (OR. The highest levels of noise that have been described were due to instruments used for total knee arthroplasty (TKA. These high levels of noise might be a potential health hazard for patients and medical staff. Therefore, we aimed to measure noise levels of current instruments that are widely used worldwide. During a conventional primary TKA the levels of noise in the OR were measured using a Class 1 integrating-averaging sound level meter. The highest A-weighted equivalent level was produced when using a hammer during the implantation of the femoral and tibial components with 90.2 dBA. In total surgical instruments were used for about 10% of the total time of surgery. Noise exposure due to instrument use during TKA does not seem to be a potential health hazard for medical staff or patients.

  4. Revision of infected knee arthroplasties in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens;

    2016-01-01

    Background and purpose - The surgical treatment of periprosthetic knee infection is generally either a partial revision procedure (open debridement and exchange of the tibial insert) or a 2-stage exchange arthroplasty procedure. We describe the failure rates of these procedures on a nationwide...... prosthesis with a re-revision rate due to infection of 34%, as compared to 55% in revisions of a revision prosthesis (p = 0.05). The failure rate of the 2-stage revisions was 30%. Median time interval between stages was 84 (9-597) days. 117 (54%) of the 2-stage revisions were revisions of a primary...... prosthesis with a re-revision rate due to infection of 21%, as compared to 29% in revisions of a previously revised prosthesis (p = 0.1). Overall postoperative mortality was 0.6% in high-volume centers (> 30 procedures within 2 years) as opposed to 7% in the remaining centers (p = 0.003). Interpretation...

  5. Total hip arthroplasty in heart transplant patients.

    Science.gov (United States)

    León, José Luis; Resines, Carlos; Zafra, Alberto

    2007-12-01

    Avascular necrosis of the femoral head (AVNFH) is a known complication after heart transplantation. In order to assess the efficacy and complications of cementless total hip arthroplasty (THA) in this population, the authors analysed 24 cementless THAs in 18 patients with advanced AVNFH (stage II affecting more than 15% of the articular surface, stage III and IV according to the Ficat-Arlet classification) after a heart transplant procedure. Average duration of follow-up was 35.4 months (range: 16 to 66). Pain and function scores (Harris Hip Score and WOMAC arthritis index) showed significant improvement from the preoperative levels. There was no evidence of component loosening, heart-related complications or infection following the THA. Cementless THA is a reasonable treatment option for advanced avascular necrosis of the femoral head following heart transplant procedures.

  6. Endotoxins in surgical instruments of hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Vania Regina Goveia

    2016-06-01

    Full Text Available Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested.

  7. Favorable results after total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E. H.; Herzberg, G.; Merser, Søren

    2013-01-01

    Background and purpose During the past 40 years, several attempts have been made with total wrist arthroplasty to avoid fusion in severely destroyed wrists. The results have often been disappointing. There is only modest clinical documentation due to the small number of patients (especially non....... The wrists had been reviewed annually and analysis was done on the latest follow-up data. Results 60 patients had been operated (5 bilaterally), 5 wrists had been revised, and 52 were available for follow-up (with the revised cases excluded). The pain scores, QuickDASH scores, ulnar flexion, and supination...... for the whole group were statistically significantly better at follow-up. There were no statistically significant differences between the rheumatoid and the non-rheumatoid patients except for motion, which was better in the non-rheumatoid group. The motion obtained depended on the preoperative motion. Implant...

  8. Distal femoral shortening in total hip arthroplasty for complex primary hip reconstruction. A new surgical technique.

    Science.gov (United States)

    Koulouvaris, Panagiotis; Stafylas, Kosmas; Sculco, Thomas; Xenakis, Theodore

    2008-10-01

    Successful total hip arthroplasty (THA) in congenital dislocated hips demands anatomical reduction in the normal center of rotation without overstretching the sciatic nerve and without excessive compression or abnormal forces across the joint. Proximal femoral and subtrochanteric shortening osteotomy has been described for THA for the treatment of dislocated hips. However, these osteotomies are demanding, associated with deformation of femoral canal and nonunion, and may increase the femoral stem stress. This study reports excellent results in 24 patients with a new surgical technique that combines THA with a distal femoral shortening in severely deformed hips using customized components.

  9. Minimally invasive total hip arthroplasty: in opposition.

    Science.gov (United States)

    Hungerford, David S

    2004-06-01

    At the Knee Society Winter Meeting in 2003, Seth Greenwald and I debated about whether there should be new standards (ie, regulations) applied to the release of information to the public on "new developments." I argued for the public's "right to know" prior to the publication of peer-reviewed literature. He argued for regulatory constraint or "proving by peer-reviewed publication" before alerting the public. It is not a contradiction for me to currently argue against the public advertising of minimally invasive (MIS) total hip arthroplasty as not yet being in the best interest of the public. It is hard to remember a concept that has so captured both the public's and the surgical community's fancy as MIS. Patients are "demanding" MIS without knowing why. Surgeons are offering it as the next best, greatest thing without having developed the skill and experience to avoid the surgery's risks. If you put "minimally invasive hip replacement" into the Google search engine (http://www.google.com), you get 5,170 matches. If you put the same words in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi), referencing the National Library of Medicine database, you get SEVENTEEN; none is really a peer-reviewed article. Most are 1 page papers in orthopedics from medical education meetings. On the other hand, there are over 6,000 peer-reviewed articles on total hip arthroplasty. Dr. Thomas Sculco, my couterpart in this debate, wrote an insightful editorial in the American Journal of Orthopedic Surgery in which he stated: "Although these procedures have generated incredible interest and enthusiasm, I am concerned that they may be performed to the detriment of our patients." I couldn't agree with him more. Smaller is not necessarily better and, when it is worse, it will be the "smaller" that is held accountable.

  10. Drain tip culture following total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Bahubali Aski

    2015-02-01

    Full Text Available Background: Placing a suction drain following total knee replacement is usual practice which is been followed by many surgeons. Closed suction drainage following arthroplasty is a routine with the aim of preventing wound hematoma and thereby reducing the risk of infection. Surgical site infections in orthopaedic surgeries are disastrous and often lead to significant morbidity and mortality. Usefulness of drain tip culture in predicting the wound infection is been tested but results are controversial. Methods: It is a prospective study of 546 drains (352 patients who underwent unilateral or bilateral Total Knee Arthroplasty (TKA. The drain tip was sent for culture at the time of removing. Cultures from the SSI (surgical site infection were also collected. Cases that had at least six months of follow up were included in the study. However in one patient with superficial infection, the drain tip culture was negative. Results: Drain tip culture was positive in total of 18 patients. Three patients had developed deep infection and 10 patients had superficial infection. All three patients with deep infection and 9 out of 10 patients of superficial infection were culture positive. Out of 8 culture positive superficial infections, one had different bacteria identified from the site. Drain tip culture was positive in 3.39% of drains and infection rate was positive in 1.88% of wounds. On statistical analysis we found drain tip culture sensitivity of 90%, specificity of 98.46%, positive predictive value of 52.9% and negative predictive value of 99.8%. Conclusion: Drain tip culture positivity helps in predicting the future chance of developing the infection. If drain tip culture is negative, then there is almost near nil chances of infection. [Int J Res Med Sci 2015; 3(2.000: 409-411

  11. A General Review of Register Theory

    Institute of Scientific and Technical Information of China (English)

    王航

    2014-01-01

    <正>Register theory is important in the study of linguistic.It is developed by Halliday who defined it as a variety of language according to use.According to Halliday,language is strained by three variables:field,tenor and mode,which are the three variables of register.Nowadays,more and more researchers are focusing on the application of register theory on specific English

  12. Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Aria Fallah

    Full Text Available OBJECTIVE: To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA compared to anterior cervical discectomy with fusion (ACDF for patient-important outcomes for single-level cervical spondylosis. DATA SOURCES: Electronic databases (MEDLINE, EMBASE, Cochrane Register for Randomized Controlled Trials, BIOSIS and LILACS, archives of spine meetings and bibliographies of relevant articles. STUDY SELECTION: We included RCTs of ACDF versus ACDA in adult patients with single-level cervical spondylosis reporting at least one of the following outcomes: functionality, neurological success, neck pain, arm pain, quality of life, surgery for adjacent level degeneration (ALD, reoperation and dysphonia/dysphagia. We used no language restrictions. We performed title and abstract screening and full text screening independently and in duplicate. DATA SYNTHESIS: We used random-effects model to pool data using mean difference (MD for continuous outcomes and relative risk (RR for dichotomous outcomes. We used GRADE to evaluate the quality of evidence for each outcome. RESULTS: Of 2804 citations, 9 articles reporting on 9 trials (1778 participants were eligible. ACDA is associated with a clinically significant lower incidence of neurologic failure (RR = 0.53, 95% CI = 0.37-0.75, p = 0.0004 and improvement in the Neck pain visual analogue scale (VAS (MD = 6.56, 95% CI = 3.22-9.90, p = 0.0001; Minimal clinically important difference (MCID = 2.5. ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary. ACDA is associated with non-statistically significant higher improvement in the Neck Disability Index Score and lower incidence of ALD requiring surgery, reoperation, and dysphagia/dysphonia. CONCLUSIONS: There is no strong evidence to support the routine use of ACDA over ACDF in single-level cervical spondylosis. Current trials lack long-term data required to

  13. Management of failed metal-backed glenoid component in patients with bilateral total shoulder arthroplasty

    Directory of Open Access Journals (Sweden)

    Xinning Li

    2013-01-01

    Full Text Available Total shoulder arthroplasty (TSA is successful in providing pain relief and functional improvements for patients with shoulder arthritis. Outcomes are directly correlated with implant position and fixation, which ultimately affects wear and longevity. Metal-backed glenoid components were introduced as an alternative to the standard cemented glenoid fixation. Early loosening and cavitary glenoid bone loss has been reported as a major complication associated with these metal-backed glenoids, which presents the surgeon with a challenging revision situation. Furthermore, failure of bilateral TSA in patients with metal-backed glenoids is extremely rare. We present two patients with early failure of bilateral TSA secondary to loosening of the metal-backed glenoids. Both patients had significant glenoid bone loss and were treated with four different types of revision techniques. A description of treatments and outcomes of both patients are reported along with the simple shoulder test and American Shoulder and Elbow Surgeons scores. One patient underwent revision to bilateral reverse prosthesis and experienced a much-improved outcome in comparison to the patient revised to a hemiarthroplasty and resection arthroplasty, for each shoulder respectively. In patients who present with failed TSA, revision to a reverse prosthesis with or without staged glenoid bone graft should be considered as an option of treatment. It is also important to rule out infection with intraoperative tissue biopsy before proceeding to revision surgery. However, in patients with catastrophic glenoid bone loss, both hemiarthroplasty and resection arthroplasty can provide an alternative treatment option, but they are associated with a poorer functional outcome and pain relief.

  14. An Unexpected Complication of Hip Arthroplasty: Knee Dislocation

    Directory of Open Access Journals (Sweden)

    Serdar Yilmaz

    2015-01-01

    Full Text Available An increasing number of patients with hip fracture have been seen with osteoporosis associated with osteoarthritis. Although knee dislocation is related to high-energy trauma, low-grade injuries can also lead to knee dislocation which is defined as “ultra-low velocity dislocation.” The case reported here is of an 82-year-old patient who presented with a left intertrochanteric hip fracture. Partial arthroplasty was planned because of osteoporosis. In the course of surgery, degenerative arthritic knee was dislocated during the hip reduction maneuver with the application of long traction. The neurovascular examination was intact, but the knee was grossly unstable and was dislocated even in a brace; thus a hinged knee prosthesis was applied nine days after surgery. The patient was mobilized with crutches after the knee prosthesis but exercise tolerance was diminished. In conclusion, it should be emphasized that overtraction must be avoided during the hip reduction maneuver in patients with advanced osteoarthritic knee.

  15. Improved knee flexion following high-flexion total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Lionberger David R

    2012-06-01

    Full Text Available Abstract Background The application of new techniques and materials in total knee arthroplasty (TKA continue to be a primary focus in orthopedic surgery. The primary aim of the present study is to evaluate post TKA total range of motion (ROM among a group of patients who received a gender specific high-flexion design modification implant compared to a control group of patients who received non-gender specific implants. Methods and results The control group was comprised of 39 TKAs that were recruited pre-operatively and received the non-gender specific implant while the study group consisted of 39 TKAs who received gender specific implants. The study group yielded an improvement in mean post-operative ROM of 21° at 12 months, whereas the mean improvement in ROM among the control group was 11°. Thus, the study group had a 10° increased ROM improvement (91% over the control group (p = 0.00060. In addition, 100% of the subjects with gender specific high-flexion implants achieved greater or equal ROM post-operatively compared to 82% for the control cohort. Lastly, women who exhibited greater pre-operative ROM and lower body mass index (BMI were found to benefit the most with the gender specific prosthesis. Conclusion Our study demonstrates that among subjects with a normal BMI, the gender specific high-flexion knee implant is associated with increased ROM as compared to the non-gender specific non-high-flexion implant designs.

  16. Arthroplasty in young adults: options, techniques, trends, and results.

    Science.gov (United States)

    Mody, Bharat S; Mody, Kshitij

    2014-06-01

    Total knee arthroplasty (TKA) has been established as a very successful and commonly performed procedure for primary and secondary osteoarthritis, and also for inflammatory arthropathies of the knee in all age groups and both genders. It has predominantly been used as a procedure in the age group of patients 65 years and above. Consequently, the literature is replete with data relevant to various issues associated with TKA in the above 65 years age group population. Although there is reasonable clarity and consensus on the broad parameters of the use of TKA in the above 65 years age group (older), this cannot be said for the same issue as relevant to the below 65 years age group (young adults). Over the last 2 decades there has been an increasing tendency toward the use of TKA in young adults, with some countries reporting a 5-fold increase in the last 10 years [1]. The present article is designed to review the most recent literature specific to this subject and assess it vis-à-vis various issues as listed in the subsequent text, with the aim of highlighting evolving thoughts and trends, which could be useful for decision making by clinicians practicing in the community.

  17. TOTAL ANKLE ARTHROPLASTY: BRAZILIAN EXPERIENCE WITH THE HINTEGRA PROSTHESIS.

    Science.gov (United States)

    Nery, Caio; Fernandes, Túlio Diniz; Réssio, Cibele; Fuchs, Mauro Luiz; Godoy Santos, Alexandre Leme de; Ortiz, Rafael Trevisan

    2010-01-01

    Ankle arthrosis is becoming more and more common. The search for solutions that preserve joint function has led to a new generation of prosthesis with three components and more degrees of freedom. This paper presents the results achieved for ten patients treated with the HINTEGRA Prosthesis (Integra, New Deal), through collaborative action between the Foot and Ankle Groups of the Orthopedics and Traumatology divisions of Escola Paulista de Medicina, Unifesp, and the School of Medicine of the University of São Paulo (USP). The ten patients (six women and four men, aged between 29 and 66 years), underwent a surgical procedure consisting of Hintermann's technique, between January and June 2005. They were evaluated at prearranged intervals, and the data were subjected to statistical analysis. The surgery led to a significant improvement in ankle mobility. Radiological evaluation showed no signs of loosening or failure in the prosthetic components in any of the patients studied. Although the complication rate in our sample was high, it was equivalent to the rates found by other authors, and directly represents the learning curve associate with this kind of procedure. Four years after the procedure, it was found that the patients pain levels had significantly decreased, and that their functional patterns had significantly improved, with AOFAS and Hintermann scores indicating results that were excellent for 20%, good for 70% and poor for 10%. Treatment of ankle arthritis by means of total arthroplasty using the HINTEGRA prosthesis was capable of providing good results over an average observation period of four years.

  18. Validation of a cerebral palsy register

    DEFF Research Database (Denmark)

    Topp, Monica Wedell; Langhoff-Roos, J; Uldall, P

    1997-01-01

    OBJECTIVES: To analyse completeness and validity of data in the Cerebral Palsy Register in Denmark, 1979-1982. METHODS: Completeness has been assessed by comparing data from The Danish National Patient Register (DNPR) with the cases included in the Cerebral Palsy Register (CPR). Agreement between......, but gestational age was subject to a systematic error, and urinary infections in pregnancy (kappa = 0.43) and placental abruption (kappa = 0.52) were seriously under-reported in the CPR. CONCLUSIONS: Completeness of the Cerebral Palsy Register in Denmark, 1979-1982, has been assessed to maximal 85%, emphasizing...

  19. Economic impact of tranexamic acid in healthy patients undergoing primary total hip and knee arthroplasty.

    Science.gov (United States)

    Gillette, Blake P; Maradit Kremers, Hilal; Duncan, Christopher M; Smith, Hugh M; Trousdale, Robert T; Pagnano, Mark W; Sierra, Rafael J

    2013-09-01

    Tranexamic acid (TA) has been shown to reduce perioperative blood loss and blood transfusion. While concern remains about the cost of antifibrinolytic medication, we hypothesized that routine use of tranexamic acid would result in lower direct hospital total cost by decreasing costs associated with blood transfusion, laboratory testing, and room & board. Patients with an American Society of Anesthesiologists (ASA) class II or less undergoing primary total hip or knee arthroplasty at a single institution during 2007-2008 were retrospectively reviewed. The estimated mean direct hospital total cost, operating room, blood/lab, room & board, and pharmacy costs were compared between patients who did and did not receive TA. The study population included 1018 patients, and 580 patients received TA. The mean direct total cost of hospitalization with and without TA was $15,099 and $15,978 (P<.0002) respectively, a difference of $879. The only increased cost associated with TA was the pharmacy cost which was $921 versus $781 (P<.0001). The routine use of tranexamic acid TA was associated with lower mean direct hospital total costs after primary total hip and knee arthroplasty as the increase in pharmacy costs was more than offset by cost savings in other categories.

  20. A preliminary report of patellofemoral arthroplasty in isolated patellofemoral arthritis

    Institute of Scientific and Technical Information of China (English)

    GAO Xiang; XU Zheng-jian; HE Rong-xin; YAN Shi-gui; WU Li-dong

    2010-01-01

    Background Isolated patellofemoral osteoarthritis is not uncommon. Surgical treatment of isolated patellofemoral arthritis remains controversial and poses a challenging treatment dilemma. The present study aimed to evaluate the short-term results of patellofemoral arthroplasty for patients with isolated patellofemoral osteoarthritis.Methods We analyzed 11 patellofemoral arthroplasties performed from March 2006 to September 2009 in 11 patients with isolated patellofemoral arthritis. The patients comprised 2 males and 9 females with an average age of 53.7 years (range, 46-74 years). Standard weightbearing radiographs were taken in the anteroposterior, lateral, and 45° axial views.The knee pain and functional status were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales and American Knee Society (AKS) scores. For comparison, 23 total knee arthroplasties in 23 patients with primary tibiofemoral osteoarthritis were matched according to age, gender, bilaterality and body mass index.The duration of follow-up was 23.7 months (range, 12-47 months).Results The majority of the 11 patients experienced improvement in their patellofemoral symptoms after patellofemoral arthroplasty. The WOMAC scores improved considerably by 7.4 points with respect to pain and by 5.2 points with respect to function. The AKS scores also improved considerably by 23.9 points with respect to pain and 44.3 points with respect to function. Although the clinical outcomes after patellofemoral arthroplasty were not better than those after total knee arthroplasty, patellofemoral arthroplasty exhibited advantages in the shorter operation time, lower blood loss and increased postoperative range of motion. At the latest follow-up, there was no clinical or radiographic evidence of patellofemoral maltracking, loosening or wear.Conclusions On the basis of our experience in this relatively small series of patients with a short-term follow-up,patellofemoral arthroplasty

  1. Clinical and radiographic results of cervical artificial disc arthroplasty: over three years follow-up cohort study

    Institute of Scientific and Technical Information of China (English)

    TIAN Wei; HAN Xiao; LIU Bo; LI Qin; HU Lin; LI Zhi-yu; YUAN Qiang; HE Da; XING Yong-gang

    2010-01-01

    Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic effects of cervical disc arthroplasty in short term have been ascertained. The aim of this study is to research the data of mid-term results.Methods In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years (range from 29 to 73). The median follow-up was 41.85months (range from 36.00-55.63 months). Patients were followed prospectively with respect to their symptoms,neurologic signs, and radiographic results.Results The median value of Japanese Orthopaedic Association (JOA) score was 14.0 before surgery, and 16.5 at the most recent follow-up (P <0.01). The median value of the recovery rate of the JOA score was 92.2%. The preoperative range of motion (ROM) at the indexed level was (10.40±4.97)°, which has significantly correlated with the most recent follow-up ROM which was (8.56±4.76)° (P <0.05, r=0.33). The ROM at the operative level at the most recent follow-upwas greater than the value at the 3-month follow-up of (7.52±3.37)° (P <0.05). The preoperative functional spinal unit (FSU) angulation was (-0.96±6.52)°, which was not significantly correlated with that of the most recent follow-up value of (-2.65±7.95)° (P <0.01, r=0.53). The preoperative endplate angulation was (2.61±4.85)°, which had no significant correlation with that of the most recent follow-up value of (0.71±6.41)° (p >0.05).Conclusions The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well

  2. Durability of cervical disc arthroplasties and its influence factors

    Science.gov (United States)

    Chen, Chao; Zhang, Xiaolin; Ma, Xinlong

    2017-01-01

    Abstract Background: The durability of cervical disc arthroplasties (CDA) may vary significantly because of different designs and implanting techniques of the devices. Nevertheless, the comparative durability remains unknown. Objectives: We aimed to assess the durability of CDAs in at least 2-year follow-up. We analyzed the classifications and causes of secondary surgical procedures, as well as the structural designs of the devices that might influence the durability. Methods: PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from the inception of each database to September 2015 using the following Keywords: “cervical disc replacement” OR “cervical disc arthroplasty” AND “randomized controlled trial (RCT).” Publication language was restricted to English. The primary outcome was the rate of secondary surgical procedures following CDA or anterior cervical decompression and fusion (ACDF). Pairwise meta-analysis and a Bayesian network meta-analysis were carried out using Review Manager v5.3.5 and WinBUGS version 1.4.3, respectively. Quality of evidence was appraised by Grading of Recommendations Assessment, Development and Evaluation methodology. Results: Twelve RCTs that met the eligibility criteria were included. Follow-up ranged from 2 years to 7 years. A total of 103 secondary surgical procedures were performed. The most frequent classification of secondary surgical procedures was reoperation (48/103) and removal (47/103). Revision (3/103) and supplementary fixation (2/103) were rare. Adjacent-level diseases were the most common cause of reoperations. The rates of secondary surgical procedures were significantly lower in Mobi-C, Prestige, Prodisc-C, Secure-C group than in ACDF group. No significant difference was detected between Bryan, PCM, Kineflex-C, Discover, and ACDF. Mobi-C, Secure-C, and Prodisc-C ranked the best, the second best, the third best, respectively. Conclusions: We concluded that Mobi-C, Secure

  3. A review of ceramic bearing materials in total joint arthroplasty.

    Science.gov (United States)

    Bal, B S; Garino, J; Ries, M; Rahaman, M N

    2007-01-01

    Bearings made of ceramics have ultra-low wear properties that make them suitable for total hip arthroplasty (THA) and total knee arthroplasty (TKA). When compared to cobalt chrome (CoCr)-on-polyethylene (PE) articulations, ceramics offer drastic reductions in bearing wear rates. Lower wear rates result in fewer wear particles produced by the articulating surfaces. In theory, this should reduce the risk of periprosthetic osteolysis and premature implant loosening, thereby contributing to the longevity of total joints. In addition to ceramics, other alternative bearing couples, such as highly cross-linked PE (XLPE) and metal-on-metal also offer less wear than CoCr-on-PE articulations in total joint arthroplasty. Alumina and zirconia ceramics are familiar to orthopaedic surgeons since both materials have been used in total joints for several decades. While not new in Europe, alumina-on-alumina ceramic total hips have only recently become available for widespread use in the United States from various orthopaedic implant manufacturers. As the search for the ideal total joint bearing material continues, composite materials of existing ceramics, metal-on-ceramic articulations, and new ceramic technologies will offer more choices to the arthroplasty surgeon. The objective of this paper is to present an overview of material properties, clinical applications, evolution, and limitations of ceramic materials that are of interest to the arthroplasty surgeon.

