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Sample records for arthroplasty register association

  1. 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.......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....

  2. Arthroplasty register for Germany

    OpenAIRE

    Hagen, Anja; Gorenoi, Vitali; Schönermark, Matthias P.

    2009-01-01

    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 ...

  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. 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

    Objectives: To evaluate implant survival following primary total hip replacement (THR) in younger patients. To describe the diversity in use of cup-stem implant combinations. Design: 29,558 primary THRs osteoarthritis (OA) patients younger than 55 years of age performed from 1995 through 2011 were...... identified using the Nordic Arthroplasty Registry Association database. We estimated adjusted relative risk (aRR) of revision with 95% confidence interval (CI) using Cox regression. Results: In general, no difference was observed between uncemented and cemented implants in terms of risk of any revision...... uncemented and hybrid implants led to elevated risk of revision due to other causes, as well as elevated risk of revision due to any reason within 2 years. 183 different uncemented cup-stem implant combinations were registered in Denmark, of these, 172 were used in less than 100 operations which is similar...

  5. 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 ar...

  6. The Nordic Arthroplasty Register Association

    DEFF Research Database (Denmark)

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

    2009-01-01

    , 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...... 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....

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

    DEFF Research Database (Denmark)

    Gundtoft, P H; Pedersen, Alma Becic; Schønheyder, H C;

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

    DEFF Research Database (Denmark)

    Münch, Henrik J; Jacobsen, Stig; Olesen, Jens T;

    2015-01-01

    database from the greater Copenhagen area (n = 27,020). RESULTS: 327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery......, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery. INTERPRETATION: While we could not confirm that a positive patch test reaction to common metals is associated...... with complications and revision surgery after knee arthroplasty, metal allergy may be a contributor to the multifactorial pathogenesis of implant failure in some cases. In cases with multiple revisions, cobalt and chromium allergies appear to be more frequent....

  10. 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

  11. Pre-operative patient education is associated with decreased risk of arthrofibrosis after total knee arthroplasty: a case control study.

    Science.gov (United States)

    Livbjerg, Anna Emilie; Froekjaer, Sara; Simonsen, Ole; Rathleff, Michael S

    2013-09-01

    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-control studies. Data on potential risk factors were extracted from the Danish Knee arthroplasty Register and from a postal questionnaire including long-term outcome measures regarding pain, function and quality of life (Oxford Knee Score and EQ-5D). Previous knee surgery and a high preoperative Knee Society Function Score were significant risk factors, whereas attending a preoperative information meeting was associated with a significantly decreased risk of postoperative stiffness requiring MUA (P<0.001). The long-term results following MUA (1-5 years) were equivalent to patients without postoperative stiffness. PMID:23507064

  12. IMPORTANCE OF A NATIONAL ARTHROPLASTY REGISTER FOR IDENTIFICATION BY MEDICAL EXAMINER

    Science.gov (United States)

    Durão, Carlos Henrique; Pinto, Rui; Ribeiro, Costa; Vieira, Duarte

    2015-01-01

    Mass catastrophes are realities that come to pass with lamentable frequency. In such situations, one of the fundamental forensic problems is in relation to identifying the victims. All the elements that might be capable of contributing towards this identification process are essential, and among these are orthopedic prostheses, which frequently remain intact. These prostheses consist basically of polymers, ceramics or metals. Metal components, which are usually composed of titanium, chromium, cobalt or steel alloys, are resistant to violent trauma or high temperatures. Human identification is possible if the identity of the implant is established and if this can be correlated with the individual in whom it was implanted. The logo on the prosthesis 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. PMID:27047880

  13. 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......-control studies. Data on potential risk factors were extracted from the Danish Knee arthroplasty Register and from a postal questionnaire including long-term outcome measures regarding pain, function and quality of life (Oxford Knee Score and EQ-5D). Previous knee surgery and a high preoperative Knee Society...

  14. 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...

  15. Total hip replacement in young adults with hip dysplasia. Age at diagnosis, previous treatment, quality of life, and validation of diagnoses reported to the Norwegian Arthroplasty Register between 1987 and 2007

    OpenAIRE

    Engesæter, Ingvild Øvstebø; Lehmann, Trude; Laborie, Lene Bjerke; Lie, Stein Atle; Rosendahl, Karen; Engesæter, Lars B

    2011-01-01

    Background and purpose: Dysplasia of the hip increases the risk of secondary degenerative change and subsequent total hip replacement. Here we report on age at diagnosis of dysplasia, previous treatment, and quality of life for patients born after 1967 and registered with a total hip replacement due to dysplasia in the Norwegian Arthroplasty Register. We also used the medical records to validate the diagnosis reported by the orthopedic surgeon to the register.Methods: Sub...

  16. 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.

  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

    BACKGROUND AND PURPOSE: It has been speculated that the prevalence of metal allergy may be higher in patients with implant failure. We compared the prevalence and cause of revisions following total hip arthroplasty (THA) in dermatitis patients suspected to have contact allergy and in patients in ...

  18. 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.

  19. 78 FR 67078 - Membership in a Registered Futures Association

    Science.gov (United States)

    2013-11-08

    ... would also be subject to certain membership fees. The Commission understands that NFA imposes initial...\\ Membership in Registered Futures Association, 72 FR 2614 (Jan. 22, 2007). \\9\\ NFA Bylaw 1101 is available at... Participants, 77 FR 2613 (Jan. 19, 2012). \\3\\ See 7 U.S.C. 21(e), which specifies that any person...

  20. Sciatic nerve palsy associated with total hip arthroplasty.

    Science.gov (United States)

    Dhillon, M S; Nagi, O N

    1992-01-01

    Six cases of clinically evident sciatic or peroneal nerve palsy occurred in a consecutive series of 380 total hip arthroplasties (THA). An additional eight cases of peroneal nerve palsy due to pressure from Thomas splint or tight bandages were seen. Factors apparently causing nerve palsy were significant lateralization and lengthening in four cases and dislocation of the hip in one case. The cases with neuroapraxia of the peroneal nerve were seen from the third to the fifth day of Thomas splint immobilization. EMG studies were conducted in all six group 1 patients; at the end of one year the results were good in two cases, fair in three cases, and poor in one case. The results suggest that limb lengthening should be limited to 4 cm to minimize this complication. It was also seen that patients with peroneal nerve palsy due to local compression do well, though some are bothered by mild residual dysesthesia over the dorsum of the foot. In contrast, patients with sciatic nerve palsy do not have such a good outlook. PMID:1345646

  1. 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...

  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. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty: A retrospective study.

    Science.gov (United States)

    Zhang, Zhendong; Zhuo, Qi; Chai, Wei; Ni, Ming; Li, Heng; Chen, Jiying

    2016-08-01

    Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF.We retrospectively analyzed the clinical data of 89 cases of PFF, and a case-control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty.The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218-20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138-9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001-1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06-5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007-44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103-59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656-38.966, P = 0.01) were all risk factors.Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take into account Vancouver

  4. 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

    of fluoridated toothpaste and caries-preventive programs implemented by the municipal dental services in Denmark. Linking Danish health registers with environmental and administrative registers offers an opportunity for obtaining sample sizes large enough to identify health effect, which otherwise could...

  5. Treatment of Arthritis Associated With Legg-Calve-Perthes Disease With Modular Total Hip Arthroplasty.

    Science.gov (United States)

    Seufert, Christopher R; McGrory, Brian J

    2015-10-01

    Legg-Calve-Perthes (LCP) disease can result in morphological deformities and associated adult hip arthritis. Thirty-five consecutive total hip arthroplasties (THA) were performed in 28 patients with a history of LCP using a non-cemented modular femoral component. There was one revision for late hematogenous infection and no evidence of prosthesis failure. Harris hip scores, on average, improved from 49.8 (26-73) to 93.9 (82-100) (P<0.05) after a minimum of 2 years follow-up (average, 8.2 years, range 2-14 years). Clinically, patients demonstrated diminished or no limping (94%, 33/35) and improved leg length equality post-operatively (100%, 35/35). This style of stem accommodated metaphyseal/diaphyseal size mismatch in 80% (28/35), allowed for abnormal anteversion in 71% (25/35), and resulted in radiographic improvements in trochanteric height (P<0.05), body weight lever arm (P<0.05), and leg length (P<0.05). PMID:25979188

  6. The geometry of the bone structure associated with total hip arthroplasty.

    Directory of Open Access Journals (Sweden)

    Zhang Yang

    Full Text Available Close adaptation of the prosthesis to the bone is the key to achieving optimal stability and fixation for total hip arthroplasty (THA. However, there have been no adequate studies of bone morphology, especially in different races. The aim of this study was to analyze the geometry of the acetabulum and proximal femur of people from South China, based on three-dimensional reconstruction, and to detect differences between different population subsets. CT scans were performed on 80 healthy volunteers (160 hips from South China, comprising 40 males (80 hips and 40 females (80 hips. The images were imported into Mimics 10.01 to perform 3D reconstruction. THA-associated anatomical parameters were measured and compared with other published data. In comparison with published data, it seemed that people from South China have smaller acetabular abduction angle, larger acetabular supro-inferior diameter, larger neck-shaft angle, smaller offset, thinner femoral shaft and more proximal isthmus, which needed to be further confirmed. There were significant differences between the genders in most parameters. As significant differences in canal flare index (CFI and distal canal flare index (DCFI were found between genders, it was concluded the most significant differences lay in the isthmus of the femur. Among the femora, according to Noble's classification we identified more normal types and fewer stovepipe and champagne-flute types than expected from the literature, indicating that uncemented prostheses would be suitable for most people from South China. Our findings reveal that simply choosing the smallest of a series of prostheses would not necessarily provide a good fit, due to the different trends from the proximal to the distal part of the femur. Significant variation exists in THA-associated anatomy between genders and population subsets. It is therefore imperative that each patient receives individual consideration rather than assuming all patients have

  7. 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...

  8. 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.

  9. 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.

  10. Prevention of infection after knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2010-01-01

    Full Text Available Scientific background: Man-made joints (joint endoprostheses, including knee endoprostheses, are used in some irreversible diseases of the human joints. The implantation of joint endoprostheses (arthroplasty is associated with an increased risk for infection. To prevent infections, different interventions without and with the use of antibiotics (hygiene procedures and antibiotic prophylaxis are used. The benefits of these interventions are not clear yet. Research questions: The presented report addresses the questions regarding the medical effectiveness, the cost-effectiveness as well as the ethical, social and legal aspects related to the use of interventions to prevent infections after knee arthroplasty. Methods: A systematic literature search is conducted in the medical electronic databases MEDLINE, EMBASE, SciSearch etc. in June 2009 and has been completed by a hand search. The analysis includes publications which describe and/or evaluate clinical data from randomized controlled trials (RCT, systematic reviews of RCT, registers of endoprostheses or databases concerning interventions to prevent infections after knee arthroplasty. The conducted literature search also aims to identify health-economic studies and publications dealing explicitly with ethical, social or legal aspects in the use of interventions to prevent infections after knee arthroplasty. The synthesis of information from different publications has been performed qualitatively. Results: The systematic literature search yields 1,030 hits. Based on the predefined inclusion and exclusion criteria a total of ten publications is included in the analysis. The presented report does not find evidence of the effectiveness of different hygiene interventions with a high evidence level. Most of the unspecific interventions are recommended on the basis of results from non-RCT, from studies for other clinical indications and/or for clinically not relevant endpoints, as well as on the basis of

  11. Factors Associated with Musculoskeletal Disorders among Registered Nurses: Evidence from the Thai Nurse Cohort Study.

    Science.gov (United States)

    Thinkhamrop, W; Laohasiriwong, W

    2015-01-01

    Background Health, safety, and well being have been known to be influenced by occupational characteristics. Nurses constantly encounter musculoskeletal disorders (MSDs) from work demands worldwide. Nevertheless, there is insufficient of knowledge regarding causes of musculoskeletal disorders among nurses in Thailand. Objective To investigate factors associated with musculoskeletal disorder among registered nurses in Thailand. Method This study is part of the 2009 Thai Nurse Cohort Study which consisted of 18,756 nationally representative sample of registered nurses. Data collection was performed via postal self-administered questionnaires. Manifesting musculoskeletal disorders was self-reported by registered nurses, 1,070 nurses were excluded since they were unemployed during previous 12 months. Multiple logistic regression was used for data analysis. Result Of 17,686 registered nurses, the overall 12 months prevalence of musculoskeletal disorders was 47.8%. It was found that workplace violence was the strongest factor which statistically significant associated with musculoskeletal disorders (adjusted odds ratio, OR, 2.01; 95% confidence interval, 95% CI, 1.42 to 2.83; P job required a lot of physical effort (OR = 1.69; 95% CI: 1.52 to 1.87; P < 0.001), every 10 years increased of age (OR = 1.40; 95% CI: 1.22 to 1.62; P < 0.001), overweight (OR = 1.39; 95% CI: 1.01 to 1.52; P = 0.015). Conclusion Registered nurses were most vulnerable of musculoskeletal disorders especially those who experienced workplace violence, anxiety/depression, strenuous work, older age, and overweight. Consequently, recommending safety practices to nurses should be considered for musculoskeletal disorders (MSDs) prevention by ergonomics and workplace design. PMID:27180371

  12. Relational coordination is associated with productivity in general practice: a survey and register based study

    DEFF Research Database (Denmark)

    Lundstrøm, Sanne Lykke; Edwards, Kasper; Reventlow, Susanne;

    2014-01-01

    In this paper we investigate the association between relational coordination among the practice team in general practice and number of consultations performed in a general practice per staff, i.e. a proxy of productivity. We measured relational coordination using the Relational Coordination Survey...... and combined the results with register data. We found that relational coordination was statistically significant associated with number of consultation per staff per year. We later divided consultations in to three types: Face-to-face, Email and phone consultations. We found a statistically...... significant associating between relational coordination and with number of face-to-face consultation per staff per year....

  13. 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...

  14. 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.

  15. 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.

  16. 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.

  17. 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...

  18. 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.

  19. 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.

  20. 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.

  1. 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...... basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death...

  2. The Incidence of Eating Disorders in a Danish Nationwide Register Study Associations with Suicide Risk and Mortality

    OpenAIRE

    Zerwas, Stephanie; Larsen, Janne Tidselbak; Petersen, Liselotte; Thornton, Laura M.; Mortensen, Preben Bo; Bulik, Cynthia M.

    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 Nationa...

  3. 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

  4. Bicompartmental knee arthroplasty

    OpenAIRE

    Sabatini, Luigi; Giachino, Matteo; Risitano, Salvatore; Atzori, Francesco

    2016-01-01

    Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect o...

  5. 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...

  6. Breast cancer risk associated with different HRT formulations: a register-based case-control study

    OpenAIRE

    Thai Do; Möhner Sabine; Heinemann Lothar AJ; Dinger Juergen C; Assmann Anita

    2006-01-01

    Abstract Background Previous epidemiological studies have inconsistently shown a modestly increased breast cancer risk associated with hormone replacement therapy (HRT). Limited information is available about different formulations – particularly concerning different progestins. Methods A case-control study was performed within Germany in collaboration with regional cancer registries and tumor centers. Up to 5 controls were matched breast cancer cases. Conditional logistic regression analysis...

  7. 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…

  8. Breast cancer risk associated with different HRT formulations: a register-based case-control study

    Directory of Open Access Journals (Sweden)

    Thai Do

    2006-09-01

    Full Text Available Abstract Background Previous epidemiological studies have inconsistently shown a modestly increased breast cancer risk associated with hormone replacement therapy (HRT. Limited information is available about different formulations – particularly concerning different progestins. Methods A case-control study was performed within Germany in collaboration with regional cancer registries and tumor centers. Up to 5 controls were matched breast cancer cases. Conditional logistic regression analysis was applied to estimate crude and adjusted odds ratios (OR and 95% confidence intervals (95% CI. Stratified analyses were performed to compare the risk of different estrogens, progestins, and combinations. Results A total of 3593 cases of breast cancer were identified and compared with 9098 controls. The adjusted overall risk estimate for breast cancer (BC associated with current or past use of HRT was 1.2 (1.1–1.3, and almost identical for lag times from 6 months to 6 years prior to diagnosis. No significant trend of increasing BC risk was found with increasing duration of HRT use, or time since first or last use in aggregate. Many established BC risk factors significantly modified the effect of HRT on BC risk, particularly first-degree family history of BC, higher age, lower education, higher body mass index (BMI, and never having used oral contraceptives (OCs during lifetime. Whereas the overall risk estimates were stable, the numbers in many of the sub-analyses of HRT formulation groups (estrogens, progestins, and combinations were too small for strong conclusions. Nevertheless, the BC risk seems not to vary much across HRT formulation subgroups. In particular, no substantial difference in BC risk was observed between HRT containing conjugated equine estrogens (CEE or medroxyprogesterone acetate (MPA and other formulations more common in Europe. Conclusion The BC risk of HRT use is rather small. Low risk estimates for BC and a high potential for

  9. The association between immigrant subgroup and poor mental health: a population-based register study.

    Science.gov (United States)

    Hollander, Anna-Clara; Bruce, Daniel; Burström, Bo; Ekblad, Solvig

    2013-08-01

    Ethnicity and immigrant subgroup (classified as refugee or nonrefugee) are associated with poor mental health among immigrants. The aim of this study was to assess whether national origin-based differences in poor mental health can be explained by immigrant subgroup and if its importance varies depending on origin. A cross-sectional, population-based study of Swedish residents was conducted in 2006. The outcome was poor mental health, measured with the proxy variable psychotropic drugs purchased. Explanatory variables included immigrant subgroup and origin. Potential confounders were age, marital status, education, time in Sweden, and children. Logistic regression was carried out. The total population was 5,507,262. Immigrants from countries outside the Organisation for Economic Co-operation and Development (OECD) numbered 298,641. Immigrant subgroup partly explained the higher likelihood of poor mental health among non-OECD immigrants; when each country or area was analyzed separately, most refugees had a higher likelihood than nonrefugees did. Immigrant subgroup partly explained the origin-based differences in mental health, but this varied between different groups of origin. PMID:23896844

  10. The Incidence of Eating Disorders in a Danish Nationwide Register Study Associations with Suicide Risk and Mortality

    Science.gov (United States)

    Zerwas, Stephanie; Larsen, Janne Tidselbak; Petersen, Liselotte; Thornton, Laura M.; Mortensen, Preben Bo; Bulik, Cynthia M.

    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 to 22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent of individuals with no eating disorders. In males, peak hazard for diagnosis was earlier than in females. The present study represents one of the largest and longest studies of eating disorder incidence and suicide attempts and death in both females and males. Eating disorders are accompanied by increased hazard of suicide attempts and death even in young adults. PMID:25958083

  11. Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study.

    Directory of Open Access Journals (Sweden)

    Benjamin D Bray

    2014-08-01

    Full Text Available BACKGROUND: Observational studies have reported higher mortality for patients admitted on weekends. It is not known whether this "weekend effect" is modified by clinical staffing levels on weekends. We aimed to test the hypotheses that rounds by stroke specialist physicians 7 d per week and the ratio of registered nurses to beds on weekends are associated with mortality after stroke. METHODS AND FINDINGS: We conducted a prospective cohort study of 103 stroke units (SUs in England. Data of 56,666 patients with stroke admitted between 1 June 2011 and 1 December 2012 were extracted from a national register of stroke care in England. SU characteristics and staffing levels were derived from cross-sectional survey. Cox proportional hazards models were used to estimate hazard ratios (HRs of 30-d post-admission mortality, adjusting for case mix, organisational, staffing, and care quality variables. After adjusting for confounders, there was no significant difference in mortality risk for patients admitted to a stroke service with stroke specialist physician rounds fewer than 7 d per week (adjusted HR [aHR] 1.04, 95% CI 0.91-1.18 compared to patients admitted to a service with rounds 7 d per week. There was a dose-response relationship between weekend nurse/bed ratios and mortality risk, with the highest risk of death observed in stroke services with the lowest nurse/bed ratios. In multivariable analysis, patients admitted on a weekend to a SU with 1.5 nurses/ten beds had an estimated adjusted 30-d mortality risk of 15.2% (aHR 1.18, 95% CI 1.07-1.29 compared to 11.2% for patients admitted to a unit with 3.0 nurses/ten beds (aHR 0.85, 95% CI 0.77-0.93, equivalent to one excess death per 25 admissions. The main limitation is the risk of confounding from unmeasured characteristics of stroke services. CONCLUSIONS: Mortality outcomes after stroke are associated with the intensity of weekend staffing by registered nurses but not 7-d/wk ward rounds by stroke

  12. 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.

  13. 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

    database with the Finnish data included. Material and methods 438,733 THRs performed during the period 1995-2011 in Sweden, Denmark, Norway, and Finland were included. Kaplan-Meier survival analysis was used to calculate survival probabilities with 95% confidence interval (CI). Cox multiple regression...

  14. 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.)

  15. Is resistance to anti-tuberculosis drugs associated with type 2 diabetes mellitus? A register review in Beijing, China

    Directory of Open Access Journals (Sweden)

    Fengling Mi

    2014-05-01

    Full Text Available Background: China has a high burden of drug-resistant tuberculosis (TB and diabetes mellitus (DM. Objective: The objectives of this study were to determine the following in patients with culture-confirmed TB: 1 demographic characteristics and disease patterns in relation to the presence or absence of type 2 diabetes and 2 presence or absence of drug resistance to isoniazid (INH, rifampicin (RMP or both in relation to duration of diabetes and control of diabetes. Design: This is a cross-sectional and retrospective study involving record reviews. Results: There were 621 patients with culture-positive TB, of whom 187 (30% had previously known or new type 2 diabetes. In those with diabetes, there was a significantly higher proportion of males, persons aged ≥35 years and patients registered with new TB (p<0.05. Prevalence of multidrug-resistant TB (MDR-TB was 6.2% in new patients (N=422 and 62.3% in previously treated patients (N=199, with no significant differences between those with and without diabetes. In patients with diabetes, there was no association of drug resistance with diabetes duration or disease control [assessed by fasting blood glucose (FBG at 1 week]. Conclusion: A high proportion of patients with TB in a tertiary health facility, Beijing, China, had diabetes, but there was no association between type 2 diabetes and drug-resistant TB. Further prospective studies are needed to confirm these findings.

  16. Reverse Shoulder Arthroplasty

    Medline Plus

    Full Text Available ... stability and soft tissue envelope. In the early days of reverse arthroplasty, it used to be said ... often we'll drain these patients for a day to try to prevent hematoma formation, especially in ...

  17. Reverse Shoulder Arthroplasty

    Medline Plus

    Full Text Available ... to conventional arthroplasty, we often use a subscap soft tissue takedown, rather than an osteotomy because of concerns ... the tendon. We've learned that this anterior soft tissue repair is critical for the stability of the ...

  18. Reverse Shoulder Arthroplasty

    Medline Plus

    Full Text Available ... here in New York to bring you a video of a recent case of reverse shoulder arthroplasty ... helped design the system that's shown in this video, so I receive royalties and therefore have a ...

  19. Reverse Shoulder Arthroplasty

    Medline Plus

    Full Text Available ... a friction bite that if you try to work it around the corner, you can get an ... stability and soft tissue envelope. In the early days of reverse arthroplasty, it used to be said ...

  20. Reverse Shoulder Arthroplasty

    Medline Plus

    Full Text Available ... case of reverse shoulder arthroplasty for cuff deficient arthritis. You should be aware that I helped design ... in the last decade for cuff deficient shoulder arthritis in the United States. The indications are a ...

  1. Reverse Shoulder Arthroplasty

    Medline Plus

    Full Text Available ... for sort of common cuff arthroplasty in an elderly thin patient where the head is already rising ... cement this case, because in the typical osteoporotic elderly patient with cuff arthropathy, we would do a ...

  2. 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.

  3. 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

  4. 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.

  5. 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...

  6. 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...

  7. 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

  8. Bipolar hip arthroplasty.

    Science.gov (United States)

    Chang, Qing; Liu, Shubing; Guan, Changyong; Yu, Fangyuan; Wu, Shenguang; Jiang, Changliang

    2011-12-01

    Our aim was to compare hip arthroplasty with internal screw fixation in the repair of intertrochanteric fractures in elderly patients with osteoporosis. Of 112 included patient, 70 (81.81 ± 4.88 years) received hip arthroplasty with a prosthesis specially designed for intertrochanteric fractures, and 42 (83.46 ± 5.11 years) underwent plate-screw fixation. The hip arthroplasty group had significantly longer operation time, intraoperative blood loss, and total volume of blood transfused but had shorter time to beginning weight-bearing (5.94 ± 2.76 vs 23.68 ± 22.01 days) and higher postoperative Harris hip score (91.37 ± 4.80 vs 86.14 ± 5.46). In the arthroplasty group, there were 2 dislocations; and in the plate-screw fixation group, there were 5 internal fixation failures. Hip arthroplasty is preferable to internal fixation in elderly patients (age >80 years) with osteoporosis. PMID:21530148

  9. TOTAL KNEE ARTHROPLASTY IN A PATIENT WITH HOFFA FRACTURE PSEUDARTHROSIS: CASE REPORT

    OpenAIRE

    Rodrigo Pires e Albuquerque; Giordano, Vincenzo; Amaral, Ney Pecegueiro do; Carvalho, Antônio Carlos Pires; Barretto, João Maurício

    2015-01-01

    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.

  10. Bicompartmental knee arthroplasty.

    Science.gov (United States)

    Sabatini, Luigi; Giachino, Matteo; Risitano, Salvatore; Atzori, Francesco

    2016-01-01

    Total knee arthroplasty (TKA) is the most worldwide practiced surgery for knee osteoarthritis and its efficacy is mightily described by literature. Concerns about the invasiveness of TKA let the introduction of segmental resurfacing of the joint for younger patients with localized osteoarthritis. Bone stock sparing and ligaments preservation are the essence of both unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BKA). Advantages related to BKA are the respect of knee biomechanics, lower complications rates, shorter hospital stay, faster rehabilitation. Moreover, in case of failure of the first implant the conversion to TKA is undemanding and can be compared to a standard prosthesis. Our experience suggest that BKA is a reliable technique in selected cases and especially younger people with higher functional requests can favourably profit from it. Although those results are encouraging, we still need further prospective, randomized, long-term studies to finally assess BKA indications and outcomes. PMID:26855941

  11. High resolution MRI of the breast at 3 T: which BI-RADS {sup registered} descriptors are most strongly associated with the diagnosis of breast cancer?

    Energy Technology Data Exchange (ETDEWEB)

    Pinker-Domenig, K.; Helbich, T.H. [Medical University Vienna, Dept. of Radiology, Division of Molecular and Gender Imaging, Vienna (Austria); Bogner, W.; Gruber, S. [Medical University Vienna, Dept. of Radiology, MR Centre of Excellence, Vienna (Austria); Medical University Vienna, Dept. of Radiology, Vienna (Austria); Bickel, H. [Medical University Vienna, Dept. of Radiology, Division of Molecular and Gender Imaging, Vienna (Austria); Medical University Vienna, Dept. of Radiology, Vienna (Austria); Duffy, S. [Queen Mary University of London, Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, London (United Kingdom); Schernthaner, M. [Medical University Vienna, Dept. of Radiology, Vienna (Austria); Dubsky, P. [Medical University Vienna, Dept. of Surgery, Vienna (Austria); Pluschnig, U. [Medical University Vienna, Dept. of Internal Medicine, Division of Oncology, Vienna (Austria); Rudas, M. [Medical University Vienna, Clinical Institute of Pathology, Vienna (Austria); Trattnig, S. [Medical University Vienna, Dept. of Radiology, MR Centre of Excellence, Vienna (Austria)

    2012-02-15

    To identify which breast lesion descriptors in the ACR BI-RADS registered MRI lexicon are most strongly associated with the diagnosis of breast cancer when performing breast MR imaging at 3 T. 150 patients underwent breast MR imaging at 3 T. Lesion size, morphology and enhancement kinetics were assessed according to the BI-RADS {sup registered} classification. Sensitivity, specificity and diagnostic accuracy were assessed. The effects of the BI-RADS {sup registered} descriptors on sensitivity and specificity were evaluated. Data were analysed using logistic regression. Histopathological diagnoses were used as the standard of reference. The sensitivity, specificity and diagnostic accuracy of breast MRI at 3 T was 99%, 81% and 93%, respectively. In univariate analysis, the final diagnosis of malignancy was positively associated with irregular shape (p < 0.001), irregular margin (p < 0.001), heterogeneous enhancement (p < 0.001), Type 3 enhancement kinetics (p = 0.02), increasing patient age (p = 0.02) and larger lesion size (p < 0.001). In multivariate analysis, significant associations with malignancy remained for mass shape (p = 0.06), mass margin (p < 0.001), internal enhancement pattern (p = 0.03) and Type 3 enhancement kinetics (p = 0.06). The ACR BI-RADS {sup registered} breast lesion descriptors that are mostly strongly associated with breast cancer in breast MR imaging at 3 T are lesion shape, lesion margin, internal enhancement pattern and Type 3 enhancement kinetics. (orig.)

  12. 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...

