What do patients know about their joint replacement implants?

BACKGROUND AND AIMS: Following a hip or knee replacement, patients may have little information about their prosthesis. This can lead to anxiety in the face of media reports about failing implants or misconceptions about how to live with a joint replacement. The aim of this study was to determine the level of understanding amongst patients who had undergone joint replacement in order to inform the development of an educational intervention. METHODS AND RESULTS: A cross-sectional, questionnaire-based survey. The survey was administered to patients attending an orthopaedic arthroplasty follow up clinic between June 2012 and October 2012. Patients were selected in a convenience sampling manner and had all undergone joint replacement at least three months prior to the survey. Responses were available from 52 patients; 49/52 (94%) of patients did not know what model of joint replacement they had and 44/52 (85%) did not know what materials the implant was made from. There was wide variation in recall of advice about activity restrictions. CONCLUSION: Whilst patients used the internet and other sources to look for advice, this survey suggests the most appropriate educational intervention for this population would involve written information including advice about type of implant, activity restrictions, dental treatment and airport security detectors.

Surgical treatment of spinal stenosis in achondroplasia: Literature review comparing results in adults and paediatrics.

BACKGROUND: This study aims to assess the quantity and quality of available literature on surgical treatment outcomes of spinal stenosis in adult and paediatric achondroplasia patients through a systematic review of literature and to investigate the suitability of conducting a meta-analysis on outcomes of surgical treatment. METHODS: Online databases were searched according to PRISMA guidelines. No restrictions regarding study design, sample size, previous treatment, or publication date were implemented. The following terms: "Spinal stenosis", "Spinal Decompression", "Spinal fusion", each term separately combined with the term "Achondroplasia" were used. Quality of the included studies were assessed used the Modified Coleman method. RESULTS: Five adult and four paediatric single-sample non-comparative studies were identified for inclusion (176 adult and 102 paediatric patients). Meta-analyses assessed the proportion of patients achieving full resolution of symptoms to be 0.51 (95% CI 0.00 to 1.00); the proportion of patients achieving full or partial resolution of symptoms to be 0.90 (95% CI 0.84 to 0.97); the proportion of procedures requiring re-operation to be 0.42 (95% CI 0.34 to 0.50; and the proportion of procedures involving dural tears to be 0.20 (95% CI 0.02 to 0.39). Statistical heterogeneity was very high for full resolution of symptoms and requirement for dural repair; and very low for other outcomes. CONCLUSIONS: The available literature on this population and condition is sparse, highly heterogenous, and is generally of low quality limiting the value of meta-analysis. Overall, outcomes of surgical decompression of symptomatic spinal stenosis in achondroplasia patients show consistent degree of resolution of symptoms. Duration of symptoms prior to surgical treatment appears to play an important role in the overall outcome of treatment. Therefore, a delay in diagnosis and treatment can potentially be detrimental in achieving a better outcome.