  4. Intellijoint HIP®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Paprosky WG

    2016-11-01

    Full Text Available Wayne G Paprosky,1,2 Jeffrey M Muir3 1Department of Orthopedics, Section of Adult Joint Reconstruction, Department of Orthopedics, Rush University Medical Center, Rush–Presbyterian–St Luke’s Medical Center, Chicago, 2Central DuPage Hospital, Winfield, IL, USA; 3Intellijoint Surgical, Inc, Waterloo, ON, Canada Abstract: Total hip arthroplasty is an increasingly common procedure used to address degenerative changes in the hip joint due to osteoarthritis. Although generally associated with good results, among the challenges associated with hip arthroplasty are accurate measurement of biomechanical parameters such as leg length, offset, and cup position, discrepancies of which can lead to significant long-term consequences such as pain, instability, neurological deficits, dislocation, and revision surgery, as well as patient dissatisfaction and, increasingly, litigation. Current methods of managing these parameters are limited, with manual methods such as outriggers or calipers being used to monitor leg length; however, these are susceptible to small intraoperative changes in patient position and are therefore inaccurate. Computer-assisted navigation, while offering improved accuracy, is expensive and cumbersome, in addition to adding significantly to procedural time. To address the technological gap in hip arthroplasty, a new intraoperative navigation tool (Intellijoint HIP® has been developed. This innovative, 3D mini-optical navigation tool provides real-time, intraoperative data on leg length, offset, and cup position and allows for improved accuracy and precision in component selection and alignment. Benchtop and simulated clinical use testing have demonstrated excellent accuracy, with the navigation tool able to measure leg length and offset to within <1 mm and cup position to within <1° in both anteversion and inclination. This study describes the indications, procedural technique, and early accuracy results of the Intellijoint HIP

  5. Retention of the posterior cruciate ligament versus the posterior stabilized design in total knee arthroplasty: a prospective randomized controlled clinical trial

    Directory of Open Access Journals (Sweden)

    van den Akker-Scheek Inge

    2009-09-01

    for total knee arthroplasty are being used. To date no studies have been performed determining whether there is a difference in patient's perceived outcome between the two designs. Additionally, there is a lack of studies determining the speed of recovery in both designs as most studies only determine the final outcome. This randomised controlled study has been designed to determine whether the patient's perceived outcome and speed of recovery differs between a posterior cruciate retaining total knee arthroplasty and a posterior stabilized total knee arthroplasty. Trial Registration The trial is registered in the Netherlands Trial Registry (NTR1673.

  6. 76 FR 10410 - Sunshine Federal Register Notice

    Science.gov (United States)

    2011-02-24

    ... March 28, 2011--Tentative Tuesday, March 29, 2011 9 a.m. Briefing on Small Modular Reactors (Public... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Sunshine Federal Register Notice AGENCY: Nuclear Regulatory Commission. DATES: Weeks of...

  7. 76 FR 11290 - Sunshine Federal Register Notice

    Science.gov (United States)

    2011-03-01

    ... Tuesday, March 29, 2011 9 a.m. Briefing on Small Modular Reactors (Public Meeting) (Contact: Stephanie... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION Sunshine Federal Register Notice AGENCY HOLDING THE MEETINGS: Nuclear Regulatory Commission....

  8. 76 FR 17460 - SUNSHINE FEDERAL REGISTER NOTICE

    Science.gov (United States)

    2011-03-29

    ... Tuesday, March 29, 2011 9 a.m. Briefing on Small Modular Reactors (Public Meeting); (Contact: Stephanie... From the Federal Register Online via the Government Publishing Office NUCLEAR REGULATORY COMMISSION SUNSHINE FEDERAL REGISTER NOTICE AGENCY HOLDING THE MEETINGS: Nuclear Regulatory Commission...

  9. The Danish registers of causes of death

    DEFF Research Database (Denmark)

    Juel, K; Helweg-Larsen, K

    1999-01-01

    In 1875 registration of causes of death in Denmark was established by the National Board of Health, and annual statistics of death have since been published. Until 1970 the national statistics were based upon punched cards with data collected from the death certificates. Since then the register h......, and the research based upon the registers, presenting some examples of research activities....

  10. Political Discourse Translation from a Register Perspective

    Institute of Scientific and Technical Information of China (English)

    杨丽梅

    2014-01-01

    Recently, register theory has been largely adopted in translation studies. It can better avoid subjective factors in transla-tion in perspective of register. It can also evaluate“faithfulness”of translated text in a rigorous way. In the paper, register theory is introduced to political discourse translation. In Halliday’s systemic functional grammar, he defines“register”as the context of sit-uation. And there are three variables of register, respectively, field, tenor and mode. Field means what is taking place in the dis-course. By tenor, it refers to who is taking part in the discourse, i.e. participant. As for mode of discourse, it means what the lan-guage will do for the participants in the context of situation. The paper aims to discuss the guiding role that register theory has to political discourse translation practice through field, tenor and mode.

  11. Total hip arthroplasty in a patient with congenital insensitivity to pain: a case report

    Directory of Open Access Journals (Sweden)

    Erdil Mehmet

    2012-07-01

    Full Text Available Abstract Introduction Congenital insensitivity to pain, a rare neurological entity, is characterized by varying degrees of sensory loss and autonomic dysfunction. Orthopedic manifestations of congenital insensitivity to pain include delayed diagnosis of fractures, nonunions, malunions, Charcot arthropathy, acro-osteolysis, avascular necrosis, osteomyelitis, heterotopic ossification and joint dislocations. We here report the case of a patient with congenital insensitivity to pain who had multiple lower extremity fractures at varying intervals, the most recent being a femoral neck fracture managed by total hip replacement. To the best of our knowledge, this is the first report of cementless hip arthroplasty in such a patient. Case presentation A 37-year-old Caucasian woman was admitted to our hospital complaining of painless swellings in her lower limb and limping. She had been diagnosed with multiple lower extremity fractures at different times. On physical examination, we found multiple perioral mucosal ulcers, shortening of her nails and acro-osteolysis, a prematurely aged facial appearance, undersized skeletal structure, Charcot arthropathy of her right ankle, anosmia, insensitivity to temperature differences and evidence of mild intellectual disability. A right subtrochanteric femur fracture was treated with an intramedullary nail. Eighteen months later, she presented with similar symptoms and we diagnosed a right femoral neck fracture. We removed the nail and performed cementless total right hip arthroplasty. Conclusions Congenital insensitivity to pain is a rare condition that is associated with severe orthopedic problems. This case report, which will be of particular interest to orthopedic surgeons, presents several difficulties in the management of patients with congenital insensitivity to pain and notes the importance of close follow-up and early recognition of complications. Cementless total hip arthroplasty may be a good therapeutic

  12. Patient-reported outcome measures in arthroplasty registries

    DEFF Research Database (Denmark)

    Rolfson, Ola; Bohm, Eric; Franklin, Patricia

    2016-01-01

    unsatisfied, dissatisfied, neutral, satisfied, or very satisfied). Survey logistics include patient instructions, paper- and electronic-based data collection, reminders for follow-up, centralized as opposed to hospital-based follow-up, sample size, patient- or joint-specific evaluation, collection intervals......The International Society of Arthroplasty Registries (ISAR) Patient-Reported Outcome Measures (PROMs) Working Group have evaluated and recommended best practices in the selection, administration, and interpretation of PROMs for hip and knee arthroplasty registries. The 2 generic PROMs in common use...... are the Short Form health surveys (SF-36 or SF-12) and EuroQol 5-dimension (EQ-5D). The Working Group recommends that registries should choose specific PROMs that have been appropriately developed with good measurement properties for arthroplasty patients. The Working Group recommend the use of a 1-item pain...

  13. Radiographic and scintigraphic evaluation of total knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, R.; Soudry, M.

    1986-04-01

    Various radiographic and scintigraphic methods are used to supplement clinical findings in the evaluation of total knee arthroplasty and its complications. Serial roentgenograms offer reliable information for diagnosing mechanical loosening. Wide and extensive radiolucency at the cement-bone interface and shift in position and alignment of prosthetic components can be seen in almost all cases by the time revision is necessary. Radiographic abnormalities are usually not present in acute infection, but are often present in chronic infection. Bone scanning has a high sensitivity for diagnosis of infection or loosening, but is nonspecific because increased uptake is often present around asymptomatic total knee arthroplasties with normal radiographs. Differential bone and Gallium scanning and scanning with Indium 111-labeled leukocytes have a greater specificity for diagnosis of infection than does bone or Gallium scanning alone. Routine radiographic and scintigraphic studies have shown a high incidence of deep vein thrombosis in the calf after total knee arthroplasty. Clinically significant pulmonary embolization is infrequent.

  14. Early total hip arthroplasty for severe displaced acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    YANG Shu-hua; ZHANG Yu-kun; XU Wei-hua; LI Jin; LIU Guo-hui; YANG Cao; LIU Yong; TIAN Hong-tao

    2006-01-01

    Objective : To investigate the effect of early total hip arthroplasty for severe displaced acetabular fractures.Methods: Total hip arthroplasty was performed on 17 cases of severe fracture of the acetabulum from 1997 to 2003. The mean follow-up was 2.1 years (1-6 years) and the average period from fracture to operation was 8 days (5-21 day). The average age of the patients was 53 years (26-69 years).Results: At the final follow-up the Harris hip score averaged 82(69-100) points and 15 cases have got a good outcome. There was one case of heterotopic bone formation. There were no radiographic evidences of late loosening of the prosthesis. One patient had severe central displacement of the cup.Conclusions: In patients with severe displaced acetabular fractures, particularly in elderly patients, early total hip arthroplasty is probably an alternative efficient way to achieve a painless and stable hip.

  15. Revision reverse shoulder arthroplasty in failed shoulder arthroplasties for rotator cuff deficiency

    Science.gov (United States)

    RANDELLI, PIETRO; RANDELLI, FILIPPO; COMPAGNONI, RICCARDO; CABITZA, PAOLO; RAGONE, VINCENZA; PULICI, LUCA; BANFI, GIUSEPPE

    2015-01-01

    Purpose the aim of this systematic literature review is to report clinical outcomes of reverse shoulder arthroplasty (RSA) used as a revision surgery following failure of the primary implant due to rotator cuff insufficiency. Methods a systematic review was performed using the following key words: revision, shoulder, rotator cuff deficiency, outcome assessment, treatment outcome, complications. Studies eligible for inclusion in the review were clinical trials investigating patients in whom a primary shoulder arthroplasty implant with an incompetent rotator cuff was replaced with a reverse shoulder prosthesis. Results nine articles were identified and further reviewed. The results refer to a total of 226 shoulders that were treated with RSA as revision surgery. The patients in the studies had a mean age ranging from 64 to 72 years and the longest follow-up was 3.8 years. Improvements in function and reduction of pain were shown by many studies, but the mean Constant score ranged from 44.2 to 56. High complication rates (of up to 62%) were recorded, and a mean reoperation rate of 27.5%. Conclusions RSA as revision surgery for patients with rotator cuff deficiency is a valid option, and often the only solution available, but it should be limited to elderly patients with poor function and severe pain. Level of evidence level IV, systematic review of level I–IV studies. PMID:26151037

  16. Functional Outcomes of Revision Total Knee Arthroplasty Following Failed Unicompartmental Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Chris Ironside

    2014-12-01

    Full Text Available Introduction: Unicompartmental knee arthroplasty (UKA can be used to treat medial compartment osteoarthritis of the knee. Some of these knees will eventually fail, and need to be revised. There is controversy about using UKA in younger patients as a definitive procedure or as a means to delay total knee arthroplasty (TKA because the outcomes of subsequent revision surgery may be inferior to a primary TKA. Methods: We retrospectively reviewed a series of 46 revision TKA patients following failed UKA (UKA revisions using functional outcomes questionnaires and compared the results with a cohort of age and gender matched primary TKA patients. Our hypothesis was that UKA revision surgery would be inferior to primary TKA surgery. Results: Data was collected on 33 knees after a mean follow-up period of five years. There was no significant difference in the Oxford Knee Score (33.7 vs 37.1, p = 0.09 or the Western Ontario and MacMasters Universities Arthritis Index (WOMAC (24.8 vs. 19.1, p = 0.22. A subgroup analysis demonstrated that UKAs, which fail early, are more likely to produce an inferior outcome following revision surgery than those that survive more than five years. Discussion: We conclude that UKA can be used effectively in appropriately selected patients, as the functional outcome of their subsequent revision to TKA is not significantly inferior to a primary TKA.

  17. Epidemiology of Total Ankle Arthroplasty: Trends in New York State.

    Science.gov (United States)

    Seaworth, Christine M; Do, Huong T; Vulcano, Ettore; Mani, Sriniwasan B; Lyman, Stephen L; Ellis, Scott J

    2016-05-01

    The rate of total ankle arthroplasty (TAA) is increasing in the United States as its popularity and indications expand. There currently is no national joint registry available to monitor outcomes, and few studies have addressed the challenges faced with TAA. The purpose of this study was to evaluate the incidence, complications, and survival rates associated with TAA using a large statewide administrative discharge database. Individuals who underwent primary TAA from 1997 to 2010 were identified in the Statewide Planning and Research Cooperative System database from the New York State Department of Health. The age, sex, comorbidities, state of residence, primary diagnosis, and readmissions within 90 days were analyzed for patients with an ICD-9-CM procedure code of 81.56 (TAA). Failure of a TAA implant was defined as revision, tibiotalar arthrodesis, amputation, or implant removal. During the 14-year period, 420 patients underwent 444 TAAs (mean patient age of 61 years, 59% women, mean Charlson-Deyo comorbidity score of 0.45, and 86% New York State residents). The primary diagnosis was 37.4% osteoarthritis, 34.3% traumatic arthritis, and 15.5% rheumatoid arthritis. Surgery for failure was associated only with a younger age (56.5 vs 62 years, P=.005). The rate of subsequent failure procedures following TAAs performed in New York State was 13.8%. The incidence of TAAs is steadily increasing. The overall survival rate in New York State is better than rates reported in other national registries, but it is not yet comparable to those of hip and knee replacements. [Orthopedics. 2016; 39(3):170-176.].

  18. Oxidized Zirconium Bearing Surfaces in Total Knee Arthroplasty: Lessons Learned.

    Science.gov (United States)

    Schüttler, Karl Friedrich; Efe, Turgay; Heyse, Thomas J; Haas, Steven B

    2015-10-01

    Polyethylene wear in total knee arthroplasty is a still unsolved problem resulting in osteolysis and long-term failure of knee joint replacement. To address the problem of polyethylene wear, research aimed for an optimal implant design and for an optimal combination of bearing surfaces. Oxidized zirconium was introduced to minimize surface wear and thus potentially increase long-term implant survival. This review comprises the current literature related to in vitro and in vivo studies evaluating performance of oxidized zirconium total knee arthroplasty and results from retrieval analyses.

  19. History and factors of survival of total hip arthroplasty.

    Science.gov (United States)

    Kolundžić, Robert; Trkulja, Vladimir; Orlić, Dubravko

    2012-02-01

    Since the 1960s total hip arthroplasty (THA) has represented one of the greatest accomplishments in orthopedic surgery. It improves the functionality, working ability and quality of life of patients with non-functional hip joint due to various reasons. This article reviews general and regional history of THA, current knowledge and concepts regarding the long-term outcomes of the procedure and emphasizes the need for establishing national (and international) THA registries as an essential way of gathering data critical for decision making in daily practice as well as in defining national healthcare policies in respect to arthroplasty procedures.

  20. Use of cuff tear arthroplasty head prosthesis for rotator cuff arthropathy treatment in elderly patients with comorbidities

    Science.gov (United States)

    Carvalho, Cassiano Diniz; Andreoli, Carlos Vicente; Pochini, Alberto de Castro; Ejnisman, Benno

    2016-01-01

    ABSTRACT Objective To evaluate the clinical and functional behavior of patients undergoing cuff tear arthroplasty at different stages of the disease. Methods Cuff tear arthroplasty hemiarthroplasties were performed in 34 patients with rotator cuff arthropathy and associated comorbidities, classified according to Seebauer. The mean age was 76.3 years, and the sample comprised 23 females (67.6%) and 11 males (32.4%). The mean follow-up period was 21.7 months, and evaluations were performed using the Visual Analog Scale for pain and the Constant scale. Results There were no statistically significant differences in the mean reduction in the Visual Analog Scale or in the Constant scale increase between the female and male groups. The variation between the pre- and postoperative Visual Analog Scale and Constant scale evaluations was significant. There was also no statistically significant difference between the Seebauer classification groups regarding the mean Visual Analog Scale reduction, or the mean Constant scale increase. Conclusion Cuff tear arthroplasty shoulder hemiarthroplasty is a good option for rotator cuff arthropathy in patients with comorbidities. PMID:28076600

  1. Individual- and neighborhood-level characteristics associated with support of in-pharmacy vaccination among ESAP-registered pharmacies: pharmacists' role in reducing racial/ethnic disparities in influenza vaccinations in New York City.

    Science.gov (United States)

    Crawford, Natalie D; Blaney, Shannon; Amesty, Silvia; Rivera, Alexis V; Turner, Alezandria K; Ompad, Danielle C; Fuller, Crystal M

    2011-02-01

    New York State (NYS) passed legislation authorizing pharmacists to administer immunizations in 2008. Racial/socioeconomic disparities persist in vaccination rates and vaccine-preventable diseases such as influenza. Many NYS pharmacies participate in the Expanded Syringe Access Program (ESAP), which allows provision of non-prescription syringes to help prevent transmission of HIV, and are uniquely positioned to offer vaccination services to low-income communities. To understand individual and neighborhood characteristics of pharmacy staff support for in-pharmacy vaccination, we combined census tract data with baseline pharmacy data from the Pharmacies as Resources Making Links to Community Services (PHARM-Link) study among ESAP-registered pharmacies. The sample consists of 437 pharmacists, non-pharmacist owners, and technicians enrolled from 103 eligible New York City pharmacies. Using multilevel analysis, pharmacy staff who expressed support of in-pharmacy vaccination services were 69% more likely to support in-pharmacy HIV testing services (OR, 1.69; 95% CI 1.39-2.04). While pharmacy staff who worked in neighborhoods with a high percent of minority residents were less likely to express support of in-pharmacy vaccination, those in neighborhoods with a high percent of foreign-born residents were marginally more likely to express support of in-pharmacy vaccination. While educational campaigns around the importance of vaccination access may be needed among some pharmacy staff and minority community residents, we have provided evidence supporting scale-up of vaccination efforts in pharmacies located in foreign-born/immigrant communities which has potential to reduce disparities in vaccination rates and preventable influenza-related mortality.

  2. Emerging technologies in arthroplasty: additive manufacturing.

    Science.gov (United States)

    Banerjee, Samik; Kulesha, Gene; Kester, Mark; Mont, Michael A

    2014-06-01

    Additive manufacturing is an industrial technology whereby three-dimensional visual computer models are fabricated into physical components by selectively curing, depositing, or consolidating various materials in consecutive layers. Although initially developed for production of simulated models, the technology has undergone vast improvements and is currently increasingly being used for the production of end-use components in various aerospace, automotive, and biomedical specialties. The ability of this technology to be used for the manufacture of solid-mesh-foam monolithic and coated components of complex geometries previously considered unmanufacturable has attracted the attention of implant manufacturers, bioengineers, and orthopedic surgeons. Currently, there is a paucity of reports describing this fabrication method in the orthopedic literature. Therefore, we aimed to briefly describe this technology, some of the applications in other orthopedic subspecialties, its present use in hip and knee arthroplasty, and concerns with the present form of the technology. As there are few reports of clinical trials presently available, the true benefits of this technology can only be realized when studies evaluating the clinical and radiographic outcomes of cementless implants manufactured with additive manufacturing report durable fixation, less stress shielding, and better implant survivorship. Nevertheless, the authors believe that this technology holds great promise and may potentially change the conventional methods of casting, machining, and tooling for implant manufacturing in the future.

  3. The femoral sulcus in total knee arthroplasty.

    Science.gov (United States)

    Lingaraj, Krishna; Bartlett, John

    2009-05-01

    The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native femoral sulcus. The location of the femoral sulcus was studied in 112 consecutive patients undergoing TKA. The mean sulcus position was 0.7 mm lateral to the midline of the distal femoral resection (SD 1.4, 95% CI, 0.5-1.0 mm). However, the variation in sulcus positions ranged from 4 mm medial to 4 mm lateral to the midline. The mean sulcus position in valgus knees was 1.0 mm lateral to the midline (SD 1.8), and that in varus knees was 0.7 mm lateral to the midline (SD 1.2) (P = 0.501). It appears prudent to centre the femoral component on the native sulcus rather than the midline of the distal femoral resection, so as to ensure accurate alignment of the prosthetic sulcus with the native sulcus and to encourage normal patella tracking.

  4. Muscular strength after total hip arthroplasty

    Science.gov (United States)

    Winther, Siri B; Husby, Vigdis S; Foss, Olav A; Wik, Tina S; Svenningsen, Svein; Engdal, Monika; Haugan, Kristin; Husby, Otto S

    2016-01-01

    Background and purpose Minimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches. Patients and methods In a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach. Leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up. Results Differences in maximal strength change were greatest after 2 and 8 days. The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach. At 3-month follow-up, no statistically significant differences between the groups were found. The operated legs were 18% weaker in leg press and 15% weaker in abduction than the unoperated legs, and the results were similar between groups. Interpretation The posterior and anterior approaches appeared to have the least negative effect on abduction and leg press muscular strength in the first postoperative week; the posterior approach had the least negative effect, even up to 6 weeks postoperatively. THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery. PMID:26141371

  5. Total Knee Arthroplasty in the Combined Contracture

    Directory of Open Access Journals (Sweden)

    O.J. Voskresensky

    2009-09-01

    Full Text Available We have offered modified access to a knee to work out a method for restoration of extensive apparatus of the knee. 91 patients with degenerative damages of the knee were under out su-pervision. All patients were differentiated in groups according to the form of access and pa-thology of the knee. At all stages of studying the following method of investigation were made: goniometry — for estimation of the knee functional condition; electroneiromyography — for reveling deficiency of muscular activity and determination of its kind. Patient's satisfac-tion by operation was defined by means of WOMAC scale subjective indexes. The received digital material was subjected to statistical processing. Thus, it has been proved that applica-tion of the modified access to a knee offered by us in total knee arthroplasty in patients with combined contracture in comparison with traditionally applied technologies of extensive ap-paratus releasing allows in short terms to restore the volume and force of movements in a knee that reduces time of rehabilitation and improves quality of patient's life

  6. Can technology improve alignment during knee arthroplasty.

    Science.gov (United States)

    Thienpont, Emmanuel; Fennema, Peter; Price, Andrew

    2013-09-01

    Component malalignment remains a concern in total knee arthroplasty (TKA); therefore, a series of technologies have been developed to improve alignment. The authors conducted a systematic review to compare computer-assisted navigation with conventional instrumentation, and assess the current evidence for patient-matched instrumentation and robot-assisted implantation. An extensive search of the PubMed database for relevant meta-analyses, systematic reviews and original articles was performed, with each study scrutinised by two reviewers. Data on study characteristics and outcomes were extracted from each study and compared. In total 30 studies were included: 10 meta-analyses comparing computer-assisted navigation and conventional instrumentation, 13 studies examining patient-matched instrumentation, and seven investigating robot-assisted implantation. Computer-assisted navigation showed significant and reproducible improvements in mechanical alignment over conventional instrumentation. Patient-matched instrumentation appeared to achieve a high degree of mechanical alignment, although the majority of studies were of poor quality. The data for robot-assisted surgery was less indicative. Computer-assisted navigation improves alignment during TKA over conventional instrumentation. For patient-matched instrumentation and robot-assisted implantation, alignment benefits have not been reliably demonstrated. For all three technologies, clinical benefits cannot currently be assumed, and further studies are required. Although current technologies to improve alignment during TKA appear to result in intra-operative benefits, their clinical impact remains unclear, and surgeons should take this into account when considering their adoption.

  7. Continuous cold therapy in total knee arthroplasty.

    Science.gov (United States)

    Leutz, D W; Harris, H

    1995-01-01

    This article describes a retrospective study that assessed 52 consecutive patients who underwent total knee arthroplasty (TKA) between January 1, 1992 and September 15, 1992. Thirty-three patients underwent TKA and received cold therapy pads placed over a thin dressing in the operating room. Nineteen patients underwent TKA using an identical operative and postoperative procedure, but did not receive continuous cold therapy. Continuous cold therapy consisted of two sterile plastic pads connnected by rubber hoses containing cool water from an electric main unit that maintained a constant temperature of 42 degrees F for the immediate postoperative period. Cold therapy pads were used an average of 3 days and removed with the first dressing change. Patients who had continuous cold therapy averaged a 200 cc decrease in postoperative blood loss. There was no significant difference in the amount of narcotic use, transfusion requirements, or hospital stay between the two groups. Postoperative swelling and range of motion were not consistently recorded. Twenty-eight other variables also examined not significant. Based on these results, we cannot recommend continuous cold therapy or justify the extra expense for all patients who undergo TKA.

  8. Register-based studies of healthcare costs

    DEFF Research Database (Denmark)

    Kruse, Marie; Christiansen, Terkel

    2011-01-01

    Introduction: The aim of this paper is to provide an overview and a few examples of how national registers are used in analyses of healthcare costs in Denmark. Research topics: The paper focuses on health economic analyses based on register data. For the sake of simplicity, the studies are divide...... a comprehensive data material, often in the form of time series, which is very useful in health economic analyses. The disadvantage of register-based data is the use of tariffs, charges, or market prices as proxies for costs in the computation of healthcare costs....