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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. PMID:25513992

  18. Reverse Shoulder Arthroplasty

    Medline Plus

    Full Text Available Reverse Shoulder Arthroplasty Zimmer, Inc. New York City, New York March 17, 2010 Welcome to this OR Live presentation, brought to you by Zimmer. Hi. I'm ... my partner, Brad Parsons. We're here in New York to bring you a video of a ...

  19. 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...

  20. 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...

  1. 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.

  2. 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.

  3. 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.

  4. Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty.

    Science.gov (United States)

    Park, Caroline N; White, Peter B; Meftah, Morteza; Ranawat, Amar S; Ranawat, Chitranjan S

    2016-01-01

    Although total knee arthroplasty is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%. Postoperative residual knee pain after total knee arthroplasty, with or without crepitation, is a major factor that contributes to patient dissatisfaction. The most common location for residual pain after total knee arthroplasty is anteriorly. Because residual pain has been associated with an un-resurfaced patella, this review includes only registry data and total knee arthroplasty with patella replacement. Some suggest that the pathogenesis of residual knee pain may be related to mechanical stimuli that activate free nerve endings around the patellofemoral joint. Various etiologies have been implicated in residual pain, including (1) low-grade infection, (2) midflexion instability, and (3) component malalignment with patellar maltracking. Less common causes include (4) crepitation and patellar clunk syndrome; (5) patellofemoral symptoms, including overstuffing and avascular necrosis of the patella; (6) early aseptic loosening; (7) hypersensitivity to metal or cement; (8) complex regional pain syndrome; and (9) pseudoaneurysm. Because all of these conditions can lead to residual pain, identifying the etiology can be a difficult diagnostic challenge. Often, patients with persistent pain and normal findings on radiographs and laboratory workup may benefit from a diagnostic injection or further imaging. However, up to 10% to 15% of patients with residual pain may have unexplained pain. This literature review summarizes the findings on the causes of residual pain and presents a diagnostic algorithm to facilitate an accurate diagnosis for residual pain after total knee arthroplasty. PMID:26811953

  5. Psychological Quality of Life and its association with Academic Employability Skills among newly-registered students from three European Faculties.

    OpenAIRE

    Ionescu Ion; Baumann Michèle; Chau Nearkasen

    2011-01-01

    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,...

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

    OpenAIRE

    Haris Habib; Ejaz Ahmed Khan; Anwar Aziz

    2011-01-01

    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...

  7. 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.

  8. Implant survival after total elbow arthroplasty

    DEFF Research Database (Denmark)

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

    2014-01-01

    in 234 patients at a mean follow-up of 8.7 years (range, 0-27 years). The overall 5-year survival was 90% (95% confidence interval [CI], 88%-94%), and 10-year survival was 81% (95% CI, 76%-86%). TEAs performed with the unlinked design had a relative risk of revision of 1.9 (95% CI, 1.1-3.2) compared......BACKGROUND: Total elbow arthroplasty (TEA) is an established treatment for late-stage arthritis of the elbow. Indications have expanded to osteoarthritis and nonunion in distal humeral fractures. Information on implant survival and risk factors for revision is still sparse. The aim of this study...... 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...

  9. [What can we learn in future from the data of the German Arthroplasty Registry (EPRD) in comparison to other registries?].

    Science.gov (United States)

    Jansson, V; Steinbrück, A; Hassenpflug, J

    2016-06-01

    The German Arthroplasty Registry (EPRD) was founded in 2010 and has been in full operation since 2014. Previous attempts at a systematic data collection of elective and non-elective knee and hip replacement in Germany failed mainly because of the long-term lack of funding. The EPRD is an interdisciplinary collaborative partnership between the German Association of Orthopedics and Orthopedic Surgery (DGOOC), all implant manufacturers of the German Medical Technology Association (BVMed), health insurers (AOK and the Association of Additional Healthcare Insurance) and hospitals (German Hospital Federation). As part of this cooperation a worldwide unique implant database has been set up, which includes all relevant components and a detailed description of implant specifications. This implant library enables a detailed evaluation of implant survival, revision rates and possible inferior implant performance of knee and hip replacements in Germany. At the end of 2015 the EPRD encompassed over 200,000 registered operations. Due to the high number of hip and knee arthroplasties in Germany with many different implants from different manufacturers there will be a rapid growth of data that are available for a national and also international comparison of the results. PMID:27160728

  10. 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.

  11. 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.

  12. 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.

  13. 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...

  14. Importance of Attenuating Quadriceps Activation Deficits after Total Knee Arthroplasty

    OpenAIRE

    Thomas, Abbey C.; Jennifer E Stevens-Lapsley

    2012-01-01

    Total knee arthroplasty (TKA) is associated with persistent quadriceps dysfunction. Since quadriceps dysfunction impairs functional performance, minimizing quadriceps dysfunction by attenuating central activation deficits early after surgery may improve function later in life. Rehabilitation strategies incorporating neuromuscular electrical stimulation and early, aggressive quadriceps strengthening may prove beneficial. Further, surgical approaches such as minimally invasive TKA may minimize ...

  15. 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...... hyperthyroidism was high in the area with the lowest iodine intake (92.9/100,000 per year) compared with the area with only mild ID (65.4/100,000 per year). Standardized rate ratio was 1.49, and 95% confidence interval was 1.22-1.81. The opposite relationship was present for overt hypothyroidism (moderate ID, 26...

  16. 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.

  17. 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.

  18. 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...

  19. 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.)

  20. National Esophageal Atresia Register.

    Science.gov (United States)

    Sfeir, Rony; Michaud, Laurent; Sharma, Duyti; Richard, Florence; Gottrand, Frédéric

    2015-12-01

    National Esophageal Atresia was created in 2008 by the National Reference Center for Esophageal Congenital Abnormalities created in 2006. Primary goal was estimation of live birth prevalence in France. A national network of surgeons and pediatricians was initiated and entire teams dealing with esophageal atresia accepted to participate in an exhaustive national register. A questionnaire was validated by a national committee and data were centralized in our center. Scientific exploitation showed that such database is useful for health authorities as for medical professionals. Live birth prevalence in France is at 1.9/10,000 births. Prenatal diagnosis is more common but its effect on prevalence is not yet fully understood. Associated congenital abnormalities are frequent and major malformations with termination of pregnancy can influence prevalence. PMID:26642387

  1. Pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China.

    Science.gov (United States)

    Jiang, Bin; Ru, Xiaojuan; Sun, Haixin; Liu, Hongmei; Sun, Dongling; Liu, Yunhai; Huang, Jiuyi; He, Li; Wang, Wenzhi

    2016-01-01

    This study aimed to explore pre-hospital delay and its associated factors in first-ever stroke registered in communities from three cities in China. The rates of delay greater than or equal to 2 hours were calculated and factors associated with delays were determined by non-conditional binary logistic regression, after adjusting for different explanatory factors. Among the 403 cases of stroke with an accurate documented time of prehospital delay, the median time (interquartile range) was 4.00 (1.50-14.00) hours. Among the 544 cases of stroke with an estimated time range of prehospital delay, 24.8% of patients were transferred to the emergency department or hospital within 2 hours, only 16.9% of patients with stroke were aware that the initial symptom represented a stroke, only 18.8% used the emergency medical service and one-third of the stroke cases were not identified by ambulance doctors. In the multivariate analyses, 8 variables or sub-variables were identified. In conclusion, prehospital delay of stroke was common in communities. Thus, intervention measures in communities should focus on education about the early identification of stroke and appropriate emergency medical service (EMS) use, as well as the development of organized stroke care. PMID:27411494

  2. Revision of infected knee arthroplasties in Denmark.

    Science.gov (United States)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer C; Bagger, Jens; Schrøder, Henrik M; Kehlet, Henrik

    2016-08-01

    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 basis. Patients and methods - 105 partial revisions (100 patients) and 215 potential 2-stage revision procedures (205 patients) performed due to infection from July 1, 2011 to June 30, 2013 were identified from the Danish Knee Arthroplasty Register (DKR). Failure was defined as surgically related death ≤ 90 days postoperatively, re-revision due to infection, or not reaching the second stage for a planned 2-stage procedure within a median follow-up period of 3.2 (2.2-4.2) years. Results - The failure rate of the partial revisions was 43%. 71 of the partial revisions (67%) were revisions of a primary 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 - The failure rates of 43% after the partial revision procedures and 30% after the 2-stage revisions in combination with the higher mortality outside high-volume centers call for centralization and reconsideration of surgical strategies. PMID:26900908

  3. 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.......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....

  4. Registered report: The common feature of leukemia-associated IDH1 and IDH2 mutations is a neomorphic enzyme activity converting alpha-ketoglutarate to 2-hydroxyglutarate

    Science.gov (United States)

    Fiehn, Oliver; Showalter, Megan Reed; Schaner-Tooley, Christine E

    2016-01-01

    The Reproducibility Project: Cancer Biology seeks to address growing concerns about reproducibility in scientific research by conducting replications of selected experiments from a number of high-profile papers in the field of cancer biology. The papers, which were published between 2010 and 2012, were selected on the basis of citations and Altmetric scores (Errington et al., 2014). This Registered Report describes the proposed replication plan of key experiments from “The common feature of leukemia-associated IDH1 and IDH2 mutations is a neomorphic enzyme activity converting alpha-ketoglutarate to 2-hydroxyglutarate” by Ward and colleagues, published in Cancer Cell in 2010 (Ward et al., 2010). The experiments that will be replicated are those reported in Figures 2, 3 and 5. Ward and colleagues demonstrate the mutations in isocitrate dehydrogenase 2 (IDH2), commonly found in acute myeloid leukemia (AML), abrogate the enzyme’s wild-type activity and confer to the mutant neomorphic activity that produces the oncometabolite 2-hydroxyglutarate (2-HG) (Figures 2 and 3). They then show that elevated levels of 2-HG are correlated with mutations in IDH1 and IDH2 in AML patient samples (Figure 5). The Reproducibility Project: Cancer Biology is a collaboration between the Center for Open Science and Science Exchange and the results of the replications will be published by eLife. DOI: http://dx.doi.org/10.7554/eLife.12626.001 PMID:26943899

  5. 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

  6. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... the NexGen® LPS-Flex Mobile and LPS-Mobile Bearing Knees March 5, 2009 Welcome to this "OR ... MIS total knee arthroplasty with the Zimmer mobile bearing knee. We invite all of you who have ...

  7. Minimally Invasive Total Knee Arthroplasty

    Medline Plus

    Full Text Available ... NexGen® LPS-Flex Mobile and LPS-Mobile Bearing Knees March 5, 2009 Welcome to this "OR Live" ... re going to be doing an MIS total knee arthroplasty with the Zimmer mobile bearing knee. We ...

  8. 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....

  9. 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....

  10. Introduction of total knee arthroplasty in Lithuania

    OpenAIRE

    Tarasevicius, Sarunas; Stucinskas, Justinas; Robertsson, Otto; Wingstrand, Hans

    2009-01-01

    Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania. Methods The 10-year revision rate for the first 595 primary ScanKnee arthroplasties inserted in Klaipeda, Lithuania, was compared to that for the first 1,280 ScanKnee primary arthroplasties inserted in Sweden. ...

  11. 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. PMID:26053050

  12. 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.

  13. Revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty.

    Science.gov (United States)

    Memişoğlu, Kaya; Müezzinoğlu, U Sefa; Kesemenli, Cumhur Cevdet

    2010-01-01

    The Gunston polycentric knee arthroplasty, first designed and performed by Frank Gunston in 1971, is the first prosthesis considering the natural knee biomechanics. Although the polycentric knee arthroplasty showed encouraging results to relieve pain and to preserve the preoperative range of motion and joint instability, the improvements in prosthesis design and arthroplasty technology rapidly made the polycentric knee prosthesis obsolete. Herein, we report a 58-year old male patient who had revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty performed 32 years after the initial operation. PMID:21343693

  14. 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-

  15. 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

  16. 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 a...... attended a six-day rehabilitation course....

  17. IT Risk register

    OpenAIRE

    Kohout, Karel

    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...

  18. Hospital charges associated with "never events": comparison of anterior cervical discectomy and fusion, posterior lumbar interbody fusion, and lumbar laminectomy to total joint arthroplasty.

    Science.gov (United States)

    Daniels, Alan H; Kawaguchi, Satoshi; Contag, Alec G; Rastegar, Farbod; Waagmeester, Garrett; Anderson, Paul A; Arthur, Melanie; Hart, Robert A

    2016-08-01

    OBJECTIVE Beginning in 2008, the Centers for Medicare and Medicaid Service (CMS) determined that certain hospital-acquired adverse events such as surgical site infection (SSI) following spine surgery should never occur. The following year, they expanded the ruling to include deep vein thrombosis (DVT) and pulmonary embolism (PE) following total joint arthroplasty. Due to their ruling that "never events" are not the payers' responsibility, CMS insists that the costs of managing these complications be borne by hospitals and health care providers, rather than billings to health care payers for additional care required in their management. Data comparing the expected costs of such adverse events in patients undergoing spine and orthopedic surgery have not previously been reported. METHODS The California State Inpatient Database (CA-SID) from 2008 to 2009 was used for the analysis. All patients with primary procedure codes indicating anterior cervical discectomy and fusion (ACDF), posterior lumbar interbody fusion (PLIF), lumbar laminectomy (LL), total knee replacement (TKR), and total hip replacement (THR) were analyzed. Patients with diagnostic and/or treatment codes for DVT, PE, and SSI were separated from patients without these complication codes. Patients with more than 1 primary procedure code or more than 1 complication code were excluded. Median charges for treatment from primary surgery through 3 months postoperatively were calculated. RESULTS The incidence of the examined adverse events was lowest for ACDF (0.6% DVT, 0.1% PE, and 0.03% SSI) and highest for TKA (1.3% DVT, 0.3% PE, 0.6% SSI). Median inpatient charges for uncomplicated LL was $51,817, compared with $73,432 for ACDF, $143,601 for PLIF, $74,459 for THR, and $70,116 for TKR. Charges for patients with DVT ranged from $108,387 for TKR (1.5 times greater than index) to $313,536 for ACDF (4.3 times greater than index). Charges for patients with PE ranged from $127,958 for TKR (1.8 times greater than

  19. 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. PMID:26251947

  20. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty: A Nationwide Cohort Study.

    Science.gov (United States)

    Gordon, Max; Rysinska, Agata; Garland, Anne; Rolfson, Ola; Aspberg, Sara; Eisler, Thomas; Garellick, Göran; Stark, André; Hailer, Nils P; Sköldenberg, Olof

    2016-02-01

    Total hip arthroplasty is a common and important treatment for osteoarthritis patients. Long-term cardiovascular effects elicited by osteoarthritis or the implant itself remain unknown. The purpose of the present study was to determine if there is an increased risk of late cardiovascular mortality and morbidity after total hip arthroplasty surgery.A nationwide matched cohort study with data on 91,527 osteoarthritis patients operated on, obtained from the Swedish Hip Arthroplasty Register. A control cohort (n = 270,688) from the general Swedish population was matched 1:3 to each case by sex, age, and residence. Mean follow-up time was 10 years (range, 7-21).The exposure was presence of a hip replacement for more than 5 years. The primary outcome was cardiovascular mortality after 5 years. Secondary outcomes were total mortality and re-admissions due to cardiovascular events.During the first 5 to 9 years, the arthroplasty cohort had a lower cardiovascular mortality risk compared with the control cohort. However, the risk in the arthroplasty cohort increased over time and was higher than in controls after 8.8 years (95% confidence interval [CI] 7.0-10.5). Between 9 and 13 years postoperatively, the hazard ratio was 1.11 (95% CI 1.05-1.17). Arthroplasty patients were also more frequently admitted to hospital for cardiovascular reasons compared with controls, with a rate ratio of 1.08 (95% CI 1.06-1.11).Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation when compared with controls. PMID:26871792

  1. 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…

  2. Outcomes Following Radial Head Arthroplasty.

    Science.gov (United States)

    Fowler, John R; Henry, Sarah E; Xu, Peter; Goitz, Robert J

    2016-05-01

    Most current series of radial head arthroplasty include small numbers of patients with short- to medium-term follow-up and significant heterogeneity in patients, treatments, and outcome measures. The purpose of this systematic review was to review outcomes for radial head arthroplasty based on injury chronicity, injury pattern, and type of implant used. The authors systematically searched electronic databases for studies containing radial head arthroplasty or radial head replacement and identified 19 studies for inclusion in the analysis. For each included study, a composite mean was obtained for Mayo Elbow Performance Score (MEPS) and range of motion. Outcomes were said to differ significantly if their confidence intervals did not overlap. The MEPS for acute treatment (90) was higher than that for delayed treatment (81). There was no difference in the pooled MEPS between the isolated (89) and complex injury pattern (87) groups or implant material. There was no difference in range of motion between the acute and delayed or isolated and complex groups, but the average degree of pronation was higher in patients treated with titanium implants (76°) compared with cobalt chromium implants (66°). This systematic review suggests that outcomes are improved following acute arthroplasty for treatment of radial head fractures compared with delayed treatment, based on MEPS. The lack of other significant differences detected is likely due to the significant heterogeneity and inadequate power in current studies. Further prospective studies isolating the different variables will be needed to determine their true effect on outcomes. [Orthopedics. 2016; 39(3):153-160.]. PMID:27045484

  3. 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

  4. Wrist arthroplasty--a systematic review

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H

    2014-01-01

    INTRODUCTION: Severely painful or dysfunctional destroyed wrists can be reconstructed by fusion, interposition of soft-tissue or by arthroplasty using artificial materials. Total and partial wrist arthroplasty (T/PWA) has been used on a regular basis since the 1960's. The objective of this study ...

  5. Simultaneous and staged bilateral total hip arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Joergensen, Christoffer Calov; Husted, Henrik;

    2013-01-01

    Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days...

  6. 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…

  7. The Danish heart register

    DEFF Research Database (Denmark)

    Abildstrøm, Steen 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...

  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. 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...

  10. Revision of the Gunston polycentric knee arthroplasty with total knee arthroplasty

    OpenAIRE

    Memisoglu, Kaya; Muezzinoglu, U. Sefa; Kesemenli, Cumhur Cevdet

    2011-01-01

    The Gunston polycentric knee arthroplasty, first designed and performed by Frank Gunston in 1971, is the first prosthesis considering the natural knee biomechanics. Although the polycentric knee arthroplasty showed encouraging results to relieve pain and to preserve the preoperative range of motion and joint instability, the improvements in prosthesis design and arthroplasty technology rapidly made the polycentric knee prosthesis obsolete. Herein, we report a 58-year-old male patient who had ...

  11. 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.

  12. Early postoperative albumin level following total knee arthroplasty is associated with acute kidney injury: A retrospective analysis of 1309 consecutive patients based on kidney disease improving global outcomes criteria.

    Science.gov (United States)

    Kim, Ha-Jung; Koh, Won-Uk; Kim, Sae-Gyeol; Park, Hyeok-Seong; Song, Jun-Gol; Ro, Young-Jin; Yang, Hong-Seuk

    2016-08-01

    Hypoalbuminemia has been reported to be an independent risk factor for acute kidney injury (AKI). However, little is known about the relationship between the albumin level and the incidence of AKI in patients undergoing total knee arthroplasty (TKA). The aim of our study was to assess incidence and risk factors for AKI and to evaluate the relationship between albumin level and AKI following TKA.The study included a retrospective review of medical records of 1309 consecutive patients who underwent TKA between January 2008 and December 2014. The patients were divided into 2 groups according to the lowest serum albumin level within 2 postoperative days (POD2_alb level < 3.0 g/dL vs ≥3.0 g/dL). Multivariate logistic regression analysis was used to assess risk factors for AKI. A comparison of incidence of AKI, hospital stay, and overall mortality in the 2 groups was performed using propensity score analysis.Of 1309 patients, 57 (4.4%) developed AKI based on Kidney Disease Improving Global Outcomes criteria. Factors associated with AKI included age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; P = 0.030), diabetes (OR 3.12; 95% CI 1.65-5.89; P < 0.001), uric acid (OR 1.51; 95% CI 1.26-1.82; P < 0.001), beta blocker use (OR 2.65; 95% CI 1.48-4.73; P = 0.001), diuretics (OR 16.42; 95% CI 3.08-87.68; P = 0.001), and POD2_alb level < 3.0 g/dL (OR 1.92; 95% CI 1.09-3.37; P = 0.023). After propensity score analysis, POD2_alb level<3.0 g/dL was associated with AKI occurrence (OR 1.82; 95% CI 1.03-3.24, P = 0.041) and longer hospital stay (P = 0.001).In this study, we demonstrated that POD2_alb level<3.0 g/dL was an independent risk factor for AKI and lengthened hospital stay in patients undergoing TKA. PMID:27495094

  13. Total knee arthroplasty in vascular malformation

    Directory of Open Access Journals (Sweden)

    Harish Bhende

    2015-01-01

    Full Text Available In Klippel–Trenaunay syndrome, vascular malformations are not only in skin and superficial soft tissues but also in deep tissues like muscles bones and joints. It is well documemted that these recurrent intraarticular bleeds can cause early arthritis and joint pain. Performing arthroplasty in such patients is difficult and fraught with complications. We describe such a case where navigated total knee arthroplasty was performed with success to avoid the problems of intra medullary alignment used in the presence of intra medullary vascular malformations. We also suggest certain measures when knee arthroplasty is considered in such patients.

  14. Israeli registered nurse workforce

    OpenAIRE

    Glazer Greer

    2012-01-01

    Abstract This commentary on the article by Nirel, Riba, Reicher and Toren, "Registered nurses in Israel - workforce employment characteristics and projected supply", describes major findings from this important Israeli study and links findings to other nursing workforce studies worldwide. Israeli projections include a 25% decrease in RNs in the workforce by 2028; the greater likelihood of leaving the progression of young nurses compared to older nurses, and the greater likelihood of leaving t...

  15. Infected total knee arthroplasty treatment outcome analysis

    Directory of Open Access Journals (Sweden)

    Radoičić Dragan

    2012-01-01

    Full Text Available Background/Aim. Infected total knee arthroplasty (TKA is a topic of great importance, because its diagnosing and treatment requires a lot of resources, and often has an unsatisfactory outcome. The aim of this study was to analyze the outcome of the treatment of infection developed following TKA. Methods. This retrospective study of infected TKAs was performed in the period from 1998 to 2008 in the Orthopedics & Traumatology Clinic of the Military Medical Academy (MMA in Belgrade. A total of 654 primary and revised TKAs were performed in the said period. We registered and surgically treated 28 infected TKAs (primary TKAs: MMA - 22, other institutions - 6. The incidence of TKA infection in the MMA was 3.36%. The most common pathogens were: Staphylococcus aureus - 14 (50% cases, and Staph. epidermidis - 3 (10.7% cases. Other isolated pathogens were: Enterococcus faecalis, Klebsiella pneum., Klebsiella spp., Streptoccocus viridans, Seratia spp, Micrococcus luteus and Peptostreptococcus spp. In one case we had mixed anaerobic flora, and in 3 cases cultures were negative. We analyzed diagnostic challenges, risk factors (such as age and previous viscosupplementation and treatment outcomes in our series of infected TKAs. Results. In our series 2 infections healed after iv antibiotics and debridement, 1 patient responded to open debridement with component retention, 4 patients responded fully to one-stage reimplantation, 10 cases responded fully to two-stage reimplantation, 11 patients ended with arthrodesis and we had 1 patient with above knee amputation. Conclusion. Two-stage reimplantation remains gold standard for treatment of infected TKA, and we recommend it as treatment of choice for eradication of infection. The antibiotic loaded spacer prothesis concept in most cases allows infection eradication, good function and high patient satisfaction.

  16. 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 stud...

  17. Introduction of total knee arthroplasty in Lithuania

    Science.gov (United States)

    Stucinskas, Justinas; Robertsson, Otto; Wingstrand, Hans

    2009-01-01

    Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania. Methods The 10-year revision rate for the first 595 primary ScanKnee arthroplasties inserted in Klaipeda, Lithuania, was compared to that for the first 1,280 ScanKnee primary arthroplasties inserted in Sweden. As in the hip replacement study, only patients with osteoarthritis (OA) were included. Primary knee arthroplasties without patellar resurfacing were included, and the endpoint was revision for any reason other than addition of a patellar component. Results We found that the cumulative revision rate was not statistically significantly different between the groups. The revision pattern was different, however, and we observed 24 isolated patellar component additions in Sweden, but none in Klaipeda. Interpretation Contrary to the results of our previous hip arthroplasty study, the cumulative revision rate after total knee arthroplasty was similar in the two groups. This suggests that compared to hip arthroplasty, the outcome of total knee arthroplasty was less dependent on surgical experience. The large difference regarding isolated patellar component additions may be explained by long-term accumulation of severe OA cases in Lithuania. To patients subject to a newly introduced surgical treatment offering great improvement in quality of life, patellofemoral pain may be a minor problem. Furthermore, patellar problems may not have seemed particularly relevant for the surgeons, considering the disability of other patients waiting to be treated. PMID:19297790

  18. Management of complications after total shoulder arthroplasty

    OpenAIRE

    Josef K Eichinger; Galvin, Joseph W.

    2015-01-01

    The outcomes of total shoulder arthroplasty (TSA) for painful arthritis of the glenohumeral joint are excellent with significant improvement in pain and function. Increased use of total shoulder arthroplasty over the past decade has led to identification of common complications. Although the complication rate is low, accurate and timely diagnosis, appropriate management, and implementation of methods for prevention are critical to a successful long-term outcome. The most common complications ...

  19. 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

  20. 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.

  1. MR Imaging of Knee Arthroplasty Implants.

    Science.gov (United States)

    Fritz, Jan; Lurie, Brett; Potter, Hollis G

    2015-01-01

    Primary total knee arthroplasty is a highly effective treatment that relieves pain and improves joint function in a large percentage of patients. Despite an initially satisfactory surgical outcome, pain, dysfunction, and implant failure can occur over time. Identifying the etiology of complications is vital for appropriate management and proper timing of revision. Due to the increasing number of knee arthroplasties performed and decreasing patient age at implantation, there is a demand for accurate diagnosis to determine appropriate treatment of symptomatic joints following knee arthroplasty, and for monitoring of patients at risk. Magnetic resonance (MR) imaging allows for comprehensive imaging evaluation of the tissues surrounding knee arthroplasty implants with metallic components, including the polyethylene components. Optimized conventional and advanced pulse sequences can result in substantial metallic artifact reduction and afford improved visualization of bone, implant-tissue interfaces, and periprosthetic soft tissue for the diagnosis of arthroplasty-related complications. In this review article, we discuss strategies for MR imaging around knee arthroplasty implants and illustrate the imaging appearances of common modes of failure, including aseptic loosening, polyethylene wear-induced synovitis and osteolysis, periprosthetic joint infections, fracture, patellar clunk syndrome, recurrent hemarthrosis, arthrofibrosis, component malalignment, extensor mechanism injury, and instability. A systematic approach is provided for evaluation of MR imaging of knee implants. MR imaging with optimized conventional pulse sequences and advanced metal artifact reduction techniques can contribute important information for diagnosis, prognosis, risk stratification, and surgical planning. PMID:26295591

  2. 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....

  3. Periarticular regional analgesia in total knee arthroplasty: a review of the neuroanatomy and injection technique.

    Science.gov (United States)

    Guild, George N; Galindo, Rubin P; Marino, Joseph; Cushner, Fred D; Scuderi, Giles R

    2015-01-01

    Postoperative pain control after total knee arthroplasty may be insufficient, resulting in insomnia, antalgic ambulation, and difficulty with rehabilitation. Current strategies, including the use of femoral nerve catheters, may control pain but have been associated with falls, motor blockade, and quadriceps inhibition. Periarticular infiltration using the appropriate technique and knowledge of intraarticular knee anatomy may increase pain control and maximize rehabilitation. PMID:25435030

  4. Does the association of education with breast cancer replicate within twin pairs? A register-based study on Danish female twins

    DEFF Research Database (Denmark)

    Madsen, M; Andersen, Per Kragh; Gerster, M;

    2011-01-01

    A positive association between socio-economic position and breast cancer has been widely observed, but not hitherto within twin pairs, where shared familial factors were adjusted for.......A positive association between socio-economic position and breast cancer has been widely observed, but not hitherto within twin pairs, where shared familial factors were adjusted for....

  5. 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.

  6. Outcome after total elbow arthroplasty

    DEFF Research Database (Denmark)

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

    2015-01-01

    BACKGROUND: Total elbow arthroplasties (TEAs) are traditionally grouped into linked and unlinked design. The aim was to analyze the difference in clinical outcomes after TEA based on implant design and indication for surgery and to evaluate primary and revision TEAs. METHODS: A total of 167 TEAs...... (126 primary and 41 revision TEAs) in 141 patients were evaluated with patient-reported outcome measure by the Oxford Elbow Score (OES) and clinically assessed with the Mayo Elbow Performance Score (MEPS), range of motion (ROM), and standard radiographs. RESULTS: The mean follow-up was 10.5 years for...... primary and 7.5 years for revision TEAs. There was no difference in OES or MEPS between linked and unlinked primary TEAs. The OES score in the social-psychological domain was significantly lower in TEAs performed due to fracture (67) compared with rheumatoid arthritis (81; P = .025). ROM in extension...