  9. Registered access: a 'Triple-A' approach.

    Science.gov (United States)

    Dyke, Stephanie O M; Kirby, Emily; Shabani, Mahsa; Thorogood, Adrian; Kato, Kazuto; Knoppers, Bartha M

    2016-12-01

    We propose a standard model for a novel data access tier - registered access - to facilitate access to data that cannot be published in open access archives owing to ethical and legal risk. Based on an analysis of applicable research ethics and other legal and administrative frameworks, we discuss the general characteristics of this Registered Access Model, which would comprise a three-stage approval process: Authentication, Attestation and Authorization. We are piloting registered access with the Demonstration Projects of the Global Alliance for Genomics and Health for which it may provide a suitable mechanism for access to certain data types and to different types of data users.

  10. The Danish Multiple Sclerosis Treatment Register

    DEFF Research Database (Denmark)

    Magyari, Melinda; Koch-Henriksen, Nils; Sørensen, Per Soelberg

    2016-01-01

    AIM OF THE DATABASE: The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, enabling the health authorities to monitor the quality of the disease-modifying treatment, and it is an important data source for epidemiological research. STUDY POPULATION......: The DMSTR includes all patients with multiple sclerosis who had been treated with disease-modifying drugs since 1996. At present, more than 8,400 patients have been registered in this database. Data are continuously entered online into a central database from all sites in Denmark at start and at regular...

  11. Effect of Hypovitaminosis D on Postoperative Pain Outcomes and Short-Term Health-Related Quality of Life After Knee Arthroplasty: A Cohort Study.

    Science.gov (United States)

    Lee, Anna; Chan, Simon Kin Cheong; Samy, Winnie; Chiu, Chun Hung; Gin, Tony

    2015-10-01

    Vitamin D may have an important role in pain perception. Inadequate vitamin D levels are associated with suboptimal recovery after surgery. However, the effects of hypovitaminosis D on postoperative pain-related outcomes and its impact on health-related quality of life after surgery are not well understood. The objective of this study was to determine the effects of hypovitaminosis D on postoperative pain-related outcomes and health-related quality of life at 3 months after knee arthroplasty.This was a longitudinal cohort study of 191 consecutive Hong Kong Chinese patients who were given patient-controlled morphine analgesia for up to 72 hours after 214 knee arthroplasties. Serum total 25-hydroxyvitamin D (25-OHD) concentration was assessed by liquid chromatography-tandem mass spectrometry. The primary outcomes were postoperative pain intensity at rest scores (0-72 h), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index (pain, stiffness and function), and moderate-to-severe persistent pain (transformed WOMAC pain score of 0-75 at 3 months after knee arthroplasty; 0, extreme pain; 100, no pain). Group differences were analyzed using generalized estimating equation models and a logistic regression model.The prevalence of preoperative hypovitaminosis D (25-OHD hypovitaminosis D (25-OHD Hypovitaminosis D increased the risk of moderate-to-severe persistent pain (adjusted odds ratio 2.64, 95% CI: 1.03-6.77).Preoperative hypovitaminosis D had subtle effects on pain intensity scores in the early postoperative period and is a risk factor for moderate-to-severe persistent pain after knee arthroplasty. Hypovitaminosis D was not associated with worse health-related quality of life at 3 months after knee arthroplasty.

  12. Perioperative safety of two-team simultaneous bilateral total knee arthroplasty in the obese patient

    Directory of Open Access Journals (Sweden)

    Gaines Steven T

    2010-06-01

    Full Text Available Abstract Background Although the rates of perioperative morbidity and mortality with simultaneous bilateral total knee arthroplasty remain a concern, multiple studies have shown the procedure to be safe in selected patient populations. Evidence also remains mixed regarding the outcomes of total knee arthroplasty in obese patients. The purpose of this paper is to compare the rates of perioperative morbidity and mortality in consecutive obese patients undergoing two-team simultaneous bilateral total knee arthroplasty and unilateral total knee arthroplasty. Methods The records on all two-team simultaneous total knee arthroplasties and unilateral total knee arthroplasties from October 1997 to December 2007 were reviewed. A total of 151 patients with a body mass index (BMI >30 undergoing two-team simultaneous total knee arthroplasty and 148 patients with a BMI >30 undergoing unilateral total knee arthroplasty were retrospectively reviewed and analyzed to determine perioperative morbidity and mortality as well as one-year mortality rates. Results Preoperative patient characteristics did not show any significant differences between groups. The simultaneous bilateral group had significantly longer operative times (127.4 versus 112.7 minutes, p Conclusions Two-team simultaneous total knee arthroplasty appears to be safe in obese patients, with similar complication rates as compared to unilateral procedures. Two-team simultaneous total knee arthroplasty also appears to have potential benefits over a staged procedure in the obese patient, although more study is required regarding this topic.

  13. National Sample Survey of Registered Nurses

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Sample Survey of Registered Nurses (NSSRN) Download makes data from the survey readily available to users in a one-stop download. The Survey has been...

  14. The Euphemism variety Based on Register theory

    Institute of Scientific and Technical Information of China (English)

    贾文庆

    2015-01-01

    It is the substitution of an agreeable expression for one that may offend something unpleasant. Euphemisms have a close relationship with context, especially tenor of discourse. This paper attempts to analyze the variation of euphemisms guided by register theory.

  15. Good performance of a titanium femoral component in cementless hip arthroplasty in younger patients: 97 arthroplasties followed for 5-11 years

    DEFF Research Database (Denmark)

    Jacobsen, Steffen; Jensen, Frank Krieger; Poulsen, Klaus

    2003-01-01

    We performed 97 uncemented primary total hip arthroplasties in 80 patients having an average age of 50 years. The femoral implant was a titanium stem with a proximal circumferential plasma spray-coating. Three different acetabular components were used: a threaded and partly porous-coated design...... osteolysis associated with a deep infection, but no signs of proximal loosening. 3 femora had areas of minor proximal osteolysis. 16 acetabular components (14 threaded) had been revised in 13 patients. The average Harris hip score was 91 points at the latest follow-up. We conclude that the uncemented...... titanium femoral component with a circumferential porous coating performed well in these patients, most of whom were young. As reported previously, aseptic loosening of threaded acetabular components was common....

  16. The Danish Multiple Sclerosis Treatment Register

    OpenAIRE

    Magyari M; Koch-Henriksen N; Sørensen PS

    2016-01-01

    Melinda Magyari,1,3 Nils Koch-Henriksen,1,2 Per Soelberg Sørensen3 1Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen, 2Department of Clinical Epidemiology, Clinical Institute, University of Aarhus, Aarhus, 3Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Aim of the database: The Danish Multiple Sclerosis Treatment Register (DMSTR) serves as a clinical quality register, e...

  17. Register as the Situational Variety of Language

    Directory of Open Access Journals (Sweden)

    Natalya B. Boyeva-Omelechko

    2016-12-01

    Full Text Available The problem discussed in the article is topical due to the interest of scientists to different types of language variations and especially registers or situational dialects treated by M.A.K. Halliday as use-related varieties of language or varieties used in a particular social setting. As discourse categorization is a very complex problem scholarly consensus has not been reached for the definitions of the term «register». The universal criteria for defining and discriminating registers have not been worked out either. The authors of the article give the review of scientific works devoted to the problem in question especially works by M.A.K. Halliday, R. Quirk, M. Joos, D. Hymes P. Trudgill, E.I. Belyaeva and others and analyze different definitions of the term «register», spectrums of registers and criteria for their discriminating. It enables the authors to come to the conclusion that only registers with the same field (religious, political, business etc. and mode (oral/written, dialogue/monologue can be compared. The difference lies in the sphere of tenor which depends on the degree of formality, distance of power and socio-psychological distance between speakers. The authors believe that it is also necessary to take into account the cooperative/ uncooperative character of conversation and para-verbal and non-verbal components of the speech situation. With this in mind they offer their definition of the register and describe main characteristics of registers in the sphere of oral communication.

  18. In vitro method for assessing the biomechanics of the patellofemoral joint following total knee arthroplasty.

    Science.gov (United States)

    Coles, L G; Gheduzzi, S; Miles, A W

    2014-12-01

    The patellofemoral joint is a common site of pain and failure following total knee arthroplasty. A contributory factor may be adverse patellofemoral biomechanics. Cadaveric investigations are commonly used to assess the biomechanics of the joint, but are associated with high inter-specimen variability and often cannot be carried out at physiological levels of loading. This study aimed to evaluate the suitability of a novel knee simulator for investigating patellofemoral joint biomechanics. This simulator specifically facilitated the extended assessment of patellofemoral joint biomechanics under physiological levels of loading. The simulator allowed the knee to move in 6 degrees of freedom under quadriceps actuation and included a simulation of the action of the hamstrings. Prostheses were implanted on synthetic bones and key soft tissues were modelled with a synthetic analogue. In order to evaluate the physiological relevance and repeatability of the simulator, measurements were made of the quadriceps force and the force, contact area and pressure within the patellofemoral joint using load cells, pressure-sensitive film, and a flexible pressure sensor. The results were in agreement with those previously reported in the literature, confirming that the simulator is able to provide a realistic physiological loading situation. Under physiological loading, average standard deviations of force and area measurements were substantially lower and comparable to those reported in previous cadaveric studies, respectively. The simulator replicates the physiological environment and has been demonstrated to allow the initial investigation of factors affecting patellofemoral biomechanics following total knee arthroplasty.

  19. Outlier analysis in orthopaedics: use of CUSUM: the Scottish Arthroplasty Project: shouldering the burden of improvement.

    Science.gov (United States)

    Macpherson, Gavin J; Brenkel, Ivan J; Smith, Rik; Howie, Colin R

    2011-12-21

    National joint registries have become well established across the world. Most registries track implant survival so that poorly performing implants can be removed from the market. The Scottish Arthroplasty Project was established in 1999 with the aim of encouraging continual improvement in the quality of care provided to joint replacement patients in Scotland. This aim has been achieved by using statistics to engage surgeons in the process of audit. We monitor easily identifiable end points of public concern and inform surgeons if they breach our statistical limits and become "outliers." Outlier status is often associated with poor implants, and our methods are therefore applicable for indirect implant surveillance. The present report describes the evolution of our statistical methodology, the processes that we use to promote positive changes in practice, and the improvements in patient outcomes that we have achieved. Failure need not be fatal, but failure to change almost always is. We describe the journey of both the Scottish Arthroplasty Project and the orthopaedic surgeons of Scotland to this realization.

  20. Amputation after failure or complication of total knee arthroplasty: prevalence, etiology and functional outcomes

    Directory of Open Access Journals (Sweden)

    Alan de Paula Mozella

    2013-09-01

    Full Text Available OBJECTIVE: Identify the etiology and incidence, as well to assess functional outcomes of patients, undergoing lower limb amputation after failure or complication of total knee arthroplasty. These patients were treated at the Center for Knee Surgery at the National Institute of Traumatology and Orthopedics (INTO, during the period of January 2001 to December 2010. METHODS: The patients were interviewed and their charts were retrospectively analyzed to evaluate their functional outcome. RESULTS: The incidence of amputation due to failure or complication of total knee arthroplasty was 0.41% in 2409 cases. Recurrent deep infection was the cause of amputation in 81% of cases, being Staphylococcus aureus and Pseudomonas aeruginosa the most frequent germs. Vascular complications and periprosthetic fracture associated to metaphyseal bone loss were also causes of amputation. In our study, 44% of amputees patients were using orthesis and 62.5% have had the ability to walk. CONCLUSION: Incidence of 0.41%, being the main cause recurrent infection. The functional outcome is limited, and the fitting achieved in 44% of patients and only 62.5% are ambulatory.

  1. Ertapenem Articulating Spacer for the Treatment of Polymicrobial Total Knee Arthroplasty Infection

    Directory of Open Access Journals (Sweden)

    Dragan Radoicic

    2016-01-01

    Full Text Available Introduction. Periprosthetic joint infections (PJIs are the primary cause of early failure of the total knee arthroplasty (TKA. Polymicrobial TKA infections are often associated with a higher risk of treatment failure. The aim of the study was to assess the efficacy of ertapenem loaded spacers in the treatment of polymicrobial PJI. Methods. There were 18 patients enrolled; nine patients with polymicrobial PJI treated with ertapenem loaded articulating spacers were compared to the group of 9 patients treated with vancomycin or ceftazidime loaded spacers. Results. Successful reimplantation with revision implants was possible in 66.67%. Ertapenem spacers were used in 6 cases in primary two-stage procedure and in 3 cases in secondary spacer exchange. Successful infection eradication was achieved in all cases; final reimplantation with revision knee arthroplasty implants was possible in 6 cases. Conclusion. Ertapenem can be successfully used as antimicrobial addition to the cement spacers in two-stage revision treatment of polymicrobial PJIs. However, this type of spacer may also be useful in the treatment of infections caused by monomicrobial extended spectrum beta-lactamases producing gram-negative bacilli. Further clinical studies are required to evaluate the efficacy and safety of ertapenem spacers in the treatment of polymicrobial and monomicrobial PJIs.

  2. Clinical effects of applying a tourniquet in total knee arthroplasty on blood loss

    Institute of Scientific and Technical Information of China (English)

    ZHANG Fu-jiang; XIAO Yu; LIU Ya-bin; TIAN Xu; GAO Zhi-guo

    2010-01-01

    Background Tourniquets used during total knee arthroplasty may lead to many complications. The aim of this study was to determine perioperative blood loss and its clinical relevance in total knee replacement surgery after applying a tourniquet.Methods From June 2009 to October 2009, 60 consecutive patients who underwent routine total knee arthroplasty were randomly divided into two groups and were treated with or without a tourniquet (30 patients/group). There were no significant differences in patient baseline characteristics between the two groups. We compared the two groups of patients in terms of intra- and postoperative bleeding, invisible or visible bleeding, and total blood loss.Results None of the patients showed poor wound healing, lower extremity deep venous thrombosis or other complications. The amount of blood loss during surgery was lower in the tourniquet group than in the control group (P<0.01). However, postoperative visible bleeding (P <0.05) and occult bleeding (P <0.05) were significantly greater in the toumiquet group than in the control group. There was no significant difference in the total amount of blood loss between the two groups (P >0.05).Conclusions Tourniquet can reduce bleeding during total knee replacement surgery, but is associated with greater visible and invisible blood loss.

  3. Register Allocation By Model Transformer Semantics

    CERN Document Server

    Wang, Yin

    2012-01-01

    Register allocation has long been formulated as a graph coloring problem, coloring the conflict graph with physical registers. Such a formulation does not fully capture the goal of the allocation, which is to minimize the traffic between registers and memory. Linear scan has been proposed as an alternative to graph coloring, but in essence, it can be viewed as a greedy algorithm for graph coloring: coloring the vertices not in the order of their degrees, but in the order of their occurence in the program. Thus it suffers from almost the same constraints as graph coloring. In this article, I propose a new method of register allocation based on the ideas of model transformer semantics (MTS) and static cache replacement (SCR). Model transformer semantics captures the semantics of registers and the stack. Static cache replacement relaxes the assumptions made by graph coloring and linear scan, aiming directly at reducing register-memory traffic. The method explores a much larger solution space than that of graph c...

  4. Low manipulation prevalence following fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill;

    2015-01-01

    Background and purpose - Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which may...

  5. Total knee arthroplasty after high tibial osteotomy. A systematic review

    NARCIS (Netherlands)

    T.M. van Raaij (Tom); M. Reijman (Max); A. Furlan (Alessandro); J.A.N. Verhaar (Jan)

    2009-01-01

    textabstractBackground: Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee art

  6. Successful total knee arthroplasty in the presence of sporotrichal arthritis.

    NARCIS (Netherlands)

    Koeter, S.; Jackson, R.W.

    2006-01-01

    Articular sporotrichosis, a chronic granulomatous fungal infection, is a rare entity but when present may lead to significant joint destruction. Severe knee arthrosis due to sporotrichal arthritis has traditionally been treated with arthrodesis. Total knee arthroplasty in the presence of sporotricha

  7. Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ Implant Arthroplasty

    Directory of Open Access Journals (Sweden)

    Amir Reza Kachooei

    2014-09-01

    Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.

  8. Wear particles and osteolysis in patients with total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Toxværd, Anders; Bansal, Manjula;

    2014-01-01

    PURPOSE: To determine whether the amount of polyethylene debris in the interphase tissue between prosthesis and bone in patients with total wrist arthroplasty correlated with the degree of periprosthetic osteolysis (PPO); and to investigate the occurrence of metal particles in the periprosthetic...

  9. Criteria used when deciding on eligibility for total knee arthroplasty

    DEFF Research Database (Denmark)

    Skou, Søren Thorgaard; Ross, Ewa M.; Laursen, Mogens Berg;

    2016-01-01

    BACKGROUND: Clinical decision-making in total knee arthroplasty (TKA) is a complex process needing further clarification. The aim of this study was to compare TKA eligibility criteria considered most important by orthopedic surgeons (OSs) to characteristics of patients with knee osteoarthritis (OA...

  10. Fast-track knee arthroplasty – status and future challenges

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Thienpont, Emmanuel

    2013-01-01

    Fast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee a...

  11. Compartment syndrome and popliteal vascular injury complicating unicompartmental knee arthroplasty

    NARCIS (Netherlands)

    Kort, Nanne Pieter; Van Raay, Jos J. J. A. M.; van Horn, Jim R.

    2007-01-01

    Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not bee

  12. Navigation improves accuracy of rotational alignment in total knee arthroplasty.

    Science.gov (United States)

    Stöckl, Bernd; Nogler, Michael; Rosiek, Rafal; Fischer, Martin; Krismer, Martin; Kessler, Oliver

    2004-09-01

    Successful total knee arthroplasty is dependent on the correct alignment of implanted prostheses. Major clinical problems can be related to poor femoral component positioning, including sagittal plane and rotational malalignment. A prospective randomized study was designed to test whether an optical navigation system for total knee arthroplasty achieved greater implantation precision than a nonnavigated technique. The primary variable was rotation of the femoral component in the transverse plane, measured from postoperative radiographs and computed tomography images. Sixty-four patients were included in the study. All patients received the Duracon total knee prosthesis. The patients were randomly divided into two groups: Group C patients had conventional total knee arthroplasty without navigation; Group N patients had total knee arthroplasty using a computer-assisted knee navigation system. Analysis showed that patients in Group N had significantly better rotational alignment and flexion angle of the femoral component than patients in Group C. In addition, superior postoperative alignment of the mechanical axis, posterior tibial slope, and rotational alignment was achieved for patients in Group N. The use of a navigation system provides improved alignment accuracy, and can help to avoid femoral malrotation and errors in axial alignment.

  13. Alpine Skiing With total knee ArthroPlasty (ASWAP)

    DEFF Research Database (Denmark)

    Kristensen, M.; Pötzelsberger, B.; Scheiber, P.;

    2015-01-01

    We investigated the effect of alpine skiing for 12 weeks on skeletal muscle characteristics and biomarkers of glucose homeostasis and cardiovascular risk factors. Twenty-three patients with a total knee arthroplasty (TKA) were studied 2.9 ± 0.9 years (mean ± SD) after the operation. Fourteen...

  14. Alpine Skiing With total knee ArthroPlasty (ASWAP)

    DEFF Research Database (Denmark)

    Koesters, A.; Poetzelsberger, B.; Dela, F.

    2015-01-01

    The aim of this study was to monitor the long-term effects of skiing on health-related parameters and implant related factors like loosening and wear in patients with total knee arthroplasty. This paper describes the overall study design, general demographics, and physiological demand of the inte...

  15. Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty : design of a randomized controlled trial

    NARCIS (Netherlands)

    Zijlstra, Wierd P.; Bos, Nanne; van Raaij, Jos J. A. M.

    2008-01-01

    Background: Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyet

  16. SCHIZOPHRENIA AND IRRITABILITY ASSOCIATED WITH AUTISTIC DISORDER | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available tamientos aberrantes (ABC).? Escala de obsesiones y compulsiones de Yale-Brown pa...tudio D1050325:? Lista de comprobación de comportamientos aberrantes (ABC).? Escala de obsesiones y compulsion

  17. CUSTOMIZED ACETABULAR COMPONENTS IN REVISION HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    G. M. Kavalersky

    2016-01-01

    Full Text Available In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years. Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months. The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be

  18. Salvage arthrodesis for failed total ankle arthroplasty

    Science.gov (United States)

    Zürcher, Arthur W

    2010-01-01

    Background and purpose Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease. Patients and methods Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, the foot function index (FFI) and by VAS scores for pain, function, and satisfaction. Results Blade plates were used in 7 ankles (4 IJD, 3 OA); all united. Nonunion developed in 7 of the 11 rheumatic ankles stabilized by other methods. 11 patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. Their mean AOFAS score was 62 and mean overall FFI was 70. VAS score for pain was 20, for function 64, and for satisfaction 74. The scores were similar in united and non-united ankles. Interpretation Blade plate fixation is successful in salvage arthrodesis for failed TAA. A high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Clinical results were fair to good. PMID:20175648

  19. Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Uchida Kenzo

    2012-09-01

    Full Text Available Abstract Introduction Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. Case presentation We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement. Conclusions Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.

  20. The association between platelet CD36 expression and risk of acute pulmonary embolism in patients undergoing total knee arthroplasty surgery%血小板CD36与膝关节置换术后发生急性肺栓塞的相关因素

    Institute of Scientific and Technical Information of China (English)

    覃巍; 郭青; 左康康; 廉凯

    2016-01-01

    Objective To study the association between platelet CD36 and acute pulmonary embolism( APE) in pa-tients after total knee arthroplasty ( TKA ) . Methods A total of 50 patients with APE and 150 non-APE patients simuleaneously were included, and baseline data were compared in this study. Results Age, anticoagulant use, to-tal cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterin (LDL-C) and D dimer (D-D) in pa-tients with APE had statistical differences compared with non-APE patients ( P<0. 05 ) , and the platelet CD36 ex-pression in patients with APE was higher than non-APE patients ( P<0. 05 ) . In Logistic regression analysis, age, anticoagulants use, D-D and platelet CD36 were close associated with APE. ROC curve analysis results showed that higher platelet CD36 expression had well diagnostic value for APE with patients of the area under the curve of 0. 821 (95%CI:0. 749~0. 892, P<0. 001), the sensitivity and specificity was 81. 6% and 71. 5%,respectively. Con-clusions The expression of platelet CD36 is high in APE patients, and higher CD36 expression in platelet is risk factors of APE after undergoing TKA, platelet CD36 has certain clinical value for preventing APE after TKA.%目的:探讨血小板CD36的表达与行全膝关节置换术( TKA)患者术后发生急性肺栓塞( APE)的关系。方法选取50例TKA术后发生APE患者和同期150例TKA术后未发生APE和血栓患者进行基本资料比较。结果两组患者年龄、抗凝剂使用、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)以及D-二聚体(D-D)比较差异均有统计学意义(P<0.05)。血小板CD36在APE患者中明显高表达,差异有统计学意义(P<0.05)。在Logistic回归分析中,年龄、抗凝剂的使用、D-D以及血小板CD36的异常表达与APE发生密切相关。 ROC曲线分析结果显示,血小板CD36的高表达在对于TKA术后发生APE具有较好的诊断价值,曲线下面积为0.821(95% CI 0.749~0

  1. Periacetabular bone mineral density changes after resurfacing hip arthroplasty versus conventional total hip arthroplasty. A randomized controlled DEXA study

    NARCIS (Netherlands)

    Smolders, J.M.; Pakvis, D.F.M.; Hendrickx, B.W.; Verdonschot, N.J.; Susante, J.L.C. van

    2013-01-01

    A randomized controlled trial was performed to evaluate acetabular bone mineral density (BMD) changes after hip resurfacing (RHA) versus an established conventional total hip arthroplasty (THA). A total of 71 patients were allocated randomly to receive either an RHA press-fit cobalt-chromium cup (n=

  2. Periacetabular Bone Mineral Density Changes After Resurfacing Hip Arthroplasty Versus Conventional Total Hip Arthroplasty. A Randomized Controlled DEXA Study

    NARCIS (Netherlands)

    Smolders, J.M.H.; Pakvis, D.F.; Hendrickx, B.W.; Verdonschot, N.J.J.; Susante, van J.L.C.

    2013-01-01

    A randomized controlled trial was performed to evaluate acetabular bone mineral density (BMD) changes after hip resurfacing (RHA) versus an established conventional total hip arthroplasty (THA). A total of 71 patients were allocated randomly to receive either an RHA press-fit cobalt–chromium cup (n

  3. Long-term results of patellofemoral arthroplasty - A report of 56 arthroplasties with 17 years of follow-up

    NARCIS (Netherlands)

    Kooijman, HJ; Driessen, APPM; van Horn, [No Value

    2003-01-01

    We studied retrospectively the outcome of patellofemoral arthroplasty (PFA) using the Richards prosthesis in 51 patients (56 knees). Their mean age was 50 years (30 to 77). In 43 patients (45 knees), the American Knee Society score and the patients' subjective judgement were assessed. Excellent or g

  4. Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery

    NARCIS (Netherlands)

    Hartel, B.P.; Alta, T.D.; Sewnath, M.E.; Willems, W.J.H.