  7. 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.

  8. Associations between patients' adherence and GPs' attitudes towards risk, statin therapy and management of non-adherence-a survey and register-based study

    DEFF Research Database (Denmark)

    Barfoed, Benedicte L; Paulsen, Maja S; Christensen, Palle M;

    2016-01-01

    BACKGROUND: Previous studies suggest that doctors' personal lifestyle, risk taking personality and beliefs about risk reducing therapies may affect their clinical decision-making. Whether such factors are further associated with patients' adherence with medication is largely unknown. OBJECTIVE: T...

  9. Hip arthroplasty by matching cups.

    Science.gov (United States)

    Gerard, Y

    1978-01-01

    A total hip surface arthroplasty consisting of matching cups and uncemented prosthetic components is a noteworthy operation. The femoral cup obtains cylindrical support from the femoral head which is reamed in the shape of a cylinder. The acetabular cup is metallic with a polyethylene liner. It is mobile over the bone but its position is constrained by contact with the femoral cup and therefore "self-centering." On the femoral side, the cup must be placed strictly in the axis of the femoral neck. The main consideration in femoral head surface replacement is the vitality of the underlying bone. Necrosis was observed in the earliest clinical trials but there have been no cases of necrosis in the past 3 1/2 years. This is attributed to a more limited surgical approach in which only the anterior part of the gluteus medius is divided and all the posterior elements of the hip are preserved. The acetabulum is sufficiently reamed to receive the cup, which protrudes beyond the external margins of the acetabulum in all positions. Errors have been committed while perfecting the prosthetic material, but the results as determined by a 6 1/2 year follow-up on purely metallic cups are encouraging. Metal-polyethylene cups presently under investigation have almost a 2 year follow-up. The reaction of the acetabulum to an uncemented cup is not yet known. However, the existence of 2 sliding surfaces and the fact that the acetabular cup moves only during the extremes of hip movement, is reason to assume that if the acetabulum is not reamed to expose cancellous bone, the risks of protrusion are minimal or delayed. Total surface arthroplasty by concentric cups has been performed in 335 hips to date. The operation is especially recommended when osteotomy is no longer possible and disabling coxarthrosis is present in relatively young patients. PMID:729253

  10. Anterior Cervical Discectomy with Arthroplasty versus Arthrodesis for Single-Level Cervical Spondylosis: A Systematic Review and Meta-Analysis

    OpenAIRE

    Aria Fallah; Elie A Akl; Shanil Ebrahim; Ibrahim, George M.; Alireza Mansouri; Foote, Clary J.; Yuqing Zhang; Fehlings, Michael G.

    2012-01-01

    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...

  11. Initial Results of an Acetabular Center Axis Registration Technique in Navigated Hip Arthroplasty with Deformed Acetabular Rims

    OpenAIRE

    Wada, Hiroshi; Mishima, Hajime; Yoshizawa, Tomohiro; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

    2016-01-01

    Background In cementless total hip arthroplasty, imageless computer-assisted navigation is usually used to register the anterior pelvic plane (APP). The accuracy of this method is influenced by the subcutaneous tissues overlying the registration landmarks. On the other hand, the acetabular center axis (ACA) is determined from the acetabular rim. Precise registration of the ACA is possible because of direct palpation using a pointer. Imageless navigation using the ACA usually targets patients ...

  12. 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...

  13. [Sport activity after hip and knee arthroplasty].

    Science.gov (United States)

    Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael

    2013-11-01

    Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them. PMID:24416822

  14. Portable shift register

    International Nuclear Information System (INIS)

    An electronics package for a small, battery-operated, self-contained, neutron coincidence counter based on a portable shift-register (PSR) has been developed. The counter was developed for applications not adequately addressed by commercial packages, including in-plant measurements to demonstrate compliance with regulations (domestic and international), in-plant process control, and in-field measurements (environmental monitoring or safeguards). Our package's features, which address these applications, include the following: Small size for portability and ease of installation;battery or mains operation; a built-in battery to power the unit and a typical detector such as a small sample counter, for over 6 h if power lines are bad or noisy, if there is a temporary absence of power, or if portability is desired; complete support, including bias, for standard neutron detectors; a powerful communications package to easily facilitate robust external control over a serial port; and a C-library to simplify creating external control programs in computers or other controllers. Whereas the PSR specifically addresses the applications mentioned above, it also performs all the measurements made by previous electronics packages for neutron coincidence counters developed at Los Alamos and commercialized. The PSR electronics package, exclusive of carrying handle, is 8 by 10 by 20 cm; it contains the circuit boards, battery, and bias supply and weighs less than 2 kg. This instrument package is the second in an emerging family of portable measurement instruments being developed; the first was the Miniature and Modular Multichannel Analyzer (M3CA). The PSR makes extensive use of hardware and software developed for the M3CA; like the M3CA, it is intended primarily for use with an external controller interfaced over a serial channel

  15. 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.

  16. 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.

  17. 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

  18. Accumulation in liver and spleen of metal particles generated at nonbearing surfaces in hip arthroplasty.

    Science.gov (United States)

    Urban, Robert M; Tomlinson, Michael J; Hall, Deborah J; Jacobs, Joshua J

    2004-12-01

    Systemic migration of metal particles generated at nonbearing surfaces rather than the intended primary bearing was studied in postmortem specimens from 30 patients with total hip arthroplasty. Using light and electron microscopy with x-ray microanalysis, submicrometer metal particles were identified within macrophages in the liver and/or the spleen in 11 of 15 patients with a revised arthroplasty and in 2 of 15 patients with primary hip arthroplasty. The macrophages formed focal aggregates in the organs without apparent toxicity. Fretting at ancillary fixation devices, loose components, and modular connections can generate a substantial volume of debris. These particles are in addition to those generated at the bearing surfaces, further increasing both the local and systemic particulate burdens. While all components can be associated with the distant spread of particles and metal ions, it is the environment of revision arthroplasty that provides the greatest potential for the generation and systemic dissemination of wear debris. The long-term effects of accumulated wear particles in the liver and spleen are unknown. PMID:15578561

  19. 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

  20. Registering Names and Addresses for Information Technology.

    Science.gov (United States)

    Knapp, Arthur A.

    The identification of administrative authorities and the development of associated procedures for registering and accessing names and addresses of communications data systems are considered in this paper. It is noted that, for data communications systems using standards based on the Open Systems Interconnection (OSI) Reference Model specified by…

  1. 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.

  2. 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.

  3. 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.

  4. 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 Pflow to reverse into the operating room. Total time with the door open significantly affected the minimum pressure recorded in the room (Ptraffic must be evaluated to identify ways to reduce this traffic and the associated risks. PMID:26558679

  5. 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.

  6. 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....

  7. 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

  8. 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

  9. 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...

  10. Hip and knee arthroplasty: quo vadis?

    NARCIS (Netherlands)

    Ho, J.; Meis, J.F.G.M.; Nabuurs-Franssen, M.H.; Voss, A.

    2015-01-01

    Despite of the steady decrease of surgical site infection (SSI) over the last two decades, the incidence of SSI after hip and knee arthroplasty has recently surged. This may be explained by technical changes that may result in an increased risk of SSI, such as the broad implementation of fast track

  11. 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-r...

  12. Knee Arthroplasty: With or Without Patellar Component?

    Directory of Open Access Journals (Sweden)

    Árpád Sólyom

    2015-09-01

    Full Text Available Arthroplasty is used when there is irreversible damage to the articular cartilage of the knee. It involves implanting a bicompartimental (femoral and tibial components or a tricompartimental (femoral, tibial and patellar components prosthesis. It is a very invasive and costly operation, so our objective was to evaluate the necessity of the patellar component.

  13. 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.

  14. Synovial cutaneous fistula complicating a reverse total shoulder arthroplasty.

    Science.gov (United States)

    Letter, Haley P; Limback, Joseph; Wasyliw, Christopher; Bancroft, Laura; Scherer, Kurt

    2016-06-01

    Reverse total shoulder arthroplasty is becoming a common form of shoulder arthroplasty that is often performed in the setting of rotator cuff pathology. Infection is a rare complication but is more common in reverse total shoulder arthroplasty than in hemiarthroplasty or anatomic total shoulder arthroplasty. We present the case of a 69-year-old patient with a reverse total shoulder arthroplasty who presented with purulent drainage from the skin of his anterior shoulder. Computed tomography arthrogram confirmed the presence of a synovial cutaneous fistula. Synovial cutaneous fistula is a rare variant of periprosthetic infection that, to our knowledge, has not been described previously in the setting of a reverse total shoulder arthroplasty. Computed tomography arthrogram proved to be a reliable method for confirming the diagnosis and was used for operative planning to remove the hardware. PMID:27257460

  15. Danish registers on aspects of reproduction

    DEFF Research Database (Denmark)

    Blenstrup, Lene Tølbøll; Knudsen, Lisbeth B.

    2011-01-01

    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 on...

  16. Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty.

    Science.gov (United States)

    Saffo, Zaid; Ognjan, Anthony

    2016-01-01

    The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis. Ultimately, resection arthroplasty with operative tissue acid fast bacterial cultures demonstrated growth of the Mycobacterium smegmatis group. Post-operatively, she completed a combination course of oral doxycycline and levofloxacin and successfully completed a replacement arthroplasty with clinical and microbial resolution of the infection. To our knowledge, literature review demonstrates three case of knee arthroplasty infection caused by the Mycobacterium smegmatis group. Correspondingly, optimal surgical procedures and antimicrobial management including antimicrobial selection, treatment duration are not well defined. Presently, the best treatment options consists of two step surgical management including prosthesis hardware removal followed by extended antimicrobial therapy, followed by consideration for re-implantation arthroplasty. Our case illustrates importance of considering atypical mycobacterial infections in post-operative arthroplasty infections not responding to traditional surgical manipulations and antimicrobials. For an arthroplasty infection involving the atypical Mycobacterium smegmatis group, two step arthroplasty revision, including arthroplasty resection, with a combination of oral doxycycline and levofloxacin can lead to successful infection resolution, allowing for a

  17. 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.

  18. 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

  19. Incidence of Severe Osteonecrosis Requiring Total Joint Arthroplasty in Children and Young Adults Treated for Leukemia or Lymphoma

    DEFF Research Database (Denmark)

    Niinimäki, Riitta; Hansen, Lene Mølgaard; Niinimäki, Tuukka;

    2013-01-01

    Purpose: The population-based incidence of severe osteonecrosis (ON) necessitating total joint arthroplasty (TJA) in patients with hematological cancer is unknown. This study assessed the incidence of ON requiring primary TJA in children and young adults treated for leukemia or lymphoma. Methods......: Patients diagnosed with leukemia or lymphoma before 31 years of age were identified from the Finnish and Danish Cancer Registries. These data were combined with those from the National Hospital Discharge and the Finnish Arthroplasty Registers. Data on the orthopedic procedures performed and the appropriate...... diagnosis codes given before the age of 40 were also retrieved. Results: The estimated cumulative incidence of TJA was 4.5% at 20 years for patients treated for chronic myeloid leukemia, followed by 2.1% for patients treated for acute myeloid leukemia. It was considerably lower in patients with acute...

  20. 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

  1. 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 s...

  2. 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

  3. Lateral dislocation of the knee joint after total knee arthroplasty: a case report

    OpenAIRE

    Ugutmen, Ender; Ozkan, Korhan; Unay, Koray; Mahirogullari, Mahir; Eceviz, Engin; Taser, Omer

    2008-01-01

    Background Total knee arthroplasty (TKA) is a successful therapy for functional improvement and pain relief in advanced symptomatic degeneration of the knee joint. But it can be associated with many complications, one of which is instability. Case presentation A 70-year-old woman was referred to our hospital because of right knee dislocation after TKA was performed on her right knee due to severe varus deformity and flexion contracture. This instability was caused by persistent MCL tightness ...

  4. 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....

  5. TIBIAL PERIPROSTHETIC FRACTURE COMBINED WITH TIBIAL STEM STRESS FRACTURE FROM TOTAL KNEE ARTHROPLASTY

    OpenAIRE

    Fonseca, Fernando; Rebelo, Edgar; Completo, Antonio

    2015-01-01

    Total knee arthroplasty complications related to the prosthetic material are very rare, except for polyethylene wear. We report the case of a 58-year-old woman who came to the emergency service of our hospital with a periprosthetic tibial fracture (Mayo Clinic type I). Careful examination showed that this fracture was concomitantly associated with a tibial stem fatigue fracture. The prosthesis and the stem were sent to an independent biomechanics laboratory for evaluation. A finite-element CA...

  6. Biomechanical behaviour of cancellous bone on patellofemoral arthroplasty with journey prosthesis : a finite element study

    OpenAIRE

    Castro, André; Completo, António; Simões, José A.; Flores, Paulo

    2015-01-01

    Isolated patellofemoral (PF) arthritis of the knee is a common cause of anterior knee pain and disability. Patellofemoral arthroplasty (PFA) is a bone conserving solution for patients with PF degeneration. Failure mechanisms of PFA include growing tibiofemoral arthritis and loosening of components. The implant loosening can be associated with bone resorption, or fatigue-failure of bone by overload. This research work aims at determining the structural effects of the implantation of PF prosthe...

  7. 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.

  8. Fulminant Nonocclusive Mesenteric Ischemia Just after Hip Arthroplasty

    Science.gov (United States)

    Auxiliadora-Martins, Maria; Alkmin-Teixeira, Gil Cezar; Feres, Omar; Martins-Filho, Olindo Assis; Basile-Filho, Anibal

    2010-01-01

    Nonocclusive mesenteric ischemia (NOMI) is not a rare clinical entity in intensive medicine, and it can be a consequence of several clinical or surgical situations. This pathology results from reduced intestinal microvascular blood supply associated with an acute inflammatory process, culminating with bowel necrosis. This is a case on a female patient who developed immediate postsurgical NOMI following hip arthroplasty and died. Since diagnosis of this potentially fatal condition remains a dilemma, NOMI should always be considered an eventual postoperative complication in high-risk surgical patients such as elderly individuals with previous history of nicotine abuse, congestive heart failure, and essential hypertension. The present paper highlights the importance of early diagnosis and prompt adequate treatment of NOMI in subjects with diminished cardiac output and severe abdominal pain. PMID:20300426

  9. Outcome of total hip arthroplasty, but not of total knee arthroplasty, is related to the preoperative radiographic severity of osteoarthritis

    Science.gov (United States)

    Tilbury, Claire; Holtslag, Maarten J; Tordoir, Rutger L; Leichtenberg, Claudia S; Verdegaal, Suzan H M; Kroon, Herman M; Fiocco, Marta; Nelissen, Rob G H H; Vliet Vlieland, Thea P M

    2016-01-01

    Background and purpose There is no consensus on the impact of radiographic severity of hip and knee osteoarthritis (OA) on the clinical outcome of total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed whether preoperative radiographic severity of OA is related to improvements in functioning, pain, and health-related quality of life (HRQoL) 1 year after THA or TKA. Patients and methods This prospective cohort study included 302 THA patients and 271 TKA patients with hip or knee OA. In the THA patients, preoperatively 26% had mild OA and 74% had severe OA; in the TKA patients, preoperatively 27% had mild OA and 73% had severe OA. Radiographic severity was determined according to the Kellgren and Lawrence (KL) classification. Clinical assessments preoperatively and 1 year postoperatively included: sociodemographic characteristics and patient-reported outcomes (PROMs): Oxford hip/knee score, hip/knee injury and osteoarthritis outcome score (HOOS/KOOS), SF36, and EQ5D. Change scores of PROMs were compared with mild OA (KL 0–2) and severe OA (KL 3–4) using a multivariate linear regression model. Results Adjusted for sex, age, preoperative scores, BMI, and Charnley score, radiographic severity of OA in THA was associated with improvement in HOOS “Activities of daily living”, “Pain”, and “Symptoms”, and SF36 physical component summary (“PCS”) scale. In TKA, we found no such associations. Interpretation The decrease in pain and improvement in function in THA patients, but not in TKA patients, was positively associated with the preoperative radiographic severity of OA. PMID:26484651

  10. Heterotopic bone formation following total shoulder arthroplasty

    DEFF Research Database (Denmark)

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

    1989-01-01

    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......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...... 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....

  11. 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.

  12. 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

  13. 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.

  14. Infected total knee arthroplasty treatment outcome analysis

    OpenAIRE

    Radoičić Dragan; Popović Zoran; Barjaktarović Radoslav; Marinković Jugoslav

    2012-01-01

    Background/Aim. Infected total knee arthroplasty (TKA) is a topic of great importance, because its diagnosing and treatment requires a lot of resources, and often has an unsatisfactory outcome. The aim of this study was to analyze the outcome of the treatment of infection developed following TKA. Methods. This retrospective study of infected TKAs was performed in the period from 1998 to 2008 in the Orthopedics & Traumatology Clinic of the Military Medical Academy (MMA) in Belgrade. ...

  15. Future Bearing Surfaces in Total Hip Arthroplasty

    OpenAIRE

    Chang, Jun-Dong

    2014-01-01

    One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom...

  16. Complications in primary total hip arthroplasty: avoidance and management: wear.

    Science.gov (United States)

    Ries, Michael D

    2003-01-01

    Many factors, including polyethylene processing, sterilization method, counterface material, femoral head size, femoral offset, acetabular component position, implant design, and patient activity level, affect the rate of wear in total hip arthroplasty. For patients with life expectancy that exceeds the longevity of the conventional implant materials, an alternative bearing surface (highly cross-linked polyethylene, metal-on-metal, or ceramic-on-ceramic) may be considered. Although laboratory wear tests with these materials are very favorable, clinical outcomes have not been clearly established. When osteolysis does develop in response to particulate debris, the location and progression of the lesions may be quite variable. Asymptomatic stable lesions can be followed clinically and radiographically while symptomatic or enlarging lesions or those that may compromise the integrity of the periprosthetic bone stock require surgery. If acetabular component revision is necessary and an adequate rim of host bone is maintained to support a revision acetabular component, defects can be filled with particulate bone graft. Large segmental defects generally require structural allografts. If the acetabular shell is well fixed in good position and the osteolytic defects are accessible, treatment with curettage and bone grafting of the lesions with liner revision is appropriate to avoid use of a structural allograft. Proximal femoral defects around a well-fixed stem can be managed in a similar manner with curettage and bone grafting. Distal lesions associated with risk of periprosthetic femur fracture or implant loosening require stem revision. Osteoclastic resportion of bone in response to particulate debris can be impaired with use of some drugs such as alendronate. However, the safety and efficacy of alendronate in the clinical management of osteolysis associated with total hip arthroplasty has not been established. PMID:12690853

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

    DEFF Research Database (Denmark)

    Larsen, Kristian; Hansen, Torben Bæk; 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...

  18. 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

  19. 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...

  20. Reverse Total Shoulder Arthroplasty for a 4-Part Proximal Humerus Fracture.

    Science.gov (United States)

    Stahl, Dan; Fuente, Guadalupe de la

    2016-08-01

    Proximal humerus fractures account for approximately 5% of all fractures and they are the third most common fracture seen in the elderly population. Complex fracture patterns, including 3-parts and 4-parts, have traditionally been amendable to shoulder hemiarthroplasty. However, several limiting factors, including poor patient satisfaction and low functional outcomes have guided further exploration for other treatment options. Reverse shoulder arthroplasty (RSA) has began to expand its traditional indications of rotator cuff arthropathy, massive rotator cuff tears, failed shoulder arthroplasties, and proximal humerus fracture sequelae. Overall, consistently improved functional outcomes are reported in RSA studies, including an increased postoperative range of motion, specifically external rotation. RSA has began to have a clinically significant role in the management of acute, complex proximal humerus fractures. Our video demonstrates the key features associated with positive patient outcomes, concluding with postoperative clinical videos. PMID:27441943

  1. 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

    . INTERPRETATION: This study shows that shoulder arthroplasty, regardless of design, is a good option in terms of reducing pain and improving function in RA patients. The high revision rate in the RHA group suggests that other designs may offer better implant survival. However, this should be confirmed in larger......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...

  2. Reliability and Validity of the Dutch Version of the International Physical Activity Questionnaire in Patients After Total Hip Arthroplasty or Total Knee Arthroplasty

    NARCIS (Netherlands)

    Blikman, Tim; Stevens, Martin; Bulstra, Sjoerd K.; van den Akker-Scheek, Inge; Reininga, Inge H. F.

    2013-01-01

    STUDY DESIGN: Psychometric assessment. OBJECTIVES: To determine test-retest reliability and concurrent validity of the International Physical Activity Questionnaire (IPAQ) in patients after total hip arthroplasty or total knee arthroplasty. BACKGROUND: Despite recognized benefits of regular physical

  3. 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.

  4. [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.

  5. 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

  6. Hypovitaminosis D in Patients Undergoing Shoulder Arthroplasty: A Single-Center Analysis.

    Science.gov (United States)

    Inkrott, Bradley P; Koberling, Jessica L; Noel, Curtis R

    2016-07-01

    Vitamin D is recognized as an essential component in bone health, muscle function, and immune system regulation. This study sought to characterize the prevalence of hypovitaminosis D in patients undergoing total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RSA), and shoulder hemiarthroplasty (HA). Between September 2013 and December 2014, a total of 218 patients undergoing TSA, RSA, and HA by a single surgeon were screened for hypovitaminosis D and retrospectively reviewed. Demographic variables and risk factors were recorded. Overall, 93 shoulder arthroplasty patients (43%) were vitamin D insufficient (<30 ng/mL) and 24 patients (11%) were vitamin D deficient (<20 ng/mL). Body mass index (BMI) had a significant effect on vitamin D levels; BMI of 30 kg/m(2) or greater was associated with lower vitamin D levels (31.5±12.1 ng/mL) compared with patients with a BMI of less than 30 kg/m(2) (36.2±15.7 ng/mL, P ≤.01). The absence of supplementation with vitamin D and calcium prior to serum testing was the most significant risk factor for hypovitaminosis D (odds ratio [OR], 8.234, P<.001). Age, gender, race, smoking status, American Society of Anesthesiologists (ASA) score, procedure, and surgical indication were not significant. This is the largest cohort of shoulder arthroplasty patients screened for hypovitaminosis D. Almost half (43%) of the study population was insufficient, and both the absence of supplementation prior to serum testing and BMI of 30 kg/m(2) or greater were found to be predictive of lower serum 25-hydroxyvitamin D levels. Given the extent of vitamin D involvement in normal musculoskeletal physiology, routine preoperative evaluation is merited. [Orthopedics. 2016; 39(4):e651-e656.]. PMID:27286046

  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. 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

  9. Systematic register of nuclear accidents

    International Nuclear Information System (INIS)

    The Systematic Register of Nuclear Accidents is a consolidation of important accidents occurred in the world during the period 1945-1984. Important accidents can be defined as those involving high radiation doses, which require the exposed individuals to undergo medical treatment. The organization and structuring of this register rests on the necessity for the availability of a database specifically oriented to researchers interested in studying the different nuclear accidents reported. Approximately 150 accidents in that period are presented in a summary form; these accidents had been described or reported in the scientific literature or made known through informal communications of Brazilian and foreign institutions and researchers. This register can be of interest particularly to all professionals who either directly of indirectly work in the area of nuclear or radioactive installations safety. In order to facilitate analysis by the researcher, that casuistic system was divided into 3 groups: criticality accidents (table I), fall-out on Marshall Islands (table II) and external irradiation accidents (table III). It is also included an overview of accidents in that period, indicating the total number of victims, fatal cases, and number of survivors. The author offers to the reader an extensive bibliography on the accidents described. (Author)

  10. Navigated minimally invasive unicompartmental knee arthroplasty.

    Science.gov (United States)

    Jenny, Jean-Yves; Müller, Peter E; Weyer, R; John, Michael; Weber, Patrick; Ciobanu, Eugène; Schmitz, Andreas; Bacher, Thomas; Neumann, Wolfram; Jansson, Volkmar

    2006-10-01

    Unicompartmental knee arthroplasty (UKA) is an alternative procedure to high tibial osteotomy. This study assessed the procedure using computer navigation to improve implantation accuracy and presents early radiological results of a group of patients implanted with the univation UKA (B. Braun Aesculap, Tuttlingen, Germany) with navigation instrumentation and a minimally invasive approach. The authors concluded that navigated implantation of a UKA using a nonimage-based system improved radiologic accuracy implantation without significant inconvenience and minimal change in the conventional operating technique. PMID:17407935

  11. Vaginal mass following uncemented total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Young-Soo Shin

    2014-01-01

    Full Text Available A 53-year-old woman developed a vaginal mass following an uncemented total hip arthroplasty. The mass was in direct communication with the hip through an acetabular medial wall defect after loosening of the acetabular component. The mass formation was caused simultaneously by changes secondary to polyethylene wear, a tiny delamination of the porous titanium mesh coating and a broken antirotational tab on the acetabular cup, all of which may have served as sources of metal particles. A careful evaluation of the patient′s history, symptoms, X-ray findings and computed tomography scans should always be performed to ensure accurate diagnosis.

  12. Hip and knee arthroplasty: quo vadis?

    OpenAIRE

    Ho, J; Meis, J. F. G. M.; Nabuurs-Franssen, M.H.; Voss, A.

    2015-01-01

    Despite of the steady decrease of surgical site infection (SSI) over the last two decades, the incidence of SSI after hip and knee arthroplasty has recently surged. This may be explained by technical changes that may result in an increased risk of SSI, such as the broad implementation of fast track programs, and/or early interventions on suspected SSI. By definition, early intervention may lead to a higher SSI score, even in the absence of a true SSI. In any case, the reverse trend of SSI war...

  13. Superficial wound closure complications with barbed sutures following knee arthroplasty.

    Science.gov (United States)

    Campbell, Abigail L; Patrick, David A; Liabaud, Barthelemy; Geller, Jeffrey A

    2014-05-01

    As quality measures may be increasingly used in knee surgery reimbursement, an important focus in outcome assessment will shift toward minimizing complications and increasing efficiency in knee arthroplasty reconstruction. The purpose of this study was to evaluate the efficacy of barbed, absorbable sutures in closure of the longitudinal surgical incision following knee arthroplasty, using post-operative complication occurrences. In 416 operations, primary outcomes assessed were deep infection, superficial infection, dehiscence, or stitch abscesses. Secondary outcomes included self-limiting eschar, severe effusion, arthrofibrosis, and keloid formation. Evaluation of overall primary outcomes showed a higher rate of wound complications using barbed sutures (P knee arthroplasty should be avoided. PMID:24184326

  14. 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....

  15. 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...

  16. Total ankle arthroplasty in France

    OpenAIRE

    Besse, Jean-Luc; Colombier, Jean-Alain; ASENCIO, Joseph; Bonnin, Michel; Gaudot, Fabrice; JARDE, Olivier; Judet, Thierry; MAESTRO, Michel; LEMRIJSE, Thibaut; LEONARDI, Christian; TOULLEC, Eric

    2010-01-01

    Objectives: After more than 10 years' experience in France, the French Foot Surgery Association (Association francaise de chirurgie du pied [AFCP]) presents an update on mobile-bearing ankle prostheses, based on a multicenter study. Meta-analysis - Biomechanics - Assessment and indications: A preliminary comparative metaanalysis of the literature studies on ankle and prosthesis biomechanics, reviews validated indications and contra-indications, and details clinical and radiological outcomes a...

  17. 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.

  18. 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

  19. 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...

  20. 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...... between January 2008 and December 2012 were included. Statistical comparison of the different screening strategies was made. RESULTS: The number of children undergoing surgery for congenital cataract before 1 year of age was 31 (17 bilateral cases) in Denmark and 92 (38 bilateral cases) in Sweden...... with red reflex examination, congenital cataract in Swedish children is detected significantly earlier than in Danish children....

  1. 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.

  2. Robot-assisted unicompartmental knee arthroplasty.

    Science.gov (United States)

    Pearle, Andrew D; O'Loughlin, Padhraig F; Kendoff, Daniel O

    2010-02-01

    The outcomes of unicompartmental knee arthroplasties (UKAs) have demonstrated inconsistent long-term survival. We report the first clinical series of UKA using a semiactive robotic system for the implantation of an inlay unicondylar knee arthroplasty. Ten patients were selected for this study. Preoperative mechanical leg alignment values ranged from 0.3 degrees varus to 9.8 degrees varus. A haptic guidance system was used; a detailed description is given in the manuscript. The setup time for the robot was 41 minutes; intraoperative registration process, 7.5 minutes (6-13 minutes); skin incision, 8 cm; robot-assisted burring, 34.8 minutes (18-50 minutes); mean tourniquet time, 87.4 minutes (68-113 minutes); and overall operation time, 132 minutes (118-152 minutes). The planned and intraoperative tibiofemoral angle was within 1 degrees. The postoperative long leg axis radiographs were within 1.6 degrees. Haptic guidance in combination with a navigation module allows for precise planning and execution of both inlay components in UKA. PMID:19056227

  3. 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.

  4. The Cruciate Ligaments in Total Knee Arthroplasty.

    Science.gov (United States)

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction. PMID:27327919

  5. [Primary radial head arthroplasty in trauma : Complications].