    2015-01-01

    INTRODUCTION: The increase of shoulder replacements will lead to a higher revision rate of shoulder arthroplasties. The aim of this study is to evaluate the clinical results of revision surgery performed in our hospital, distinguish the differences in clinical outcome according to revision indicatio

  5. Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty

    Science.gov (United States)

    Park, Chan Ho; Lee, Young-Kyun

    2017-01-01

    Purpose Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a grave complication. Urinary tract infection (UTI) as a source for PJI is controversial. Our purposes were, (1) to evaluate the incidence of PJI after elective primary THA and (2) to determine whether UTI was associated with a risk of PJI after elective primary THA. Materials and Methods We retrospectively reviewed the medical records of 527 patients who underwent elective primary THA by using universal aseptic technique from May 2003 to October 2007. UTI group (13 patients) was defined as patients who underwent THA in status of having an UTI, and the remaining patients were defined as control group (514 patients). We compared the incidence of PJI in both groups. Results During the study period, the incidence of PJI was 0%, regardless of existence (or presence) of UTI. Conclusion There was no significant association between UTI and PJI, when cautiously performed THA. PMID:28316960

  6. Predicting acute recovery of physical function following total knee joint arthroplasty.

    Science.gov (United States)

    Robbins, Shawn M; Rastogi, Ravi; McLaughlin, Terry-Lyne

    2014-02-01

    The objective was to explore predictors of physical function during acute in-patient rehabilitation within a few days after TKA. Physical function status of participants (n = 72) three days after total knee arthroplasty (TKA) was measured using the Timed Up and Go Test (TUG) and the function subscale of the Western Ontario McMaster Universities Index of Osteoarthritis (WOMAC-function). Potential predictors of physical function were measured day one post-TKA. Their relationship with physical function was examined using backward elimination, multiple regression analyses. Older age and increased comorbidity were associated (R(2) = 0.20) with worse TUG times. Increased pain severity was associated (R(2) = 0.08) with worse WOMAC-function scores. Age, comorbidity, and pain severity should be considered when predicting which patients will struggle with acute recovery post-TKA.

  7. Hip arthroplasty in patients with complex femoral deformity after surgical treatment of dysplasia

    OpenAIRE

    V. V. Bliznyukov; R. M. Tikhilov; I. I. Shubnyakov; A. O. Denisov; V. A. Shilnikov; A. Z. Chernyi; S. S. Bilyk

    2014-01-01

    Objective - based on the analysis of remote results of total hip arthroplasty in patients with complex deformities of the femur to compare the effectiveness of operations with standard cases and identify the factors that determine the surgery effectiveness. Material and methods. in Vreden clinic 73 patients with complex deformities of the femur underwent surgical treatment between 2001 and 2013 by various surgical interventions: arthroplasty without femoral osteotomy (23); arthroplasty accomp...

  8. Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of Unplanned ICU Admission

    OpenAIRE

    2016-01-01

    Background: Malnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown. Methods: 1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin Results: The overall incidence of malnutrition was 16.9% (primary and revision arth...

  9. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique

    OpenAIRE

    MEROLLA, GIOVANNI; Nastrucci, Guglielmo; Porcellini, Giuseppe

    2013-01-01

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid compon...

  10. Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows.

    Science.gov (United States)

    Egol, Kenneth A; Tsai, Peter; Vazques, Oscar; Tejwani, Nirmal C

    2011-02-01

    Treating intra-articular fractures about the osteoporotic distal humerus poses a significant challenge. The purpose of this retrospective study was to evaluate functional outcomes for distal humeral fractures treated with total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) in a nonarthritic elderly population with osteoporosis. We reviewed the records of all women older than age 60 who had undergone surgical treatment for intraarticular distal humerus fractures (Orthopaedic Trauma Association types 13B and 13C) by 1 of 2 surgeons. Demographic and operative data were obtained, charts were reviewed, and patients were asked to have their outcomes evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Mayo Elbow Performance Index (MEPI). Twenty-two patients (23 elbows) were identified, and 2 of these (3 elbows) were excluded. Of the remaining 20 patients, 9 had undergone cemented, semiconstrained TEA as initial treatment, and 11 had undergone ORIF. These 2 groups were compared. Mean follow-up was 14.8 months (range, 6-38 months). There were no significant differences between the TEA and ORIF groups with respect to demographic factors. Final elbow range of motion was 92° flexion-extension arc (arthroplasty group) and 98° (fixation group). Two patients in the arthroplasty group and 2 in the fixation group died. For the remaining patients, mean DASH scores were 30.2 (arthroplasty) and 32.1 (fixation), and mean MEPI scores were 79 (arthroplasty) and 85 (fixation). These differences were not statistically significant. Four TEAs developed radiographic loosening by a mean of 15 months, and 1 of these underwent revision with good outcome. Ten of the 11 fractures in the fixation group healed radiographically; the 1 nonunion with collapse continued to be asymptomatic. Two patients in the fixation group underwent contracture release after union for limited elbow range of motion. Many factors come into play in the

  11. The Norwegian immunisation register--SYSVAK.

    Science.gov (United States)

    Trogstad, L; Ung, G; Hagerup-Jenssen, M; Cappelen, I; Haugen, I L; Feiring, B

    2012-04-19

    The Norwegian immunisation register, SYSVAK, is a national electronic immunisation register. It became nationwide in 1995. The major aim was to register all vaccinations in the Childhood Immunisation Programme to ensure that all children are offered adequate vaccination according to schedule in the programme, and to secure high vaccination coverage. Notification to SYSVAK is mandatory, based on personal identification numbers. This allows follow up of individual vaccination schedules and linkage of SYSVAK data to other national health registers for information on outcome diagnoses, such as the surveillance system for communicable diseases. Information from SYSVAK is used to determine vaccine coverage in a timely manner. Coverage can be broken down to regional/local levels and used for active surveillance of vaccination coverage and decisions about interventions. During the 2009 influenza A(H1N1)pdm09 pandemic, an adaptation of SYSVAK enabled daily surveillance of vaccination coverage on national and regional levels. Currently, data from SYSVAK are used, among others, in studies on adverse events related to pandemic vaccination. Future challenges include maximising usage of collected data in surveillance and research, and continued improvement of data quality. Immunisation registers are rich sources for high quality surveillance of vaccination coverage, effectiveness, vaccine failure and adverse events, and gold mines for research.

  12. Suicides after pregnancy in Finland, 1987-94: register linkage study.

    OpenAIRE

    1996-01-01

    OBJECTIVE: To determine rates of suicide associated with pregnancy by the type of pregnancy. DESIGN: Register linkage study. Information on suicides in women of reproductive age was linked with the Finnish birth, abortion, and hospital discharge registers to find out how many women who committed suicide had had a completed pregnancy during her last year of life. SETTING: Nationwide data from Finland. SUBJECTS: Women who committed suicide in 1987-94. RESULTS: There were 73 suicides associated ...

  13. Register-based research on twins

    DEFF Research Database (Denmark)

    Christensen, Kaare; Ohm Kyvik, Kirsten; Holm, Niels V

    2011-01-01

    Introduction: The Danish Twin Registry (DTR) has for more than 50 years been based on surveys and clinical investigations and over the two last decades also on register linkage. Currently these two approaches are merged within Statistics Denmark. Research topics: Here we report on three major...... groups of register-based research in the DTR that used the uniqueness of twinning. First, we focus on the ''long-term prognosis'' of being a twin compared with being a singleton and show that Danish twins have health trajectories in adulthood similar to singletons, which is a result of interest for twins...... and their families as well as a test of the fetal origins hypothesis that states that fetal growth restriction has long-term health consequences. Secondly, we summarise some of the most important register-based ''classical twin studies'', e.g. heritability studies on lifespan and exceptional longevity. Finally, we...

  14. A Novel Register Allocation Algorithm for Testability

    Institute of Scientific and Technical Information of China (English)

    SUN Qiang; ZHOU Tao; LI Haijun

    2007-01-01

    In the course of high-level synthesis of integrate circuit, the hard-to-test structure caused by irrational schedule and allocation reduces the testability of circuit. In order to improve the circuit testability, this paper proposes a weighted compatibility graph (WCG), which provides a weighted formula of compatibility graph based on register allocation for testability and uses improved weighted compatibility clique partition algorithm to deal with this WCG. As a result, four rules for testability are considered simultaneously in the course of register allocation so that the objective of improving the design of testability is acquired. Tested by many experimental results of benchmarks and compared with many other models, the register allocation algorithm proposed in this paper has greatly improved the circuit testability with little overhead on the final circuit area.

  15. Global Register Allocation for SIMD Multiprocessors

    Institute of Scientific and Technical Information of China (English)

    BenjaminHAO; DavidPEARSON; 等

    1996-01-01

    It is relatively clear how to map regular,repetitive or grid oriented computations onto SIMD architectures.It is not so clear,however,how to do this for irregular computations even though there may be significant amounts of intrinsic parallelism in branch free code.We study compilation techniques for this type of code when targeted to SIMD computers and illustrate their use on a simple model architecture.In this paper,we present one of the compilation techniques,global register allocation,we have developed for SIMD computers,and demonstrate that it can effectively allocate registers for parallelizing irregular computations in branch free code.This technique is an extension and a modification of the register allocation via graph coloring approach used by sequential compilers.Our performance results validate our method.

  16. Pre-operative ambulatory measurement of asymmetric leg loading during sit to stand in hip arthroplasty patients

    NARCIS (Netherlands)

    Martínez-Ramírez, Alicia; Weenk, Dirk; Lecumberri, Pablo; Verdonschot, Nico; Pakvis, Dean; Veltink, Peter H.

    2013-01-01

    Total hip arthroplasty is a successful surgical procedure to treat patients with hip osteoarthritis. Clinicians use different questionnaires to evaluate these patients. Gait velocity and these questionnaires; usually show significant improvement after total hip arthroplasty. This clinical evaluation

  17. Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials

    Directory of Open Access Journals (Sweden)

    Barker Karen L

    2009-08-01

    Full Text Available Abstract Background Physiotherapy has long been a routine component of patient rehabilitation following hip joint replacement. The purpose of this systematic review was to evaluate the effectiveness of physiotherapy exercise after discharge from hospital on function, walking, range of motion, quality of life and muscle strength, for osteoarthritic patients following elective primary total hip arthroplasty. Methods Design: Systematic review, using the Cochrane Collaboration Handbook for Systematic Reviews of Interventions and the Quorom Statement. Database searches: AMED, CINAHL, EMBASE, KingsFund, MEDLINE, Cochrane library (Cochrane reviews, Cochrane Central Register of Controlled Trials, DARE, PEDro, The Department of Health National Research Register. Handsearches: Physiotherapy, Physical Therapy, Journal of Bone and Joint Surgery (Britain Conference Proceedings. No language restrictions were applied. Selection: Trials comparing physiotherapy exercise versus usual/standard care, or comparing two types of relevant exercise physiotherapy, following discharge from hospital after elective primary total hip replacement for osteoarthritis were reviewed. Outcomes: Functional activities of daily living, walking, quality of life, muscle strength and range of hip joint motion. Trial quality was extensively evaluated. Narrative synthesis plus meta-analytic summaries were performed to summarise the data. Results 8 trials were identified. Trial quality was mixed. Generally poor trial quality, quantity and diversity prevented explanatory meta-analyses. The results were synthesised and meta-analytic summaries were used where possible to provide a formal summary of results. Results indicate that physiotherapy exercise after discharge following total hip replacement has the potential to benefit patients. Conclusion Insufficient evidence exists to establish the effectiveness of physiotherapy exercise following primary hip replacement for osteoarthritis. Further

  18. Metadata For Identity Management of Population Registers

    Directory of Open Access Journals (Sweden)

    Olivier Glassey

    2011-04-01

    Full Text Available A population register is an inventory of residents within a country, with their characteristics (date of birth, sex, marital status, etc. and other socio-economic data, such as occupation or education. However, data on population are also stored in numerous other public registers such as tax, land, building and housing, military, foreigners, vehicles, etc. Altogether they contain vast amounts of personal and sensitive information. Access to public information is granted by law in many countries, but this transparency is generally subject to tensions with data protection laws. This paper proposes a framework to analyze data access (or protection requirements, as well as a model of metadata for data exchange.

  19. Up-To-Date Architectural Heritage Register

    Directory of Open Access Journals (Sweden)

    Živilė Šulskaitė

    2011-04-01

    Full Text Available The article focuses on the registration history and legal acts of Lithuanian cultural heritage and examines the register of estate cultural heritage and conditions for including estate cultural heritage into the register. The article also looks at the criteria of evaluating estate cultural heritage such as age limit, authentication features and the level of significance (national, regional, local. The paper presents information on the criteria applied for assessing heritage list in the United Kingdom, and UNESCO as well as introduces the Convention concerning the Protection of the World Cultural and Natural Heritage and the Nara Document. Article in Lithuanian

  20. BIOLOGIC JOINT RECONSTRUCTION: ALTERNATIVES TO ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Brian J. Cole

    2009-06-01

    limited prosthetic resurfacing. Section VI is "Operative treatment-elbow" including chapters arthroscopy, nonprosthetic elbow arthroplasty, biological resurfacing. The Section VII is "Operative treatment-foot and ankle" including chapters about ankle arthroscopy and cartilage repair in the ankle.The text is one of the most comprehensive and up-to-date references in the treatment of cartilage pathologies and biological joint reconstruction. Some other minimal invasive surgical techniques such as prosthetic partial resurfacing or some osteotomies are also subjected as other alternative treatments for joint restoration. Basic sciences, diagnostic imaging, pharmacological treatment and neutraceuticals, and rehabilitation are making the text. The chapter about future developments in cartilage repair is not only describing the recent technology, different types of tissue engineering and related centers in the world but also gives an idea for the possibilities of future in cartilage repair. Chapters about surgical techniques and procedures are uniformly composed of parts including introduction, preoperative evaluation, surgical technique, postoperative issues, results and references in which the techniques and management described in detail. Numerous high quality images, rich illustrations and figures, page design and also colored tables about key points, protocols, or helpful hints makes the reading and understanding easier

  1. 78 FR 28770 - Scope of the Register of Copyright's Exclusive Authority Over Statements of Account Under the...

    Science.gov (United States)

    2013-05-16

    ... to the Register on April 17, 2013. \\2\\ The National Music Publishers' Association, Inc., the Songwriters Guild of America, the Nashville Songwriters Association International, the Church Music Publishers... that the CRJs enjoy such authority. May 1, 2013. Maria A. Pallante, Register of Copyrights....

  2. Registro de artroplastias do ombro Shoulder arthroplasty records

    Directory of Open Access Journals (Sweden)

    Geraldo Motta Filho

    2009-04-01

    Full Text Available OBJETIVO: Determinar as características clínico-cirúrgicas referentes a 145 artroplastias do ombro realizadas no período entre julho de 2004 a dezembro de 2006. MÉTODOS: No período de estudo foram realizadas 145 artroplastias de ombro. Através de protocolo prospectivo, informações demográficas, da anamnese, exame físico e exame radiográfico foram armazenadas em um banco de dados. Os dados coletados foram organizados em três grandes grupos: doenças articulares degenerativas, fraturas e seqüelas traumáticas. Esses dados foram correlacionados a fim de definir o perfil epidemiológico dos pacientes, das lesões e artroplastias. RESULTADOS: Das 145 artroplastias de ombro realizadas 37% foram por seqüelas traumáticas, 30% por doença articular degenerativa e 33% com diagnóstico de fratura. Foram 12% artroplastias totais e 88% parciais. Ocorreram cinco complicações no pós-operatório recente. CONCLUSÃO: As artroplastias de ombro tornaram-se um procedimento frequente na prática ortopédica. Registros cirúrgicos são importantes a fim de demonstrar essa evolução progressiva e permitir avaliações de resultados clínicos no futuro.OBJECTIVE: The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. METHODOLOGY: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. RESULTS: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus

  3. Development and first validation of a simplified CT-based classification system of soft tissue changes in large-head metal-on-metal total hip replacement: intra- and interrater reliability and association with revision rates in a uniform cohort of 664 arthroplasties

    Energy Technology Data Exchange (ETDEWEB)

    Boomsma, Martijn F.; Warringa, Niek [Isala Hospital, Department of Radiology, Zwolle (Netherlands); Edens, Mireille A. [Isala Hospital, Department of Innovation and Science, Zwolle (Netherlands); Lingen, Christiaan P. van; Ettema, Harmen B.; Verheyen, Cees C.P.M. [Isala Hospital, Department of Orthopaedics, Zwolle (Netherlands); Maas, Mario [AMC, Department of Radiology, Amsterdam (Netherlands)

    2015-08-15

    After implantation of a metal-on-metal total hip arthroplasty (MoM THA), a large incidence of pseudotumor formation has been described recently. Several centers have invited patients for follow-up in order to screen for pseudotumor formation. The spectrum of abnormalities found by CT in MoM THA patients can be unfamiliar to radiologists and orthopedic surgeons. Previously, a CT five-point grading scale has been published. In this paper, a simplification into a three-point classification system gives insight in the morphological distinction of abnormalities of the postoperative hip capsule in MoM implants in relation to the decision for revision. The reliability of this simplified classification regarding intra- and interrater reliability and its association with revision rate is investigated and discussed. All patients who underwent MoM THA in our hospital were invited for screening. Various clinical measures and CT scan were obtained in a cross-sectional fashion. A decision on revision surgery was made shortly after screening. CT scans were read in 582 patients, of which 82 patients were treated bilaterally. CT scans were independently single read by two board-certified radiologists and classified into categories I-V. In a second meeting, consensus was obtained. Categories were subsequently rubricated in class A (categories I and II), B (category III), and C (categories IV and V). Intra- and inter-radiologist agreement on MoM pathology was assessed by means of the weighted Cohen's kappa. Categorical data were presented as n (%), and tested by means of Fisher's exact test. Continuous data were presented as median (min-max) and tested by means of Mann-Whitney U test (two group comparison) or Kruskal-Wallis test (three group comparison). Logistic regression analysis was performed in order to study independence of CT class for association with revision surgery. Univariate statistically significant variables were entered in a multiple model. All statistical

  4. Therapy-associated late effects after irradiation of malignant diseases in childhood and adolescence. Feasibility analyses of a prospective multicenter register study; Behandlungsassoziierte Spaetfolgen nach Strahlentherapie maligner Erkrankungen im Kindes- und Jugendalter. Machbarkeitsanalyse einer prospektiven multizentrischen Registerstudie

    Energy Technology Data Exchange (ETDEWEB)

    Boelling, T.; Schuck, A.; Hesselmann, S.; Willich, N. [Klinik fuer Strahlentherapie, Universitaetsklinikum Muenster (Germany); Ruebe, C.; Speiser-Held, I. [Klinik fuer Strahlentherapie, Universitaetsklinikum Homburg/Saar (Germany); Pape, H. [Klinik fuer Strahlentherapie, Universitaetsklinikum Duesseldorf (Germany); Dieckmann, K. [Klinik fuer Strahlentherapie, Universitaetsklinikum Wien (Austria); Poellinger, B. [Klinik fuer Strahlentherapie, Universitaetsklinikum Muenchen (Germany); Kortmann, R.D. [Klinik fuer Strahlentherapie, Universitaetsklinikum Leipzig (Germany); Meyer, F.M. [Klinik fuer Strahlentherapie, Klinikum Augsburg (Germany); Martini, C. [Klinik fuer Strahlentherapie, Universitaetsklinikum Freiburg (Germany); Asadpour, B. [Klinik fuer Strahlentherapie, Universitaetsklinikum Aachen (Germany); Timmermann, B. [Paul-Scherrer-Inst. Villigen (Switzerland); Beck, J.D.; Langer, T.; Paulides, M. [Abt. fuer Paediatrische Onkologie, LESS-Zentrum, Universitaetskinderklinik Erlangen (Germany); Schmidt, B. [Klinik fuer Strahlentherapie, Katharinenhospital Stuttgart (Germany)

    2006-08-15

    Background and purpose: Radiogenic late effects in children and adolescents have been evaluated retrospectively in most analyses, with small patient numbers. The German Group of Pediatric Radiation Oncology (APRO) has generated a concept for a prospective evaluation of radiation-associated late effects in childhood. The aim of this study was to evaluate the feasibility of a nationwide central database for the documentation of radiation parameters and side effects of all children treated within therapy protocols of the German Society of Pediatric Oncology and Hematology (GPOH). Material and methods: A study center has been implemented in Muenster, the documentation has started in July 2001 in few centers in a pilot phase. Since February 2004 the documentation is done countrywide. Detailed documentation forms have been designed for treatment parameters and for doses applied at organs at risk. Furthermore, a uniform toxicity documentation, according to the RTOG/EORTC criteria, was chosen. Patients were reported from the study centers of the GPOH to the study center. All information was collected and analyzed in the study center. Results: Till July 31, 2205, 438 documentations of radiation and 579 toxicity documentations of side effects have been collected in the study center. 46 centers for radiotherapy in Germany and one center each in Austria and in Switzerland took part in the documentation. The quality of documentation regarding completeness and plausibility fulfilled the expected criteria in most cases. This feasibility analysis showed that important information about organ dose levels and side effects was documented in a large number of patients (Figures 1 and 2). Conclusion: This prospective evaluation of radiotherapy and radiogenic side effects in children and adolescents will allow correlating doses at organs at risk and the incidence of acute and late sequelae in Germany. Further documentations and a longer follow-up are necessary to obtain powerful results

  5. The Euphemism variety Based on Register theory

    Institute of Scientific and Technical Information of China (English)

    贾文庆

    2015-01-01

    It is the substitution of an agreeable expression for one that may offend something unpleasant.Euphemisms have a close relationship with context,especially tenor of discourse.This paper attempts to analyze the variation of euphemisms guided by register theory.

  6. Palliative care registers: infringement on human rights?

    Science.gov (United States)

    Anthony-Pillai, Rosemarie

    2012-04-01

    A personal view made in light of the recent news article regarding a husband wanting to sue Addenbrooke's hospital over a Do Not Attempt Resuscitation decision. This article aims to highlight how the rolling out of cross boundary palliative care registers may be more at risk of infringing human rights.

  7. Register of Environmental Engineering Undergraduate Programs.

    Science.gov (United States)

    Aulenbach, Donald B., Ed.

    This document outlines undergraduate programs leading to degrees in environmental engineering from 22 schools across the country. The register includes general information on the school and program as well as specific information on admission requirements, degree requirements, course work, and faculty and student data. A copy of the questionnaire…

  8. The establishment of a polyposis register

    DEFF Research Database (Denmark)

    Bülow, Steffen; Burn, J; Neale, K;

    1993-01-01

    Guidelines are presented for the establishment of a regional or national register of patients with familial adenomatous polyposis. The detailed recommendations are based on the work in committees of the "Leeds Castle Polyposis Group" and the "EuroFAP". The aims of national and regional polyposis...

  9. Circumstance Adverbials in Registers of Indian English

    Science.gov (United States)

    Balasubramanian, Chandrika

    2009-01-01

    This is a corpus-based investigation of "also" and "too" in 11 registers of Indian English. The corpus used for this study is a combination of a Corpus of Contemporary Indian English (CCIE), and certain sections of ICE-India. The study: (1) determines the proportions of "also" and "too" with respect to each…

  10. Revision of Failed Hip Resurfacing and Large Metal-on-Metal Total Hip Arthroplasty Using Dual-Mobility Components.

    Science.gov (United States)

    Snir, Nimrod; Park, Brian K; Garofolo, Garret; Marwin, Scott E

    2015-06-01

    Revision of metal-on-metal (MoM) total hip arthroplasty (THA) or hip resurfacing is associated with high complication rates. The authors propose dual-mobility components as a surgical option and present short- to mid-term results of MoM hips revised with dual-mobility components. Eighteen consecutive hips that underwent revision of MoM THA or hip resurfacing using dual-mobility components were identified. At final follow-up (mean, 17.5 months), the visual analog scale, modified Harris Hip Score, and SF-12 scores had all improved (Phip resurfacing using a dual-mobility device is an effective strategy.

  11. How effective is multiple needle puncturing for medial soft tissue balancing during total knee arthroplasty? A cadaveric study.

    Science.gov (United States)

    Koh, In Jun; Kwak, Dai-Soon; Kim, Tae Kyun; Park, In Joo; In, Yong

    2014-12-01

    We investigated the quantitative effect and risk factors for over-release during multiple needle puncturing (MNP) for medial gap balancing in varus total knee arthroplasty (TKA). Of the ten pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo MNP in extension (E group), while the other knee underwent MNP in flexion (F group). The increased extension and 90° flexion gaps after every five needle punctures were measured until over-release occurred. The extension gap (knee, a narrow MCL, and severe osteoarthritis were associated with a smaller number of MNPs required to over-release.