    Science.gov (United States)

    Schmidt-Horlohé, K; Buschbeck, S; Wincheringer, D; Weißenberger, M; Hoffmann, R

    2016-10-01

    Radial head fractures are common injuries in elbow trauma. Non-displaced fractures are best treated conservatively. Simple but displaced fractures require anatomic reduction and fixation, typically using screws. The treatment course for complex fractures with multiple fragments is still being debated, as results are less predictable. Radial head resection is not advised if concomitant injuries of the coronoid process or the collateral ligaments with instability are present. Favorable outcomes following open reduction and fixation using plates were reported recently. However, complication rates are very high. Radial head replacement is a valuable tool in treating complex fractures of the radial head with predominantly good and excellent results. Patients who suffer radial head fractures are typically of a younger age, resulting in high functional demands. Certainly, unspecific and specific complications related to radial head arthroplasty were reported in up to 40 % of cases in an acute fracture setting. This article highlights common complications in radial head arthroplasty and aims to present strategies to avoid them. PMID:27600571

  6. 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.

  7. 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. PMID:27049189

  8. 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.

  9. Total knee arthroplasty in patients with a previous patellectomy.

    Science.gov (United States)

    Maslow, Jed; Zuckerman, Joseph D; Immerman, Igor

    2013-01-01

    Post-patellectomy patients represent a specific subgroup of patients that may develop arthritis and persistent knee pain and potentially require treatment with total knee arthroplasty. This article reviews the treatment and functional outcomes following total knee arthroplasty in patients with prior patellectomy. A case report is presented as an example of the clinical management of a post-patellectomy patient with significant knee pain and disability treated with total knee arthroplasty. Emphasis will be placed in decision- making, specifically with the use of a posterior stabilized implant. In addition, postoperative strengthening of the quadriceps is essential to compensate for the lack of the patella and increase the success of total knee arthroplasty in this subgroup of patients. PMID:24151951

  10. Mesh hernia repair and male infertility: A retrospective register study.

    OpenAIRE

    Hallén, Magnus; Westerdahl, Johan; Nordin, Pär; Gunnarsson, Ulf; Sandblom, Gabriel

    2012-01-01

    BACKGROUND: Previous studies have suggested that the use of mesh in groin hernia repair may be associated with an increased risk for male infertility as a result of inflammatory obliteration of structures in the spermatic cord. In a recent study, we could not find an increased incidence of involuntary childlessness. The aim of this study was to evaluate this issue further. METHODS: Men born between 1950 and 1989, with a hernia repair registered in the Swedish Hernia Register between 1992 and ...

  11. Registered nurses' job satisfaction in Navy hospitals.

    Science.gov (United States)

    Zangaro, George A; Johantgen, Meg

    2009-01-01

    Because of the increasing use of civilian registered nurses to supplement the nursing staff at U.S. Navy hospitals, it is imperative to understand the factors that influence satisfaction in both Navy and civilian nurses in military hospitals. This study sought to expand knowledge of satisfaction in hospital-based active duty Navy registered nurses and federal civilian nurses. Respondents completed a survey with a response rate of 42% (N=496). The survey was designed using well-known satisfaction models and included measures of work attitudes, work setting, and demographic characteristics. Linear regression models explained 51% of the variance in job satisfaction for Navy nurses and 55% for civilian nurses. Routinization had the strongest significant negative association with job satisfaction for Navy and civilian nurses. Supervisor support was significantly associated with satisfaction for Navy nurses although coworker support was a significant factor for civilians. These findings have implications for nurse administrators and health care executives who desire to retain nurse employees. PMID:19216301

  12. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact

    Directory of Open Access Journals (Sweden)

    Pinto PR

    2013-09-01

    Full Text Available Patrícia R Pinto,1–3 Teresa McIntyre,4,5 Ramón Ferrero,6 Vera Araújo-Soares,3,7 Armando Almeida1,2 1Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal; 2Life and Health Sciences Research Institute/3Bs, PT Government Associate, Braga/Guimarães, Portugal; 3Health Psychology Group, Newcastle University, Newcastle, UK; 4Texas Institute for Measurement, Evaluation and Statistics, 5Department of Psychology, University of Houston, TX, USA; 6Alto Ave Hospital Center, Orthopedics Unit, Guimarães, Portugal; 7Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle, UK Abstract: This study compares the incidence, nature, and impact of persistent post-surgical pain after total knee arthroplasty (TKA and total hip arthroplasty (THA and investigates differences between these procedures, with the focus on potential presurgical and post-surgical issues that could be related to the distinct persistent post-surgical pain outcomes between these two groups. A consecutive sample of 92 patients was assessed prospectively 24 hours before, 48 hours, and 4–6 months after surgery. The data show that TKA patients had a higher likelihood of developing persistent post-surgical pain, of reporting higher pain levels, and of using more neuropathic descriptors when classifying their pain. In addition, TKA patients more often reported interference from pain on functional domains, including general activity, walking ability, and normal work. Demographic factors, like gender and age, along with presurgical clinical factors like disease onset, existence of medical comorbidities, and other pain problems, may have contributed to these differences, whereas baseline psychologic factors and functionality levels did not seem to exert an influence. Heightened acute post-surgical pain experience among TKA patients could also be related to distinct outcomes for persistent post

  13. TROCHANTERIC ARTHROPLASTY IN THE SEPTIC ARTHRITIC SEOUELA OF THE HIP

    OpenAIRE

    Cakmak, Mehmet; Karamehmetoglu, Mahmut; Taser, Omer; Alturfan, Aziz

    2004-01-01

    7 cases have been treated with trochanteric arthroplasty, in which femoral neads and necks were lost due to the septic arthritic sequela of the hip. These seven cases have been followed for 2,7 years with 1,5 being the youngest 4 the oldest made on the fact that in those cases in which heads and necks are lost in combination, the best solution can be obtained by trochanteric arthroplasty.

  14. Fungal prosthetic joint infection after total knee arthroplasty

    OpenAIRE

    Reddy, Kankanala J; Shah, Jay D; Rohit V Kale; T Jayakrishna Reddy

    2013-01-01

    Fungal prosthetic joint infection after total knee arthroplasty (TKA) is a rare complication. Lacunae exist in the management of this complication. 62 year old lady presented with pain and swelling in left knee and was diagnosed as Candida tropicalis fungal infection after TKA. She underwent debridement, resection arthroplasty and antifungal plus antibiotic loaded cement spacer insertion, antifungal therapy with fluconazole followed by delayed revision TKA and further fluconazole therapy. Tot...

  15. MOBILE TIBIAL POLYETHYLENE BEARING IN TOTAL KNEE ARTHROPLASTY

    OpenAIRE

    de Araújo Barros Cobra, Hugo Alexandre; da Palma, Idemar Monteiro

    2015-01-01

    Debris of polyethylene tibial bearings have been recognized as a major cause for the onset of the cascade of biological events leading to osteolysis and loosening of prosthetic components after total knee arthroplasty. Since then, research has been focused on alternative bearing surfaces in order to minimize the amount and rate of polyethylene wear off and, in doing so, increasing the survivorship rate for knee arthroplasties. One such option is to have a mobile tibial bearing allowing more c...

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

    OpenAIRE

    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 been reported previously after unicompartmental knee arthroplasty in the literature. Low level of suspicion may delay the diagnosis, as popliteal vascular injury and compartment syndrome are not well ...

  17. Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

    OpenAIRE

    Shin, Young-Soo; Hwang, Yeok-Gu; Savale, Abhijit Prakash; Han, Seung-Beom

    2014-01-01

    An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudo...

  18. SCREW MIGRATION IN TOTAL KNEE ARTHROPLASTY: CLINICAL REPORT

    OpenAIRE

    Fonseca, Fernando; Tomé, José; Barreto, Manuel

    2015-01-01

    Complications from total knee arthroplasty caused by the implanted material are rare, with the exception of polyethylene wear. Descriptions of screw migration into the knee joint cavity are very rare. The authors report intra-articular migration of a polyethylene safety screw in a case of total knee arthroplasty, with sacrifice of the posterior cruciate ligament (TKA Performance; Biomet, Warsaw, IN, USA), which necessitated new surgery to remove the screw, replace the polyethylene insert and ...

  19. Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty

    OpenAIRE

    Jackson, Keith L.; Hire, Justin M; Jacobs, Jeremy M.; Key, Charles C.; DeVine, John G.

    2015-01-01

    To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly re...

  20. Total Disc Arthroplasty for Treating Lumbar Degenerative Disc Disease

    OpenAIRE

    Mostofi, Keyvan

    2015-01-01

    Study Design Lumber disc arthroplasty is a technological advancement that has occurred in the last decade to treat lumbar degenerative disk diseases. Purpose The aim of this retrospective study was to establish the impact and outcomes of managing patients with lumbar degenerative disk disease who have been treated with lumbar total disc arthroplasty (TDA). Overview of Literature Several studies have shown promising results following this surgery. Methods We reviewed the files of 104 patients ...

  1. COMPARION OF GAP ARTHROPLASTY AND INTERPOSITIONAL GAP ARTHROPLASTY ON THE TEMPOROMANDIBULAR JOINT ANKYLOSIS

    OpenAIRE

    M. Ramezanian T. Yavary

    2006-01-01

    Temporomandibular joint ankylosis causes limitation in mouth opening and establishes severe deformity and asymmetry in patient’s face, especially in children. Surgery is the only treatment. This study was conducted to compare the effect of two surgical approaches, gap arthropasty and interpositional gap arthroplasty, on rate of maximum interincisal opening in temporomandibular joint ankylosis. We also evaluated the relapse rate of these two surgical approaches. A total of 48 patients were enr...

  2. Femoral Component Survival in Hybrid Total Knee Arthroplasty.

    Science.gov (United States)

    Perry, Clayton R; Perry, Kevin I

    2016-05-01

    Although the majority of North American surgeons perform total knee arthroplasty by cementing both the femoral and the tibial components, hybrid fixation with a press-fit femur and cemented tibia is an alternative form of total knee arthroplasty performed by some. Currently, there is a paucity of literature evaluating long-term outcomes after hybrid total knee arthroplasty. As such, the purpose of the current study was to describe the long-term results of total knee arthroplasty performed using the hybrid technique. The authors retrospectively reviewed a total of 77 hybrid total knee arthroplasties with at least 12 years of follow-up. Clinical and radiographic evaluations were performed to determine patient function and the incidence of femoral component failure after hybrid total knee arthroplasty. At the time of last follow-up, 76 of 77 (99%) of the femoral components remained in place without evidence of loosening. One femoral component failed due to aseptic loosening and was ultimately revised to a cemented femoral component without further complication. In addition, 1 tibial component and 2 patellar components failed due to aseptic loosening. Four tibial polyethylene liners were revised for polyethylene wear. In conclusion, press-fit fixation of the femoral component is a reliable and durable alternative to cemented fixation. [Orthopedics. 2016; 39(3):181-186.]. PMID:27135453

  3. 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...

  4. Neurologic injuries after primary total ankle arthroplasty: prevalence and effect on outcomes

    OpenAIRE

    Primadi, Andri; Xu, He-Xing; Yoon, Taek-Rim; Ryu, Je-Hwang; Lee, Keun-Bae

    2015-01-01

    Background Neurologic injuries are complications that can arise after total joint arthroplasty. However, no comprehensive study has been conducted on peripheral nerve injuries after total ankle arthroplasty. The purpose of the present study was to identify the prevalence of neurologic injury following primary total ankle arthroplasty, the predisposing factors, and evaluate the effect on clinical outcomes. Methods We retrospectively analyzed 150 consecutive primary total ankle arthroplasty usi...

  5. Cost of Radiotherapy Versus NSAID Administration for Prevention of Heterotopic Ossification After Total Hip Arthroplasty

    International Nuclear Information System (INIS)

    Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered

  6. After total knee arthroplasty, many people are not active enough to maintain their health and fitness: an observational study

    OpenAIRE

    Groen, Jan-Willem; Stevens, Martin; Kersten, Roel F. M. R.; Reininga, Inge H. F.; van den Akker-Scheek, Inge

    2012-01-01

    Questions: What proportion of people after total knee arthroplasty adheres to the physical activity regimen recommended for maintenance of health (moderate intensity physical activity for at least 30 min on 5 days/week)? What proportion adheres to the activity regimen recommended to improve fitness (vigorous intensity physical activity for at least 20 min on 3 days/week)? What factors are associated with adherence to these recommendations? Design: An observational study. Participants: 830 adu...

  7. Deviation of Register in English Talk Shows

    Institute of Scientific and Technical Information of China (English)

    贺静

    2016-01-01

    Halliday's register theory and G. Leech's deviation of register are the general knowledge of the topic in the academic field. This paper focuses on connection between deviation of register and humorous effects in English talk shows. The significance of this paper is to put this theory in broader use and to help English learners better understand western humor and talk shows.

  8. Register Analysis of English for housekeeping

    Institute of Scientific and Technical Information of China (English)

    李秀娟

    2006-01-01

    @@ Introduction Register is one of the cores of Functive Linguistics. It offers three decisive factors in language, that is, Field, Tenor and Mode. This paper plans to say something on the theory of register and analyze a short passage from the point of register.

  9. 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.

  10. Metaphyseal bone loss in revision knee arthroplasty.

    Science.gov (United States)

    Ponzio, Danielle Y; Austin, Matthew S

    2015-12-01

    The etiology of bone loss encountered during revision total knee arthroplasty (TKA) is often multifactorial and can include stress shielding, osteolysis, osteonecrosis, infection, mechanical loss due to a grossly loose implant, and iatrogenic loss at the time of implant resection. Selection of the reconstructive technique(s) to manage bone deficiency is determined by the location and magnitude of bone loss, ligament integrity, surgeon experience, and patient factors including the potential for additional revision, functional demand, and comorbidities. Smaller, contained defects are reliably managed with bone graft, cement augmented with screw fixation, or modular augments. Large metaphyseal defects require more extensive reconstruction such as impaction bone grafting with or without mesh augmentation, prosthetic augmentation, use of bulk structural allografts, or use of metaphyseal cones or sleeves. While each technique has advantages and disadvantages, the most optimal method for reconstruction of large metaphyseal bone defects during revision TKA is not clearly established. PMID:26362647

  11. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    ; patient-characteristics to predict outcome; and traditions which may be barriers in optimizing outcomes. Patients should be informed and motivated to be active participants and their expectations should be modulated in order to improve satisfaction. Also, organizational aspects need to be analyzed...... and optimized. New logistical approaches should be implemented; the ward ideally (re)structured to only admit arthroplasties; the staff educated to have a uniform approach; extensive preoperative information given including discharge criteria and intended length of stay. This thesis includes 9 papers...... degrees of safety (morbidity/mortality) and patient satisfaction. Future research strategies are multiple and include both research strategies as efforts to implement the fast-track methodology on a wider basis. Research areas include improvements in pain treatment, blood saving strategies, fluid plans...

  12. 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

  13. The national dose register in Finland

    International Nuclear Information System (INIS)

    The Finnish Dose Register includes exposure data for all workers engaged in radiation work. These data already cover a period of almost 50 y. The earliest data in the register apply to workers in health care, research and industry. Data on nuclear power plant workers have been recorded since 1977 and data on air crews since 2001. The Dose Register is an extensive national register with doses currently recorded for more than 15 000 workers annually. This paper presents the content and structure of the register, together with recently completed and forthcoming reforms. It also describes how the recorded data are used in the regulatory control of radiation practices. (authors)

  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. Iatrogenic vascular injuries during arthroplasty of the hip.

    Science.gov (United States)

    Alshameeri, Z; Bajekal, R; Varty, K; Khanduja, V

    2015-11-01

    Vascular injuries during total hip arthroplasty (THA) are rare but when they occur, have serious consequences. These have traditionally been managed with open exploration and repair, but more recently there has been a trend towards percutaneous endovascular management. We performed a systematic review of the literature to assess if this change in trend has led to an improvement in the overall reported rates of morbidity and mortality during the last 22 years in comparison with the reviews of the literature published previously. We found a total of 61 articles describing 138 vascular injuries in 124 patients. Injuries because of a laceration were the most prevalent (n = 51, 44%) and the most common presenting feature, when recorded, was bleeding (n = 41, 53.3%). Delay in diagnosis was associated with the type of vascular lesion (p < 0.001) and the clinical presentation (p = 0.002). Open exploration and repair was the most common form of management, however percutaneous endovascular intervention was used in one third of the injuries and more constantly during the last 13 years. The main overall reported complications included death (n = 9, 7.3%), amputation (n = 2, 1.6%), and persistent ischaemia (n = 9, 7.3%). When compared with previous reviews there was a similar rate of mortality but lower rates of amputation and permanent disability, especially in patients managed by endovascular strategies. PMID:26530643

  16. 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.

  17. 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.

  18. 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

  19. Fretting and Corrosion in Modular Shoulder Arthroplasty: A Retrieval Analysis

    Science.gov (United States)

    Panzram, Benjamin

    2016-01-01

    Tribocorrosion in taper junctions of retrieved anatomic shoulder arthroplasty implants was evaluated. A comparison of the tribocorrosion between cobalt-chromium and titanium alloy stems was conducted and the observations were correlated with the individual's clinical data. Adverse effects caused by metal debris and subsequent elevated serum metal ion levels are frequently reported in total hip arthroplasty. In total shoulder arthroplasty, to date only a small number of retrieval analyses are available and even fewer address the issue of tribocorrosion at the taper junctions. A total of 36 retrieved hemiarthroplasties and total shoulder arthroplasties were assessed using the modified Goldberg score. The prevalence of fretting and corrosion was confirmed in this cohort. Titanium stems seem to be more susceptible to damage caused by tribocorrosion than cobalt-chromium stems. Furthermore, stemless designs offered less tribocorrosion at the taper junction than stemmed designs. A weak correlation between time to revision and increased levels of tribocorrosion was seen. Whether or not tribocorrosion can lead to adverse clinical reactions and causes failure of shoulder arthroplasties remains to be examined. PMID:27433471

  20. Hip arthroplasty for failed treatment of proximal femoral fractures.

    Science.gov (United States)

    D'Arrigo, Carmelo; Perugia, Dario; Carcangiu, Alessandro; Monaco, Edoardo; Speranza, Attilio; Ferretti, Andrea

    2010-10-01

    Failed treatment of an intertrochanteric fracture typically leads to profound functional disability and pain. Salvage treatment with hip arthroplasty may be considered. The aim of this study was to evaluate the results and complications of hip arthroplasty performed as a salvage procedure after the failed treatment of an intertrochanteric hip fracture. Twenty-one patients were treated in our hospital with hip arthroplasty for failed treatment of intertrochanteric hip fracture. There were sixteen women and five men with a mean age of 75.8 years (range 61-85 years). Fourteen patients had failure of a previous nail fixation procedure, five had failure of a plate fixation, one of hip screws fixation and one of Ender nail fixation. In 19 out of 21 patients we performed a total hip arthroplasty-14 cases used modular implants with long-stems and five cases used a standard straight stem. In 2 of 21 cases we used a bipolar hemiarthroplasty. A statistically significant improvement was found comparing pre and postoperative conditions (p < 0.05). Our experience confirms that total hip arthroplasty is a satisfactory salvage procedure after failed treatment of an intertrochanteric fracture in elderly patients with few serious orthopaedic complications and acceptable clinical outcomes. PMID:19572131

  1. The Synovial Lining and Synovial Fluid Properties after Joint Arthroplasty

    Directory of Open Access Journals (Sweden)

    Michael Shang Kung

    2015-05-01

    Full Text Available The lubrication of the cartilaginous structures in human joints is provided by a fluid from a specialized layer of cells at the surface of a delicate tissue called the synovial lining. Little is known about the characteristics of the fluids produced after a joint arthroplasty procedure. A literature review was carried out to identify papers that characterized the synovial lining and the synovial fluids formed after total hip or knee arthroplasty. Five papers about synovial lining histology and six papers about the lubricating properties of the fluids were identified. The cells making up the re-formed synovial lining, as well as the lining of interface membranes, were similar to the typical Type A and B synoviocytes of normal joints. The synovial fluids around joint replacement devices were typically lower in viscosity than pre-arthroplasty fluids but the protein concentration and phospholipid concentrations tended to be comparable, suggesting that the lining tissue function was preserved after arthroplasty. The widespread, long-term success of joint arthroplasty suggests that the lubricant formed from implanted joint synovium is adequate for good clinical performance in the majority of joints. The role the fluid plays in component wear or failure is a topic for future study.

  2. Ten-Year Comparison of Oxidized Zirconium and Cobalt-Chromium Femoral Components in Total Knee Arthroplasty

    Science.gov (United States)

    Roe, Justin; Vioreanu, Mihai; Salmon, Lucy; Waller, Alison; Pinczewski, Leo

    2016-01-01

    Objective: The purpose of this study was to determine if oxidized zirconium femoral components had better outcomes than cobalt-chromium in vivo at medium and long term and if the use of oxidized zirconium components had clinical adverse effects. Methods: Forty consecutive patients (eighty knees) underwent simultaneous bilateral cruciate-retaining total knee arthroplasty for primary osteoarthritis from January 2002 to December 2003. For each patient, the knees were randomized to receive the oxidized zirconium femoral component, with the contralateral knee receiving the cobalt-chromium component. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, Knee Society score, and British Orthopaedic Association patient satisfaction scale. Radiographic outcomes include the Knee Society total knee arthroplasty roentgenographic evaluation and scoring system and measurement of radiographic wear. Patients and assessors were blinded to the treatment groups and results. Results: There were no significant differences in clinical, subjective, and radiographic outcomes between the two implants at ten years postoperatively. Ten years following surgery, 36% of the patients preferred the cobalt-chromium knee compared with 11% who preferred the oxidized zirconium knee (p = 0.02) and 53% had no preference. Conclusions: Ten-year outcomes after total knee arthroplasty with oxidized zirconium and cobalt-chromium femoral components showed no significant differences in clinical, subjective, and radiographic outcomes. Patients had no preference or preferred the cobalt chromium prosthesis to the oxidized zirconium prosthesis. There were no adverse effects associated with the use of oxidized zirconium femoral implants.

  3. Impact of chronic kidney disease stage on lower-extremity arthroplasty.

    Science.gov (United States)

    Deegan, Brian F; Richard, Raveesh D; Bowen, Thomas R; Perkins, Robert M; Graham, Jove H; Foltzer, Michael A

    2014-07-01

    End-stage renal disease and dialysis is commonly associated with poor outcomes after joint replacement surgery. The goal of this study was to evaluate postoperative complications in patients with less advanced chronic kidney disease undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients who underwent THA or TKA between 2004 and 2011 with stage 1, 2, or 3 chronic kidney disease were retrospectively reviewed via an electronic medical record. The authors compared 377 patients who had stage 1 to 2 chronic kidney disease with 402 patients who had stage 3 chronic kidney disease. No significant differences in 90-day readmission or revision rates were found between the stage 1 to 2 and stage 3 patient groups. For patients with stage 3 chronic kidney disease, the overall mortality rate was greater than that in patients with stage 1 to 2 chronic kidney disease. However, when adjusted for comorbid disease, no significant increases were seen in joint infection, readmission, or early revision between patients with stage 1 to 2 chronic kidney disease vs patients with stage 3 chronic kidney disease. The overall incidence of infection was high (3.5%) but far less than reported for patients with end-stage renal disease, dialysis, and kidney transplant. In conclusion, patients with stage 1, 2, or 3 chronic kidney disease may have a higher than expected rate of prosthetic joint infection (3.5%) after total joint arthroplasty. Patients with stage 3 chronic kidney disease are at higher risk for postoperative mortality compared with those with lesser stages of kidney disease. PMID:24992055

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. 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 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

  9. TMJ ANKYLOSIS: MANAGEMENT WITH RECONSTRUCTION AND INTERPOSITIONAL ARTHROPLASTY.

    Science.gov (United States)

    Madhumati, Singh; Shruthi, R; Mitul, Sojitra; Karan, Abhishek; Aziz, Abdul

    2015-01-01

    Temporomandibular joint (TMJ) ankylosis is a very desolating structural condition that involves fusion of the mandibular condyle to the base of the skull. It causes difficulty in mastication and breathing. Trauma and Infections are usually responsible. If trauma occurs in young age, it leads to disturbance in growth & facial asymmetry. Treatment of temporomandibular joint (TMJ) ankylosis usually requires adequate excision of the involved ankylotic block (arthroplasty) or interpositional arthroplasty using autogenous or alloplastic materials. Early mobilization, physiotherapy & strict follow up are essential to prevent postop adhesions. In our cases fascia lata was used as an interpositional grafting material. One case was treated by gap arthroplasty, second case by costochondral graft & third case was managed with titanium condylar prosthesis. PMID:27487617

  10. Transfusion practice in hip arthroplasty - a nationwide study

    DEFF Research Database (Denmark)

    Jans, Øivind; Kehlet, H; Hussain, Zubair Butt;

    2011-01-01

    Background and Objectives The optimal transfusion strategy in hip arthroplasty remains controversial despite existing guidelines. The aim of this study was to evaluate the transfusion practice in patients undergoing primary total hip arthroplasty (THA) or revision total hip arthroplasty (RTHA......) in Denmark. Materials and Methods We performed a retrospective cohort study of all patients undergoing THA or RTHA in Denmark in 2008. Primary outcomes were intercentre variation in red blood cell (RBC) transfusion rates and the timing of transfusion related to surgery. Results Six thousand nine hundred...... 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...

  11. Pelvic pseudotumor following total hip arthroplasty – case report,

    Directory of Open Access Journals (Sweden)

    Nelson Franco Filho

    2014-10-01

    Full Text Available Loosening is a well-known complication of total hip arthroplasty. The accumulation of detritus resulting from mechanical wear forms inflammatory cells that have the function of phagocytizing this debris. Over the long term, these cells may give rise to a local granulomatous reaction. Here, we present a report on a case of pelvic pseudotumor subsequent to total hip arthroplasty, which is considered rare in the literature. The patient was a 48-year-old black man who started to be followed up medically eight months earlier because of uncharacteristic abdominal pains, dysuria and pollakiuria. He had undergone left total hip arthroplasty 17 years previously. Through clinical investigation and complementary examinations, an extra-articular granulomatous mass was diagnosed, constituting a pelvic pseudotumor.

  12. Computer-Navigated Total Knee Arthroplasty Utilization.

    Science.gov (United States)

    Bala, Abiram; Penrose, Colin Thomas; Seyler, Thorsten Markus; Mather, Richard Chad; Wellman, Samuel Secord; Bolognesi, Michael Paul

    2016-07-01

    Computer-navigated total knee arthroplasty (CN-TKA) has been used to improve component alignment, though the evidence is currently mixed on whether there are clinically significant differences in long-term outcomes. Given the established increased costs and operative time, we hypothesized that the utilization rate of CN-TKA would be decreasing relative to standard TKA in the Medicare population given the current health care economic environment. We queried 1,914,514 primary TKAs performed in the entire Medicare database from 2005 to 2012. Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify and separate CN-TKAs. Utilization of TKA was compared by year, gender, and region. Average change in cases per year and compound annual growth rate (CAGR) were used to evaluate trends in utilization of the procedure. We identified 30,773 CN-TKAs performed over this time period. There was an increase in utilization of CN-TKA per year from 984 to 5,352 (average = 572/year, R (2) = 0.85, CAGR = 23.58%) from 2005 to 2012. In contrast, there was a slight decrease in overall TKA utilization from 264,345 to 230,654 (average = 4297/year, R (2) = 0.74, CAGR = - 1.69%). When comparing proportion of CN-TKA to all TKAs, there was an increase from 0.37 to 2.32% (average 0.26%/year, R (2) = 0.88, CAGR = 25.70%). CN-TKA growth in males and females was comparable at 24.42 and 23.11%, respectively. The South region had the highest growth rate at 28.76%, whereas the Midwest had the lowest growth rate at 15.51%. The Midwest was the only region that peaked (2008) with a slow decline in utilization until 2012. Despite increased costs with unclear clinical benefit, CN-TKA is increasing in utilization among Medicare patients. Reasons could include patient preference, advertising, proper of coding the procedure, and increased publicly available information about

  13. 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

  14. 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...

  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. Mid-Term Results of Oxford Medial Unicompartmental Knee Arthroplasty

    OpenAIRE

    Choy, Won-Sik; Kim, Kap Jung; Lee, Sang Ki; Yang, Dae Suk; Lee, Neung Ki

    2011-01-01

    Background This study examined the clinical and radiologic mid-term results of patients treated by Oxford minimally invasive unicompartmental knee arthroplasty. Methods One hundred and eighty-eight knees of unicompartmental knee arthroplasties with Oxford Uni® in 166 patients (16 males and 150 females), which were performed between 2002 and 2005, were reviewed. The mean age was 65.3 years (range, 44 to 82 years) and the mean follow-up period was 79.8 months (range, 56 to 103 months). The preo...

  18. Reverse shoulder arthroplasty: radiological and clinical short–term results

    OpenAIRE

    Atalar, Ata Can; Salduz, Ahmet; Cil, Hilal; Sungur, Mustafa; Celik, Derya; Demirhan, Mehmet

    2014-01-01

    Objective: The aim of this study was to examine the radiological and clinical short term results of the patients who underwent reverse shoulder arthroplasty for rotator cuff arthropathy. Methods: The study included 14 (2 male, 12 female) patients who underwent reverse shoulder arthroplasty for rotator cuff arthropathy between 2009 and 2010. The mean age of the patients was 74 (57–80) years and the mean follow–up period was 32 (21–40) months. Radiological methods as well as the range of mot...