  12. Total Hip Arthroplasty after Treatment of an Atypical Subtrochanteric Femoral Fracture in a Patient with Pycnodysostosis

    Directory of Open Access Journals (Sweden)

    Takahito Yuasa

    2015-01-01

    Full Text Available The authors describe the case of a 51-year-old woman with an osteonecrosis of her right femoral head after treatment of an atypical subtrochanteric fracture caused by pycnodysostosis. She had this fracture after a low-trauma fall. She was of short stature with typical facial features, short stubby hands, and radiological features including open cranial sutures, obtuse mandible, and generalized skeletal sclerosis. The majority of cases of atypical subtrochanteric fractures are associated with long-term use of bisphosphonates; some occur in bisphosphonate-free patients. We report a rare case of total hip arthroplasty (THA in a patient with pycnodysostosis who developed an osteonecrosis of the femoral head after treatment of an atypical subtrochanteric femoral fracture. We performed cementless THA in combination with a plate and cables. Cementless THA is a potential intervention in a patient with pycnodysostosis; although the bone quality may have been sclerotic, healing is not a problem in this condition.

  13. Tibia valga morphology in osteoarthritic knees: importance of preoperative full limb radiographs in total knee arthroplasty.

    Science.gov (United States)

    Alghamdi, Ahmed; Rahmé, Michel; Lavigne, Martin; Massé, Vincent; Vendittoli, Pascal-André

    2014-08-01

    Osteoarthritis of the knee is associated with deformities of the lower limb. Tibia valga is a contributing factor to lower limb alignment in valgus knees. We evaluated 97 valgus knees and 100 varus knees. Long-leg films were taken in weight bearing with both knees in full extension. For valgus knees, 52 knees (53%) had a tibia valga deformity. Average tibia valgus deformation was 5.0°. For varus knees, there was only 1 case of tibia valga (1%), with a deformation of 2.5°. The aim of this study was to assess the prevalence of primary tibia valga in valgus and varus knees and understand how it affects our approach to total knee arthroplasty (TKA). We recommend having full-leg length films when planning for TKA in valgus knees.

  14. Risk Factors of Heterotopic Ossification Following Total Hip Arthroplasty in Patients With Ankylosing Spondylitis.

    Science.gov (United States)

    Thilak, Jai; Panakkal, Jiss Joseph; Kim, Tae-Young; Goodman, Susan M; Lee, Sang-Soo; Salvati, Eduardo A

    2015-12-01

    This study was to identify the risk factors of heterotopic ossification (HO) after total hip arthroplasty (THA) in ankylosing spondylitis. We analyzed 47 hips (24 patients) with ankylosing spondylitis that underwent primary THA. The incidence of HO was 14.9%. The risk factors were divided into modifiable and nonmodifiable factors. Female gender (P=0.008), preoperative ankylosed hip (P<0.001), occurrence of HO in previous surgery (P=0.036) were nonmodifiable risk factors which increased the prevalence of HO. Of the various modifiable risk factors, elevated preoperative ESR (P=0.007), elevated preoperative CRP (P=0.004) and prolonged duration of surgery (P=0.014) were associated with increased occurrence of HO. Perioperative medical intervention to reduce inflammation (ESR and CRP) may help to decrease HO.

  15. Rheumatoid Arthritis vs Osteoarthritis in Patients Receiving Total Knee Arthroplasty: Perioperative Outcomes

    Science.gov (United States)

    Stundner, Ottokar; Danninger, Thomas; Chiu, Ya-Lin; Sun, Xuming; Goodman, Susan M; Russell, Linda A; Figgie, Mark; Mazumdar, Madhu; Memtsoudis, Stavros G

    2013-01-01

    There is a paucity of data available on perioperative outcomes of patients undergoing total knee arthroplasty (TKA) for rheumatoid arthritis (RA). We determined differences in demographics and risk for perioperative adverse events between patients suffering from osteoarthritis (OA) versus RA using a population-based approach. Of 351,103 entries for patients who underwent TKA, 3.4% had a diagnosis of RA. RA patients were on average younger [RA: 64.3 years vs OA: 66.6 years; p<0.001] and more likely female [RA: 79.2% vs OA: 63.2%; P<0. 001]. The unadjusted rates of mortality and most major perioperative adverse events were similar in both groups, with the exception of infection [RA: 4.5% vs. OA: 3.8%; P<0.001]. RA was not associated with increased adjusted odds for combined adverse events. PMID:23764034

  16. Clinical Application of Total Knee Arthroplasty on Patients with Advanced Knee Osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    WU Zhi-sen; ZHENG Chen-xiao; QI Liang; CHANG Shang-yi

    2014-01-01

    Objective:To investigate the clinical value of total knee arthroplasty (TKA) on patients with advanced knee osteoarthritis. Methods:The clinical data and efficacy of 26 patients with advanced knee osteoarthritis (26 knees) who were given TKA in our department from June 2012 to May 2013 were retrospectively observed and analyzed. The knee function scores before operation and after follow up were evaluated according to American HSS scoring standard. Results:At the end of follow up, of the 26 patients, 18 were excellent, 6 were good and 2 were not bad in knee function and mobility without sense of pain, which was regarded to be associated with the poor enthusiasm in knee function training, and the total rate of excellent and good was 92.3%. Conclusion:TKA has signiifcant clinical value and favorable efifcacy on patients with advanced knee osteoarthritis.

  17. Vascular complications following total hip arthroplasty: a case study and a review of the literature.

    Science.gov (United States)

    Barbier, Olivier; Pierret, Charles; Bazile, Fabrice; De Kerangal, Xavier; Duverger, Vincent; Versier, Gilbert

    2012-11-01

    Vascular complications after total hip arthroplasty (THA) are rare but represent a real risk. The diversity of clinical presentations can make diagnosis difficult. They could manifest as an immediate and acute hemorrhage or subsequent ischemia. We report the case of a patient who presented a thrombosis of the femoral artery associated with a sciatic palsy after THA for a coxa profunda. The diagnosis was actually made 3 years after surgery because of atypical symptoms. The mechanism involved was either a crash of the artery by a retractor on the anterior wall of the acetabulum, or a stretching of the artery. A review of the literature of vascular complications occurring after THA recalls the multiplicity of clinical presentations and the diagnostic difficulties. They could manifest as an immediate and acute hemorrhage or deferred ischemia, as in our case. Knowledge of these complications should help prevent them, and the diagnosis should be considered in atypical sequences after THA.

  18. Radiologic findings in cases involving complications arising from total knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Deok Ho; Ryu, Kyung Nam; Bae, Dae Kyung [Kyunghee Univ. Hospital, Seoul (Korea, Republic of)

    1999-09-01

    Total knee arthroplasty(TKA) has been used for the treatment of knee joint pain, deformity, and instability caused by osteoarthritis, rheumatoid arthritis, or tuberculous arthritis, and by virtue of good results and rapid development, the procedure has been increasingly employed. With the development of total knee prosthesis, complications have also increased, however, and due to complications occurring up to six years after surgery, fusion occurs in about 2% of all replaced knees. The most common complication of TKA is loosening, followed by infection. Others are thrombosis, subluxation, dislocation and fracture, and complications may be divided into four groups: biologic, technical, specific to type of components, and associated with certain diagnosis. Where these complications occur, a patient must undergo a second procedure, but the success rate is lower than for the initial procedure. Exact etiological evaluation important clinically and radiologically. We illustrate the etiologies and radiologic characteristics of TKA complications according to classification.

  19. Dislocation of primary total hip arthroplasty and the risk of redislocation.

    LENUS (Irish Health Repository)

    Brennan, Stephen A

    2012-09-01

    6554 primary total hip arthroplasties were reviewed. Risk factors for dislocation were analysed to assess which were important in terms of predicting recurrent instability. The patients risk of having a second dislocation was independently associated with the surgical approach adopted (p = 0.03) and the time to first dislocation from the primary hip replacement (p = 0.002). Early dislocators whose surgery was performed through an anterolateral approach had less recurrence than late dislocators through a posterior or transtrochanteric approach. None of the other risk factors including head size (p = 0.59), modularity (p = 0.54), mechanism of dislocation (p = 0.23), leg length discrepancy (p = 0.69) and acetabular inclination (p = 0.31) were influential. The use of an abduction brace was not useful in preventing a further dislocation with 69.2% of those braced re-dislocating compared to 68.5% who were not braced (p = 0.96).

  20. A novel formulation for scratch-based wear modelling in total hip arthroplasty.

    Science.gov (United States)

    Kruger, Karen M; Tikekar, Nishant M; Heiner, Anneliese D; Baer, Thomas E; Lannutti, John J; Callaghan, John J; Brown, Thomas D

    2014-01-01

    Damage to the femoral head in total hip arthroplasty often takes the form of discrete scratches, which can lead to dramatic wear acceleration of the polyethylene (PE) liner. Here, a novel formulation is reported for finite element (FE) analysis of wear acceleration due to scratch damage. A diffused-light photography technique was used to globally locate areas of damage, providing guidance for usage of high-magnification optical profilometry to determine individual scratch morphology. This multiscale image combination allowed comprehensive input of scratch-based damage patterns to an FE Archard wear model, to determine the wear acceleration associated with specific retrieval femoral heads. The wear algorithm imposed correspondingly elevated wear factors on areas of PE incrementally overpassed by individual scratches. Physical validation was provided by agreement with experimental data for custom-ruled scratch patterns. Illustrative wear acceleration results are presented for four retrieval femoral heads.

  1. Results of porous-coated anatomic and duracon total knee arthroplasty.

    Science.gov (United States)

    Pennington, Jonathon; Quinlan, John; Doyle, Terry; Bayan, Ali; Theis, Jean-Claude

    2010-12-01

    The Duracon total knee replacement and its forerunner the Porous-Coated Anatomic (PCA) knee system have been associated with good results. This study reviews a series of 181 knee replacements performed with these systems by seven general orthopedic surgeons with follow-up to a mean of 6.7 years. The mean Knee Society knee and function scores were 72 and 68. The mean Western Ontario and MacMaster Universities Osteoarthritis Index score was 76, and the mean 12-Item Short-Form Health Survey result was 55. A mean flexion of 104 degrees was recorded, and 93.8% of patients rated their satisfaction as good to excellent. Fifty-five percent of patients had minor radiographic lucencies-these were of questionable clinical significance. Seven patients required revision. These knee systems used in a relatively low-volume general unit provide consistent results comparable with those from larger arthroplasty units.

  2. Clinical Application of Total Knee Arthroplasty on Patients with Advanced Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    WU Zhi-sen

    2014-09-01

    Full Text Available Objective: To investigate the clinical value of total knee arthroplasty (TKA on patients with advanced knee osteoarthritis. Methods: The clinical data and efficacy of 26 patients with advanced knee osteoarthritis (26 knees who were given TKA in our department from June 2012 to May 2013 were retrospectively observed and analyzed. The knee function scores before operation and after follow up were evaluated according to American HSS scoring standard. Results: At the end of follow up, of the 26 patients, 18 were excellent, 6 were good and 2 were not bad in knee function and mobility without sense of pain, which was regarded to be associated with the poor enthusiasm in knee function training, and the total rate of excellent and good was 92.3%. Conclusion: TKA has significant clinical value and favorable efficacy on patients with advanced knee osteoarthritis.

  3. Lower limb biomechanics in individuals with knee osteoarthritis before and after total knee arthroplasty surgery.

    Science.gov (United States)

    Levinger, Pazit; Menz, Hylton B; Morrow, Adam D; Feller, Julian A; Bartlett, John R; Bergman, Neil R

    2013-06-01

    We investigated the biomechanical changes that occur in the lower limb following total knee arthroplasty (TKA). Lower limb joint kinematics and kinetics were evaluated in 32 patients before and 12 months following TKA and 28 age-matched controls. Analysis of variance with Bonferroni-adjusted post-hoc tests showed no significant changes in knee joint kinematics and kinetics following TKA despite significant improvements in pain and function. Significant increases in peak ankle plantarflexion and dorsiflexion moments and ankle power generation were observed which may be a compensatory response to impaired knee function to allow sufficient power generation for propulsion. Differences in knee gait parameters may arise as a result of the presence of osteoarthritis and mechanical changes associated with TKA as well as retention of the pre-surgery gait pattern.

  4. Cryotherapy temperature differences after total knee arthroplasty: a prospective randomized trial.

    Science.gov (United States)

    Radkowski, Christopher A; Pietrobon, Ricardo; Vail, Thomas P; Nunley, James A; Jain, Nitin B; Easley, Mark E

    2007-01-01

    In spite of its widespread use after orthopaedic procedures, the literature evaluating the clinical efficacy of cryotherapy is controversial. The purpose of this prospective randomized trial was to compare two different temperatures for administering cryotherapy after total knee arthroplasty with regards to short-term postoperative outcomes. Sixty-four subjects were assigned either the 45 degrees F group or the 75 degrees F group. Subjects in the 45 degrees group were as likely to report a lower pain score at the time of follow-up compared to the 75 degrees group. Our results demonstrate no additional analgesic effect associated with the lower temperature of cryotherapy. Postoperative narcotic consumption, postoperative drainage, self-reported knee function, and range of motion were not affected by the different cryotherapy temperatures. No adverse effects were reported with the cryotherapy treatment.

  5. Conventional Versus Cross-Linked Polyethylene for Total Hip Arthroplasty.

    Science.gov (United States)

    Surace, Michele F; Monestier, Luca; Vulcano, Ettore; Harwin, Steven F; Cherubino, Paolo

    2015-09-01

    The clinical and radiographic outcomes of 88 patients who underwent primary total hip arthroplasty with either conventional polyethylene or cross-linked polyethylene (XLPE) from the same manufacturer were compared. There were no significant differences between the 2 subpopulations regarding average age, gender, side affected, or prosthetic stem and cup size. The average follow-up was 104 months (range, 55 to 131 months). To the authors' knowledge, this is the longest follow-up for this particular insert. Clinical and radiographic evaluations were performed at 1, 3, 6, and 12 months and then annually. Results showed that XLPE has a significantly greater wear reduction than that of standard polyethylene in primary total hip arthroplasty. At the longest available follow-up for these specific inserts, XLPE proved to be effective in reducing wear.

  6. [Modern tribology in total hip arthroplasty: pros and cons].

    Science.gov (United States)

    Gómez-García, F

    2014-01-01

    The wear products and adverse reactions that occur on bearing surfaces represent one of the greatest challenges in prosthetic replacements, as the latter experience increasing demands due to the large number of young and older adult patients that have a long life expectancy and remarkable activity. The purpose of this review is to analyze the pros and cons of the new advances in the bearing components of the articular surfaces of current total hip arthroplasties. We also discuss the strategies used historically, their problems, results and the surgeon's role in prescribing the tribologic couple that best fits each patient's needs. We conclude with practical recommendations for the prescription and management of the latest articular couples for total hip arthroplasty.

  7. The use of postoperative suction drainage in total hip arthroplasty.

    Science.gov (United States)

    Acus, R W; Clark, J M; Gradisar, I A; Kovacik, M W

    1992-11-01

    Two hundred eight primary total hip arthroplasties were reviewed to evaluate the effect of closed suction drainage. This review included 45 hips in which closed drains were used and 163 hips in which drains were not used. These two groups were compared for possible differences in wound problems, temperature elevations, changes in Hgb/Hct, and the need for transfusions. There was no statistically significant difference in postoperative temperatures or decrease in Hgb. However, there were four superficial wound infections in the drained group and three superficial wound infections in the non-drained group (P < .025). There were no deep infections in either group. These findings suggest closed suction drainage provides no apparent advantage in uncomplicated primary total hip arthroplasty.

  8. Nursing in fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik

    2015-01-01

    AIM: To describe the increased activity in total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2002 to 2012 in a single orthopaedic department, the organisation of fast-track and its consequences for nursing care. METHODS: Retrospective, descriptive design. Data collection; from...... the hospital administrative database, local descriptions of fast-track, personal contact and discussion with staff. RESULTS: The number of operations increased threefold from 351 operations in 2002 to 1024 operations in 2012. In 2012, THA/TKA patients had a postoperative mean LOS of 2.6/2.8 days. Nurses had......, be considered a worthwhile investment to employ expert/highly qualified professional nurses in fast-track THA and TKA units....

  9. Prediction of Wear in Crosslinked Polyethylene Unicompartmental Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jonathan Netter

    2015-05-01

    Full Text Available Wear-related complications remain a major issue after unicompartmental arthroplasty. We used a computational model to predict knee wear generated in vitro under diverse conditions. Inverse finite element analysis of 2 different total knee arthroplasty designs was used to determine wear factors of standard and highly crosslinked polyethylene by matching predicted wear rates to measured wear rates. The computed wear factor was used to predict wear in unicompartmental components. The articular surface design and kinematic conditions of the unicompartmental and tricompartmental designs were different. Predicted wear rate (1.77 mg/million cycles was very close to experimental wear rate (1.84 mg/million cycles after testing in an AMTI knee wear simulator. Finite element analysis can predict experimental wear and may reduce the cost and time of preclinical testing.

  10. Knitted outer gloves in primary hip and knee arthroplasty.

    Science.gov (United States)

    Tanner, J; Wraighte, P; Howard, P

    2006-01-01

    A randomised trial was carried out to determine the rate of perforation to inner gloves when comparing latex with knitted gloves during hip and knee arthroplasty. Members of the surgical team were randomised to wear either two pairs of latex gloves (standard double gloving) or a knitted glove on top of a latex glove. In addition, participants completed a visual analogue assessment of their overall satisfaction with the gloves. A total of 406 inner gloves were tested for perforations over a four-month period: 23% of inner gloves were perforated when latex outer gloves were used and 6% of inner gloves were perforated when knitted outer gloves were used. In total, there were 64 perforations to the inner gloves; only one of these perforations was detected by the glove wearer. Wearing knitted outer gloves during hip and knee arthroplasty statistically significantly reduces the risk of perforation to inner latex gloves (p<0.0001).

  11. In vivo determination of total knee arthroplasty kinematics

    Energy Technology Data Exchange (ETDEWEB)

    Komistek, Richard D [ORNL; Mahfouz, Mohamed R [ORNL; Bertin, Kim [Utah Bone & Joint Center, Salt Lake City, Utah (USA); Rosenberg, Aaron [Rush-Presbyterian-St. Luke' s Med Center, Chicago IL (USA); Kennedy, William [Kennedy-White Orthopaedic Center, Sarasota, FL (USA)

    2008-01-01

    The objective of this study was to determine if consistent posterior femoral rollback of an asymmetrical posterior cruciate retaining (PCR) total knee arthroplasty was mostly influenced by the implant design, surgical technique, or presence of a well-functioning posterior cruciate ligament (PCL). Three-dimensional femorotibial kinematics was determined for 80 subjects implanted by 3 surgeons, and each subject was evaluated under fluoroscopic surveillance during a deep knee bend. All subjects in this present study having an intact PCL had a well-functioning PCR knee and experienced normal kinematic patterns, although less in magnitude than the normal knee. In addition, a surprising finding was that, on average, subjects without a PCL still achieved posterior femoral rollback from full extension to maximum knee flexion. The findings in this study revealed that implant design did contribute to the normal kinematics demonstrated by subjects having this asymmetrical PCR total knee arthroplasty.

  12. Improved radiographic outcomes with patient-specific total knee arthroplasty.

    Science.gov (United States)

    Ivie, Conrad B; Probst, Patrick J; Bal, Amrit K; Stannard, James T; Crist, Brett D; Sonny Bal, B

    2014-11-01

    Patient-specific guides can improve limb alignment and implant positioning in total knee arthroplasty, although not all studies have supported this benefit. We compared the radiographs of 100 consecutively-performed patient-specific total knees to a similar group that was implanted with conventional instruments instead. The patient-specific group showed more accurate reproduction of the theoretically ideal mechanical axis, with fewer outliers, but implant positioning was comparable between groups. Our odds ratio comparison showed that the patient-specific group was 1.8 times more likely to be within the desired +3° from the neutral mechanical axis when compared to the standard control group. Our data suggest that reliable reproduction of the limb mechanical axis may accrue from patient-specific guides in total knee arthroplasty when compared to standard, intramedullary instrumentation.

  13. Risk Prediction Tools for Hip and Knee Arthroplasty.

    Science.gov (United States)

    Manning, David W; Edelstein, Adam I; Alvi, Hasham M

    2016-01-01

    The current healthcare environment in America is driven by the concepts of quality, cost containment, and value. In this environment, primary hip and knee arthroplasty procedures have been targeted for cost containment through quality improvement initiatives intended to reduce the incidence of costly complications and readmissions. Accordingly, risk prediction tools have been developed in an attempt to quantify the patient-specific assessment of risk. Risk prediction tools may be useful for the informed consent process, for enhancing risk mitigation efforts, and for risk-adjusting data used for reimbursement and the public reporting of outcomes. The evaluation of risk prediction tools involves statistical measures such as discrimination and calibration to assess accuracy and utility. Furthermore, prediction tools are tuned to the source dataset from which they are derived, require validation with external datasets, and should be recalibrated over time. However, a high-quality, externally validated risk prediction tool for adverse outcomes after primary total joint arthroplasty remains an elusive goal.

  14. Discordance between patient and surgeon satisfaction after total joint arthroplasty.

    Science.gov (United States)

    Harris, Ian A; Harris, Anita M; Naylor, Justine M; Adie, Sam; Mittal, Rajat; Dao, Alan T

    2013-05-01

    We surveyed 331 patients undergoing total hip or knee arthroplasty pre-operatively, and patients and surgeons were both surveyed 6 and 12 months post-operatively. We identified variables (demographic factors, operative factors and patient expectations) as possible predictors for discordance in patient-surgeon satisfaction. At 12 months, 94.5% of surgeons and 90.3% of patients recorded satisfaction with the outcome. The discordance between patient and surgeon satisfaction was mainly due to patient dissatisfaction-surgeon satisfaction. In an adjusted analysis, the strongest predictors of discordance in patient-surgeon satisfaction were unmet patient expectations and the presence of complications. Advice to potential joint arthroplasty candidates regarding the decision to proceed with surgery should be informed by patient reported outcomes, rather than the surgeon's opinion of the likelihood of success.

  15. 中国髋、膝关节置换的现状及展望%The current status and future perspective of hip and knee arthroplasty in China

    Institute of Scientific and Technical Information of China (English)

    裴福兴

    2012-01-01

    In this review, we have been elected to include reviews on the following points, a: The current status of primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Total joint arthroplasty volume is projected to continue increasing during the past several years in China. The most commonly used combination for THA was metal-on-polyethylene. However, the number of the choices of a hard-on-hard, metal-on-metal or ceramic-on-ceramic bearing was increasing. The majority of the hard-on-hard bearing surface was used in younger patients. Hip resurfacing arthroplasty also has gained popularity as an alternative to conventional THA in selected patients. In TKA, the posteriorly stabilized implants was the most commonly used prosthesis in China. High-flexion and mobile bearing designs were also used during the past several years, b: The current status of hip and knee revision surgery. Most causes of hip revision in China were infection, instability, and loosening. For knee revision, the most common cause was infection. Revision surgeries are usually performed in large, teaching hospitals in big cities. Two-stage revision was the main strategy for revision joint arthroplasty. C: The current status of minimally invasive surgery and navigation surgery. Minimally invasive surgery and navigation assisted arthroplasty were also performed in some teaching hospitals in China. The short-term results were better, however, the follow-up was still needed for mid to long-term effect, d: The current status of pain management and prophylaxis for venous thromboembolism. Over the last decade, perioperative protocols have emerged to reduce postoperative pain and to improve early function. These protocols have included preemptive pain management, intraoperative medications, periarticular injections, and postoperative avoidance of parenteral narcotics. Venous thromboembolism is a severe complication. The most preferred recommendation, by the Chinese Orthopaedic Association (COA), is

  16. Intellijoint HIP®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty

    Science.gov (United States)

    Paprosky, Wayne G; Muir, Jeffrey M

    2016-01-01

    Total hip arthroplasty is an increasingly common procedure used to address degenerative changes in the hip joint due to osteoarthritis. Although generally associated with good results, among the challenges associated with hip arthroplasty are accurate measurement of biomechanical parameters such as leg length, offset, and cup position, discrepancies of which can lead to significant long-term consequences such as pain, instability, neurological deficits, dislocation, and revision surgery, as well as patient dissatisfaction and, increasingly, litigation. Current methods of managing these parameters are limited, with manual methods such as outriggers or calipers being used to monitor leg length; however, these are susceptible to small intraoperative changes in patient position and are therefore inaccurate. Computer-assisted navigation, while offering improved accuracy, is expensive and cumbersome, in addition to adding significantly to procedural time. To address the technological gap in hip arthroplasty, a new intraoperative navigation tool (Intellijoint HIP®) has been developed. This innovative, 3D mini-optical navigation tool provides real-time, intraoperative data on leg length, offset, and cup position and allows for improved accuracy and precision in component selection and alignment. Benchtop and simulated clinical use testing have demonstrated excellent accuracy, with the navigation tool able to measure leg length and offset to within <1 mm and cup position to within <1° in both anteversion and inclination. This study describes the indications, procedural technique, and early accuracy results of the Intellijoint HIP surgical tool, which offers an accurate and easy-to-use option for hip surgeons to manage leg length, offset, and cup position intraoperatively. PMID:27920583

  17. Increasing risk of prosthetic joint infection after total hip arthroplasty

    DEFF Research Database (Denmark)

    Dale, Håvard; Fenstad, Anne M; Hallan, Geir;

    2012-01-01

    Background and purpose The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden). Materials and methods The...... explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA....

  18. Can pelvic tilting be ignored in total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Won Yong Shon

    2014-01-01

    CONCLUSION: The sagittal position of pelvis is a key factor in impingement and dislocation after total hip arthroplasty. Pelvic tilting affects the position of acetabular component in the sagittal plane of the body as compared with its anatomic position in the pelvis. We suggest a preoperative lateral view of spine-pelvis, in upright and supine position for evaluation of a corrective adaptation of the acetabular cup accordingly with pelvic balance.

  19. Total ankle arthroplasty in end-stage ankle arthritis

    OpenAIRE

    Demetracopoulos, Constantine A.; Halloran, James P.; Maloof, Paul; Samuel B Adams; Parekh, Selene G.

    2013-01-01

    Recent advancements in ankle prosthesis design, combined with improved surgical techniques for correction of coronal plane deformity and ligamentous balancing, have led to a resurgence of interest in total ankle arthroplasty for the treatment of end-stage ankle arthritis. Although ankle arthrodesis has long been considered the gold standard treatment for ankle arthritis, recent studies have shown that patients who undergo total ankle replacement have equivalent pain relief and improved functi...

  20. FAST TRACK SURGERY IN TOTAL KNEE ARTHROPLASTY - A REVIEW.

    OpenAIRE

    2015-01-01

    The number of orthopedic surgeons who are convinced in the need for significant changes in planned total knee arthroplasty (TKA) is increasing slowly and steadily. A new approach to pain control has been developed over the past 10-15 years, and the introduction of techniques to reduce perioperative stress, and the use of minimally invasive surgical techniques can help limit postoperative complications and shorten recovery time. This type of optimization is regarded as Fast-track Care program,...

  1. Stress fracture of the proximal fibula after total knee arthroplasty.

    Science.gov (United States)

    Vaish, Abhishek; Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2016-04-22

    We report a rare case of proximal fibular fatigue fracture developing 14 years after total knee arthroplasty in a known case of rheumatoid arthritis. A valgus deformity of the knee can put abnormal stress on the upper fibula leading to its failure. We believe that, as the fibula acts as an important lateral strut, its disruption due to a fracture led to rapid progress of the valgus deformity of the knee in this patient.

  2. Spontaneous arteriorrhexis in affected lower limb following total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ya-feng; JIANG Qing; WANG Jun-fei

    2008-01-01

    @@ Total knee arthroplasty ( TKA) is now a standard treatment for serious osteoarthritis all over the world. Although it is a standard treatment, it has many complications, among which deep vein thrombosis ( DVT) is the exclusive blood vessel complication that has been reported.1,2 However, we found a new blood vessel complication of TKA in this study, which is spontaneous arteriorrhexis in the affected lower limb.

  3. Changes in knee kinematics following total knee arthroplasty.

    Science.gov (United States)

    Akbari Shandiz, Mohsen; Boulos, Paul; Saevarsson, Stefan Karl; Yoo, Sam; Miller, Stephen; Anglin, Carolyn

    2016-04-01

    Total knee arthroplasty (TKA) changes the knee joint in both intentional and unintentional, known and unknown, ways. Patellofemoral and tibiofemoral kinematics play an important role in postoperative pain, function, satisfaction and revision, yet are largely unknown. Preoperative kinematics, postoperative kinematics or changes in kinematics may help identify causes of poor clinical outcome. Patellofemoral kinematics are challenging to record since the patella is obscured by the metal femoral component in X-ray and moves under the skin. The purpose of this study was to determine the kinematic degrees of freedom having significant changes and to evaluate the variability in individual changes to allow future study of patients with poor clinical outcomes. We prospectively studied the 6 degrees of freedom patellofemoral and tibiofemoral weightbearing kinematics, tibiofemoral contact points and helical axes of rotation of nine subjects before and at least 1 year after total knee arthroplasty using clinically available computed tomography and radiographic imaging systems. Normal kinematics for healthy individuals were identified from the literature. Significant differences existed between pre-TKA and post-TKA kinematics, with the post-TKA kinematics being closer to normal. While on average the pre-total knee arthroplasty knees in this group displayed no pivoting (only translation), individually only five knees displayed this behaviour (of these, two showed lateral pivoting, one showed medial pivoting and one showed central pivoting). There was considerable variability postoperatively as well (five central, two lateral and two medial pivoting). Both preop and postop, flexion behaviour was more hinge-like medially and more rolling laterally. Helical axes were more consistent postop for this group. An inclusive understanding of the pre-TKA and post-TKA kinematics and changes in kinematics due to total knee arthroplasty could improve implant design, patient diagnosis and

  4. On the Embodiment of Register in Business English

    Institute of Scientific and Technical Information of China (English)

    沈妍斌

    2009-01-01

    This paper analyzes the register character of business English from the systemic functional linguistics. By citing some examples, this paper attempts to highlight the expression and effect of register theory in business English, aiming at helping business people understand the register in order to apply the register correctly and avoiding making mistakes in daily communication and practices, so that business go smoothly.

  5. 46 CFR 401.510 - Operation without Registered Pilots.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Operation without Registered Pilots. 401.510 Section 401... REGULATIONS Penalties; Operations Without Registered Pilots § 401.510 Operation without Registered Pilots. (a... Registered Pilot when the vessel or its cargo is in distress or jeopardy. (b) A vessel may be navigated...

  6. A Study of Register Labeling in Bilingual Dictionary---Based on the Register Theory

    Institute of Scientific and Technical Information of China (English)

    Wu Xiu

    2013-01-01

    Register theory is one of the most important theories of systemic functional linguistics,which is concerned with the vari-ables of field,tenor,and mode,and is a useful abstraction which relates variations of language use to variations of social context.Bilingual dic-tionaries contain as adrule in the front matter systematic categorization and detailed description of register labels.This paper attempts to analyze the register labels in bilingual dictionaries and discuss the problems existing indregister labeling.

  7. DIAGNOSTIC AND THERAPEUTIC ARTHROSCOPY IN SYMPTOMATIC PATIENTS AFTER KNEE ARTHROPLASTY

    Science.gov (United States)

    Severino, Fabricio Roberto; Souza, Clodoaldo José Duarte de; Severino, Nilson Roberto

    2015-01-01

    Objectives: Assess the worthiness of arthroscopy in investigating and treating knee pain after arthroplasty unexplained by clinical and subsidiary examinations. Methods: Among 402 patients submitted to total or unicompartimental arthroplasty between September 2001 and April 2007 at a public university hospital, 17 presented with pain on prosthetic articulation, without clear diagnosis by clinical, X-ray, laboratory, scintiscan, or nuclear magnetic resonance tests. All patients were submitted to arthroscopy and symptoms were assessed by using the Lysholm scale, comparing pre-and post-arthroscopy periods. Peroperative findings have been recorded. Results: The procedure was effective for pain relief in 14 of 17 patients (82.35%). The median for Lysholm scale climbed from 36 points before arthroscopy to 94 points after the procedure (p < 0.001). Most of the patients (12) were arthroscopically diagnosed with fibrosis known as “cyclop”; on the remaining five patients, anterior synovitis was found. All patients were treated by resection. Conclusions: Knee arthroscopy after arthroplasty in patients presenting unclear persistent pain shows localized arthrofibrosis (“cyclops”) or synovitis, which can be treated by using the same procedure, resulting in pain relief. PMID:27022517

  8. [Periprosthetic humeral fractures: Strategies and techniques of revision arthroplasty].

    Science.gov (United States)

    Kirchhoff, C; Beirer, M; Brunner, U

    2016-04-01

    The primary aims when performing revision arthroplasty of periprosthetic humeral fractures (PHF) are preservation of bone stock, achieving fracture healing and preserving a stable prosthesis with the focus on regaining the preoperative shoulder-arm function. The indications for revision arthroplasty are given in PHF in combination with loosening of the stem. In addition, further factors must be independently clarified in the case of an anatomical arthroplasty. In this context secondary glenoid erosion as well as rotator cuff insufficiency are potential factors for an extended revision procedure. For the performance of revision surgery modular revision sets including long stems, revision glenoid and metaglene components as well as plate and cerclage systems are obligatory besides the explantation instrumentation. Despite a loosened prosthesis, a transhumeral removal of the stem along with a subpectoral fenestration are often required. Length as well as bracing of revision stems need to bridge the fracture by at least twice the humeral diameter. Moreover, in many cases a combined procedure using an additional distal open reduction and internal fixation (ORIF) plus cable cerclages as well as biological augmentation might be needed. Assuming an adequate preparation, the experienced surgeon is able to achieve a high fracture union rate along with an acceptable or even good shoulder function and to avoid further complications.

  9. [Recovery from total knee arthroplasty through continuous passive motion].

    Science.gov (United States)

    Sánchez Mayo, B; Rodríguez-Mansilla, J; González Sánchez, B

    2015-01-01

    The purpose of this study was to know the effects of continuous passive mobilization in patients who underwent total knee arthroplasty. A search strategy was developed to retrieve all clinical trials, written in English and/or Spanish, published in the electronic search databases PubMed, Cochrane Library Plus, Dialnet, CSIC and PEDro. The inclusion criteria were: clinical trials published from January 2000 until November 2014 in English or Spanish. Out of 537 clinical trials that were potentially relevant, a total of 12 were included in this review. The evaluation of 1,153 patients shows that there is no significant difference in improving the range of the joint, pain, balance, motion, healing and hospital stay using continuous passive mobilization against the regular physiotherapy treatment for total knee arthroplasty. The application of continuous passive mobilization in the long-term does not provide any benefit in terms of the breadth of the range of the joint, pain and improvement of standing and motion in comparison with conventional postoperative physiotherapy treatment in total knee arthroplasty. In the short term an improvement is obtained in the range of joint motion in knee flexion.

  10. Review of Arthroscopic and Histological Findings Following Knee Inlay Arthroplasty.

    Science.gov (United States)

    Markarian, Gregory G; Kambour, Michael T; Uribe, John W

    2016-01-01

    The phenomenon of cartilage rim loading in defects exceeding the threshold diameter of 10 mm is well documented. Contoured defect fill off-loads the perimeter and counteracts further delamination and progression of defects. When biological procedures have failed, inlay arthroplasty follows these concepts. The human biological response to contoured metallic surface implants has not been described. Four patients underwent non-implant-related, second-look arthroscopy following inlay arthroplasty for bi- (n=3) and tricompartmental (n=1) knee arthrosis without subchondral bone collapse. Arthroscopic probing of the implant-cartilage interface of nine prosthetic components did not show signs of implant-cartilage gap formation, loosening, or subsidence. The implant periphery was consistently covered by cartilage confluence leading to a reduction of the original defect size diameter. Femoral condyle cartilage flow appeared to have more hyaline characteristics. Trochlear cartilage flow showed greater histological variability and less organization with fibrocartilage and synovialized scar tissue. This review reconfirmed previous basic science results and demonstrated effective defect fill and rim off-loading with inlay arthroplasty.

  11. Loosening of Total Knee Arthroplasty after Brucellosis Infection: A Case Report

    Science.gov (United States)

    Sazegari, Mohammad Ali; Bahramian, Fateme; Mirzaee, Fateme; Zafarani, Zohreh; Aslani, Hamidreza

    2017-01-01

    In this report we describe a 78-year-old man whose total knee arthroplasty showed the symptoms of infection with brucella with radiographic signs of loosening 5 years after the index surgery. The patient was treated successfully after a 2-stage revision arthroplasty surgery along with using rifampicin and doxycycline for 8 weeks. PMID:28271092

  12. Prevention of post-operative anaemia in hip and knee arthroplasty - a systematic review

    DEFF Research Database (Denmark)

    Khan, Nissa; Troelsen, Anders; Husted, Henrik

    2015-01-01

    and minimised the length of stay. A similar result was found for fibrin spray in total hip arthroplasty. However, for total knee arthroplasty, the outcome was blurred. Tourniquet use was uniformly not significant in the measured parameters. CONCLUSIONS: Tranexamic acid is useful in managing anaemia and blood...

  13. Adductor canal block for postoperative pain treatment after revision knee arthroplasty

    DEFF Research Database (Denmark)

    Jæger, Pia; Koscielniak-Nielsen, Zbigniew J; Schrøder, Henrik M

    2014-01-01

    BACKGROUND: Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary tota...

  14. Analgesic efficacy of intracapsular and intra-articular local anaesthesia for knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, L Ø; Husted, H; Kristensen, B B;

    2010-01-01

    The optimal site for wound delivery of local anaesthetic after total knee arthroplasty is undetermined. Sixty patients having total knee arthroplasty received intra-operative infiltration analgesia with ropivacaine 0.2% and were then were randomly assigned to receive either intracapsular or intra...

  15. Patellofemoral Joint Arthroplasty: Our Experience in Isolated Patellofemoral and Bicompartmental Arthritic Knees

    Science.gov (United States)

    Sabatini, L.; Schirò, M.; Atzori, F.; Ferrero, G.; Massè, A.

    2016-01-01

    INTRODUCTION Isolated patellofemoral (PF) arthritis is rare, and there is no complete agreement about the best surgical treatment. The operative treatments are total knee arthroplasty and patellofemoral replacement (PFR). The incidence of many early complications of PF arthroplasty has decreased with the introduction of newer designs. Nowadays, the main cause of revision surgery is the progression of tibiofemoral osteoarthritis. In the past, PF arthroplasty was contraindicated in patients with evidence of osteoarthritis or pain in medial or lateral tibiofemoral compartments. The improvement in implant designs and surgical techniques has allowed the addition of a monocompartmental arthroplasty for the medial or lateral tibiofemoral compartment. In this work, we evaluate our first experience with PF arthroplasty and its combination with unicompartmental knee arthroplasty. MATERIALS AND METHODS From May 2014 to March 2016, we treated 14 patients. An isolated PF arthroplasty was performed in six knees (five patients), and a combined PF and unicompartmental knee arthroplasty was performed in nine cases. We observed a significant improvement in the clinical and functional Knee Society Scores (KSSs) after surgery in our patients. RESULTS We obtained good results in our cases both for clinical and functional KSSs. Patellar clunk was recorded in one case. DISCUSSION AND CONCLUSION We are going toward a new attitude in which partial osteoarthritic changes could be treated with partial resurfacing prosthetic solutions such as unicompartmental, bi–unicompartmental or PFR alone, or unicompartmental combined, which respects the cruciates and achieves maximal bone preservation, which is vital, particularly, for young patients. PMID:27891054

  16. Revision total knee arthroplasty with the use of trabecular metal cones

    DEFF Research Database (Denmark)

    Jensen, Claus L; Petersen, Michael Mygind; Schrøder, Henrik;

    2012-01-01

    "Trabecular Metal Cone" (TM Cone) (Zimmer, Inc, Warsaw, Ind) for reconstruction of bone loss in the proximal tibia during revision total knee arthroplasty is now optional. Forty patients were randomized to receive revision total knee arthroplasty with or without TM Cone (No TM Cone). The Anderson...

  17. Low Risk of Thromboembolic Events After Routine Administration of Tranexamic Acid in Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Madsen, Rune V; Nielsen, Christian S; Kallemose, Thomas;

    2016-01-01

    BACKGROUND: The blood-conserving effect of intravenous (IV) tranexamic acid (TXA) is well-documented for total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the risk of thromboembolic (TE) events after routine use of TXA is unclear and the safety profile is debated. This retr...

  18. The role of pain for early rehabilitation in fast track total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis;

    2010-01-01

    To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA).......To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA)....

  19. Minimally Invasive Total Hip and Knee Arthroplasty-Implications for the Elderly Patient

    NARCIS (Netherlands)

    Reininga, Inge H. F.; Stevens, Martin; Wagenmakers, Robert; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge

    2012-01-01

    Total hip arthroplasty and total knee arthroplasty have proven to be effective surgical procedures for the treatment of hip and knee osteoarthritis. In recent decades, there have been considerable efforts to improve the component designs, modes of fixation, and surgical techniques. Minimally invasiv

  20. Bilateral osteoarthritis of the trapeziometacarpal joint treated by bilateral tendon interposition arthroplasty

    NARCIS (Netherlands)

    Damen, A; vanderLei, B; Robinson, PH

    1997-01-01

    Twenty-four flexor carpi radialis (FCR) tendon interposition arthroplasties of the trapezium for bilateral trapeziometacarpal osteoarthritis were reviewed. Pain was reduced in all cases. Function was improved in all right hands and in 92% of the left hands. FCR tendon interposition arthroplasty for

  1. Low risk of thromboembolic complications after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B;

    2010-01-01

    Pharmacological prophylaxis can reduce the risk of deep venous thrombosis (DVT), pulmonary embolism (PE), and death, and it is recommended 10–35 days after total hip arthroplasty (THA) and at least 10 days after total knee arthroplasty (TKA). However, early mobilization might also reduce the risk...

  2. Loss of knee-extension strength is related to knee swelling after total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten T; Bencke, Jesper;

    2010-01-01

    To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA).......To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA)....

  3. Reconstructing the rheumatoid wrist: a utility analysis comparing total wrist fusion and total wrist arthroplasty from the perspectives of rheumatologists and hand surgeons.

    Science.gov (United States)

    Cavaliere, Christi M; Oppenheimer, Adam J; Chung, Kevin C

    2010-03-01

    Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical intervention, either total wrist fusion or total wrist arthroplasty, for the rheumatoid wrist. A utility analysis was conducted to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management of severe rheumatoid wrist disease. A web-based trade-off utility survey was developed, and participants were presented with survey scenarios comparing well-controlled rheumatoid arthritis with operative and non-operative management. Utility values were calculated for each scenario, and a decision analytic model was constructed. Utility values for rheumatologists and hand surgeons did not differ significantly for any scenario. Total wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup. This decision analytic model demonstrates similar opinions between two subspecialties that have historically demonstrated divergent attitudes towards rheumatoid hand surgery.

  4. The use of the Gait Deviation Index for the evaluation of participants following total hip arthroplasty

    DEFF Research Database (Denmark)

    Jensen, Carsten; Rosenlund, Signe; Nielsen, Dennis B;

    2015-01-01

    trial was used to determine changes in gait quality in participants walking at self-selected speed. Upon completion of the first assessment, the participants were randomly assigned to either resurfacing hip arthroplasty or conventional hip arthroplasty. The outcome was changes in overall gait 'quality......, there was no additional effect of resurfacing hip arthroplasty on GDI scores compared with conventional hip arthroplasty. Participants with the most pathological preoperative gait pattern improved the most. The GDI increased, which indicates an overall improvement in gait pathology after surgery. TRIAL REGISTRATION: NCT......INTRODUCTION: In this paper, the Gait Deviation Index (GDI) was used as a convenient method to evaluate pre-to-postoperative gait pattern changes after total hip arthroplasty and identify factors which might be predictive of outcome. DESIGN: Three-dimensional gait data from a randomized clinical...

  5. Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty

    DEFF Research Database (Denmark)

    Villadsen, Allan; Overgaard, Søren; Holsgaard-Larsen, Anders

    2014-01-01

    neuromuscular exercise prior to total joint arthroplasty (TJA) of the hip or knee did not confer additional benefits 3 months postoperatively compared with TJA alone. However, the intervention group experienced a statistically significant short-term benefit in ADL and pain, suggesting an earlier onset......OBJECTIVE: To investigate the postoperative efficacy of a supervised programme of neuromuscular exercise prior to hip or knee arthroplasty. METHODS: In this assessor-blinded randomised controlled trial, we included 165 patients scheduled for hip or knee arthroplasty due to severe osteoarthritis (OA......). An 8-week preoperative neuromuscular supervised exercise programme was delivered twice a week for 1 h as adjunct treatment to the standard arthroplasty procedure and compared with the standard arthroplasty procedure alone. The primary outcome was self-reported physical function measured...

  6. Arthroplasty Utilization in the United States is Predicted by Age-Specific Population Groups.

    Science.gov (United States)

    Bashinskaya, Bronislava; Zimmerman, Ryan M; Walcott, Brian P; Antoci, Valentin

    2012-01-01

    Osteoarthritis is a common indication for hip and knee arthroplasty. An accurate assessment of current trends in healthcare utilization as they relate to arthroplasty may predict the needs of a growing elderly population in the United States. First, incidence data was queried from the United States Nationwide Inpatient Sample from 1993 to 2009. Patients undergoing total knee and hip arthroplasty were identified. Then, the United States Census Bureau was queried for population data from the same study period as well as to provide future projections. Arthroplasty followed linear regression models with the population group >64 years in both hip and knee groups. Projections for procedure incidence in the year 2050 based on these models were calculated to be 1,859,553 cases (hip) and 4,174,554 cases (knee). The need for hip and knee arthroplasty is expected to grow significantly in the upcoming years, given population growth predictions.

  7. Cancer incidence after total knee arthroplasty: a nationwide Finnish cohort from 1980 to 1996 involving 9,444 patients.

    Science.gov (United States)

    Paavolainen, P; Pukkala, E; Pulkkinen, P; Visuri, T

    1999-12-01

    A nationwide, computer-based survey of all total joint arthroplasties performed in Finland has been carried out since January 1980. From these records, a cohort of 9,444 patients, with 51,756 person-years, after primary operation with a total polyethylene-on-metal knee arthroplasty (TKA) was followed up for cancer through the Finnish Cancer Register up to December 31, 1996. During the follow-up, 706 cancers were observed. The expected number, based on national rates, was 719; therefore, the standardized incidence ratio (SIR) for all cancers was 0.98. The SIRs for non-Hodgkin's lymphoma (1.40), Hodgkin's disease (1.24) and multiple myeloma (1.54) were increased, but only that of non-Hodgkin's lymphoma was statistically significant 3-10 years after the operation. The numbers of observed cases of prostate cancer exceeded that of expected, with a SIR value of 1.49. A low SIR of lung cancer was observed among men, especially during the first 3 years (0.61), but not in women. The SIR for colon cancer was below unity in women only (SIR 0.70). The SIR for cancer of the urinary organs was close to unity (0.97). SIR relating to soft tissue and bone cancer did not differ significantly from unity, and none of the 6 sarcomas was observed at the site of a prosthesis. The overall cancer risk after TKA done for primary osteoarthrosis seems not to be increased. The increases in lymphoma and prostate cancer risk, however, are observations that could be related to TKA and justify further follow-up of the cohort.

  8. The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA: a meta analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Baohui Yang

    Full Text Available BACKGROUND: Cervical disc arthroplasty is being used as an alternative degenerative disc disease treatment with fusion of the cervical spine in order to preserve motion. However, whether replacement arthoplasty in the spine achieves its primary patient centered objective of lowering the frequency of adjacent segment degeneration is not verified yet. METHODOLOGY: We conducted a meta-analysis according to the guidelines of the Cochrane Collaboration using databases including PubMed, Cochrane Central Register of Controlled Trials and Embase. The inclusion criteria were: 1 Randomized, controlled study of degenerative disc disease of the cervical spine involving single segment or double segments using Cervical disc arthroplasty (CDA with anterior cervical discectomy and fusion (ACDF as controls; 2 A minimum of two-year follow-up using imaging and clinical analyses; 3 Definite diagnostic evidences for "adjacent segment degeneration" and "adjacent segment disease"; 4 At least a minimum of 30 patients per population. Two authors independently selected trials; assessed methodological quality, extracted data and the results were pooled. RESULTS: No study has specifically compared the results of adjacent segment degenerative; Two papers describing 140 patients with 162 symptomatic cervical segment disorders and compared the rate of postoperative adjacent segment disease development between CDA and ACDF treatments, three publications describing the rate of adjacent-segment surgery including 1273 patients with symptomatic cervical segments. The result of the meta-analysis indicates that there were fewer the rate of adjacent segment disease and the rate for adjacent-segment surgery comparing CDA with ACDF, but the difference was not statistically significant. CONCLUSIONS: Based on available evidence, it cannot be concluded, that CDA can significantly reduce the postoperative rate of the adjacent segment degenerative and adjacent segment disease. However, due

  9. National Register of Historic Places - National Geospatial Data Asset (NGDA) NPS National Register Dataset

    Data.gov (United States)

    Federal Geographic Data Committee — A current, accurate spatial representation of all historic properties listed on the National Register of Historic Places is of interest to Federal agencies, the...