  19. 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.]. PMID:27135448

  20. 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.].

  1. 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.

  2. 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.

  3. 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

  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. 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. PMID:24764230

  6. 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.

  7. Surgical approaches for total knee arthroplasty.

    Science.gov (United States)

    Vaishya, Raju; Vijay, Vipul; Demesugh, Daniel Mue; Agarwal, Amit Kumar

    2016-01-01

    There are various surgical approaches to the knee joint and its surrounding structures and such approaches are generally designed to allow the best access to an area of pathology whilst safeguarding important surrounding structures. Controversy currently surrounds the optimal surgical approach for total knee arthroplasty (TKA). The medial parapatellar arthrotomy, or anteromedial approach, has been the most used and has been regarded as the standard approach for exposure of the knee joint. It provides extensive exposure and is useful for open anterior cruciate ligament reconstruction, total knee replacement, and fixation of intra-articular fractures. Because this approach has been implicated in compromise of the patellar circulation, some authors have advocated the subvastus, midvastus, and trivector approaches for exposure of the knee joint. While these approaches expose the knee from the medial side, the anterolateral approach exposes the knee joint from the lateral side. With careful planning and arthrotomy selection, the anterior aspect of the joint can be adequately exposed for TKA in different clinical scenarios. PMID:27182142

  8. CURBSIDE CONSULTATION IN KNEE ARTHROPLASTY: 49 CLINICAL QUESTIONS

    Directory of Open Access Journals (Sweden)

    Craig J. Della Vale

    2008-12-01

    Full Text Available A user- friendly reference for decision making in complicated cases of knee arthroplasty desingned in a question and answers format composed of articles containing current concepts and preferences of experts in total knee replacement surgery, enhanced by several images, diagrams and references and written in the form of a casual advice by Craig J. Della Vale, MD. and his collaborators. PURPOSE By this practical reference of knee arthroplasty, the editor and the contributors have aimed providing straightforward and brief answers, evidence-based advices, their preference and opinions containing current concepts for unanswered questions about complicated cases in total knee replacement surgery which are often controversial and not addressed clearly in traditional knee arthroplasty references. FEATURES There are 49 subjects each written by a different expert designed in 4 sections 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 including indications, unicompartmental osteoarthritis of the knee, patient with vascular problems, donating blood, bilateral arthroplasty, patellar resurfacing, range of motion, bearing surface, contraindications, teaching class for patients prior surgery. The second section is about intraoperative questions including skin incision, patella femoral maltracking, femoral component rotation, tibial component rotation, lateral release, femoral component sizing, flexion instability, varus deformity, and valgus deformity, tightness in extension, iatrogenic MCL injury, antibiotic-loaded cement, and perioperative pain. The third section subjects postoperative questions including wound drainage, preventing tromboembolic events, vascular complications, foot drop, manipulation under anesthesia, patella fractures, supracondylar femur fractures, acute extensor mechanism disruptions. In the fourth

  9. "Legal Language": Varieties, Genres, Registers, Discourses.

    Science.gov (United States)

    Kurzon, Dennis

    1997-01-01

    Analyzes classification of "legal language," clarifying terms such as "variety,""genre,""register," and "discourse," and related issues in languages for special purposes, particularly as they apply to professions. Argues that "genre," not "register," is the most appropriate term for legal language, and that study of legal discourse should focus on…

  10. 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 divided...... into three main categories: economic evaluations of healthcare interventions, cost-of-illness analyses, and other analyses such as assessments of healthcare productivity. Conclusion: We examined a number of studies using register-based data on healthcare costs. Use of register-based data renders...... 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....

  11. 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.

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

    Science.gov (United States)

    Radoicic, Dragan; Milanovic, Milomir; Marinkovic, Jugoslav; Radoicic, Danica

    2016-01-01

    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. PMID:27366173

  13. 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.

  14. 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.

  15. 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.

  16. Alternative outcome measures in young total hip arthroplasty patients

    DEFF Research Database (Denmark)

    Klit, Jakob; Jacobsen, Steffen; Schmiegelow, Victoria;

    2015-01-01

    In this prospective multicentre cohort study we studied subjects younger than 60 years of age scheduled for primary total hip arthroplasty (THA). The study assessed patients' overall satisfaction, fulfillment of preoperative expectations, the effect on socioeconomic parameters, and quality of sex...

  17. 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.

  18. 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...

  19. Periprosthetic fractures of the femur after total knee arthroplasty

    OpenAIRE

    McGraw, Phil; Kumar, Arun

    2010-01-01

    Periprosthetic fracture following total knee arthroplasty is a potentially serious complication. This injury can involve the distal femur, proximal tibia or the patella. This review article analyzes the prevalence, risk factors, classification and treatment options for periprosthetic fractures of the femur.

  20. 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

  1. Wear simulation strategies for reverse shoulder arthroplasty implants.

    Science.gov (United States)

    Langohr, G Daniel G; Athwal, George S; Johnson, James A; Medley, John B

    2016-05-01

    Reverse total shoulder arthroplasty is a clinically accepted surgical procedure; however, its long-term wear performance is not known. The purpose of this work is to review wear simulator testing of reverse total shoulder arthroplasty, to develop a wear simulator protocol for reverse total shoulder arthroplasty, and to test it by performing a pilot study. The review of wear simulator testing in the literature revealed considerable variation in protocols. A combination of our own cadaveric testing and those of other research groups helped in determining the magnitude and direction of joint loading for the development of the present protocol. A MATCO orbital-bearing simulator was adapted using custom fixtures to simulate a circumduction motion of the shoulder under mildly adverse conditions, and a pilot study gave wear rates within the wide range found in the literature. Arguments were presented in support of the currently developed protocol, but it was also suggested that, rather than rely on one protocol, a series of simulator wear protocols should be developed to fully test the implant wear performance in reverse total shoulder arthroplasty.

  2. Wear simulation strategies for reverse shoulder arthroplasty implants.

    Science.gov (United States)

    Langohr, G Daniel G; Athwal, George S; Johnson, James A; Medley, John B

    2016-05-01

    Reverse total shoulder arthroplasty is a clinically accepted surgical procedure; however, its long-term wear performance is not known. The purpose of this work is to review wear simulator testing of reverse total shoulder arthroplasty, to develop a wear simulator protocol for reverse total shoulder arthroplasty, and to test it by performing a pilot study. The review of wear simulator testing in the literature revealed considerable variation in protocols. A combination of our own cadaveric testing and those of other research groups helped in determining the magnitude and direction of joint loading for the development of the present protocol. A MATCO orbital-bearing simulator was adapted using custom fixtures to simulate a circumduction motion of the shoulder under mildly adverse conditions, and a pilot study gave wear rates within the wide range found in the literature. Arguments were presented in support of the currently developed protocol, but it was also suggested that, rather than rely on one protocol, a series of simulator wear protocols should be developed to fully test the implant wear performance in reverse total shoulder arthroplasty. PMID:27160563

  3. 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

  4. The role of shoulder fusion in the era of arthroplasty

    OpenAIRE

    González-Díaz, R.; Rodríguez-Merchán, E. C.; Gilbert, M. S.

    1997-01-01

    The indications, surgical techniques, results and complications of shoulder fusion are described. The indications are bacterial infection, paralytic disorders in infancy, combined deltoid and rotator cuff paralysis, post-traumatic brachial plexus lesions, inflammatory arthritis with severe rotator cuff involvement, failed arthroplasty, recurrent dislocation, after resection of tumours, irreparable rotator cuff tear, painful arthritis in a patient whose activities requi...

  5. 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

  6. Future bearing surfaces in total hip arthroplasty.

    Science.gov (United States)

    Chang, Jun-Dong

    2014-03-01

    One of the most important issues in the modern total hip arthroplasty (THA) is the bearing surface. Extensive research on bearing surfaces is being conducted to seek an ideal bearing surface for THA. The ideal bearing surface for THA should have superior wear characteristics and should be durable, bio-inert, cost-effective, and easy to implant. However, bearing surfaces that are currently being implemented do not completely fulfill these requirements, especially for young individuals for whom implant longevity is paramount. Even though various new bearing surfaces have been investigated, research is still ongoing, and only short-term results have been reported from clinical trials. Future bearing surfaces can be developed in the following ways: (1) change in design, (2) further improvement of polyethylene, (3) surface modification of the metal, (4) improvement in the ceramic, and (5) use of alternative, new materials. One way to reduce wear and impingement in THA is to make changes in its design by using a large femoral head, a monobloc metal shell with preassembled ceramic liner, dual mobility cups, a combination of different bearing surfaces, etc. Polyethylene has improved over time with the development of highly crosslinked polyethylene. Further improvements can be made by reinforcing it with vitamin E or multiwalled carbon nanotubes and by performing a surface modification with a biomembrane. Surface modifications with titanium nitride or titanium niobium nitride are implemented to try to improve the metal bearings. The advance to the fourth generation ceramics has shown relatively promising results, even in young patients. Nevertheless, further improvement is required to reduce fragility and squeaking. Alternative materials like diamond coatings on surfaces, carbon based composite materials, oxidized zirconium, silicon nitride, and sapphire are being sought. However, long-term studies are necessary to confirm the efficacy of these surfaces after enhancements

  7. 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

  8. 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.

  9. 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......, and health services but minimal clinical information. Validity and coverage: The register covers everyone living in Denmark and data is available from 1990. No validity studies have been reported. Because the data is connected to reimbursement the coverage is assumed to be good. CONCLUSION: The strengths...

  10. The impact of peripheral nerve blocks on perioperative outcome in hip and knee arthroplasty-a population-based study.

    Science.gov (United States)

    Memtsoudis, Stavros G; Poeran, Jashvant; Cozowicz, Crispiana; Zubizarreta, Nicole; Ozbek, Umut; Mazumdar, Madhu

    2016-10-01

    The role of anesthesia techniques on perioperative outcomes on a population level has recently gained widespread interest. Although mainly neuraxial vs general anesthesia has been addressed, population-level data on the impact of peripheral nerve blocks (PNBs) are still lacking. Therefore, we investigated the association between PNB use and outcomes using retrospective data on 1,062,152 recipients of hip and knee arthroplasties (total hip arthroplasty [THA]/total knee arthroplasty [TKA]) from the national Premier Perspective database (2006-2013). Multilevel multivariable logistic regression models measured associations between PNB use and outcomes. Complications included cardiac, pulmonary, gastrointestinal and renal complications, cerebrovascular events, infections, wound complications, thromboembolic complications, inpatient falls, and mortality. Resource utilization variables included blood transfusions, intensive care unit admissions, opioid consumption, cost, and length of stay. Overall, 12.5% of patients received a PNB, with an increase over time particularly among TKAs. Peripheral nerve block use was associated with lower odds for most adverse outcomes mainly among patients with THA. Notable beneficial effects were seen for wound complications (odds ratio 0.60 [95% confidence interval, 0.49-0.74]) among THA recipients and pulmonary complications (odds ratio 0.83 [95% confidence interval, 0.72-0.94]) in patients with TKA. Peripheral nerve block use was significantly (P < 0.0001) associated with a -16.2% and -12.7% reduction in opioid consumption for patients with THA and TKA, respectively. In conclusion, our results indicate that PNBs might be associated with superior perioperative population-level outcomes. In light of the inability to establish a causal relationship and the presence of residual confounding, we strongly advocate for further prospective investigation, ideally in multicenter, randomized trials, to establish the potential impact of PNBs on

  11. 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

  12. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

    OpenAIRE

    Singh Alka; Singh Yashwant; Singh Pankaj; Singh Vinay; Javed Sadaf; Abdunabi Murad

    2010-01-01

    Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in...

  13. Revision to reverse shoulder arthroplasty with retention of the humeral component

    OpenAIRE

    Werner, Birgit S.; Boehm, Dorota; Gohlke, Frank

    2013-01-01

    Background Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss. Newer modular systems allow conversion from anatomic to reverse shoulder arthroplasty with retention of a well-fixed humeral stem. We report on a prospectively evaluated series of conversions from hemiarthroplasty to reverse shoulder arthroplasty. Methods In 14 cases of failed hemiarthroplasty due to rotator cuff deficiency and painful pseudopa...

  14. 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

  15. The Federal Register System and You.

    Science.gov (United States)

    Galdi, Ernest J.; Girard, Martha

    1978-01-01

    Describes the "Federal Register" system as the vehicle for federal agencies to communicate with the public and briefly outlines the advantages of this centralized system as well as the problem presented by the mass of information published. (JMF)

  16. 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.

  17. Validation of the danish national diabetes register

    DEFF Research Database (Denmark)

    Green, Anders; Sortsø, Camilla; Jensen, Peter Bjødstrup;

    2015-01-01

    The Danish National Diabetes Register (NDR) was established in 2006 and builds on data from Danish health registers. We validated the content of NDR, using full information from the Danish National Patient Register and data from the literature. Our study indicates that the completeness in NDR...... is ≥95% concerning ascertainment from data sources specific for diabetes, ie, prescriptions with antidiabetic drugs and diagnoses of diabetes in the National Patient Register. Since the NDR algorithm ignores diabetes-related hospital contacts terminated before 1990, the establishment of the date...... of inclusion is systematically delayed for ≥10% of the registrants in general and for ≥30% of the inclusions before 1997 in particular. This bias is enhanced for ascertainment by chiropody services and by frequent measurements of blood glucose because the date of reimbursement of services, rather than the date...

  18. 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. It is intended to...

  19. Register allocation for programs in SSA Form

    OpenAIRE

    Hack, Sebastian

    2007-01-01

    This book investigates register allocation for programs in static single-assignment form. Its main result is that the interference graphs of SSA-form programs are chordal. This gives the compiler precise knowledge over the register demand and allows for separating spilling, assignment and coalescing. For each of these phases, we present methods specially tailored to the SSA setting and provide a first evaluation.

  20. 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....... 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...

  1. 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...

  2. Analog capacitance ROM with IGFET bucket-brigade shift register

    DEFF Research Database (Denmark)

    Bruun, Erik; Olesen, Ole

    1975-01-01

    A new type of monolithic analog read-out memory is described. It consists of a memory element and associated on-chip readout circuitry. The memory can be used for storing sample values of time-varying analog signals. The memory element is a matrix of MOS capacitors, preprogrammed in size by a spe...... by a special mask. The readout element is a bucket-brigade shift register with parallel input and serial output. A test circuit that permits investigation of different principles of information transfer from capacitance matrix to shift register has been developed.......A new type of monolithic analog read-out memory is described. It consists of a memory element and associated on-chip readout circuitry. The memory can be used for storing sample values of time-varying analog signals. The memory element is a matrix of MOS capacitors, preprogrammed in size...

  3. [Diagnosis in patients with a painful arthroplasty].

    Science.gov (United States)

    Carrega, Giuliana; Antonini, Andrea; Burastero, Giorgio; Casalino-Finocchio, Giorgetta; Ronca, Agostina; Salomone, Carlo; Riccio, Giovanni

    2015-06-01

    The differential diagnosis between asepting loosening or prosthetic joint infection is not always easy. Tc-99m-labelled leucocyte scans, frozen section and histology can help recognise doubtful cases. We report the experience of the Unit for Infectious Diseases and Septic Orthopaedics of the ASL-2 Liguria, Italy, with a Tc-99m-labelled leucocyte scan and intraoperative frozen section to choose the best therapeutic approach: one-stage or two-stage exchange or arthrodesis-arthroplastica. All cases underwent histology and intraoperative cultures to confirm the diagnosis, and the effectiveness of the approach was evaluated at follow up after 18 months. From January 2011 to December 2012, 36 patients were evaluated (21 hip and 15 knee arthroprosthesis). The Tc-99m-labelled leukocyte scan was positive in 31 and negative in 5 patients. Frozen section was negative in 7 patients. Five of them were patients with a negative Tc-99m-labelled leucocyte scan and were treated successfully with one-stage exchange, even if, in one of them, Enterococcus faecalis was isolated at replacement and suppressive antibiotic treatment was needed. The other 31 patients were treated with arthrodesis arthroplasty (3 patients) or a two-stage exchange. In this group the Tc-99m-labelled leucocyte scan was positive in all patients and the frozen section was positive in 29/31 cases with 6% false negative. Histology was positive in 27/31 with 13% of false negative. The sensitivity and specificity value was respectively 90% and 100% in the frozen section, 84% and 100% in histology. Cultures were positive in 23/31 cases. Patients subjected to two-stage exchange were evaluated again during prosthesis replacement but the results of the Tc-99m-labelled leucocyte scan and histology showed unclear results more frequently: the Tc-99m-labelled leucocyte scan was positive in two cases, the frozen section in three and histology in seven in spite of positive culture in three cases and one relapse in a patient

  4. 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

  5. Knee extension range of motion and self-report physical function in total knee arthroplasty: mediating effects of knee extensor strength

    OpenAIRE

    Pua Yong-Hao; Ong Peck-Hoon; Chong Hwei-Chi; Yeo William; Tan Celia; Lo Ngai-Nung

    2013-01-01

    Abstract Background Knee extensor strength and knee extension range of motion (ROM) are important predictors of physical function in patients with a total knee arthroplasty (TKA). However, the relationship between the two knee measures remains unclear. The purpose of this study was to examine whether changes in knee extensor strength mediate the association between changes in knee extension ROM and self-report physical function. Methods Data from 441 patients with a TKA were collected preoper...

  6. 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

    International Nuclear Information System (INIS)

    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

  7. 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

  8. Normalized knee-extension strength or leg-press power after fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Aalund, Peter K; Larsen, Kristian; Hansen, Torben Bæk;

    2013-01-01

    OBJECTIVE: (s): To investigate which of the two muscle-impairment measures for the operated leg, normalized knee extension strength or leg press power, is more closely associated to performance-based and self-reported measures of function shortly following total knee arthroplasty (TKA). DESIGN...... dynamic leg presses to determine their body-mass normalized knee extension strength and leg press power, respectively. The 10-m fast speed walking and 30-s chair stand tests were used to determine performance-based function, while the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and...

  9. The Analgesic Effect of Obturator Nerve Block Added to a Femoral Triangle Block After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Runge, Charlotte; Børglum, Jens; Jensen, Jan Mick;

    2016-01-01

    BACKGROUND AND OBJECTIVES: Total knee arthroplasty (TKA) is associated with severe pain, and effective analgesia is essential for the quality of postoperative care and ambulation. The analgesic effects of adding an obturator nerve block (ONB) to a femoral triangle block (FTB) after TKA have not...... been tested previously. We hypothesized that combined ONB and FTB will reduce opioid consumption and pain compared with those of a single FTB or local infiltration analgesia (LIA). METHODS: Seventy-eight patients were randomized to combined ONB and FTB, single FTB, or LIA after primary unilateral TKA...

  10. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty

    OpenAIRE

    Anwander, H; Cron, G. O.; Rakhra, K.; Beaule, P. E.

    2016-01-01

    Objectives Hips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethyl...

  11. 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.

  12. 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

  13. Lateral dislocation of the knee joint after total knee arthroplasty: a case report

    Science.gov (United States)

    Ugutmen, Ender; Ozkan, Korhan; Unay, Koray; Mahirogullari, Mahir; Eceviz, Engin; Taser, Omer

    2008-01-01

    Background Total knee arthroplasty (TKA) is a successful therapy for functional improvement and pain relief in advanced symptomatic degeneration of the knee joint. But it can be associated with many complications, one of which is instability. Case presentation A 70-year-old woman was referred to our hospital because of right knee dislocation after TKA was performed on her right knee due to severe varus deformity and flexion contracture. This instability was caused by persistent MCL tightness and iatrogenic lateral collateral, arcuate ligament, and popliteus tendon injury. The torn lateral collateral ligament and arcuate ligament were sutured with no. 2 non-absorbable (Ethibond) sutures with plication of the posterolateral knee capsule. A deep-dish liner was inserted to optimize soft tissue tension. Conclusion This is a very severe complication, and surgeons must be cautious about ligament balancing and soft tissue resection during TKA for severe varus and valgus deformities. PMID:18687153

  14. 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).

  15. Chronic Lymphedema of the Lower Limb: A Rare Cause of Dislocation of Total Hip Arthroplasty.

    Science.gov (United States)

    Vaishya, Raju; Agarwal, Amit Kumar; Gupta, Nishint; Vijay, Vipul

    2016-01-01

    Total hip arthroplasty (THA) in a patient with chronic lymphedema of both lower limbs is rarely reported in the literature. Chronic lymphedema is a challenging condition associated with various complications especially in a patient with THA. However, dislocation of the total hip prosthesis due to acute exacerbation of lower limb swelling in the postoperative period is an extremely rare complication. The cause that led to the dislocation of the prosthesis is intricate and difficult to assess, as this has not been discussed in the literature yet. We believe that the excessive weight of the limb due to chronic lymphedema had a deleterious effect on the biomechanics of total hip prosthesis, thereby increasing the tendency for dislocation. This case illustrates that chronic lymphedema of the lower limb should be dealt with aggressively using various modalities like intermittent pneumatic compression pumps and compression stockings after THA in such patients. PMID:27226940

  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. 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.

  19. 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

    score, during active flexion of the knee (primary endpoint), was observed in favour of Group A, 95% confidence interval (CI): 23-42, Panalysis revealed that 25......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...... category compared with placebo. METHODS: Fifty patients with severe pain, defined as having a visual analogue scale (VAS) pain score of >60 during active flexion of the knee on the first or the second postoperative day after TKA, were included in this randomized, double-blind, placebo-controlled trial. All...

  20. Register for the local elections in France

    CERN Multimedia

    DSU Department

    2007-01-01

    If you are a European Union citizen residing in France and wish to vote in the forthcoming local elections you must register on the supplementary register at your town hall (mairie) before 31 December 2007. EU citizens are regarded as residing in France if their primary residence is in France or if they live there continuously. To be eligible to vote you must: be a national of one of the 26 listed States of the European Union and present a valid identification document. Residence permits are valid; be at least 18 years old by the closing date of revision of the supplementary electoral register, i.e. by the last day of February; enjoy civic rights both in France and in your State of origin. For more information: http://vosdroits.service-public.fr/particuliers/F1937.xhtml?&n=Elections&l=N4&n=Elections%20politiques&l=N47

  1. 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

  2. Early recovery after fast-track Oxford unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Munk, Stig; Dalsgaard, Jesper; Bjerggaard, Karin;

    2012-01-01

    performance reached the preoperative level after 1 month. Only slight postoperative knee swelling was observed with rapid restoration of knee flexion and function. A high level of pain during the first postoperative night and day fell considerably thereafter. None of the patients needed physiotherapy...... supervision in the first month after discharge. Interpretation Fast-track MIS Oxford UKA with discharge on the day after surgery is safe and leads to early recovery of knee motion and strength even when no physiotherapy is used.......Background and purpose After total knee arthroplasty with conventional surgical approach, more than half of the quadriceps extension strength is lost in the first postoperative month. Unicompartmental knee arthroplasty (UKA) operated with minimally invasive surgery (MIS) results in less operative...

  3. Nursing in fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik;

    2015-01-01

    must still focus on the individual patient. Nurses need to have enough education to manage the complex tasks and increased responsibility. To prevent undesirable outcomes in the future, there is a need to pay attention to the nursing quality in balance with the nursing budget. It may, therefore......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...... gained tasks from surgeons and physiotherapists and thus gained more responsibility, for example, for pain management and mobilisation. Staffing levels in the ward in 2002 and 2012 were almost unchanged; 16.0 and 15.8 respectively. Nurses were undertaking more complicated tasks. CONCLUSION: Nursing care...

  4. Catastrophic failure of ceramic-polyethylene bearing total hip arthroplasty.

    Science.gov (United States)

    Needham, Justin; Burns, Travis; Gerlinger, Tad

    2008-06-01

    Complications of ceramic-polyethylene bearing total hip arthroplasty (THA) include osteolysis, loosening, dislocation, and component failure. Catastrophic acetabular component failure involves severe damage to both the polyethylene liner and metal shell. This case study presents the first reported complete wear-through of the acetabular portion of a ceramic-polyethylene arthroplasty presenting as a dislocation and a review of the literature. In this study, a patient's alumina ceramic femoral head penetrated the polyethylene liner and titanium shell and presented as a dislocated THA. The contributing factors for this catastrophic failure include young patient age, high activity level, thin polyethylene liner, backside wear, component positioning, polyethylene sterilization with gamma irradiation in air, and lack of appropriate follow-up. Revision THA was performed without complications. PMID:18514888

  5. 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).

  6. 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. PMID:26375527

  7. Modification of the total first metatarsophalangeal joint implant arthroplasty.

    Science.gov (United States)

    Corrigan, G; Kanat, I O

    1989-01-01

    The Swanson Silastic HP 100 Flexible Hinge Toe Implant (Dow Corning Wright, Arlington Tennessee) displays superior tensile, elongation and tear propagation strength in comparison to other silicone implant materials. It is, however, subject to many factors which may shorten its life-span. One reason for such failure has been attributed to the irregular contour of bone ends created after metatarsophalangeal joint arthroplasty, resulting in abrasion shards and shearing fractures of the implant stems and hinge. Titanium grommets were developed to alleviate this factor. This case report demonstrates a complication subsequent to total first metatarsophalangeal joint implant arthroplasty and the effectiveness of the Swanson Flexible Hinge Toe Joint Grommet. (Dow Corning Wright, Arlington, Tennessee). PMID:2794361

  8. 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

  9. 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

  10. 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.

  11. 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....

  12. Spontaneous Knee Ankylosis through Heterotopic Ossification after Total Knee Arthroplasty

    OpenAIRE

    Samuel Boulezaz; Emmanuel Gibon; Philippe Loriaut; Laurent Casabianca; Romain Rousseau; Benjamin Dallaudiere; Hugues Pascal-Moussellard

    2016-01-01

    This paper reports on a case of total ankylosis of the knee after a cruciate-sacrificing cemented total knee arthroplasty (TKA). An 82-year-old female patient previously underwent primary TKA for osteoarthritis twenty years ago in our institution. She had recovered uneventfully and returned to her regular activities. There was no history of postsurgical trauma; however, she progressively lost knee range of motion. Radiographs revealed severe bridging heterotopic ossification.

  13. Recovery of physical functioning after total hip arthroplasty

    OpenAIRE

    2014-01-01

    Purpose. The overall aim of this thesis was to examine recovery of physical functioning in patients with hip osteoarthritis (OA) during the first year after total hip arthroplasty (THA). The specific aims were 1) to examine the desires of a group of patients regarding improvements in physical functioning before they underwent THA and at three and 12 months after surgery, 2) to examine changes in physical functioning during the first year of recovery and examine which preoperative measures pre...

  14. 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.

  15. Do pessimists report worse outcomes after total hip arthroplasty?

    OpenAIRE

    Singh, Jasvinder A; Colligan, Robert C.; O’Byrne, Megan M.; David G Lewallen

    2016-01-01

    Background Seligman’s theory of causal attribution predicts that patients with a pessimistic explanatory style will have less favorable health outcomes. We investigated this hypothesis using self-reported hip pain and hip function 2- years after total hip arthroplasty (THA). Methods Most THA patients had completed the Minnesota Multiphasic Personality Inventory (MMPI) during their usual clinical care long before THA (median, 14.7 to 16.6 years). Scores from the MMPI Optimism-Pessimism (PSM) s...

  16. Factors Influencing Range of Motion after Total Knee Arthroplasty

    OpenAIRE

    H Farahini; Moghtadaei, M; Bagheri, A; Akbarian, E

    2012-01-01

    Background The range of motion after a total knee arthroplasty is an important clinical outcome affecting the life of the patient. The aim of this study was to determine the most important factors influencing the postoperative knee flexion in Tehran, Iran. Methods Between July 2007 and January 2009, on 95 cases of total knee joint replacement (89 patients), who were followed for 1 year postoperatively, the risk factors were assessed. Patient demographics (sex, age, body mass index, previous s...

  17. Short-Term Results of Medial Unicondylar Knee Arthroplasty

    OpenAIRE

    Murat Yılmaz; Samed Ordu; Erhan Bayram; İbrahim Sungur; Ercan Çetinus

    2014-01-01

    Aim: This study aimed to determine the short-term clinical and radiologic results of medial unicondylar knee arthroplasty (UKA). Methods: We retrospectively evaluated hospital records of eight patients who have undergone Oxford phase-3 medial UKA between 2011 and 2013. We included seven patients (two males and five females) in the study. The mean age of the patients was 63 years and the mean follow-up period was 17 months. The patients underwent UKA with the Oxford phase 3 cemented mobile ...

  18. Management of failed metal-on-metal total hip arthroplasty

    OpenAIRE

    Griffin, Justin W.; D’Apuzzo, Michele; Browne, James A.

    2012-01-01

    The theoretical advantages of metal-on-metal (MOM) bearing couples in total hip arthroplasty (THA) have been recently balanced by concerns regarding adverse local and systemic effects. Higher than anticipated early revision rates have been reported by several joint registries. Failed MOM hips present with a spectrum of symptoms and findings and traditional methods of failure must be considered in addition to the failure modes that appear to be unique to the MOM bearing couple. Metal hypersens...