  10. Registered criminality and sanctioning of schizophrenia patients

    DEFF Research Database (Denmark)

    Munkner, Runa; Haastrup, Soeren; Joergensen, Torben;

    2009-01-01

    BACKGROUND: Patients with schizophrenia have been shown to have an increased risk of criminality, especially violent crimes. AIMS: The aim of the current study was to describe the pattern of crimes committed by Danish patients with schizophrenia and examine the sanctions given for crimes...... in relation to the different periods in the patients' lives: not yet known to the psychiatric hospital system, known to the system but not yet diagnosed with schizophrenia, and after being diagnosed with schizophrenia. METHODS: Information from the Danish Psychiatric Central Research Register was correlated...... with data from the Danish National Crime Register. RESULTS: One of the more prominent findings was that 16% of patients diagnosed with schizophrenia receive a prison sentence or a suspended prison sentence, despite the fact that Denmark is a co-signatory of the European Prison Rules and should treat, rather...

  11. Assessing registered nurses' clinical skills in orthopaedics.

    Science.gov (United States)

    Clarke, Sonya; McDonald, Sinead; Rainey, Debbie

    The aim of this article is to explore the views of registered nurses undertaking the new Objective Structured Clinical Examination (OSCE), incorporating an integrated preparatory skills workshop. The workshop and the OSCE were audited with particular regard to the student experience. This article describes the audit process and the results of three questionnaires: one carried out before the OSCE assessment, a second immediately after the workshop and a third four days after the assessment. The results provide an insight into the student experience.

  12. AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Van der Linden-Van der Zwaag Henrica MJ

    2011-07-01

    Full Text Available Abstract Background In the light of both the importance and large numbers of case series and cohort studies (observational studies in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening. Methods A web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability. Results The internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist. Conclusions Checklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.

  13. 78 FR 67078 - Membership in a Registered Futures Association

    Science.gov (United States)

    2013-11-08

    ... entities. \\20\\ Policy Statement and Establishment of Definitions of ``Small Entities'' for Purposes of the..., 20 CPOs, 605 CTAs, and 25 CPO/CTAs. To arrive at the monetary estimate, the 652 figure was multiplied... possible, quantify such costs. Do the types of costs or amount of costs vary depending on whether the...

  14. RNA interference and Register Machines (extended abstract

    Directory of Open Access Journals (Sweden)

    Masahiro Hamano

    2012-11-01

    Full Text Available RNA interference (RNAi is a mechanism whereby small RNAs (siRNAs directly control gene expression without assistance from proteins. This mechanism consists of interactions between RNAs and small RNAs both of which may be single or double stranded. The target of the mechanism is mRNA to be degraded or aberrated, while the initiator is double stranded RNA (dsRNA to be cleaved into siRNAs. Observing the digital nature of RNAi, we represent RNAi as a Minsky register machine such that (i The two registers hold single and double stranded RNAs respectively, and (ii Machine's instructions are interpreted by interactions of enzyme (Dicer, siRNA (with RISC com- plex and polymerization (RdRp to the appropriate registers. Interpreting RNAi as a computational structure, we can investigate the computational meaning of RNAi, especially its complexity. Initially, the machine is configured as a Chemical Ground Form (CGF, which generates incorrect jumps. To remedy this problem, the system is remodeled as recursive RNAi, in which siRNA targets not only mRNA but also the machine instructional analogues of Dicer and RISC. Finally, probabilistic termination is investigated in the recursive RNAi system.

  15. 405 nm light exposure of osteoblasts and inactivation of bacterial isolates from arthroplasty patients: potential for new disinfection applications?

    Directory of Open Access Journals (Sweden)

    RS McDonald

    2013-01-01

    Full Text Available Infection rates after arthroplasty surgery are between 1-4 %, rising significantly after revision procedures. To reduce the associated costs of treating these infections, and the patients’ post-operative discomfort and trauma, a new preventative method is required. High intensity narrow spectrum (HINS 405 nm light has bactericidal effects on a wide range of medically important bacteria, and it reduced bacterial bioburden when used as an environmental disinfection method in a Medical Burns Unit. To prove its safety for use for environmental disinfection in orthopaedic theatres during surgery, cultured osteoblasts were exposed to HINS-light of intensities up to 15 mW/cm2 for 1 h (54 J/cm2. Intensities of up to 5 mW/cm2 for 1 h had no effect on cell morphology, activity of alkaline phosphatase, synthesis of collagen or osteocalcin expression, demonstrating that under these conditions this dose is the maximum safe exposure for osteoblasts; after exposure to 15 mW/cm2 all parameters of osteoblast function were significantly decreased. Viability (measured by protein content and Crystal Violet staining of the osteoblasts was not influenced by exposure to 5 mW/cm2 for at least 2 h. At 5 mW/cm2 HINS-light is an effective bactericide. It killed 98.1 % of Staphylococcus aureus and 83.2 % Staphylococcus epidermis populations seeded on agar surfaces, and is active against both laboratory strains and clinical isolates from infected hip and knee arthroplasties. HINS-light could have potential for development as a method of disinfection to reduce transmission of bacteria during arthroplasty, with wider applications in diverse surgical procedures involving implantation of a medical device.

  16. Effect of perioperative administration of dexketoprofen on opioid requirements and inflammatory response following elective hip arthroplasty.

    LENUS (Irish Health Repository)

    Iohom, G

    2012-02-03

    BACKGROUND: In this double-blind, randomized, placebo-controlled trial, the safety and analgesic efficacy of perioperative dexketoprofen were evaluated. METHODS: Thirty ASA I or II patients undergoing elective hip arthroplasty were randomized to one of two groups. One group (D) received dexketoprofen 25 mg tds for 24 h before and 48 h after surgery; the second group (P) received placebo tablets at equivalent times. Hyperbaric 0.5% bupivacaine (17.5 mg if greater than 70 kg and 15 mg if less than 70 kg) and preservative-free morphine (0.6 mg) were administered intrathecally. Postoperatively, PCA was provided (bolus morphine sulphate 1 mg; lockout 5 min; no continuous infusion). RESULTS: The two groups were similar in terms of age, gender, weight, height, ASA class, duration of operation, and level of sensory block on arrival to the recovery room. Groups were also similar in terms of blood loss, transfusion requirements, ventilatory frequency, and haemodynamic variables. According to visual analogue pain scores patients in group D experienced less pain at 15 h (P=0.02) postoperatively. Cumulative morphine consumption was also less in group D compared with group P at 6 (0.06 (0.2) vs 0.85 (1.4) mg, P=0.04) and 48 h postoperatively (10.1 (8) vs 26.2 (20) mg, P<0.01). Plasma interleukin 6 concentrations increased postoperatively to a significantly lesser extent in group D than in group P (P=0.02). Nausea and vomiting were less (P<0.01) in group D compared with group P at 18 h postoperatively. Sedation scores were less (P=0.03) in group D. CONCLUSIONS: Perioperative administration of dexketoprofen 25 mg 8 hourly markedly improves analgesia and decreases opioid requirements (and associated adverse effects) following hip arthroplasty. It appears that this regimen decreases the postoperative pro-inflammatory response.

  17. Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals

    Science.gov (United States)

    Cortada, Aline Pinheiro dos Santos; da Silva, Telma Gomes; da Silva, André Campos; Golmia, Ricardo Prado; Guerra, Renata Leborato; Takemoto, Maíra Libertad Soligo; Monteiro, Roberta Dyonisio Canaveira; Scheinberg, Morton Aaron

    2015-01-01

    Objective To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system. Methods A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization). Results A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively. Conclusion Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio. PMID:26313439

  18. The Inflammatory Phenotype in Failed Metal-On-Metal Hip Arthroplasty Correlates with Blood Metal Concentrations.

    Directory of Open Access Journals (Sweden)

    Erja-Leena Paukkeri

    Full Text Available Hip arthroplasty is the standard treatment of a painful hip destruction. The use of modern metal-on-metal (MOM bearing surfaces gained popularity in total hip arthroplasties during the last decade. Recently, worrisome failures due to adverse reaction to metal debris (ARMD, including pseudotumor response, have been widely reported. However, the pathogenesis of this reaction remains poorly understood. The aim of the present study was to investigate the ARMD response by flow cytometry approach.Sixteen patients with a failed Articular Surface Replacement (ASR hip prosthesis were included in the study. Samples of pseudotumor tissues collected during revision surgery were degraded by enzyme digestion and cells were typed by flow cytometry. Whole blood chromium and cobalt concentrations were analyzed with mass spectrometry before revision surgery.Flow cytometry analysis showed that the peri-implant pseudotumor tissue expressed two principal phenotypes, namely macrophage-dominated and T-lymphocyte-dominated response; the average portions being 54% (macrophages and 25% (T-lymphocytes in macrophage-dominated inflammation and 20% (macrophages and 54% (T-lymphocytes in T-lymphocyte-dominated response. The percentages of B-lymphocytes and granulocytes were lower in both phenotypes. Interestingly, the levels of blood chromium and cobalt were significantly higher in patients with macrophage-dominated response.The results suggest that the adverse tissue reactions induced by MOM wear particles contain heterogeneous pathogeneses and that the metal levels are an important factor in the determination of the inflammatory phenotype. The present results support the hypothesis that higher metal levels cause cytotoxicity and tissue injury and macrophages are recruited to clear the necrotic debris. On the other hand, the adverse response developed in association with lower metal levels is T-lymphocyte-dominated and is likely to reflect hypersensitivity reaction.

  19. Effect of Body Mass Index on Blood Transfusion in Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Frisch, Nicholas; Wessell, Nolan M; Charters, Michael; Peterson, Ed; Cann, Brett; Greenstein, Alex; Silverton, Craig D

    2016-09-01

    Perioperative blood management remains a challenge during total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to systematically examine the relationship between body mass index (BMI) and perioperative blood transfusion during THA and TKA while attempting to resolve conflicting results in previously published studies. The authors retrospectively evaluated 2399 patients, 896 of whom underwent THA and 1503 of whom underwent TKA. Various outcome variables were assessed for their relationship to BMI, which was stratified using the World Health Organization classification scheme (normal, 30 kg/m(2)). Among patients undergoing THA, transfusion rates were 34.8%, 27.6%, and 21.9% for normal, overweight, and obese patients, respectively (P=.002). Among patients undergoing TKA, transfusion rates were 17.3%, 11.4%, and 8.3% for normal, overweight, and obese patients, respectively (P=.002). Patients with an elevated BMI have decreased rates of blood transfusion following both THA and TKA. This same cohort also loses a significantly decreased percentage of estimated blood volume. No trends were identified for a relationship between BMI and deep venous thrombosis, pulmonary embolism, myocardial infarction, discharge location, length of stay, 30-day readmission rate, and preoperative hemoglobin level. Elevated BMI was significantly associated with increased estimated blood loss in patients undergoing THA and those undergoing TKA. There was a statistically significant trend toward increased deep surgical-site infection in patients undergoing THA (P=.043). Patients with increased BMI have lower rates of blood transfusion and lose a significantly smaller percentage of estimated blood volume following THA and TKA. [Orthopedics.2016; 39(5):e844-e849.].

  20. Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder: 837 operations reported to the Danish Shoulder Arthroplasty Registry.

    Science.gov (United States)

    Rasmussen, J V; Polk, A; Sorensen, A K; Olsen, B S; Brorson, S

    2014-04-01

    In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7.5%) required revision; the cumulative five-year rate of revision was 9.9%. Patients aged < 55 years had a statistically significant inferior WOOS score, which exceeded the minimal clinically important difference, compared with older patients (mean difference 14.2 (8.8; 95% CI 19.6; p < 0.001), but with no increased risk of revision. There was no significant difference in the mean WOOS or the risk of revision between designs of resurfacing hemiarthroplasty.

  1. Strain shielding in distal radius after wrist arthroplasty with a current generation implant: An in vitro analysis.

    Science.gov (United States)

    Completo, A; Pereira, J; Nascimento, A; Almeida, F

    2017-02-08

    A systematic review of peer reviewed articles has shown that the main cause for wrist arthroplasty revision is carpal and radial prosthetic loosening and instability. To improve arthroplasty outcomes, successive generations of implants have been developed over time. The problem with the current generation of implants is the lack of long-term outcomes data. The aim of the present work was to test the hypothesis that the current generation Maestro WRS implant has a stress, strain and stability behaviour which may be associated with a reduced risk of long-term radial component loosening. This study was performed using synthetic radii to experimentally predict the cortex strain behaviour and implant stability considering different load conditions for both intact and implanted conditions. Finite element models were developed to assess the structural behaviour of cancellous-bone and bone-cement, these models were validated against experimentally measured cortex strains. Measured cortex strains showed a significant reduction between intact and implanted states. Cancellous bone adjacent to the radial body component suffers a two to threefold strain reduction, comparing with the intact condition, while along the radial stem, in the axial direction, a strain increase was observed. It is concluded that the use of contemporary Maestro WRS implant changes the biomechanical behaviour of the radius and is associated with a potential risk of bone resorption by stress-shielding in the distal radius region for wrist loads in the range of daily activities.

  2. Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study

    Directory of Open Access Journals (Sweden)

    O'Gorman Donal J

    2010-06-01

    Full Text Available Abstract Background Supervised preoperative muscle strengthening programmes (prehabilitation can improve recovery after total joint arthroplasty but are considered resource intensive. Neuromuscular electrical stimulation (NMES has been shown to improve quadriceps femoris muscle (QFM strength and clinical function in subjects with knee osteoarthritis (OA however it has not been previously investigated as a prehabilitation modality. Methods This pilot study assessed the compliance of a home-based, NMES prehabilitation programme in patients undergoing total knee arthroplasty (TKA. We evaluated its effect on preoperative and postoperative isometric quadriceps femoris muscle (QFM strength, QFM cross-sectional area (CSA and clinical function (subjective and objective. Seventeen subjects were recruited with 14 completing the study (NMES group n = 9; Control group n = 5. Results Overall compliance with the programme was excellent (99%. Preoperative QFM strength increased by 28% (p > 0.05 with associated gains in walk, stair-climb and chair-rise times (p 0.05 at 12 weeks postoperatively compared to baseline. There were only limited associations found between objective and subjective functional outcome instruments. Conclusions This pilot study has shown that preoperative NMES may improve recovery of quadriceps muscle strength and expedite a return to normal activities in patients undergoing TKA for OA. Recommendations for appropriate outcome instruments in future studies of prehabilitation in TKA have been provided.

  3. Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study.

    Science.gov (United States)

    Barrack, R L; Wolfe, M W; Waldman, D A; Milicic, M; Bertot, A J; Myers, L

    1997-08-01

    of the patella in one knee and retention of the patella in the other. These patients expressed no clear preference for either knee. Eight (13 per cent) of the sixty knees that had not had resurfacing were painful anteriorly compared with four (7 per cent) of the fifty-eight that had; this was not a significant difference (p = 0.38), with the numbers available. The anterior pain that was noted postoperatively was predominantly of new onset; it had not been observed preoperatively in three of the four knees that had had resurfacing or in four of the eight that had not. No additional treatment options were offered to the patients who had anterior pain in the knee after resurfacing. However, six (10 per cent) of the sixty knees that had not had resurfacing had it subsequently, because of anterior pain in the knee, after the twelfth postoperative month (range, fifteen to thirty-nine months). The pain decreased in four of these knees. Thus, total knee arthroplasty with retention of the patella yielded clinical results that were comparable with those after total knee arthroplasty with patellar resurfacing, but it was associated with a 10 per cent prevalence of the need for subsequent resurfacing. The prevalence of anterior pain after total knee arthroplasty was not influenced by whether or not the patella had been resurfaced. The postoperative clinical scores, the postoperative development of anterior pain, and the need for subsequent resurfacing were not predicted by the presence of preoperative anterior pain, obesity, or the grade of chondromalacia observed intraoperatively. Because of the short duration of follow-up, these results should be considered preliminary. Additional follow-up is planned.

  4. The effect of the Oxford uncemented medial compartment arthroplasty on the bone mineral density and content of the proximal tibia.

    Science.gov (United States)

    Hooper, G J; Gilchrist, N; Maxwell, R; March, R; Heard, A; Frampton, C

    2013-11-01

    We studied the bone mineral density (BMD) and the bone mineral content (BMC) of the proximal tibia in patients with a well-functioning uncemented Oxford medial compartment arthroplasty using the Lunar iDXA bone densitometer. Our hypothesis was that there would be decreased BMD and BMC adjacent to the tibial base plate and increased BMD and BMC at the tip of the keel. There were 79 consecutive patients (33 men, 46 women) with a mean age of 65 years (44 to 84) with a minimum two-year follow-up (mean 2.6 years (2.0 to 5.0)) after unilateral arthroplasty, who were scanned using a validated standard protocol where seven regions of interest (ROI) were examined and compared with the contralateral normal knee. All had well-functioning knees with a mean Oxford knee score of 43 (14 to 48) and mean Knee Society function score of 90 (20 to 100), showing a correlation with the increasing scores and higher BMC and BMD values in ROI 2 in the non-implanted knee relative to the implanted knee (p = 0.013 and p = 0.015, respectively). The absolute and percentage changes in BMD and BMC were decreased in all ROIs in the implanted knee compared with the non-implanted knee, but this did not reach statistical significance. Bone loss was markedly less than reported losses with total knee replacement. There was no significant association with side, although there was a tendency for the BMC to decrease with age in men. The BMC was less in the implanted side relative to the non-implanted side in men compared with women in ROI 2 (p = 0.027), ROI 3 (p = 0.049) and ROI 4 (p = 0.029). The uncemented Oxford medial compartment arthroplasty appears to allow relative preservation of the BMC and BMD of the proximal tibia, suggesting that the implant acts more physiologically than total knee replacement. Peri-prosthetic bone loss is an important factor in assessing long-term implant stability and survival, and the results of this study are encouraging for the long-term outcome of this arthroplasty.

  5. Artroplastia total do joelho em paciente com pseudoartrose de fratura de Hoffa: relato de caso Total knee arthroplasty in a patient with Hoffa fracture pseudarthrosis: case report

    Directory of Open Access Journals (Sweden)

    Rodrigo Pires e Albuquerque

    2011-01-01

    Full Text Available Os autores relatam a rara ocorrência de um caso de pseudoartrose de fratura de Hoffa em um paciente alcoólatra com geno valgo associado à insuficiência venosa que foi submetido a artroplastia total do joelho. Fazem uma revisão da literatura e discutem os principais fatores de indicação cirúrgica de artroplastia total do joelho após fratura do joelho. A artroplastia total do joelho foi uma opção viável em um paciente de 60 anos com pseudoartrose de fratura de Hoffa e comorbidades.A rare occurrence of a case of Hoffa fracture pseudarthrosis in an alcoholic patient with genu valgum associated with venous insufficiency who underwent total knee arthroplasty is reported. The literature is reviewed and the main factors for surgical indication of total knee arthroplasty after a fracture of the knee are discussed. Total knee arthroplasty was a viable option in a 60-year-old patient with Hoffa fracture pseudarthrosis and comorbidities.

  6. The Danish Multiple Sclerosis Treatment Register

    Directory of Open Access Journals (Sweden)

    Magyari M

    2016-10-01

    Full Text Available Melinda Magyari,1,3 Nils Koch-Henriksen,1,2 Per Soelberg Sørensen3 1Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, Copenhagen, 2Department of Clinical Epidemiology, Clinical Institute, University of Aarhus, Aarhus, 3Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Aim of the database: The Danish Multiple Sclerosis Treatment Register (DMSTR serves as a clinical quality register, enabling the health authorities to monitor the quality of the disease-modifying treatment, and it is an important data source for epidemiological research. Study population: The DMSTR includes all patients with multiple sclerosis who had been treated with disease-modifying drugs since 1996. At present, more than 8,400 patients have been registered in this database. Data are continuously entered online into a central database from all sites in Denmark at start and at regular visits. Main variables: Include age, sex, onset year and year of the diagnosis, basic clinical information, and information about treatment, side effects, and relapses. Descriptive data: Notification is done at treatment start, and thereafter at every scheduled clinical visit 3 months after treatment start, and thereafter every 6 months. The longitudinally collected information about the disease activity and side effects made it possible to investigate the clinical efficacy and adverse events of different disease-modifying therapies. Conclusion: The database contributed to a certain harmonization of treatment procedures in Denmark and will continue to be a major factor in terms of quality in clinical praxis, research and monitoring of adverse events, and plays an important role in research. Keywords: multiple sclerosis, epidemiology, immunomodulatory treatment, neutralizing antibodies, observational studies, registry research, disease modifying therapy

  7. Optimizing Instruction Scheduling and Register Allocation for Register-File-Connected Clustered VLIW Architectures

    Directory of Open Access Journals (Sweden)

    Haijing Tang

    2013-01-01

    Full Text Available Clustering has become a common trend in very long instruction words (VLIW architecture to solve the problem of area, energy consumption, and design complexity. Register-file-connected clustered (RFCC VLIW architecture uses the mechanism of global register file to accomplish the inter-cluster data communications, thus eliminating the performance and energy consumption penalty caused by explicit inter-cluster data move operations in traditional bus-connected clustered (BCC VLIW architecture. However, the limit number of access ports to the global register file has become an issue which must be well addressed; otherwise the performance and energy consumption would be harmed. In this paper, we presented compiler optimization techniques for an RFCC VLIW architecture called Lily, which is designed for encryption systems. These techniques aim at optimizing performance and energy consumption for Lily architecture, through appropriate manipulation of the code generation process to maintain a better management of the accesses to the global register file. All the techniques have been implemented and evaluated. The result shows that our techniques can significantly reduce the penalty of performance and energy consumption due to access port limitation of global register file.

  8. 10-year survival of total ankle arthroplasties

    Science.gov (United States)

    2011-01-01

    Background and purpose There is an ongoing need to review large series of total ankle replacements (TARs) for monitoring of changes in practice and their outcome. 4 national registries, including the Swedish Ankle Register, have previously reported their 5-year results. We now present an extended series with a longer follow-up, and with a 10-year survival analysis. Patients and methods Records of uncemented 3-component TARs were retrospectively reviewed, determining risk factors such as age, sex, and diagnosis. Prosthetic survival rates were calculated with exchange or removal of components as endpoint—excluding incidental exchange of the polyethylene meniscus. Results Of the 780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010. The overall survival rate fell from 0.81 (95% CI: 0.79–0.83) at 5 years to 0.69 (95% CI: 0.67–0.71) at 10 years. The survival rate was higher, although not statistically significantly so, during the latter part of the period investigated. Excluding the STAR prosthesis, the survival rate for all the remaining designs was 0.78 at 10 years. Women below the age of 60 with osteoarthritis were at a higher risk of revision, but age did not influence the outcome in men or women with rheumatoid arthritis. Revisions due to technical mistakes at the index surgery and instability were undertaken earlier than revisions for other reasons. Interpretation The results have slowly improved during the 18-year period investigated. However, we do not believe that the survival rates of ankle replacements in the near future will approach those of hip and knee replacements—even though improved instrumentation and design of the prostheses, together with better patient selection, will presumably give better results. PMID:22066551

  9. Hirschsprung's disease prevalence in Europe. A register based study

    DEFF Research Database (Denmark)

    Best, Kate E; Addor, Marie-Claude; Arriola, Larraitz;

    2014-01-01

    BACKGROUND: Hirschsprung's disease is a congenital gut motility disorder, characterised by the absence of the enteric ganglion cells along the distal gut. The aim of this study was to describe the epidemiology of Hirschsprung's disease, including additional congenital anomalies, total prevalence......, trends, and association with maternal age. METHODS: Cases of Hirschsprung's disease delivered during 1980 to 2009 notified to 31 European Surveillance of Congenital Anomaly registers formed the population-based case-series. Prevalence rates and 95% confidence intervals were calculated as the number...... of cases per 10,000 births. Multilevel Poisson regression was performed to investigate trends in prevalence, geographical variation and the association with maternal age. RESULTS: There were 1,322 cases of Hirschsprung's disease among 12,146,210 births. The total prevalence was 1.09 (95% confidence...

  10. Approach towards total knee arthroplasty in Brazil: cross-sectional study

    Directory of Open Access Journals (Sweden)

    Raul Frankllim de Carvalho Almeida

    Full Text Available CONTEXT AND OBJECTIVE: Total knee arthroplasty (TKA has evolved particularly since the 1970s, with improvements in implants and surgical instruments, and has thus become an effective intervention for treating knee arthrosis. Many studies have presented rates of satisfactory clinical and radiological results greater than 90%, from follow-ups of over ten years. Nevertheless, despite scientific evidence showing the efficacy of TKA, the approaches taken present controversies in certain respects. The objective of this study was to evaluate how the Brazilian orthopedists deal with TKA, with investigation of the main aspects of this procedure. DESIGN AND SETTING: Cross-sectional survey conducted during the 39th Brazilian Congress of Orthopedics and Traumatology, in São Paulo, Brazil, in November 2007. METHODS: We applied a questionnaire to orthopedists registered at the congress. The questionnaire was randomly distributed and participation was voluntary; 858 completed questionnaires were included in the analysis. RESULTS: Most of the Brazilian orthopedists were members of SBOT and worked in the southeastern region. They used imported cemented implants through an anterior access route centered on the patella, with replacement of the joint surface of the patella and preservation of the posterior cruciate ligament. They did not have experience with simultaneous bilateral TKA. Postoperatively, they used antibiotics and suction drains for 48 hours. There was no consensus regarding prophylaxis for venous thromboembolism or the frequency of the main complications. CONCLUSION: The majority of Brazilian orthopedists work in the southeastern region of the country and agree about the main aspects of the approaches towards TKA.