  19. 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...

  20. 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

  1. 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.

  2. Measuring optical temperature coefficients of Intralipid (registered)

    International Nuclear Information System (INIS)

    The temperature sensitivities of absorption and reduced scattering coefficients in the range 700-1000 nm are determined for the liquid phantom Intralipid (registered) using spatially resolved continuous wave measurements. The measurements were conducted on a 10 L heated volume of 1% Intralipid (registered) subjected to a 40-30 deg. C cooling regime. The temperature sensitivities of the absorbance coefficients are similar to that expected for pure water. However, the reduced scattering coefficients are more sensitive than can be explained by temperature related density changes, and show an unexpected relationship with wavelength. We have also found that temperature perturbations provide a useful means to evaluate instrument model performance

  3. Applications of porous tantalum in total hip arthroplasty.

    Science.gov (United States)

    Levine, Brett; Della Valle, Craig J; Jacobs, Joshua J

    2006-11-01

    Porous tantalum is an alternative metal for total joint arthroplasty components that offers several unique properties. Its high volumetric porosity (70% to 80%), low modulus of elasticity (3 MPa), and high frictional characteristics make it conducive to biologic fixation. Tantalum has excellent biocompatibility and is safe to use in vivo. The low modulus of elasticity allows for more physiologic load transfer and relative preservation of bone stock. Because of its bioactive nature and ingrowth properties, tantalum is used in primary as well as revision total hip arthroplasty components, with good to excellent early clinical results. In revision arthroplasty, standard and custom augments may serve as a structural bone graft substitute. Formation of a bone-like apatite coating in vivo affords strong fibrous ingrowth properties and allows for substantial soft-tissue attachment, indicating potential for use in cases requiring reattachment of muscles and tendons to a prosthesis. Development of modular components and femoral stems also is being evaluated. The initial clinical data and basic science studies support further investigation of porous tantalum as an alternative to traditional implant materials. PMID:17077337

  4. 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

  5. [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. PMID:26486536

  6. Outcome of total knee arthroplasty with insall burstein-11 prosthesis

    International Nuclear Information System (INIS)

    Patients with severe degenerative knee joint disease often require knee arthroplasty to reduce pain, improve stability and restore function. Insall Burstein II prosthesis is posteriorly stabilized condylar prosthesis, which provide posterior cruciate ligament substitution. It was designed to improve range of motion, stair climbing ability and to prevent posterior subluxation. Evaluate the functional outcome of total knee arthroplasty with IB II prosthesis and Evaluate the alignment of prosthetic components by radiological parameters and its correlation with functional outcome. Sixty knees of sixty patients were replaced by using Insall Burstein II prosthesis. Postoperative radiographs were evaluated for alignment of knee and prosthetic components by criteria selected from knee society roentogenographic evaluation system. Functional outcome was evaluated by rationale of knee society knee rating system. Prosthetic component was aligned in 93% and mal-alignment in 7% of the cases. There was significant improvement in functions core from mean score 33.83 +-15.5 to 59.5+-17.7 and knee score from 37 +- 12.5 to 76.4 +-2.2. Postoperative functional score was found correlated with alignment significantly. Conclusion: Total knee arthroplasty with I-B-II prosthesis is a safe durable and predictable procedure with proper surgical technique and expertise good alignment and satisfactory functional out come can be achieved. (author)

  7. 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.

  8. Acrylic bone cement in total joint arthroplasty: A review.

    Science.gov (United States)

    Saleh, Khaled J; El Othmani, Mouhanad M; Tzeng, Tony H; Mihalko, William M; Chambers, Monique C; Grupp, Thomas M

    2016-05-01

    Acrylic bone cement has a variety of applications in orthopedic surgery. Primary uses in total arthroplasties are limited to prostheses fixation and antibiotic delivery. With the large number of total joint arthroplasties expected to continue to rise, understanding the role bone cement plays in the success of total joint arthroplasty can have a significant impact on daily practice. The literature is inconclusive on whether cemented or cementless fixation technique is superior, and choice of fixation type is mainly determined by surgeon preference and experience. Surgeons should understand that if poor techniques exist, short-term outcomes of the replaced joint may be at risk. Statement of clinical significance: This article attempts to clarify some points of bone cement use through a review of the mechanical properties related to bone cement, a comparison to alternative materials, influence of additives, and the effects on surgical outcomes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:737-744, 2016. PMID:26852143

  9. Care principles at four fast-track arthroplasty departments in Denmark

    DEFF Research Database (Denmark)

    Husted, Henrik; Solgaard, Søren; Hansen, Torben Bæk;

    2010-01-01

    The goal of this study was to describe the logistic and clinical set-up at four Danish arthroplasty departments offering fast-track surgery.......The goal of this study was to describe the logistic and clinical set-up at four Danish arthroplasty departments offering fast-track surgery....

  10. 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)....

  11. 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...

  12. Cirrhosis patients have increased risk of complications after hip or knee arthroplasty

    DEFF Research Database (Denmark)

    Deleuran, T.; Vilstrup, H.; Overgaard, Søren;

    2015-01-01

    Background and purpose: The risk of complications in cirrhosis patients after orthopedic surgery is unclear. We examined this risk after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients and methods: Using Danish healthcare registries, we identified all Danish residents who...

  13. Role of patient characteristics for fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, C C; Kehlet, H

    2013-01-01

    BACKGROUND: /st>Patient age and comorbidity have been found to increase the length of hospital stay (LOS), readmissions, and mortality after surgery, including in elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Whether the same applies in fast-track THA and TKA...

  14. 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)....

  15. Small increase of actual physical activity 6 months after total hip or knee arthroplasty

    NARCIS (Netherlands)

    I.B. de Groot (Ingrid); J.B.J. Bussmann (Hans); H.J. Stam (Henk); J.A.N. Verhaar (Jan)

    2008-01-01

    textabstractLimitation in daily physical activity is one of the reasons for total hip arthroplasty (THA) or total knee arthroplasty (TKA). However, studies of the effects of THA or TKA generally do not determine actual daily activity as part of physical functioning. We determined the effect of THA o

  16. 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

  17. 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...

  18. 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...

  19. 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.

  20. 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 has...

  1. 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.

  2. 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...

  3. ELIGIBILITY FOR THE HIP-RESURFACING ARTHROPLASTY PROCEDURE: AN EVALUATION ON 592 HIPS

    Science.gov (United States)

    Queiroz, Roberto Dantas; Faria, Rafael Salomon Silva; Duarte, David Marcelo; Takano, Marcelo Itiro; Sugiyama, Mauricio Morita

    2015-01-01

    Objective: To investigate the percentage of ideal patients who would be eligible for hip-resurfacing surgery at a reference service for hip arthroplasty. Methods: Out of all the cases of hip arthroplasty operated at Hospital do Servidor Público Estadual de São Paulo (HSPE) between January 2009 and December 2010, we assessed a total of 592 procedures that would fit the criteria for indication for resurfacing arthroplasty, after clinical and radiological evaluation according to the criteria established by the Food and Drug Administration (FDA) and by Seyler et al. Results: Among the total number of hip replacement arthroplasty cases, 5.74% of the patients were eligible. Among the patients who underwent primary arthroplasty, we found that 8.23% presented ideal conditions for this procedure. Conclusion: The study demonstrated that this type of surgery still has a limited role among hip surgery methods. PMID:27047851

  4. 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.

  5. Does Physical Activity Increase After Total Hip or Knee Arthroplasty for Osteoarthritis? A Systematic Review.

    Science.gov (United States)

    Arnold, John B; Walters, Julie L; Ferrar, Katia E

    2016-06-01

    Study Design Systematic review. Background Despite improvements in self-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is unclear whether changes in objectively measured physical activity (PA) occur after surgery. Objective To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. Methods Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer- and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. Results Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. Conclusion The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative

  6. 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.

  7. Reverse total shoulder arthroplasty for the management of fractures of the proximal humerus: a systematic review.

    Science.gov (United States)

    Longo, U G; Petrillo, S; Berton, A; Denaro, V

    2016-08-01

    Reverse total shoulder arthroplasty (RTSA) represents a good solution for the management of patients with fracture of the proximal humerus with associated severe osteoporosis and RC dysfunction. A systematic review of the literature according to the PRISMA guidelines was performed matching the following keywords: "reverse total shoulder arthroplasty"; "reverse total shoulder prostheses"; "fractures"; "fracture of the proximal humerus." Medline, EMBASE, Google Scholar, and Ovid database have been screened. Ten studies were considered in the qualitative analysis. No randomized prospective controlled trials have been found. A total of 256 patients received a RTSA for the management of fracture of the proximal humerus. There were 28 males (10.8 %) and 228 females (89.2 %). The mean age of patients was 75.5 ± 2.2 years (range 70-78 years). The mean follow-up period was 27.8 ± 21.8 months range (6-86 months). Overall, the mean Constant score was 56.7 ± 7.6 points (range 44-67.8 points), the mean DASH score was 39.9 ± 6 points (range 31.5-46.8 points), the ASES averaged 70.3 ± 6.8 points (range 65-78 points), and the OSS averaged 28.7 points (range 15-56 points). RTSA restores function and relieves pain in patients with proximal humeral fractures. However, no randomized controlled trials are available to support RTSA versus osteosintesis, anatomical prostheses or hemiarthroprotesis. Further studies are needed to evaluate the effectiveness of RTSA in the management of fracture of the proximal humerus. PMID:27316439

  8. 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.

  9. 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

  10. 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.

  11. The Inflammatory Phenotype in Failed Metal-On-Metal Hip Arthroplasty Correlates with Blood Metal Concentrations

    Science.gov (United States)

    Paukkeri, Erja-Leena; Korhonen, Riku; Hämäläinen, Mari; Pesu, Marko; Eskelinen, Antti; Moilanen, Teemu; Moilanen, Eeva

    2016-01-01

    Introduction 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. Methods 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. Results 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. Conclusions 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

  12. 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

  13. 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.

  14. 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...

  15. Registered criminality and sanctioning of schizophrenia patients

    DEFF Research Database (Denmark)

    Munkner, Runa; Haastrup, Soeren; Joergensen, Torben;

    2009-01-01

    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 than imprison, individuals with schizophrenia. CONCLUSION: The findings suggest that greater alertness is needed in the judicial system for individuals diagnosed with schizophrenia....

  16. Current report from Russian Diabetic Retinopathy Register

    OpenAIRE

    Dmitriy Valentinovich Lipatov; Vera Kirillovna Aleksandrova; Dmitriy Sergeevich Atarshchikov; Elena Grigor'evna Bessmertnaya; Irina L'vovna Kon; Anatoliy Gennad'evich Kuz'min; Nataliya Borisovna Smirnova; Anna Anatol'evna Tolkacheva; Timofey Aleksandrovich Chistyakov

    2014-01-01

    A pandemic expansion of diabetes mellitus (DM) observed nowadays across the globe is increasingly acknowledged as a disaster by all peoples of the world. Statistical analysis indicates an annual increase in prevalence of DM in Russian Federation that had reached 3 779 423 registered patients by 01.01.2013. Besides the humanitarian aspects, DM poses severe economic challenges for this country – challenges that stem both from high mortality and growing disability rate due to limb loss, decrease...

  17. 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.

  18. 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.

  19. 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...

  20. 49 CFR 592.6 - Duties of a registered importer.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Duties of a registered importer. 592.6 Section 592... SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) REGISTERED IMPORTERS OF VEHICLES NOT... registered importer. Each Registered Importer must: (a) With respect to each motor vehicle that it...

  1. 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.

  2. 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...

  3. Register-based studies on migration, ethnicity, and health

    DEFF Research Database (Denmark)

    Norredam, Marie; Kastrup, Marianne; Helweg-Larsen, Karin

    2011-01-01

    to highlight the process of how migrant study populations have been established and studied in relation to different registers: The Danish Cancer Registry, the Danish Central Psychiatric Research Register, the Danish National Patient Register, the Danish National Health Service Register, the Danish Injury...... Register, and the Danish Medical Birth Register. CONCLUSION: Our paper documents the unique opportunities to study migration, ethnicity, and health through Danish national registers. Our examples show that in Denmark ''country of birth'' is the most commonly used measure. It renders information on whether...

  4. 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.

  5. Imaging of hip joint arthroplasty; Bildgebung bei Hueftgelenkendoprothesen

    Energy Technology Data Exchange (ETDEWEB)

    Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C. [Univ.-Klinik fuer Radiodiagnostik, Medizinische Universitaet Wien, Abteilung fuer Neuroradiologie und Muskuloskelettale Radiologie, Wien (Austria)

    2009-05-15

    The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [German] Dem Hueftgelenk als groesstem Gelenk des menschlichen Koerpers kommt eine besondere Bedeutung in der muskuloskelettalen Radiologie zu. Entsprechend wichtig ist auch die radiologische Beurteilung von Hueftgelenkendoprothesen, die z. B. infolge degenerativer Gelenkerkrankungen, einer Hueftkopfnekrose oder einer Fraktur eingesetzt werden. Die Projektionsradiographie ist weiterhin die primaere Modalitaet zur Beurteilung von Hueftgelenkendoprothesen, direkt postoperativ und zur laengerfristigen Verlaufskontrolle. Diese Methode erlaubt in der Mehrzahl der Faelle eine suffiziente Antwort auf die Frage nach Lockerung, periprothetischer Fraktur oder Prothesenmaterialbruch, Luxation, Infektion und Weichteilkalzifikation

  6. Patient-reported outcome measures in arthroplasty registries.

    Science.gov (United States)

    Rolfson, Ola; Eresian Chenok, Kate; Bohm, Eric; Lübbeke, Anne; Denissen, Geke; Dunn, Jennifer; Lyman, Stephen; Franklin, Patricia; Dunbar, Michael; Overgaard, Søren; Garellick, Göran; Dawson, Jill

    2016-07-01

    The International Society of Arthroplasty Registries (ISAR) Steering Committee established the Patient-Reported Outcome Measures (PROMs) Working Group to convene, evaluate, and advise on best practices in the selection, administration, and interpretation of PROMs and to support the adoption and use of PROMs for hip and knee arthroplasty in registries worldwide. The 2 main types of PROMs include generic (general health) PROMs, which provide a measure of general health for any health state, and specific PROMs, which focus on specific symptoms, diseases, organs, body regions, or body functions. The establishment of a PROM instrument requires the fulfillment of methodological standards and rigorous testing to ensure that it is valid, reliable, responsive, and acceptable to the intended population. A survey of the 41 ISAR member registries showed that 8 registries administered a PROMs program that covered all elective hip or knee arthroplasty patients and 6 registries collected PROMs for sample populations; 1 other registry had planned but had not started collection of PROMs. The most common generic instruments used were the EuroQol 5 dimension health outcome survey (EQ-5D) and the Short Form 12 health survey (SF-12) or the similar Veterans RAND 12-item health survey (VR-12). The most common specific PROMs were the Hip disability and Osteoarthritis Outcome Score (HOOS), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Oxford Hip Score (OHS), the Oxford Knee Score (OKS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the University of California at Los Angeles Activity Score (UCLA). PMID:27168175

  7. 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.

  8. Chronic pain following total hip arthroplasty: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf;

    2006-01-01

    of chronic pain after THA in relation to pre-operative pain and early post-operative pain. METHODS: A questionnaire was sent to 1231 consecutive patients who had undergone THA 12-18 months previously, and whose operations had been reported to the Danish Hip Arthroplasty Registry. RESULTS: The response rate...... 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...

  9. Evaluation and management of the painful total ankle arthroplasty.

    Science.gov (United States)

    Hsu, Andrew R; Haddad, Steven L; Myerson, Mark S

    2015-05-01

    Total ankle arthroplasty (TAA) is an increasingly popular treatment option for patients with end-stage ankle arthritis. Although improved short- and long-term clinical and radiographic outcomes have been achieved with TAA, revision surgery may be necessary in the setting of aseptic loosening, subsidence, impingement, arthrofibrosis, or infection. Factors such as patient selection, implant design, and surgical technique can all contribute to TAA failure. Treatment of patients with a painful TAA is complex and requires careful consideration of symptom history, workup, and nonsurgical and surgical treatment options. Surgical management of failed TAA includes arthrodesis, revision surgery, or below-knee amputation. PMID:25829450

  10. 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.

  11. Early morbidity after simultaneous and staged bilateral total knee arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer Calov; Husted, Henrik;

    2015-01-01

    PURPOSE: The aim of this nationwide study was to investigate the early morbidity after bilateral simultaneous and staged total knee arthroplasty (TKA) in order to clarify potential benefits of a well-established fast-track regime. METHODS: The Danish National Patient Registry was searched for all...... with 14 % (CI 11.5-20.1) after bilateral staged TKA within 7-18 months. CONCLUSIONS: The results from this nationwide study indicate that bilateral simultaneous TKA can safely be performed in a fast-track set-up....

  12. Acute Failure of a Glenoid Component in Anatomic Shoulder Arthroplasty.

    Science.gov (United States)

    Daner Iii, William E; Boardman Iii, Norman D

    2016-01-01

    Glenoid loosening is the most common cause of failure in primary total shoulder arthroplasty (TSA) and often occurs years after the initial surgery. It is rare for a glenoid component to fail acutely. Several case reports of complete glenoid dissociation appear in the literature. It is important to report these failures to identify technical errors or component design flaws to improve outcomes in TSA. In this case report, we present an unrecognized acute failure of a cemented hybrid glenoid component at the time of surgery. PMID:27555976

  13. 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...... have influenced the prevalence of joint stiffness and subsequent manipulation. We investigated the prevalence of manipulation following fast-track TKA and identified patients at risk of needing manipulation. PATIENTS AND METHODS: 3,145 consecutive unselected elective primary unilateral TKA patients...

  14. GAP ARTHROPLASTY IN TEMPOROMANDIBULAR JOINT ANKYLOSIS: A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Himanshu

    2015-03-01

    Full Text Available Temporomandibular joint (TMJ ankylosis is a disorder that leads to a restriction of the mouth opening from partial reduc tion to complete immobility of the jaw. The author retrospectively analyzed 20 patients with TMJ ankylosis which were treated by gap a rthroplasty in department of surgery, Government Medical Colleg e, Haldwani from March 2008 to J an 2015. Mean follow up was at least twenty - four months ( M inimum 24 and maximum 48 months. The purpose of this paper was to show that gap arthroplasty improve m outh opening when treating TMJ ankylosis. This was the first study in Kumaon region of U ttarakhand .

  15. 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.

  16. 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

  17. 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

  18. A Case of Improperly Registered "Wansheng" Trademark

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    @@ In September 1999, the Trademark Review and Adjudication Board of the China State Administration for In-dustry and Commerce (SAIC) made its fi-nal decision on revocation of the "Wangsheng" trademark: the ground for the revocation raised by Hitachi Maxell Ltd.(Hitachi) that the Shenzhen Hua Yuan In-dustrial (Group) Co., Ltd. (Hua Yuan) has registered, by improper means, the "Wansheng" trademark no. 592880 for Class 9 floppy and magnetic disks and no.870819 for Class 9 battery are tenable and the trademark is revoked.

  19. Generational differences in registered nurse turnover.

    Science.gov (United States)

    LeVasseur, Sandra A; Wang, Chen-Yen; Mathews, Barbara; Boland, Mary

    2009-08-01

    The chronic nature of the nursing workforce shortage in the United States is a continuing concern. As the nationwide gap between supply and demand grows, it remains unknown what impact turnover will have on nursing, access to care, and efforts to improve quality and safety of health care. It also remains unclear whether the recent turnover trends among new graduate registered nurses differ from past generational cohorts of new nurses. The aims of this study were to identify the reasons why registered nurses turnover by generational cohort (Veterans, Baby Boomers, and GenXMs) and to compare the length of time nurses were employed in their first five nursing positions by generational cohort. The findings suggest the three generational cohorts displayed similar reasons for leaving nursing positions with relocation, career advancement, and personal/family reasons reported most frequently. Except for the first nursing position, significant generational effects were found in the length of time Veterans, Baby Boomer, and GenXMs stayed employed in their nursing positions. It remains unknown why the GenXMs displayed a significantly shorter length of employment time in their second, third, fourth, and fifth nursing positions. The decline in length of employment time displayed in both the Baby Boomers and GenXMs may be an issue of concern requiring future research. PMID:20026454

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    van Raaij Jos JAM

    2008-10-01

    Full Text Available Abstract 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 polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: a conventional 28 mm metal-on-polyethylene articulation and a large head metal-on-metal articulation. We hypothesize that the latter arthroplasties show less bone density loss and higher serum metal ion concentrations. We expect equal functional scores, greater range of motion, fewer dislocations, fewer periprosthetic radiolucencies and increased prosthetic survival with the metal-on-metal articulation. Methods A randomized controlled trial will be conducted. Patients to be included suffer from non-inflammatory degenerative joint disease of the hip, are aged between 18 and 80 and are admitted for primary cementless unilateral total hip arthroplasty. Patients in the metal-on-metal group will receive a cementless titanium alloy acetabular component with a cobalt-chromium liner and a cobalt-chromium femoral head varying from 38 to 60 mm. Patients in the metal-on-polyethylene group will receive a cementless titanium alloy acetabular component with a polyethylene liner and a 28 mm cobalt-chromium femoral head. We will assess acetabular bone mineral density by dual energy x-ray absorptiometry (DEXA, serum ion concentrations of cobalt, chromium and titanium, self reported functional status (Oxford hip score, physician reported functional status and range of motion (Harris hip score, number of dislocations and prosthetic survival. Measurements will take place preoperatively, perioperatively, and postoperatively (6 weeks, 1 year, 5 years and 10 years. Discussion

  2. 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......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 intervention, an average of 25.5 days of guided skiing was conducted by each patient. Daily heart rate (HR) profiles and global positioning system data throughout the ski day were recorded. The intervention group completed an average of 3393 vertical meters of downhill skiing, with a total skiing distance...... of 33.6 km/day. Average skiing speed was 8.2 m/s. In the skiing phase, the average physiological load was 75.9 ± 6.6% of HRmax. Further effects of the 12-week skiing intervention on the tested parameters will be reported in the following papers of this supplementum....

  3. Lower limb length and offset in total hip arthroplasty.

    Science.gov (United States)

    Flecher, X; Ollivier, M; Argenson, J N

    2016-02-01

    Restoration of normal hip biomechanics is a key goal of total hip arthroplasty (THA) and favorably affects functional recovery. Furthermore, a major concern for both the surgeon and the patient is preservation or restoration of limb length equality, which must be achieved without compromising the stability of the prosthesis. Here, definitions are given for anatomic and functional limb length discrepancies and for femoral and hip offset, determined taking anteversion into account. Data on the influence of operated-limb length and offset on patient satisfaction, hip function, and prosthesis survival after THA are reviewed. Errors may adversely impact function, quality of life, and prosthetic survival and may also generate conflicts between the surgeon and patient. Surgeons rely on two- or three-dimensional preoperative templating and on intraoperative landmarks to manage offset and length. Accuracy can be improved by using computer-assisted planning or surgery and the more recently introduced EOS imaging system. The prosthetic's armamentarium now includes varus-aligned and lateralized implants, as well as implants with modular or custom-made necks, which allow restoration of the normal hip geometry, most notably in patients with coxa vara or coxa valga. Femoral anteversion must also receive careful attention. The most common errors are limb lengthening and a decrease in hip offset. When symptoms are caused by an error in length and/or offset, revision arthroplasty may deserve consideration. PMID:26797005

  4. Blood Conservation Strategies in Total Hip and Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    David Liu

    2015-01-01

    Full Text Available Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

  5. Functional rehabilitation after total hip arthroplasty with uncemented prosthesis

    Directory of Open Access Journals (Sweden)

    Nicolae-Bogdan Negru-Aman

    2011-12-01

    Full Text Available Arthritis is a disease that acts irreversibly on joint surfaces with significant consequences especially in the third quarter of life. About 7% of our population is affected by arthritis localized at a certain level and stage of development, and this percentage is expected to reach a much higher value in future years. Aim: The aim of this study is to propose a rehabilitation program for functional recovery after total hip arthroplasty and a set of recommendations for post surgery period. Material and methods: There were included 13 subjects (10 female and 3 male aged between 51 and 78 years old, ready for total hip arthroplasty with uncemented prosthesis. The subjects were selected in Orthopaedics and Traumatology department of Military Clinical Emergency Hospital ”Dr. Victor Popescu” Timisoara. The evaluations regarding programs’ efficiency were made using 3 questionnaires (Oxford Hip Score, Harris Hip Score, Outcome Hip Score and goniometry. The subjects were tested initially before the surgery and 3 times after (at one month, at 3 months and at 6 months. Results: The results showed a remarcable increase for the scores of majority, in both questionnaire and goniometry values. Conclusions: functional rehabilitation exercises proved to be particularly important in regaining independence, control of the prosthetic leg, pain reduction and functional and social reintegration.

  6. Wear debris pseudotumor following total knee arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Kontovazenitis Panayiotis

    2009-11-01

    Full Text Available Abstract Introduction In patients who have undergone a total joint replacement, any mass occurring in or adjacent to the joint needs thorough investigation and a wear debris-induced cyst should be suspected. Case presentation An 81-year-old man presented with a painful and enlarging mass at the popliteal fossa and calf of his right knee. He had had a total right knee replacement seven years previously. Plain radiographs showed narrowing of the medial compartment. Magnetic resonance imaging showed a cystic lesion at the postero-medial aspect of the knee joint mimicking popliteal cyst or soft tissue sarcoma. Fine needle aspiration was non-diagnostic. A core-needle biopsy showed metallosis. Intraoperative findings revealed massive metallosis related to extensive polyethylene wear, delamination and deformation. Revision knee and patella arthroplasty was carried out after a thorough debridement of the knee joint. Conclusion Long-term follow-up is critical for patients with total joint replacement for early detection of occult polyethylene wear and prosthesis loosening. In these cases, revision arthroplasty may provide a satisfactory knee function.

  7. Favorable outcome of a total hip arthroplasty with insufficient bone coverage of the roof reinforcement ring

    Directory of Open Access Journals (Sweden)

    Fernando M. Judas

    2015-01-01

    Conclusion: This result can be supported by the good fixation of the metal ring to the pelvis with screws, the adequate orientation of both components of the total hip arthroplasty, and the bone graft incorporation.

  8. The Isolated Effect of Adductor Canal Block on Quadriceps Femoris Muscle Strength After Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Sørensen, Johan Kløvgaard; Jæger, Pia; Dahl, Jørgen Berg;

    2016-01-01

    BACKGROUND: Using peripheral nerve block after total knee arthroplasty (TKA), without impeding mobility, is challenging. We hypothesized that the analgesic effect of adductor canal block (ACB) could increase the maximum voluntary isometric contraction (MVIC) of the quadriceps femoris muscle after...

  9. A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Karen V; Bak, Marie; Christensen, Birgitte V;

    2010-01-01

    There have been few studies describing wound infiltration with additional intraarticular administration of multimodal analgesia for total knee arthroplasty (TKA). In this study, we assessed the efficacy of wound infiltration combined with intraarticular regional analgesia with epidural infusion...

  10. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Singh Alka

    2010-01-01

    Full Text Available Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in a 63-year-old Caucasian man of British origin with patellar tendon injury. The patient was treated successfully through a revision of the patellar component and tendon repair. In two years follow-up the patient is asymptomatic with no sign of loosening of his patellar prosthesis. Conclusions A thorough understanding of knee biomechanics is imperative in performing total knee arthroplasty in order to achieve a better functional outcome and to prevent early prosthetic failure.

  11. Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines.

    Science.gov (United States)

    Min, Byung-Woo; Kim, Yeesuk; Cho, Hong-Man; Park, Kyung-Soon; Yoon, Pil Whan; Nho, Jae-Hwi; Kim, Sang-Min; Lee, Kyung-Jae; Moon, Kyong-Ho

    2016-03-01

    Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty. PMID:27536639

  12. Total Hip Arthroplasty in Mucopolysaccharidosis Type IH

    OpenAIRE

    S. O'hEireamhoin; Bayer, T.; Mulhall, K. J.

    2012-01-01

    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 disor...