  11. Ceramic-on-ceramic versus ceramic-on-polyethylene bearing surfaces in total hip arthroplasty.

    Science.gov (United States)

    Hu, Dongcai; Yang, Xiao; Tan, Yang; Alaidaros, Mohammed; Chen, Liaobin

    2015-04-01

    The choice between ceramic-on-ceramic (COC) and ceramic-on-polyethylene (COP) in primary total hip arthroplasty (THA) remains controversial. The purpose of this study was to evaluate the reliability and durability of COC vs COP bearing surfaces in THA. Based on published randomized, controlled trials (RCTs) identified in PubMed, Embase, and the Cochrane Central Register of Controlled Trials, the authors performed a meta-analysis comparing the clinical and radiographic outcomes of COC with those of COP. Two investigators independently selected the studies and extracted the data. The methodological quality of each RCT was assessed using the Physiotherapy Evidence Database (PEDro) scale. Relative risks and 95% confidence intervals from each trial were pooled using random-effects or fixed-effects models depending on the heterogeneity of the included studies. Nine RCTs involving 1575 patients (1747 hips) met the predetermined inclusion criteria. Eight of 9 included RCTs had high methodological quality. The heterogeneity was not significant, and all the results were pooled using a fixed-effects model. The results demonstrated that COC significantly increased the risks of squeaking and total implant fracture compared with COP. No significant differences with respect to revision, osteolysis and radiolucent lines, loosening, dislocation, and deep infection were observed between the COC and COP bearing surfaces. This meta-analysis resulted in no sufficient evidence to identify any clinical or radiographic advantage of COC vs COP bearing surfaces in the short- to mid-term follow-up period. Long-term follow-up is required for further evaluation.

  12. The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications

    Science.gov (United States)

    Kim, In-Sung; Bhardwaj, Atul M.; Badami, Ramachandra N.

    2017-01-01

    In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly. PMID:28316957

  13. Compartment syndrome after total knee arthroplasty: regarding a clinical case

    Directory of Open Access Journals (Sweden)

    Ana Alexandra da Costa Pinheiro

    2015-08-01

    Full Text Available ABSTRACT Although compartment syndrome is a rare complication of total knee arthroplasty, it is one of the most devastating complications. It is defined as a situation of increased pressure within a closed osteofascial space that impairs the circulation and the functioning of the tissues inside this space, thereby leading to ischemia and tissue dysfunction. Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented. The patient had a history of arthroscopic meniscectomy and presented knee flexion of 10° before the operation, which consisted of total arthroplasty of the right knee. The operation seemed to be free from intercurrences, but the patient evolved with compartment syndrome of the ipsilateral leg after the operation. Since compartment syndrome is a true surgical emergency, early recognition and treatment of this condition through fasciotomy is crucial in order to avoid amputation, limb dysfunction, kidney failure and death. However, it may be difficult to make the diagnosis and cases may not be recognized if the cause of compartment syndrome is unusual or if the patient is under epidural analgesia and/or peripheral nerve block, which thus camouflages the main warning sign, i.e. disproportional pain. In addition, edema of the limb that underwent the intervention is common after total knee arthroplasty operations. This study presents a review of the literature and signals that the possible rarity of cases is probably due to failure to recognize this condition in a timely manner and to placing these patients in other diagnostic groups that are less likely, such as neuropraxia caused by using a tourniquet or peripheral nerve injury.

  14. Definitive Treatment of Infected Shoulder Arthroplasty With a Cement Spacer.

    Science.gov (United States)

    Mahure, Siddharth A; Mollon, Brent; Yu, Stephen; Kwon, Young W; Zuckerman, Joseph D

    2016-09-01

    Infection in the setting of shoulder arthroplasty can result in significant pain, loss of function, and the need for additional surgery. As the use of shoulder arthroplasty increases, the medical and economic burdens of periprosthetic joint infection increase as well. The ideal management of infected shoulder prostheses has not been established. This report describes 9 patients from a single institution who had an infected shoulder arthroplasty that was definitively managed with a cement spacer. All patients had a minimum of 2 years of follow-up. Of the 9 patients in this study, 6 were men. Mean age was 73±9 years. Of the study patients, 1 had diabetes, 2 presented with Parkinson's disease, and 5 had a history of tobacco use. Average body mass index was 27.9±7 kg/m(2). After mean follow-up of 4 years, none of the patients had clinical or radiographic evidence of infection. Functional outcomes, as measured by American Shoulder and Elbow Surgeons scores, were good or fair in 89% of patients, and the average American Shoulder and Elbow Surgeons score was 57. A review of recent literature suggested that the current findings were similar to those in studies reporting 1- or 2-stage revision procedures. Although cement spacers are typically used as part of a 2-stage revision procedure, the current findings suggest that cement spacers can be used effectively to eradicate infection and allow for acceptable functional recovery and range of motion in patients who have severe medical comorbidities and cannot tolerate additional surgery. [Orthopedics. 2016; 39(5):e924-e930.].

  15. Total hip arthroplasty following failed fixation of proximal hip fractures

    Directory of Open Access Journals (Sweden)

    Srivastav Shekhar

    2008-01-01

    Full Text Available Background: Most proximal femoral fractures are successfully treated with internal fixation but a failed surgery can be very distressing for the patient due to pain and disability. For the treating surgeon it can be a challenge to perform salvage operations. The purpose of this study was to evaluate the short-term functional outcome and complications of total hip arthroplasty (THA following failed fixation of proximal hip fracture. Materials and Methods: In a retrospective study, 21 hips in 20 patients (13 females and seven males with complications of operated hip fractures as indicated by either established nonunion or fracture collapse with hardware failure were analysed. Mean age of the patients was 62 years (range 38 years to 85 years. Nine patients were treated for femoral neck fracture, 10 for intertrochanteric (I/T fracture and two for subtrochanteric (S/T fracture of the hip. Uncemented THA was done in 11 cases, cemented THA in eight hip joints and hybrid THA in two patients. Results: The average duration of follow-up was four years (2-13 years. The mean duration of surgery was 125 min and blood loss was 1300 ml. There were three dislocations postoperatively. Two were managed conservatively and one was operated. There was one superficial infection and one deep infection. Only one patient required a walker while four required walking stick for ambulation. The mean Harris Hip score increased from 32 preoperatively to 79 postoperatively at one year interval. Conclusion: Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.

  16. Compartment syndrome after total knee arthroplasty: regarding a clinical case.

    Science.gov (United States)

    Pinheiro, Ana Alexandra da Costa; Marques, Pedro Miguel Dantas Costa; Sá, Pedro Miguel Gomes; Oliveira, Carolina Fernandes; da Silva, Bruno Pombo Ferreira; de Sousa, Cristina Maria Varino

    2015-01-01

    Although compartment syndrome is a rare complication of total knee arthroplasty, it is one of the most devastating complications. It is defined as a situation of increased pressure within a closed osteofascial space that impairs the circulation and the functioning of the tissues inside this space, thereby leading to ischemia and tissue dysfunction. Here, a clinical case of a patient who was followed up in orthopedic outpatient consultations due to right gonarthrosis is presented. The patient had a history of arthroscopic meniscectomy and presented knee flexion of 10° before the operation, which consisted of total arthroplasty of the right knee. The operation seemed to be free from intercurrences, but the patient evolved with compartment syndrome of the ipsilateral leg after the operation. Since compartment syndrome is a true surgical emergency, early recognition and treatment of this condition through fasciotomy is crucial in order to avoid amputation, limb dysfunction, kidney failure and death. However, it may be difficult to make the diagnosis and cases may not be recognized if the cause of compartment syndrome is unusual or if the patient is under epidural analgesia and/or peripheral nerve block, which thus camouflages the main warning sign, i.e. disproportional pain. In addition, edema of the limb that underwent the intervention is common after total knee arthroplasty operations. This study presents a review of the literature and signals that the possible rarity of cases is probably due to failure to recognize this condition in a timely manner and to placing these patients in other diagnostic groups that are less likely, such as neuropraxia caused by using a tourniquet or peripheral nerve injury.

  17. Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty

    Science.gov (United States)

    Kachooei, Amir Reza; Chase, Samantha M; Jupiter, Jesse B

    2014-01-01

    Background: Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to administer the disabilities of the arm shoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median follow-up time of 60 months (range: 2 to 102 months). Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation. PMID:25386579

  18. Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ Implant Arthroplasty

    Directory of Open Access Journals (Sweden)

    Amir Reza Kachooei

    2014-09-01

    Full Text Available Background:  Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna.  The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months. Also, patients were contacted prospectively by phone in order to  minister the disabilities of the armshoulder and hand (DASH, patient rated wrist evaluation (PRWE, and visual analogue scale (VAS, and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median followup time of 60 months (range: 2 to 102 months.  Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation.

  19. Component rotation and anterior knee pain after total knee arthroplasty.

    Science.gov (United States)

    Barrack, R L; Schrader, T; Bertot, A J; Wolfe, M W; Myers, L

    2001-11-01

    All patients undergoing cruciate-retaining primary total knee arthroplasty for degenerative osteoarthritis at one center were studied prospectively. Clinical and radiographic followup was obtained at a minimum 5 years in 102 knees in 73 patients. Patients were asked specifically about the presence of the pain in the anterior aspect of the knee in the vicinity of the patella and rated the severity of the pain on a visual analog scale. Significant anterior knee pain rating at least 3 of 10 on the visual analog scale was present in 16 knees (13 patients). Eleven patients with 14 symptomatic knees agreed to undergo computed tomography scanning to accurately determine the rotation of the tibial and femoral components. The epicondylar axis and tibial tubercle were used as references using a previously validated technique. A control group of 11 asymptomatic patients (14 knees), matched for age, gender, and length of followup also underwent computed tomography scanning. All patients in both groups had normal axial alignment. There was a highly significant difference in tibial component rotation between the two groups with the patients with anterior knee pain averaging 6.2 degrees internal rotation compared with 0.4 degrees external rotation in the control group. There also was a significant difference in combined component rotation with the patients with anterior knee pain averaging 4.7 degrees internal rotation compared with 2.6 degrees external rotation in the control group. There was no significant difference in the degree of radiographic patellar tilt or patellar subluxation between the two groups. Patients with combined component internal rotation were more than five times as likely to experience anterior knee pain after total knee arthroplasty compared with those with combined component external rotation. Component malrotation is a significant factor in the development of anterior knee pain after total knee arthroplasty.

  20. A Stylistic Analysis of Register Theory in Oliver Twist

    Institute of Scientific and Technical Information of China (English)

    刘鑫

    2015-01-01

    Stylistic analysis refers to the linguistic approach to literature.Stylistics will mainly focus on the register theory,taking Charles Dickens' masterpiece Oliver Twist as a good example to demonstrate how the register theory is embodied in the work.

  1. Validity of stroke diagnoses in a National Register of Patients

    DEFF Research Database (Denmark)

    Krarup, Lars-Henrik; Boysen, Gudrun; Janjua, Huma;

    2007-01-01

    Many registers containing routine medical information have been developed for research and surveillance purposes. In epidemiological research assessment of endpoints is often conducted via registers. In the present study we validated stroke and transient ischemic attack (TIA) diagnoses...

  2. A Stylistic Analysis of Register Theory in Oliver Twist

    Institute of Scientific and Technical Information of China (English)

    刘鑫

    2015-01-01

    Stylistic analysis refers to the linguistic approach to literature.Stylistics will mainly focus on the register theory,taking Charles Dickens’ masterpiece Oliver Twist as a good example to demonstrate how the register theory is embodied in the work.

  3. Registering Different DBMSs to Panorama with CORBA

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Recently, there is an increasing use of CORBA implementation indeveloping mult idatabase systems. MIND and Panorama are some of the examples of multidatabase prototypes that have been implemented on the top of CORBA compliant namely Obje ctBroker and VisiBroker respectively. They both aim to achieve interoperability among Oracle, Sybase and other different DBMSs through the registration of these DBMSs to them using CORBA. This registration to a CORBA-based multidatabase sy stem offers an advanced way in achieving interoperability.We first introduce Panorama multidatabase system and discuss the basic implementation decisions in registering different DBMSs using the CORBA co mpliant ORB, namely VisiBroker to this system. Then, it aims to discuss the method we've used in registering different DBMSs to our designed multidataba se system-Panorama. A detailed discussion about the registration of Oracle8 and Sybase is given. And finally, a conclusion and the future work for this system h ave been given.

  4. Risk factors for pulmonary embolism after hip and knee arthroplasty: a population-based study

    Science.gov (United States)

    Besculides, Melanie C.; Gaber, Licia; Liu, Spencer; González Della Valle, Alejandro

    2008-01-01

    Pulmonary embolism (PE) is a cause of death after total hip and knee arthroplasty (THA, TKA). We characterised the patient population suffering from in-hospital PE and identified perioperative risk factors associated with PE using nationally representative data. Data from the National Hospital Discharge Survey between 1990 and 2004 on patients who underwent primary or revision THA/TKA in the United States were analysed. Multivariate regression analysis was performed to determine if perioperative factors were associated with increased risk of in-hospital PE. An estimated 6,901,324 procedures were identified. The incidence of in-hospital PE was 0.36%. Factors associated with an increased risk for the diagnosis of PE included: revision THA, female gender, dementia, obesity, renal and cerebrovascular disease. An increased association with PE was found among patients with diagnosis of Adult Respiratory Distress Syndrome (ARDS), psychosis (confusion), and peripheral thrombotic events. Our findings may be useful in stratifying the individual patient’s risk of PE after surgery. PMID:18925395

  5. Resection arthroplasty of the hip in paralytic dislocations.

    Science.gov (United States)

    Kalen, V; Gamble, J G

    1984-06-01

    The chronically dislocated paralytic hip causes postural difficulties, nursing and hygiene problems, and pain. Therapeutic options are limited. This study reviews the results of resection arthroplasty on 18 hips of 15 such patients. This procedure has many complications, including hip ankylosis, heterotopic ossification, abduction contracture and bony overgrowth. Despite this, all of the nursing goals were achieved and most patients had relief of pain. The operation is most successful in the skeletally mature patients, and it relies on soft-tissue interposition between the bony fragments and postoperative positioning to ensure optimum posture.

  6. Shoulder arthroplasty in complex acute and chronic proximal humeral fractures

    DEFF Research Database (Denmark)

    Frich, Lars Henrik; Søjbjerg, J.O.; Sneppen, O.

    1991-01-01

    From 1983 to 1988, 42 shoulder arthroplasties were performed on comminuted acute or chronic proximal humeral fractures. Patients were categorized according to the post-fracture operative delay; there were 15 four-part fractures, with median post-fracture delay of 13 days (range: 7 to 21), and 27...... instability were seen in shoulders formerly treated with osteosynthesis (one acute and four chronic cases). Two of these cases developed an infection. Good results can be expected after prosthetic replacement in acute proximal humeral fractures. Failed primary treatment reduces the possibility of a good...

  7. Lateral femoral cutaneous nerve block after total hip arthroplasty

    DEFF Research Database (Denmark)

    Thybo, K H; Mathiesen, O; Dahl, J B;

    2016-01-01

    BACKGROUND: Peripheral regional nerve blocks are commonly used for pain management after lower extremity surgery, but motor blockade can be a significant concern. The lateral femoral cutaneous nerve (LFCN) is a purely sensory nerve from the lumbar plexus. We hypothesised that an LFCN block would...... reduce movement-related pain after total hip arthroplasty (THA) in patients with moderate-to-severe pain. METHODS: Sixty patients with visual analogue scale (VAS) score > 40 mm during 30-degree active flexion of the hip on either the first or second postoperative day after THA were included...

  8. Fracture of the ceramic epiphysis in hip arthroplasty.

    Science.gov (United States)

    Toni, A; Terzi, S; Sudanese, A; Zappoli, F A; Giunti, A

    1996-01-01

    Between November 1985 and October 1993, a total of 694 ceramic-ceramic hip arthroplasties were implanted; up until 1987 the alumina used in the first 82 cases was Ostalox, produced by IMEC of Caravaggio, characterized by poor control of the size of the crystals; after 1987 Biolox alumina of the Feldmhule company was used in 612 cases. Fracture of the ceramic head occurred in 2 cases; in both patients ceramic was of the Ostalox type, meaning a 2.4% incidence of fracture; up until the present none of the 612 Biolox heads has presented this complication.

  9. The constraints on day-case total knee arthroplasty

    DEFF Research Database (Denmark)

    Thienpont, E; Lavand'homme, P; Kehlet, H

    2015-01-01

    Total knee arthroplasty (TKA) is a major orthopaedic intervention. The length of a patient's stay has been progressively reduced with the introduction of enhanced recovery protocols: day-case surgery has become the ultimate challenge. This narrative review shows the potential limitations of day...... of the group of potential day-case patients. The cost reduction achieved by day-case TKA needs to be balanced against any increase in morbidity and mortality and the cost of advanced follow-up at a distance with new technology. These factors need to be evaluated before adopting this ultimate 'fast...

  10. Chronic pain following total hip arthroplasty: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf;

    2006-01-01

    BACKGROUND: Chronic post-operative pain is a well-recognized problem after various types of surgery, but little is known about chronic pain after orthopedic surgery. Severe pre-operative pain is the primary indication for total hip arthroplasty (THA). Therefore, we examined the prevalence...... was 93.6%. Two hundred and ninety-four patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post...

  11. Excision arthroplasty for management of coxofemoral luxation in pet birds.

    Science.gov (United States)

    MacCoy, D M

    1989-01-01

    Coxofemoral luxation, although not a common injury, can cause considerable pelvic limb dysfunction in pet birds. Luxation usually is craniodorsal, as it is in dogs. Previously recommended treatments have not always been effective in managing the injury. Sequelae can include dorsolateral deviation of the pelvic limb, with loss of function and bumblefoot in the nonluxated limb, owing to abnormal weight-bearing. Excision arthroplasty combined with a muscular sling constructed from a segment of the iliofibularis muscle was used to treat coxofemoral luxation in a hyacinth macaw, a moluccan cockatoo, and an African gray parrot. The outcome was excellent in 2 of the 3 birds.

  12. Internal iliac artery pseudoaneurysm in primary total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Sanjay Agarwala

    2016-01-01

    Full Text Available Vascular injury is one of the rare complications of primary total hip arthroplasty (THA. We report an unusual case of lobulated pseudoaneurysm arising from one of the branches of the left internal iliac artery during acetabulum preparation in THA, which was successfully treated with coil embolization and multidisciplinary care. After 6 years follow up, patient did not have any symptoms related to the hip replacement. We recommend that surgeons should be extremely cautious while drilling medial wall of the acetabulum for depth assessment. Aggressive multidisciplinary approach, including possible support from an interventional radiologist is required for the treatment of such vascular injuries.

  13. Two Case Studies Related to Total Knee Arthroplasty

    Science.gov (United States)

    Hale, David

    2016-01-01

    Objectives: Report on Two Case Studies related to Total Knee Arthroplasty Previously Discussed by AKS Members Methods: Case Series Case 1: A 76 year old woman requiring a right total knee replacement in the presence of marked dystrophic calcification affecting the quadriceps tendon on a background of having sustained a post operative quadriceps tendon rupture post left TKR in 2013 Case 2: Management issues related to performing a TKR in a 80 year old woman with a possible past history of TB affecting the joint Conclusion: Both procedures went smoothly and particularly as advice was given by AKS members, these are presented largely for feedback.

  14. FAST TRACK SURGERY IN TOTAL KNEE ARTHROPLASTY - A REVIEW.

    Directory of Open Access Journals (Sweden)

    Pencho Kosev

    2015-08-01

    Full Text Available The number of orthopedic surgeons who are convinced in the need for significant changes in planned total knee arthroplasty (TKA is increasing slowly and steadily. A new approach to pain control has been developed over the past 10-15 years, and the introduction of techniques to reduce perioperative stress, and the use of minimally invasive surgical techniques can help limit postoperative complications and shorten recovery time. This type of optimization is regarded as Fast-track Care program, where improved healing process is particularly useful to comorbid patients.

  15. Monoblock versus modular polyethylene insert in uncemented total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Mikkel Rathsach; Winther, Nikolaj; Lind, Thomas;

    2016-01-01

    Background and purpose - Backside wear of the polyethylene insert in total knee arthroplasty (TKA) can produce clinically significant levels of polyethylene debris, which can lead to loosening of the tibial component. Loosening due to polyethylene debris could theoretically be reduced in tibial...... as maximum total point motion (MTPM)) of the 2 different implant designs. Results - We did not find any statistically significant difference in MTPM between the groups at 3 months (p = 0.2) or at 6 months (p = 0.1), but at 12 and 24 months of follow-up there was a significant difference in MTPM of 0.36 mm (p...

  16. Transfusion practice in hip arthroplasty - a nationwide study

    DEFF Research Database (Denmark)

    Jans, Øivind; Kehlet, H; Hussain, Zubair Butt;

    2011-01-01

    thirty-two THA patients and 1132 RTHA patients were included for analysis of which 1674 (24%) THA and 689 (61%) RTHA patients received RBC transfusion. Of these, 47% of THA and 73% of RTHA patients received transfusion on the day of surgery. Transfusion rates between centres varied from 7 to 71......% and between 26 and 85% in THA and RTHA patients, respectively. Patients receiving RBC transfusion had longer length of stay and for THA patients an increased odds-ratio (5·5) of death within 90 days. Conclusion Despite established guidelines, RBC transfusion practice in hip arthroplasty remains highly...

  17. Physical rehabilitation after total joint arthroplasty in companion animals.

    Science.gov (United States)

    Marcellin-Little, Denis J; Doyle, Nancy D; Pyke, Joanna Freeman

    2015-01-01

    Patients who have total joint arthroplasty have varying needs related to rehabilitation. In the short term, rehabilitation should be used in all dogs to identify high-risk patients and to minimize the likelihood of postoperative complications. Many patients undergoing total hip replacement recover uneventfully without needing long-term physiotherapy. All patients undergoing total knee replacement and total elbow replacement need rehabilitation to restore limb use and maximize their functional recovery. This article presents rehabilitation considerations for companion animals undergoing total hip replacement, total knee replacement, and total elbow replacement; postoperative complications and how to mitigate risks; and anticipated patient outcomes.

  18. Migration of polyethylene fixation screw after total knee arthroplasty.

    Science.gov (United States)

    Cho, Woo-Shin; Youm, Yoon-Seok

    2009-08-01

    Duracon (Howmedica, Rutherford, NJ) posterior stabilized total knee system has a snap fit locking mechanism of a tibial polyethylene, including an additional locking screw for further fixation of polyethylene. We report 13 cases of locking screw migration from tibial component after Duracon posterior stabilized primary total knee arthroplasty. Among 13 knees, screw migration in 10 asymptomatic cases was incidentally detected during regular follow-up, and they were just observed in the outpatient clinic. Only 3 knees had moderate pain, swelling, and instability, and revision was done on 2 of 3 knees.

  19. Tranexamic Acid Decreases Incidence of Blood Transfusion in Simultaneous Bilateral Total Knee Arthroplasty.

    Science.gov (United States)

    Bagsby, Deren T; Samujh, Christopher A; Vissing, Jacqueline L; Empson, Janene A; Pomeroy, Donald L; Malkani, Arthur L

    2015-12-01

    Blood management for simultaneous bilateral total knee arthroplasty (TKA) patients is more challenging than in unilateral arthroplasty. We examined if administration of tranexamic acid (TXA) to patients undergoing simultaneous bilateral TKA would reduce blood loss and decrease allogeneic blood transfusion requirements. A retrospective review of 103 patients, 57 in the control and 46 in the TXA group, was performed. There was higher postoperative day 1 hemoglobin in patients receiving TXA (2.95±1.33 versus 4.33±1.19, Ptransfusion incidence with administration of TXA (17.4% versus 57.9%, Ptransfusion rates by almost 70% in simultaneous bilateral total knee arthroplasty.

  20. Revision total knee arthroplasty using a custom tantalum implant in a patient following multiple failed revisions.

    Science.gov (United States)

    McNamara, Colin A; Gösthe, Raúl G; Patel, Preetesh D; Sanders, Kristopher C; Huaman, Gustavo; Suarez, Juan C

    2017-03-01

    The number of revision total knee arthroplasty procedures performed annually is increasing and, subsequently, so is the number of patients presenting following a failed revision. Rerevising a total knee arthroplasty after one or more failed revision procedures presents many challenges, including diminished bone stock for prosthetic fixation. "Off the shelf" implants may not offer the best alternative for reconstruction. We present the case of a 55-year-old patient who required a rerevision total knee arthroplasty following multiple failed revisions with severe femoral and tibia bone loss. We describe a novel technique we employed to improve component fixation within the compromised bone stock.