  13. Illinois I/O Register to FASTBUS Interface

    International Nuclear Information System (INIS)

    The I/O Register to FASTBUS Interface (IORFI) is connected to a processor via two 16-bit output registers (OR1,OR2) and two 16-bit output resisters (IR1,IR2). One of the output registers (OR1) is used to specify the interface function which is to be performed when the interface is accessed via the Data-in Register (IR2) or the Data-out Register (OR2). The other input register (IR1) is used to read the direct status of the FASTBUS lines independent of OR1. The changes made to the SLAC design at the University of Illinois are described

  14. Register Variation in Electronic Business Correspondence

    Directory of Open Access Journals (Sweden)

    Rosa Giménez Moreno

    2011-06-01

    Full Text Available Electronic correspondence is a highly dynamic genre within the business world in which Register Variation (RV is frequently used as a tool to improve communication but it often can lead to misunderstanding. In order to shed some light on this still unexplored area, the present study firstly offers a practical approach to classify and analyse RV within professional communication. After this, it reviews previous studies on email writing to apply their findings to this approach and, in the third part of the study, a corpus of recent business emails in English is analysed to examine how the key parameters of RV are currently used within this genre. The results will show that, not only the context, but also the roles and intentions of the senders influence an email’s register, often causing internal oscillations between different registers within the same text.La correspondencia electrónica es un género comunicativo de especial dinamismo dentro del mundo empresarial en el que la variación de registros se utiliza como herramienta para mejorar la interacción y las relaciones entre los interlocutores, pero que a menudo también genera confusión y malentendidos. Para aportar luz a esta área, el presente trabajo ofrece una aproximación práctica para la clasificación y el análisis de los registros lingüísticos dentro de la comunicación profesional. A continuación, revisa los estudios previos sobre este género con el fin de adaptar sus resultados a la teoría propuesta. Finalmente, se analiza un corpus de mensajes escritos en inglés para examinar el funcionamiento de los registros dentro de este género. Los resultados mostrarán que, no solo el contexto situacional, sino sobre todo los roles e intenciones de los emisores determinan el registro de un mensaje, provocando a menudo oscilación interna entre varios registros dentro del mismo texto.

  15. Prothrombin fragment 1+2 in urine as an indicator of sustained coagulation activation after total hip arthroplasty

    DEFF Research Database (Denmark)

    Borris, L.C.; Breindahl, M.; Ryge, C.;

    2007-01-01

    Purpose: Prothrombin fragment 1 + 2 measured in spot urine (uF1 + 2) is an indicator of thrombin generation. We examined whether measured levels of uF1 + 2 can be used to differentiate between patients who do and do not acquire sustained coagulation activation after total hip arthroplasty (THA). ...... (8.8%) in the second study suffered VTC or death, assumed to be caused by a coagulation problem. Analysis of variance revealed the following statistically significant associations: pre- vs. postoperative tog uF1 + 2 Levels (P...... and to examine the association between the uF1 + 2 concentrations and risk of vascular thrombotic complications (VTC) or death. Finally, we sought to define a cut-off concentration value that could be used to identify patients with a sustained uF1 + 2 elevation after the first postoperative week. The urine...

  16. Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, C. C.; Jans; Kehlet, H.;

    2015-01-01

    BACKGROUND: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered...... gastrointestinal (GI) cancer requiring further investigation. However, the association between preoperative anaemia and cancer 1 year after elective total hip (THA) and total knee arthroplasty (TKA) is unknown. We evaluated 1-year cancer diagnoses, particularly GI cancers, in anaemic and non-anaemic THA and TKA......·3%) and 79 (1·6%) new cancers in anaemic and non-anaemic patients, respectively (OR: 1·38; 95% CI: 0·81-2·35, P = 0·228). After propensity matching of 661 anaemic and 1305 non-anaemic patients, we found no association between preoperative anaemia and cancer (OR: 0·94; 95% CI: 0·51-1·73, P = 0·837) or with GI...

  17. Subacute pain and function after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Gaarn-Larsen, L; Kristensen, B B;

    2009-01-01

    In a well-defined fast-track setup for total hip and knee arthroplasty, with a multimodal analgesic regimen consisting of intra-operative local anaesthetic infiltration and oral celecoxib, gabapentin and paracetamol for 6 days postoperatively, we conducted a prospective, consecutive, observationa...... walking 1 month after surgery with a concomitant increase in the use of strong opioids. These results emphasise the need for improvement in analgesia after discharge following total knee arthroplasty, to facilitate rehabilitation....

  18. Scapular Spine Stress Fracture as a Complication of Reverse Shoulder Arthroplasty

    OpenAIRE

    Burkholz, Kimberly J.; Roberts, Catherine C.; Hattrup, Steven J.

    2015-01-01

    We report a case of a stress fracture of the scapular spine which developed as a late complication of a reverse shoulder arthroplasty. After initially doing well after surgery, our patient developed pain and decreased shoulder function. A nondisplaced scapular spine fracture was noted on radiographs. Because reverse shoulder arthroplasty is a relatively new procedure in this country, radiologists may be unfamiliar with its potential complications. Stress or insufficiency fractures of the scap...

  19. Obesity is a Major Risk Factor for Prosthetic Infection after Primary Hip Arthroplasty

    OpenAIRE

    Dowsey, Michelle M.; Choong, Peter F M

    2008-01-01

    The incidence of obesity and the number of hip arthroplasties being performed in Australia each year are increasing. Although uncommon, periprosthetic infection after surgery can have a devastating effect on patient outcomes. We therefore asked whether obesity correlated with periprosthetic infection after primary hip arthroplasty. We further asked whether variables such as patient comorbidities, operative time, blood transfusions, use of drains, and cementation practices correlated with peri...

  20. Initial Stability of Subtrochanteric Oblique Osteotomy in Uncemented Total Hip Arthroplasty: A Preliminary Finite Element Study

    OpenAIRE

    Li, Liangtao; Yu, Mingyang; Ma, Renshi; Zhu, Dong; Gu, Guishan

    2015-01-01

    Background Subtrochanteric oblique osteotomy (SOO) has been widely used to reconstruct highly dislocated hips in uncemented total hip arthroplasty. The occurrence of complications can be attributed to the instability of the osteotomy region. The aim of this study was to evaluate the initial stability of SOO in uncemented total hip arthroplasty. Material/Methods A 3-dimensional finite element femur-stem model was created, and a virtual SOO was performed at 4 oblique angles: 30°, 45°, 60°, and ...

  1. Investigation of Pain in Hip Disease Patients before and after Arthroplasty

    OpenAIRE

    MORIMOTO,Yosuke(Researcher of Graduate School of Kyoto University ); Kondo, Yasutaka; Shimosako, Junpei; Kozu, Ryo; Kataoka, Hideki; Sakamoto, Junya; Nakano, Jiro; Okita, Minoru

    2011-01-01

    [Purpose] This study examined pain in patients with hip disease before and after arthroplasty and whether the pain was induced in the hip joint itself. [Subjects and Methods] Fifty-two patients presenting with hip disease who did not exhibit dementia, disease of the lower limbs or lumbar disease were included in this investigation. Regional pain, the site of maximum pain and Visual Analogue Scale (VAS) of the site of maximum pain before and after arthroplasty were evaluated. [Results] Groin d...

  2. Dynamic splinting for knee flexion contracture following total knee arthroplasty: a case report

    OpenAIRE

    Finger, Eric; Willis, F Buck

    2008-01-01

    Total Knee Arthroplasty operations are increasing in frequency, and knee flexion contracture is a common pathology, both pre-existing and post-operative. A 61-year-old male presented with knee flexion contracture following a total knee arthroplasty. Physical therapy alone did not fully reduce the contracture and dynamic splinting was then prescribed for daily low-load, prolonged-duration stretch. After 28 physical therapy sessions, the active range of motion improved from -20° to -12° (stiff ...

  3. Generating synthetic baseline populations from register data

    DEFF Research Database (Denmark)

    Rich, Jeppe; Mulalic, Ismir

    2012-01-01

    algorithm. The solution strategy consists in establishing a harmonisation process for the population targets, which combined with a linear programming approach, is applied to generate a consistent target representation. The model approach is implemented and tested on Danish administrative register data. A......The paper presents a population synthesiser based on the method of Iterative Proportional Fitting (IPF) algorithm developed for the new Danish national transport model system. The synthesiser is designed for large population matrices and allows target variables to be represented in several target...... test on historical census data shows that a 2006 population could be predicted by a 1994 population with an overall percentage deviation of 5–6% given that targets were known. It is also indicated that the deviation is approximately a linear function of the length of the forecast period....

  4. Studies based on the Danish Adoption Register

    DEFF Research Database (Denmark)

    Petersen, Liselotte; Sørensen, Thorkild I A

    2011-01-01

    INTRODUCTION: The genetic and familial environmental influences making up familial correlations in traits and familial aggregation of diseases may be disentangled by adoption studies. Thus, resemblance between the adoptee and the biological relatives indicates a contribution of the segregating gene...... they have in common, and resemblance between the adoptee and the rearing adoptive family members indicates influences of the shared family environment. The Danish Adoption Register includes information on all 14,425 non-familial adoptions of Danish children legally granted in Denmark from 1924 to 1947....... RESEARCH TOPICS: To illustrate the adoption study approach in research, we present results achieved in schizophrenia, body fatness, smoking, and mortality. Significantly higher prevalence of schizophrenia and related conditions were found in biological relatives to adoptees with schizophrenia than among...

  5. Spiritual care perspectives of Danish Registered Nurses

    DEFF Research Database (Denmark)

    Christensen, Kirsten Haugaard; Turner, de Sales

    2008-01-01

    Spiritual care perspectives of Danish Nurses The purpose of this study was to explore how Danish registered nurses understand the phenomenon of spiritual care and how their understanding impacts on their interventions with their patients. Nurses are responsible for the provision of care which...... would engage in provision of spiritual care. The participants acknowledged that their understanding of spirituality influenced their provision of spiritual care, which was recognized as a challenge requiring the nurse’s initiative and courage. Spirituality was primarily understood as a patient’s private...... respects patients’ values, religion, customs, and spiritual beliefs. Literature however revealed that the phenomenon of spiritual care is complex and variously interpreted, and that there seems to be a lack of conceptual clarity regarding what constitutes spiritual care. A phenomenological and hermeneutic...

  6. Current report from Russian Diabetic Retinopathy Register

    Directory of Open Access Journals (Sweden)

    Dmitriy Valentinovich Lipatov

    2014-03-01

    Full Text Available A pandemic expansion of diabetes mellitus (DM observed nowadays across the globe is increasingly acknowledged as a disaster by all peoples of the world. Statistical analysis indicates an annual increase in prevalence of DM in Russian Federation that had reached 3 779 423 registered patients by 01.01.2013. Besides the humanitarian aspects, DM poses severe economic challenges for this country – challenges that stem both from high mortality and growing disability rate due to limb loss, decrease in visual acuity and need for hemodialysis, plaguing many DM patients.Aim. To produce an epidemiological evaluation based on the dynamics of prevalence of diabetic retinopathy in the Russian Federation – nationwide and in individual regions – across the last 13 years.Materials and Methods. Current survey included patients from various regions of the Russian Federation that were examined during epidemiological missions conducted by the federal Endocrinology Research Centre (2000–2009, as well as National Programmes «Health» (2007 and «Diabetes – Learn In Advance» (2012–2013.Results. In the Russian Federation registered more than 630,000 patients with different stages of diabetic retinopathy. The prevalence of diabetic retinopathy among adults (18 years and older with type 1 diabetes is 35.25%, while in type 2 diabetes - 16.67%. On average, this means that almost one in five patients (17.63% with diabetes have certain eye problems.Conclusion. In summary, our data indicate a dramatic growth in the rate of diabetic ocular complications, with a particular increase in proliferative diabetic retinopathy, complicated cataract and neovascular glaucoma. These findings call for an even closer attention to early diagnostics, adequate management and, above everything else, timely prevention of ocular pathologies in patients with DM.

  7. Continuous Local Infiltration Analgesia for Pain Control After Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Sun, Xiao-Lei; Zhao, Zhi-Hu; Ma, Jian-Xiong; Li, Feng-Bo; Li, Yan-Jun; Meng, Xin-Min; Ma, Xin-Long

    2015-11-01

    A total knee arthroplasty (TKA) has always been associated with moderate to severe pain. As more research is conducted on the use of continuous local infiltration analgesia (CLIA) to manage pain after a TKA, it is necessary to reassess the efficacy and safety of the TKA method. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the efficacy and safety of pain control of CLIA versus placebo after a TKA. In January 2015, a systematic computer-based search was conducted in the Medline, Embase, PubMed, CENTRAL (Cochrane Controlled Trials Register), Web of Science, Google database, and Chinese Wanfang databases. This systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement criteria. The primary endpoint was the visual analog scale score after a TKA with rest or mobilization at 24, 48, and 72 hours, which represents the effect of pain control after TKA. The complications of infection, nausea, and whether it prolonged wound drainage were also compiled to assess the safety of CLIA. RevMan 5.30 software was used for the meta-analysis. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modeling when necessary. Ten studies involving 735 patients met the inclusion criteria. The meta-analysis revealed that continuous infusion analgesia provided better pain control with rest at 24 hours (mean difference [MD] -12.54, 95% confidence interval [CI] -16.63 to 8.45), and with mobilization at 24 hours (MD -18.27, 95% CI -27.52 to 9.02) and 48 hours (MD -14.19, 95% CI -21.46 to 6.93). There was no significant difference with respect to the visual analog scale score at 48 hours (MD -6.15, 95% CI -13.51 to 1.22, P = 0.10) and 72 hours (MD -3.63, 95% CI -10.43 to 3.16, P = 0.29) with rest and at 72 hours with mobilization (MD -4.25, 95% CI -16.27 to 7.77, P = 0

  8. Systematic review: Do patient expectations influence treatment outcomes in total knee and total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Haanstra Tsjitske M

    2012-12-01

    Full Text Available Abstract Objective This systematic review aims to summarise all the available evidence related to the association between pre-operative patient expectations (outcome expectations, process expectations and self efficacy expectations and 5 different treatment outcomes (overall improvement, pain, function, stiffness and satisfaction in patients with total knee or total hip arthroplasty at three different follow-op periods (>6 weeks; >6 weeks- ≤6 months; >6 months. Methods English and Dutch language articles were identified through PubMed, EMBASE.com, PsycINFO, CINAHL and The Cochrane Library from inception to September 2012. Articles assessing the association between pre-operative patient expectations and treatment outcomes for TKA/THA in either adjusted or unadjusted analysis were included. Two reviewers, working independently, determined eligibility, rated methodological quality and extracted data on study design, population, expectation measurements, outcome measurements and strength of the associations. Methodological quality was rated by the same reviewers on a 19 item scale. The scores on the quality assessment were taken into account when drawing final conclusions. Results The search strategy generated 2252 unique references, 18 articles met inclusion criteria. Scores on the methodological quality assessment ranged between 6% and 79%. Great variety was seen in definitions and measurement methods of expectations. No significant associations were found between patient expectations and overall improvement, satisfaction and stiffness. Both significant positive and non-significant associations were found for the association between expectations and pain and function. Conclusions There was no consistency in the association between patients’ pre-operative expectations and treatment outcomes for TKA and THA indentified in this systematic review. There exists a need for a sound theoretical framework underlying the construct of

  9. 78 FR 52308 - Harmonization of Compliance Obligations for Registered Investment Companies Required To Register...

    Science.gov (United States)

    2013-08-22

    ... Advisors: Compliance Obligations rulemaking. 77 FR 11252, 11252 (Feb. 24, 2012). With the publication of..., supra note 6, 77 FR at 11252, 11255. The Commission exercised its authority under Sec. Sec. 4 and 8a of... Rule, supra note 6, 77 FR at 11260 (``Entities required to register due to the amendments to Sec....

  10. 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...

  11. 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.

  12. 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.

  13. Do hip prosthesis related infection codes in administrative discharge registers correctly classify periprosthetic hip joint infection?

    DEFF Research Database (Denmark)

    Lange, Jeppe; Pedersen, Alma B; Troelsen, Anders;

    2015-01-01

    ) periprosthetic hip joint infection diagnosis code in the Danish National Patient Register. METHODS: Patients were identified with an ICD-10 discharge diagnosis code of T84.5 ("Infection and inflammatory reaction due to internal joint prosthesis") in association with hip-joint associated surgical procedure codes...

  14. Dislocation of a constrained total knee arthroplasty with patellar tendon rupture after trivial trauma

    Institute of Scientific and Technical Information of China (English)

    Raju Vaishya; Vipul Vijay; Abhishek Vaish

    2015-01-01

    Constrained total knee prostheses are used in knees with severe deformities and insufficiency of collaterals to provide stable and mobile knees.Dislocation after constrained knee prosthesis is an extremely rare and dreaded complication.When dislocation is associated with patellar tendon rupture,the management includes restoration of the extensor apparatus along with a stable knee.Repair of the patellar tendon is challenging due to poor soft tissue coverage in the area and a bulky repair can put tension on the wound closure.Ideal method of restoration of the extensor apparatus is a matter of debate.There are various modalities used ranging from primary end-to-end repair,augmentation by medial gastrocnemius flap,semitendinosus and synthetic implants and allograft tendoachilles.We report a rare case of a posterior dislocation of a constrained total knee arthroplasty in association with patellar tendon rupture due to a minor fall after a few weeks of surgery.The first episode was managed by reposition of the dislocation and V-Y plasty of the quadriceps and primary repair.The second episode of dislocation with re-rupture needed augmentation by semitendinosus along with the insertion of the thicker insert.The management of this complex problem along with the review of literature is discussed in this case report.

  15. The Role of The Commercial Register in The Commercial Law

    OpenAIRE

    Beranová, Marie

    2008-01-01

    The aim of this diploma thesis is to analyse the substantial and procedural legal regulation of the Commercial Register in the Czech Republic briefly though coherently and to clarify the most important principles, fundamentals and proceedings that are binding for the Commercial Register. Firstly I will introduce the Commercial Register in general and clear up the term "principle of publicity". Further I will focuse on the registered subjects and information and I will look closer on the Colle...

  16. 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 in the Dan......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...

  17. Universal Verification Methodology Based Register Test Automation Flow.

    Science.gov (United States)

    Woo, Jae Hun; Cho, Yong Kwan; Park, Sun Kyu

    2016-05-01

    In today's SoC design, the number of registers has been increased along with complexity of hardware blocks. Register validation is a time-consuming and error-pron task. Therefore, we need an efficient way to perform verification with less effort in shorter time. In this work, we suggest register test automation flow based UVM (Universal Verification Methodology). UVM provides a standard methodology, called a register model, to facilitate stimulus generation and functional checking of registers. However, it is not easy for designers to create register models for their functional blocks or integrate models in test-bench environment because it requires knowledge of SystemVerilog and UVM libraries. For the creation of register models, many commercial tools support a register model generation from register specification described in IP-XACT, but it is time-consuming to describe register specification in IP-XACT format. For easy creation of register model, we propose spreadsheet-based register template which is translated to IP-XACT description, from which register models can be easily generated using commercial tools. On the other hand, we also automate all the steps involved integrating test-bench and generating test-cases, so that designers may use register model without detailed knowledge of UVM or SystemVerilog. This automation flow involves generating and connecting test-bench components (e.g., driver, checker, bus adaptor, etc.) and writing test sequence for each type of register test-case. With the proposed flow, designers can save considerable amount of time to verify functionality of registers. PMID:27483924

  18. Formality Degrees of Language from the Perspective of Register

    Institute of Scientific and Technical Information of China (English)

    ZHU Xia

    2014-01-01

    The three variables-field, mode and tenor form the integrated system of a register which has the function of reflecting culture and language features. Via the analysis of the three dimensions of register, it intends to explore the influence of register on the formality degrees of language, so that the proper formality degrees of language are chosen during communication.

  19. Bilateral hip arthroplasty: is 1-week staging the optimum strategy?

    Directory of Open Access Journals (Sweden)

    Willis-Owen Charles A

    2010-11-01

    Full Text Available Abstract Seventy-nine patients underwent bilateral hip arthroplasty staged either at 1 week (Group 1 or after greater intervals (as suggested by the patients, mean 44 weeks, range 16-88 weeks (Group 2, over a five year period at one Institution. Sixty-eight patients (29 bilateral hip resurfacings and 39 total hip replacements completed questionnaires regarding their post-operative recovery, complications and overall satisfaction with the staging of their surgery. There was no significant age or ASA grade difference between the patient groups. Complication rates in the two groups were similar and overall satisfaction rates were 84% in Group 1 (n = 32 and 89% in Group 2 (n = 36. Cumulative hospital lengths of stay were significantly longer in Group 1 patients (11.9 days vs 9.1 days(p The mean time to return to part-time work was 16.4 weeks for Group 1, and a cumulative 17.2 weeks (8.8 and 8.4 weeks for Group 2. The time to return to full-time work was significantly shorter for Group 1 patients (21.0 weeks, compared with a cumulative 29.7 weeks for Group 2(p Hip resurfacing patients in Group 2 had significantly shorter durations of postoperative pain and were able to return to part-time and full time work sooner than total hip arthroplasty patients. There was a general trend towards a faster recovery and resumption of normal activities following the second operation in Group 2 patients, compared with the first operation. Bilateral hip arthroplasty staged at a 1-week interval resulted in an earlier resolution of hip pain, and an earlier return to full-time work (particularly following total hip replacement surgery, with high levels of patient satisfaction and no increased risk in complications; however the hospital length of stay was significantly longer. The decision for the timing of staged bilateral surgery should be made in conjunction with the patient, making adjustments to accommodate their occupational needs and functional demands.

  20. Transitioning from military medics to registered nurses

    Directory of Open Access Journals (Sweden)

    Keita MD

    2015-11-01

    Full Text Available Mohamed D Keita,1 Valerie J Diaz,1,2 Audrey P Miller,1 Maria Olenick,1 Sharon R Simon1 1Department of Undergraduate Nursing, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, 2Operational Health Support Unit Jacksonville, United States Navy Nurse Corps, Jacksonville, FL, USA Abstract: The nursing shortage in the USA is expected to reach 260,000 registered nurses (RNs by 2025. The most profound shortages are expected in California and Florida, translating into 109,779 and 128,364 RN jobs, respectively. Despite a foreseen growth in nursing career opportunities nationwide, the supply of nurses will be insufficient to meet the corresponding demand. Capitalizing on prior education, experience, and skills of military clinical personnel to fill these jobs could significantly reduce the projected nursing shortage. Florida International University's Nicole Wertheim College of Nursing and Health Sciences is circumventing barriers to recruit, retain, and graduate transitioning veteran medics and corpsmen as Bachelor of Science in Nursing prepared RNs who reintegrate into the civilian workforce. The Veteran Bachelor of Science in Nursing (VBSN program is in the form of a cooperative agreement between Florida International University and the US Health Resources and Services Administration. The VBSN program's main objective is to build upon the unique leadership skills, clinical education, and training of military medics and corpsmen to ensure successful completion of the Bachelor of Science in Nursing curriculum. VBSN students, as veterans themselves, have unique knowledge and exposure to the specific health issues and needs of the veteran population overall. They are poised and best prepared to effectively care for the US population, particularly the current 22 million US veterans and 1.6 million Florida veterans. Additionally, the VBSN program will alleviate the challenges, such as the lack of recognition of

  1. Comparison of continuous femoral nerve block (CFNB/SA) and continuous femoral nerve block with mini-dose spinal morphine (CFNB/SAMO) for postoperative analgesia after total knee arthroplasty (TKA): a randomized controlled study

    OpenAIRE

    Sundarathiti, Petchara; Thammasakulsiri, Jadesadha; Supboon, Supawadee; Sakdanuwatwong, Supalak; Piangjai, Molruedee

    2016-01-01

    Background Unsatisfactory analgesia for major knee surgery with femoral nerve block (FNB) alone was reported and the additional benefit of sciatic block to continuous femoral nerve block (CFNB) was not conclusive. The aim of the present study was to find the benefit of the additional mini-dose spinal morphine (0.035 mg) to CFNB for postoperative pain control and to compare their associated side effects after total knee arthroplasty (TKA). Methods After written informed consent and with Instit...

  2. A Qualitative Modal Representation of Quantum Register Transformations

    CERN Document Server

    Masini, Andrea; Zorzi, Margherita

    2008-01-01

    We introduce two modal natural deduction systems that are suitable to represent and reason about transformations of quantum registers in an abstract, qualitative, way. Quantum registers represent quantum systems, and can be viewed as the structure of quantum data for quantum operations. Our systems provide a modal framework for reasoning about operations on quantum registers (unitary transformations and measurements), in terms of possible worlds (as abstractions of quantum registers) and accessibility relations between these worlds. We give a Kripke--style semantics that formally describes quantum register transformations and prove the soundness and completeness of our systems with respect to this semantics.

  3. Anterolateral muscle sparing approach total hip arthroplasty: an anatomic and clinical study

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xian-long; SHEN Hao; QIN Xiao-long; WANG Qi

    2008-01-01

    Background Many kinds of approaches have been used for minimally invasive surgery of total hip arthroplasty (MIS-THA). However, until now when considering the balance of efficacy and associated surgical injury there is no approach widely accepted for MIS-THA. In this study, a modified anterolateral muscle sparing approach was developed to optimize MIS-THA. Methods Twenty adult cadaver specimens (40 hips) were used for anatomic research. The distance from anterior origin of the gluteus medius on the lilac crest to the anterior superior lilac spine was measured; the course of the superior gluteal nerve and the distances from the nerve to the regional anatomic landmarks were recorded. Simulated surgeries were performed in three fresh cadaver specimens to evaluate the soft tissues injury around incisions. From October 2004 to June 2006, 57 patients (57 hips) were treated with anterolateral muscle sparing minimally invasive total hip arthroplasty, of which 17 were femoral neck fractures, 9 osteoarthritis, 16 developmental dysplasia of hip (DDH) and 15 avascular necrosis (AVN). All the operations were performed by the same senior surgeon. Operation time, blood loss and drainage volume were recorded and the correlation between the local complications and the native anatomical characteristics was especially noted. All cases were followed for at least 12 months.Results The distance from the anterior origin of the gluteus medius to anterior superior lilac spine along the lilac crest was (61±4) mm (range, 55-68 mm), and the distance from inferior branch of the superior gluteal nerve to the anterior tubercle of the greater trochanter was (74±6)mm (range, 60-88 mm). In simulated surgeries, excessive distraction of tissue was found to be the main cause of the anterior border injury of the gluteus medius muscle. Of the 57 patients treated with anterolateral muscle sparing MIS-THA, the average incision length was 9 cm (range 7.5-13 cm). Blood transfusions were performed in 11

  4. Th1 type lymphocyte reactivity to metals in patients with total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Finnegan Alison

    2008-02-01

    releasing IFN-gamma and IL-4, respectively between those total hip arthroplasty subjects which demonstrated metal-reactivity and those that did not, indicated a Th1 type (IFN-gamma pro-inflammatory response. Conclusion Elevated proliferation and production of IFN-gamma to metals in hip arthroplasty subjects' lymphocytes indicates that a Th1 (vs. Th2 type response is likely associated with any metal induced reactivity. The involvement of an elevated and specific lymphocyte response suggests an adaptive (macrophage recruiting immunity response to metallic implant debris rather than an innate (nonspecific immune response.

  5. 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......-system and classified into four groups. Pain relief was satisfactory in the acute group, but was unpredictable in the chronic group. The results in the acute group were significantly superior (P less than .05). In the acute group, 3 (20%) patients had an excellent result and 6 patients (40%) had a good result, compared...... 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...

  6. Posttraumatic pseudoaneurysm of popliteal artery following total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Sanjay R Agarwala

    2013-01-01

    Full Text Available We report a case of posttraumatic false aneurysm of popliteal artery after a total knee arthroplasty in an 82-year-old woman. This case is characterized by the distinct history of trauma to the popliteal fossa in the immediate postoperative period and the location of false aneurysm. In addition, the clinical symptoms were similar to those of deep vein thrombosis. The ultrasonographic examination and computed tomography (CT angiography confirmed the diagnosis on 6 th day after the surgery. Ultrasonographic examination 1 day later revealed no increase in the size of false aneurysm. She was treated with open surgical repair. Presenting the difficulty in the diagnosis, unusual location, etiology, and its management is the intention of this case report.

  7. 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...... patients participated in the intervention group (IG) and nine in the control group (CG). Blood samples and muscle biopsies were obtained before (PRE) and 7.3 ± 0.8 days after (POST) the intervention, and blood samples again after a retention (RET) phase of 8 weeks. With skiing, glucose homeostasis improved...... I fibers increased with skiing in IG with no change in CG. Inflammatory biomarkers, plasma lipids, and mitochondrial proteins and activity did not change. Alpine skiing is metabolically beneficial and can be used as a training modality by elderly people with TKA....

  8. Analysis of stem tip pain in revision total knee arthroplasty.

    Science.gov (United States)

    Kimpton, Christine I; Crocombe, Andrew David; Bradley, William Neil; Gavin Huw Owen, Brigstocke

    2013-06-01

    Stem tip pain following revision total knee arthroplasty is a significant cause of patient dissatisfaction, which in the presence of an aseptic well-fixed component has no widely accepted surgical solution. A definitive cause of stem tip pain remains elusive, however it has been suggested that high stress concentrations within the region of the stem tip may play a role. This paper reports a finite element study of a novel clinical technique where a plate is attached to the tibia within the region of the stem tip to reduce stem tip pain. The results demonstrate that the plate reduces stress concentrations in the bone at the stem tip of the implant. The magnitude of stress reduction is dependent upon plate location, material and attachment method. PMID:23523204

  9. Mobile bearing and fixed bearing total knee arthroplasty

    Science.gov (United States)

    Dolfin, Marco; Saccia, Francesco

    2016-01-01

    The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience. PMID:27162777

  10. Total Hip Arthroplasty – over 100 years of operative history

    Directory of Open Access Journals (Sweden)

    Stephen Richard Knight

    2011-11-01

    Full Text Available Total hip arthroplasty (THA has completely revolutionised the nature in which the arthritic hip is treated, and is considered to be one of the most successful orthopaedic interventions of its generation (1. With over 100 years of operative history, this review examines the progression of the operation from its origins, together with highlighting the materials and techniques that have contributed to its development. Knowledge of its history contributes to a greater understanding of THA, such as the reasons behind selection of prosthetic materials in certain patient groups, while demonstrating the importance of critically analyzing research to continually determine best operative practice. Finally, we describe current areas of research being undertaken to further advance techniques and improve outcomes.

  11. The difficult primary total knee arthroplasty: a review.

    Science.gov (United States)

    Baldini, A; Castellani, L; Traverso, F; Balatri, A; Balato, G; Franceschini, V

    2015-10-01

    Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella. Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes. When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation.

  12. The constraints on day-case total knee arthroplasty

    DEFF Research Database (Denmark)

    Thienpont, E; Lavand'homme, P; Kehlet, H

    2015-01-01

    -case TKA. These constraints may be social, linked to patient's comorbidities, or due to surgery-related adverse events (e.g. pain, post-operative nausea and vomiting, etc.). Using patient stratification, tailored surgical techniques and multimodal opioid-sparing analgesia, day-case TKA might be achievable......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...

  13. Reverse shoulder arthroplasty in acute fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Rasmussen, Jeppe; Olsen, Bo Sanderhoff;

    2013-01-01

    arthroplasty (RSA) has been suggested. We aimed to review clinical studies reporting benefits and harms of RSA in acute fractures. A systematic review. We included 18 studies containing 430 RSA in acute fractures. We found no randomized clinical trials. Four studies compared outcome after RSA with a historical......, and baseplate failure. Scapular notching was reported in 11 studies with a median value of 25% (range 0-94). Heterogeneity of study designs and lack of primary data precluded statistical pooling of data. No high quality evidence was identified. Based on the available evidence the use of RSA in acute...... fractures is questionable. The complication rate was high and the clinical implications of long term scapular notching are worrying. Randomized studies with long term follow up using the latest techniques of tubercular reinsertion in RSA toward HA should be encouraged....

  14. Hip arthroplasty. Part 1: prosthesis terminology and classification

    International Nuclear Information System (INIS)

    Hip arthroplasty is an extremely common orthopaedic procedure and there is a wide array of implants that are in current use in the UK. The follow-up of patients who have undergone insertion of a hip prosthesis is shifting from a consultant-lead hospital service towards primary care. As this change in patient care continues it becomes increasingly important that an accurate description of the radiographic features is communicated to the primary-care practitioner so appropriate specialist input can be triggered. This review focuses on the terminology and classification of hip prostheses. This acts as a precursor for Part 2 of this series, which describes the normal and abnormal radiographic findings following hip prosthesis insertion.

  15. Tantalum cones and bone defects in revision total knee arthroplasty.

    Science.gov (United States)

    Boureau, F; Putman, S; Arnould, A; Dereudre, G; Migaud, H; Pasquier, G

    2015-04-01

    Management of bone loss is a major challenge in revision total knee arthroplasty (TKA). The development of preformed porous tantalum cones offers new possibilities, because they seem to have biological and mechanical qualities that facilitate osseointegration. Compared to the original procedure, when metaphyseal bone defects are too severe, a single tantalum cone may not be enough and we have developed a technique that could extend the indications for this cone in these cases. We used 2 cones to fill femoral bone defects in 7 patients. There were no complications due to wear of the tantalum cones. Radiological follow-up did show any migration or loosening. The short-term results confirm the interest of porous tantalum cones and suggest that they can be an alternative to allografts or megaprostheses in case of massive bone defects.

  16. Genu Recurvatum versus Fixed Flexion after Total Knee Arthroplasty

    Science.gov (United States)

    Silva, Amila; Chong, Hwei Chi; Chin, Pak Lin; Chia, Shi Lu; Lo, Ngai Ngung; Yeo, Seng Jin

    2016-01-01

    Background To date, there is no study comparing outcomes between post-total knee replacement genu recurvatum and fixed flexion. This study aims to provide data that will help in deciding which side to err on when neutral extension is not achieved. Methods A prospective cohort study of primary total knee arthroplasties was performed, which compared the 6-month and 2-year clinical outcomes between fixed flexion and genu recurvatum deformities at 6 months. Results At 6 months, knees in genu recurvatum did better than knees in fixed flexion deformity in terms of knee flexion. However, at 2 years, knees in fixed flexion deformity did better in terms of knee scores and showed better improvement in the degree of deformity. Conclusions We conclude that it is better to err on the side of fixed flexion deformity if neutral alignment cannot be achieved. PMID:27583106

  17. Hydrotherapy after total knee arthroplasty. A follow-up study.

    Science.gov (United States)

    Giaquinto, S; Ciotola, E; Dall'Armi, V; Margutti, F

    2010-01-01

    The study evaluated the subjective functional outcome following total knee arthroplasty (TKA) in participants who underwent hydrotherapy (HT) six months after discharge from a rehabilitation unit. A total of 70 subjects, 12 of which were lost at follow-up, were randomly assigned to either a conventional gym treatment (N=30) or HT (N=28). A prospective design was performed. Participants were interviewed with Western-Ontario McMasters Universities Osteoarthritis Index (WOMAC) at admission, at discharge and six months later. Kruskal-Wallis and Wilcoxon tests were applied for statistical analysis. Both groups improved. The WOMAC subscales, namely pain, stiffness and function, were all positively affected. Statistical analysis indicates that scores on all subscales were significantly lower for the HT group. The benefits gained by the time of discharge were still found after six months. HT is recommended after TKA in a geriatric population.

  18. Mobile bearing and fixed bearing total knee arthroplasty.

    Science.gov (United States)

    Capella, Marcello; Dolfin, Marco; Saccia, Francesco

    2016-04-01

    The mobile bearing (MB) concept in total knee arthroplasty (TKA) was developed as an alternative to fixed bearing (FB) implants in order to reduce wear and improve range of motion (ROM), especially focused on younger patients. Unfortunately, its theoretical advantages are still controversial. In this paper we exhibit a review of the more recent literature available comparing FB and MB designs in biomechanical and clinical aspects, including observational studies, clinical trials, national and international registries analyses, randomized controlled trials, meta-analyses and Cochrane reviews. Except for some minor aspects, none of the studies published so far has reported a significant improvement related to MBs regarding patient satisfaction, clinical, functional and radiological outcome or medium and long-term survivorship. Thus the presumed superiority of MBs over FBs appears largely inconsistent. The routine use of MB is not currently supported by adequate evidences; implant choice should be therefore made on the basis of other factors, including cost and surgeon experience. PMID:27162777

  19. Porous metals and alternate bearing surfaces in shoulder arthroplasty.

    Science.gov (United States)

    Carpenter, Shannon R; Urits, Ivan; Murthi, Anand M

    2016-03-01

    Total shoulder arthroplasty (TSA) provides an effective solution for the treatment of glenohumeral arthritis. However, long-term outcomes have been limited by glenoid component aseptic loosening and polyethylene (PE) wear. Previous attempts to improve glenoid fixation with metal-backed glenoids resulted in inferior results. Newer component designs that contain porous metal allow for biological ingrowth of the prosthesis, potentially improving longevity and overall outcomes. Porous metal can also improve humeral component fixation, obviating the need for cement and simplifying revision surgery. Advances such as highly cross-linked polyethylene (HXLPE), vitamin E-doped HXLPE, and alternate bearing surfaces like ceramics and pyrolytic carbon have proven to provide superior wear characteristics in other joint replacements and may prove beneficial in the shoulder as well. PMID:26797775

  20. Predictors of bone loss in revision total knee arthroplasty.

    Science.gov (United States)

    Bloomfield, Michael R; Klika, Alison K; Lee, Ho H; Joyce, David M; Mehta, Priyesh; Barsoum, Wael K

    2010-03-01

    Revision total knee arthroplasty (RTKA) requires preoperative planning to enable the reconstruction of bony deficiencies. The objective of this project was to identify predictors of bone loss management at RTKA based on the preoperative failure mode and patient demographics known preoperatively. We retrospectively reviewed 245 consecutive RTKA procedures in which the same revision knee system was utilized. Patient demographic and treatment data were recorded, and locations of bone loss were identified based on the reconstructive management. We identified significant predictors for use of femoral augments at all four positions. Several predictors significantly predisposed to use of a thick (>19 mm) polyethylene; however, no predictors of tibial augments were significant. Although the reconstruction of bone loss is primarily based on the intraoperative assessment, these findings may provide additional information to help the surgeon prepare for difficult revision procedures. PMID:20812582

  1. Total Ankle Arthroplasty: An Overview of the Canadian Experience.

    Science.gov (United States)

    Latham, Warren C W; Lau, Johnny T C

    2016-06-01

    Total ankle arthroplasty use has increased across Canada over the last two decades. Multiple implant designs are readily available and implanted across Canada. Although arthrodesis is a reliable procedure for treating end-stage ankle arthritis, ankle replacement is often the preferred surgical treatment by patients. A recent prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis at multiple centers across Canada, with variability in prosthesis type, surgeon, and surgical technique. Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; however, rates of reoperation and major complications were higher after ankle replacement.

  2. The Validity of Administrative BMI Data in Total Joint Arthroplasty.

    Science.gov (United States)

    Lau, Edmund C; Son, Min-Sun; Mossad, David; Toossi, Nader; Johanson, Norman A; Gonzalez, Mark H; Meller, Menachem M

    2015-10-01

    Identifying BMI via administrative data is a useful way to evaluate outcomes in total joint arthroplasty (TJA) for varying degrees of obesity. The purpose of this study was to evaluate the concordance between BMI coding in administrative claims data and actual clinical BMI measurements in the medical record for patients undergoing TJA. Clinical BMI value was shown to be a significant determinant of whether ICD-9 codes were used to report the patient's obesity status (P<0.01). Although a higher clinical BMI strongly increased the likelihood of having either of the ICD-9 diagnosis codes used to identify obesity status, only the accuracy of the V85 code increased with increasing levels of BMI. PMID:26088396

  3. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: guide to the Register, version 3-2010

    DEFF Research Database (Denmark)

    McMurray, Janet; Zérah, Simone; Hallworth, Michael;

    2010-01-01

    In 1997, the European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) set up a Register for European Specialists in Clinical Chemistry and Laboratory Medicine. The operation of the Register is undertaken by a Register Commission (EC4RC). During the last 12 years, more...

  4. Does location of patellofemoral chondral lesion influence outcome after Oxford medial compartmental knee arthroplasty?

    Science.gov (United States)

    Konan, S.; Haddad, F. S.

    2016-01-01

    Aims Medial unicompartmental knee arthroplasty (UKA) is associated with successful outcomes in carefully selected patient cohorts. We hypothesised that severity and location of patellofemoral cartilage lesions significantly influences functional outcome after Oxford medial compartmental knee arthroplasty. Patients and Methods We reviewed 100 consecutive UKAs at minimum eight-year follow-up (96 to 132). A single surgeon performed all procedures. Patients were selected based on clinical and plain radiographic assessment. All patients had end-stage medial compartment osteoarthritis (OA) with sparing of the lateral compartment and intact anterior cruciate ligaments. None of the patients had end-stage patellofemoral OA, but patients with anterior knee pain or partial thickness chondral loss were not excluded. There were 57 male and 43 female patients. The mean age at surgery was 69 years (41 to 82). At surgery the joint was carefully inspected for patellofemoral chondral loss and this was documented based on severity of cartilage loss (0 to 4 Outerbridge grading) and topographic location (medial, lateral, central, and superior or inferior). Functional scores collected included Oxford Knee Score (OKS), patient satisfaction scale and University College Hospital (UCH) knee score. Intraclass correlation was used to compare chondral damage to outcomes. Results All patients documented significant improvement in pain and improved functional scores at mid-term follow-up. There were four revisions (mean 2.9 years, 2 to 4; standard deviation (sd) 0.9) in this cohort, three for tibial loosening and one for femoral loosening. There was one infection that was treated with debridement and insert exchange. The mean OKS improved from 23.2 (sd 7.1) to 39.1 (sd 6.9); p < 0.001. The cohort with central and lateral grade 3 patellofemoral OA documented lower mean satisfaction with pain (90, sd 11.8) and function (87.5, sd 10.3) on the patient satisfaction scale. On the UCH scale, patients

  5. Intrathecal ketorolac enhances intrathecal morphine analgesia following total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Gabriela R Lauretti

    2013-01-01

    Full Text Available Background: Total knee arthroplasty represents one of the most painful surgeries. The aim of the study was to compare analgesia and adverse effects of intrathecal (IT ketorolac versus IT morphine, versus the combination of IT ketorolac and morphine. Materials and Methods: After ethical approval and patient consent, 80 patients undergoing knee arthroplasty were randomized to one of 4 groups. All groups received 15 mg IT bupivacaine plus IT test drug (2 ml. The control group (CG received saline as IT test drug. The morphine group (MG received IT 200 g morphine, the ketorolac group (KG IT 2 mg ketorolac and the morphine-ketorolac group (MKG 200 g morphine + 2 mg ketorolac as test drugs. Pain and adverse effects were evaluated. P < 0.05 was considered significant. Results: The MG and KG were similar in their times to time to first rescue analgesic (440 ± 38 min and 381 ± 44 min, respectively. Both groups were longer when compared to the CG (170 ± 13 min (P < 0.01. The MG and KG had lesser ketoprofen consumption compared to the CG (P < 0.05. The time to first rescue analgesic was longer to the MKG (926 ± 222 min (15 h compared to CG (P < 0.001 and to the MG and the KG (P < 0.01. MKG displayed lesser ketoprofen consumption compared to MG and KG (P < 0.05 and to the CG (P < 0.02. Conclusions: The data suggest a role for spinal ketorolac and morphine in orthopaedic surgery because this combination of agents provided 15 h of analgesia compared to 7 h after each drug alone, with no significant side-effects.

  6. Platelet-rich plasma (PRP applied during total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    João Paulo Fernandes Guerreiro

    2015-04-01

    Full Text Available OBJECTIVE: To evaluate the efficacy of platelet-rich plasma regarding healing, pain and hemostasis after total knee arthroplasty, by means of a blinded randomized controlled and blinded clinical study.METHODS: Forty patients who were going to undergo implantation of a total knee prosthesis were selected and randomized. In 20 of these patients, platelet-rich plasma was applied before the joint capsule was closed. The hemoglobin (mg/dL and hematocrit (% levels were assayed before the operation and 24 and 48 h afterwards. The Womac questionnaire and a verbal pain scale were applied and knee range of motion measurements were made up to the second postoperative month. The statistical analysis compared the results with the aim of determining whether there were any differences between the groups at each of the evaluation times.RESULTS: The hemoglobin (mg/dL and hematocrit (% measurements made before the operation and 24 and 48 h afterwards did not show any significant differences between the groups (p > 0.05. The Womac questionnaire and the range of motion measured before the operation and up to the first two months also did not show any statistical differences between the groups (p > 0.05. The pain evaluation using the verbal scale showed that there was an advantage for the group that received platelet-rich plasma, 24 h, 48 h, one week, three weeks and two months after the operation (p < 0.05.CONCLUSIONS: In the manner in which the platelet-rich plasma was used, it was not shown to be effective for reducing bleeding or improving knee function after arthroplasty, in comparison with the controls. There was an advantage on the postoperative verbal pain scale.

  7. Does rural residence impact total ankle arthroplasty utilization and outcomes?

    Science.gov (United States)

    Singh, Jasvinder A; Ramachandaran, Rekha

    2016-02-01

    The objective of this study was to compare total ankle arthroplasty (TAA) utilization and outcomes by patient residence. We used the Nationwide Inpatient Sample (NIS) from 2003 to 2011 to compare utilization and outcomes (post-arthroplasty discharge disposition, length of hospitalization, and mortality) by rural vs. urban residence. Ten thousand eight hundred thirty-three patients in urban and 3,324 patients in rural area underwent TAA. Compared to rural residents, urban residents had: lower mean age, 62.4 vs. 61.8 years (p < 0.0001); higher percent of women, 49 vs. 56 % (p = 0.0008); and lower proportion of Whites, 93 vs. 86 % (p = 0.0005). There were rural-urban disparities in TAA utilization in 2003 (0.32 vs. 0.39/100,000; p = 0.021), but not in 2011 (1.19 vs. 1.17/100,00; p = 0.80). TAA outcomes did not differ by rural vs. urban residence: (1) 11.3 % rural vs. 14.2 % urban residents were discharged to an inpatient facility (p = 0.098); (2) length of hospital stay above the median stay, was 44.8 vs. 42.2 % (p = 0.30); and (3) mortality was 0.2 vs. 0.1 %, respectively (p = 0.81). Multivariable-adjusted logistic regression models did not show any significant differences in discharge to home, length of stay, or mortality, by residence. Our study demonstrated an absence of any evidence of rural-urban differences in TAA outcomes. The rural-urban differences in TAA utilization noted in 2003 were no longer significant in 2011.

  8. Dislocation following total knee arthroplasty: A report of six cases

    Directory of Open Access Journals (Sweden)

    Villanueva Manuel

    2010-01-01

    Full Text Available Background: Dislocation following total knee arthroplasty (TKA is the worst form of instability. The incidence is from 0.15 to 0.5%. We report six cases of TKA dislocation and analyze the patterns of dislocation and the factors related to each of them. Materials and Methods: Six patients with dislocation of knee following TKA are reported. The causes for the dislocations were an imbalance of the flexion gap (n=4, an inadequate selection of implants (n=1, malrotation of components (n=1 leading to incompetence of the extensor mechanism, or rupture of the medial collateral ligament (MCC. The patients presented complained of pain, giving way episodes, joint effusion and difficulty in climbing stairs. Five patients suffered posterior dislocation while one anterior dislocation. An urgent closed reduction of dislocation was performed under general anaesthesia in all patients. All patients were operated for residual instability by revision arthroplasty after a period of conservative treatment. Results: One patient had deep infection and knee was arthrodesed. Two patients have a minimal residual lag for active extension, including a patient with a previous patellectomy. Result was considered excellent or good in four cases and fair in one, without residual instability. Five out of six patients in our series had a cruciate retaining (CR TKA designs: four were revised to a posterior stabilized (PS TKA and one to a rotating hinge design because of the presence of a ruptured MCL. Conclusion: Further episodes of dislocation or instability will be prevented by identifying and treating major causes of instability. The increase in the level of constraint and correction of previous technical mistakes is mandatory.

  9. Identifying victims of violence using register-based data

    DEFF Research Database (Denmark)

    Kruse, Marie; Sørensen, Jan; Brønnum-Hansen, Henrik;

    2010-01-01

    AIMS: The aim of this study was twofold. Firstly we identified victims of violence in national registers and discussed strengths and weaknesses of this approach. Secondly we assessed the magnitude of violence and the characteristics of the victims using register-based data. METHODS: We used three...... nationwide registers to identify victims of violence: The National Patient Register, the Victim Statistics, and the Causes of Death Register. We merged these data and assessed the degree of overlap between data sources. We identified a reference population by selecting all individuals in Denmark over 15....... RESULTS: In 2006, 22,000 individuals were registered as having been exposed to violence. About 70% of these victims were men. Most victims were identified from emergency room contacts and police records, and few from the Causes of Death Register. There was some overlap between the two large data sources...

  10. Prevalence of modifiable surgical site infection risk factors in hip and knee joint arthroplasty patients at an urban academic hospital.

    Science.gov (United States)

    Pruzansky, Jason S; Bronson, Michael J; Grelsamer, Ronald P; Strauss, Elton; Moucha, Calin S

    2014-02-01

    Surgical site infections after hip and knee arthroplasty can be devastating if they lead to periprosthetic joint infection. We examined the prevalence of the modifiable risk factors for surgical site infection described by the American Academy of Orthopaedic Surgery Patient Safety Committee. Our study of 300 cases revealed that only 20% of all cases and 7% of revision cases for infection had no modifiable risk factors. The most common risk factors were obesity (46%), anemia (29%), malnutrition (26%), and diabetes (20%). Cases with obesity or diabetes were associated with all histories of remote orthopedic infection, 89% of urinary tract infections, and 72% of anemia cases. The high prevalence of several modifiable risk factors demonstrates that there are multiple opportunities for perioperative optimization of such comorbidities.

  11. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study.

    Science.gov (United States)

    Klatte, Till Orla; Kendoff, Daniel; Sabihi, Reza; Kamath, Atul F; Rueger, Johannes M; Gehrke, Thorsten

    2014-07-01

    During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction. PMID:24559522

  12. Knee joint biomechanics and neuromuscular control during gait before and after total knee arthroplasty are sex-specific.

    Science.gov (United States)

    Astephen Wilson, Janie L; Dunbar, Michael J; Hubley-Kozey, Cheryl L

    2015-01-01

    The future of total knee arthroplasty (TKA) surgery will involve planning that incorporates more patient-specific characteristics. Despite known biological, morphological, and functional differences between men and women, there has been little investigation into knee joint biomechanical and neuromuscular differences between men and women with osteoarthritis, and none that have examined sex-specific biomechanical and neuromuscular responses to TKA surgery. The objective of this study was to examine sex-associated differences in knee kinematics, kinetics and neuromuscular patterns during gait before and after TKA. Fifty-two patients with end-stage knee OA (28 women, 24 men) underwent gait and neuromuscular analysis within the week prior to and one year after surgery. A number of sex-specific differences were identified which suggest a different manifestation of end-stage knee OA between the sexes.

  13. Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study

    NARCIS (Netherlands)

    Bisseling, P.; Wit, B.W. de; Hol, A.M.; Gorp, M.J. van; Kampen, A. van; Susante, J.L. van

    2015-01-01

    Patients from a randomised trial on resurfacing hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24 to 65) comparing a conventional 28 mm metal-on-metal total hip arthroplasty (MoM THA) (n = 28, 17 males; median age 59 years, 37 to 65) and a matched control group of asymptomatic patien

  14. Patella Eversion Reduces Early Knee Range of Motion and Muscle Torque Recovery after Total Knee Arthroplasty: Comparison between Minimally Invasive Total Knee Arthroplasty and Conventional Total Knee Arthroplasty

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    Tokifumi Majima

    2011-01-01

    Full Text Available We hypothesized that patella eversion during total knee arthroplasty (TKA reduces early return of active knee extension and flexion, quadriceps muscle strength, and postoperative pain. In 100 conventional TKA knees and 100 minimally invasive TKA (MIS TKA knees, we compared knee range of motion (ROM, postoperative pain, and quadriceps muscle strength at 1 day, 4 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 12 weeks, 1 year, and 5 years after surgery. The differences of surgical approach between MIS TKA and conventional TKA of this study are length of skin incision with subcutaneal flap and patella eversion. In MIS TKA, skin incision is shorter than conventional TKA. Furthermore, patella is not everted in MIS TKA procedure. There were no significant differences in preoperative factors. Postoperative improvement of ROM, postoperative muscle strength recovery, and postoperative improvement of visual analog scale were faster in patients with MIS TKA when compared to that in patients with conventional TKA. On the other hand, no significant difference was observed in complication, 5-year clinical results of subjective knee function score, and the postoperative component angle and lower leg alignment. These results indicate that patella eversion may affect muscle strength recovery and postoperative pain.

  15. Rehabilitation following total hip arthroplasty evaluation over short follow-up time: Randomized clinical trial

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    Carolina Sant'anna Umpierres, MSc

    2015-03-01

    Full Text Available Hip osteoarthritis (OA is a degenerative disease, and total hip arthroplasty (THA is one of the surgical procedures of choice to improve the OA patient’s quality of life. Without a rehabilitation program, THA patients will develop functional limitations. A randomized double-blind trial was performed between July 2009 and October 2011 to compare over a short follow-up time two groups of patients who underwent THA for OA. The THA protocol (THAP group received verbal instructions and physiotherapy exercise demonstrations, and the THA physiotherapy care protocol (THAPCP group received the same verbal instructions and demonstrations associated with daily exercise practice guided by a physiotherapist. The outcomes that were assessed preoperatively and 15 d postoperatively in 106 patients were muscle strength force, goniometry, Medical Outcomes Study 36-Item Short Form Health Survey, and Merle d’Aubigné and Postel score. Higher muscle strength force scores and degrees in range of motion were found in the THAPCP group. Greater improvements were also observed for the THAPCP group than the THAP group in the Merle d’Aubigné and Postel score. At the end of the follow-up period, the intervention in the THAPCP group improved functional capacity, quality of life, mobility, muscle strength, goniometry, and pain. It appears to be a safe tool for accelerating recovery in THA patients.

  16. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis.

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    Kadry, Bassam; Press, Christopher D; Alosh, Hassan; Opper, Isaac M; Orsini, Joe; Popov, Igor A; Brodsky, Jay B; Macario, Alex

    2014-01-01

    Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI) in patients undergoing total hip arthroplasty (THA) with different components of operating room (OR) time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE) was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P 35 kg/m(2) each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization.

  17. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis

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    Bassam Kadry

    2014-08-01

    Full Text Available Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI in patients undergoing total hip arthroplasty (THA with different components of operating room (OR time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P 35 kg/m2 each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization.

  18. Safety of Tourniquet Use in Total Knee Arthroplasty in Patients With Radiographic Evidence of Vascular Calcifications.

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    Koehler, Steven M; Fields, Adam; Noori, Naudereh; Weiser, Mitchell; Moucha, Calin S; Bronson, Michael J

    2015-09-01

    Tourniquets are often used in total knee arthroplasty (TKA) to improve visualization of structures, shorten operative time, reduce intraoperative bleeding, and improve cementing technique. Despite these advantages, controversy remains regarding the safety of tourniquet use. Tourniquets have been associated with nerve palsies, vascular injury, and muscle damage. Some have hypothesized they may also cause deep vein thrombosis. Last, increased incidence of postoperative wound complications has been reported with use of tourniquets. We conducted a retrospective cohort study to determine whether tourniquet use in TKA in patients with preexisting radiographic evidence of vascular disease increases the risk for wound complications or venous thromboembolism (VTE). Patients (N = 373) were placed in 2 groups: One had no preoperative radiographic evidence of knee arterial calcification (n = 285), and the other had arterial calcifications (n = 88). Overall, arterial calcification did not increase the risk for wound complication or VTE (P > .05). Furthermore, location of arterial calcification did not affect risk for wound complication or VTE. There were no arterial injuries. Diabetes, hypertension, prior VTE, coronary artery disease, and male sex were linked to higher wound complication rates (P < .05). Patients who have preoperative radiographic evidence of arterial calcification can safely undergo tourniquet-assisted TKA.

  19. Anxiety in patients undergoing fast-track knee arthroplasty in the light of recent literature

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    Ziętek, Paweł

    2014-10-01

    Full Text Available The rapid progress in knee implants technology and operational techniques go together with more and more modern medical programs, designed to optimize the patients’ care and shorten their stay in hospital. However, this does not guarantee any elimination of perioperative stress in patients. Anxiety is a negative emotional state arising from stressful circumstances accompanied by activation of the autonomous nervous system. Anxiety causes negative physiological changes, including wound healing, resistance to anesthetic induction, it is associated with an increased perioperative pain and prolong recovery period. The purpose of this work is to present the current state of knowledge on the preoperative anxiety and discuss its impact on pain and other parameters in patients undergoing fast-track arthroplasty of big joints. The work also shows selected issues of anxiety pathomechanism, and actual methods reducing preoperative anxiety in hospitalized patients. The common prevalence of anxiety in patients undergoing surgery induces the attempt to routinely identify patients with higher anxiety, which may be a predictive factor of worse results after TKA. Undertaking widely understood psychological support in these patients before and after the operation could be a favorable element, which would influence the final result of the treatment of patients after big joints arthroplastics.

  20. Effect of immediate postoperative portable radiographs on reoperation in primary total knee arthroplasty.

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    Moussa, Mohamed E; Malchau, Henrik; Freiberg, Andrew A; Kwon, Young-Min

    2014-09-01

    Cost-containment strategies are of increasing importance in total knee arthroplasty (TKA). Obtaining immediate postoperative radiographs following primary TKA is common practice, but their usefulness is controversial. The goal of this study was to evaluate the effect of immediate postoperative radiographs on reoperation within 60 days, assess film quality, and determine the cost associated with these radiographs. Using a billing registry at the authors' institution, the number of TKAs performed from 2000 to 2011 was determined. Of those, the authors determined which had undergone reoperation within 60 days. They evaluated those who had immediate postoperative radiographs following their primary TKA, and determined those who had been reoperated on as a result of information obtained from these radiographs. Of 6603 patients who underwent primary TKA from 2000 to 2011, 136 (2%) underwent reoperation within the first 60 days. The causes leading to reoperation were arthrofibrosis, infection, wound-healing complications, and hematoma. Of the 136 who underwent reoperation, 76 had immediate postoperative radiographs. None of them underwent reoperation as a result of findings noted in the radiographs. Of the radiographs reviewed, only 43% were deemed adequate by predetermined criteria. The results of the current study demonstrate that these radiographs do not affect the decision for reoperations that occur within 60 days of the index procedure. Although there may be a benefit to immediate postoperative radiographs in selected clinical situations, the decision for routine use needs to be weighed in light of significant cost and limited clinical usefulness. PMID:25350625