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1.
Musculoskelet Surg ; 2024 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-39093383

RESUMO

PURPOSE: Quality of care in total knee arthroplasty (TKA) between implants was assessed using a novel composite outcome measure, early optimal recovery (EOR), to indicate ideal clinical outcomes and minimal healthcare resource utilization. METHODS: Patients that underwent primary TKA in the study group (ATTUNE® Knee System) or control group (LCS® COMPLETE Knee System) were included in this retrospective, single-center study. EOR was defined as no complications, no readmissions, no extra outpatient visits, ≤ 48 h length of hospital stay (LOS), and restored range of motion and pain perception at 3-month follow-up. Multivariate logistic regression was used to compare EOR between the study and control groups. Results were adjusted for differences in baseline characteristics and are presented with 95% confidence intervals (CI). Data were collected from a specialized clinic for elective surgeries in the Netherlands, between January 2017 and December 2020. RESULTS: A total of 566 patients (62.4% female, mean age 67 years) were included for analysis; 185 patients (32.7%) underwent TKA in the study group. Compared to the control group, patients in the study group had greater probability of achieving EOR (65.8% [95% CI: 55.1-75.2] vs. 38.9% [95% CI: 32.8-45.3]; p < 0.001), a LOS ≤ 48 h (77.2% [95% CI: 67.7-84.5] vs. 61.4% [95% CI: 54.7-67.7]; p < 0.05), and ideal pain perception at 3-month follow-up (93.3% [95% CI: 85.7-97.0] vs. 78.2% [95% CI: 71.0-83.9]; p < 0.05). CONCLUSION: The study group was associated with a greater probability of achieving EOR versus the control group, suggesting improved quality of care.

2.
ESMO Open ; 7(3): 100509, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35714479

RESUMO

BACKGROUND: Research in sarcomas has historically been the domain of scientists and clinicians attempting to understand the disease to develop effective treatments. This traditional approach of placing scientific rigor before the patient's reality is changing. This evolution is reflected in the growth of patient-centered organizations and patient advocacy groups that seek to meaningfully integrate patients into the research process. The aims of this study are to identify the unanswered questions regarding sarcomas (including gastrointestinal stromal tumors and desmoid fibromatosis) from patient, carer, and clinical perspectives and examine how patients and carers want to be involved in sarcoma research. METHODS: The Patient-Powered Research Network of Sarcoma Patients EuroNet set up a Priority Setting Partnership (PSP) in collaboration with stakeholders from the sarcoma research field. This PSP is largely based on the James Lind Alliance methodology. RESULTS: In total, 264 sarcoma patients (73%) and carers (27%) from all over the world participated in the online survey and covered the full spectrum of sarcomas. The topics mentioned were labeled in accordance with the Common Scientific Outline of the International Cancer Research Partnership and lists for potential research topics, advocacy topics, and requests for information were constructed. With regard to patient and carer involvement, 64% were very willing to be actively involved and mainly in the following areas: sharing perspectives, discussing patient-clinician interactions, and attending research meetings. CONCLUSIONS: The first results of this sarcoma PSP identified important research questions, but also important topics for patient advocacy groups and further improvement of information materials. Sarcoma patients and carers have a strong wish to be involved in multiple aspects of sarcoma research. The next phase will identify the top 10 research priorities per tumor type. These priorities will provide guidance for research that will achieve greatest value and impact.


Assuntos
Cuidadores , Sarcoma , Humanos , Sarcoma/terapia , Inquéritos e Questionários , Resultado do Tratamento
3.
Musculoskelet Surg ; 104(2): 207-214, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31250379

RESUMO

BACKGROUND: Irreparable rotator cuff tears (RCT) are still a challenging problem. RCT can result in disability and severe pain. The optimal treatment for this disabling and painful diagnosis remains controversial. The arthroscopic implantation of a biodegradable subacromial balloon spacer is a possible treatment option. In this prospective study, we evaluate the clinical outcome of this balloon spacer after approximately 3 years. METHODS: Between March 2014 and December 2015, the biodegradable balloon spacer was implanted into the subacromial space of 46 shoulders of 44 patients with massive irreparable RCT. Pain was evaluated using a numeric rating scale (NRS), and functional outcome was evaluated using the Oxford shoulder score (OSS). Patients were followed prospectively for approximately 3 years. This present study focuses on the comparison between the early and the midterm results up to approximately 3 years. RESULTS: All patients were treated by surgical implantation of the subacromial balloon spacer. The comparison between the outcomes of the NRS and the OSS after one and 3 years was made and showed no mutual significant differences, respectively, p = 0.61 and p = 0.08. Significant pain reduction and functional improvement was noticed postoperatively and maintained after approximately 3 years. At last follow-up (mean: 34 months), pain was reduced to a NRS of 3.09 points (95% CI: 2.17-4.01). Functional outcome based on the OSS improved significantly from 21.32 preoperatively to 34.39 (95% CI: 29.17-36.70) at the last follow-up. Correction for estimated confounders did not show significant differences. 82% of the patients were satisfied with the outcome after implantation of the subacromial balloon spacer. No surgical or postoperative medical complications due to implantation of the balloon spacer were reported. CONCLUSIONS: Arthroscopic implantation of the biodegradable balloon spacer in the subacromial space is a safe and minimally invasive intervention. It leads to significant reduction in pain and significant improvement of functional daily activities in patients with irreparable RCT during 3 years of follow-up starting postoperative and maintain over time beyond device degradation. A high percentage of patients are satisfied postoperatively. Despite of these positive results after 3 years of follow-up, the specific contribution of the balloon needs further investigation.


Assuntos
Implantes Absorvíveis , Artroscopia/métodos , Lesões do Manguito Rotador/cirurgia , Dor de Ombro/prevenção & controle , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Lesões do Manguito Rotador/complicações , Índice de Gravidade de Doença , Dor de Ombro/etiologia , Resultado do Tratamento
4.
Musculoskelet Surg ; 102(3): 247-255, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29151232

RESUMO

BACKGROUND: Massive rotator cuff tear (RCT) can result in disability and severe pain. When conservative treatment fails, surgical treatment should be considered, as various surgical options can provide relatively satisfactory results. However, choosing an optimal treatment remains controversial. A relatively new treatment for irreparable RCT is the arthroscopic implantation of a biodegradable balloon spacer into the subacromial space. Here, we examined whether placement of this balloon spacer reduces pain and improves functional outcome in patients with an irreparable RCT. Patients were followed for 1 year following implantation. METHODS: In this prospective single-arm study, a biodegradable balloon spacer was implanted into the subacromial space of patients with a massive RCT. Pain was evaluated using a numeric rating scale (NRS), and functional outcome was evaluated using the Oxford shoulder score (OSS) and the Constant-Murley shoulder score (CMS). Five follow-up visits were performed during the first postoperative year. RESULTS: Forty-six shoulders in 44 patients with massive RCT were treated by surgical implantation of the subacromial balloon spacer. The mean reduction in NRS score was 3.5 points (95% CI 2.5-4.4), and 74% of patients achieved the minimal clinically important difference of 2 points by the 1-year follow-up visit. Functional outcome improved significantly based on OSS and CMS scores, and 80% of patients reported that they were satisfied with their outcome. No surgical or postoperative medical complications due to implantation of the balloon spacer were reported. CONCLUSIONS: Our results suggest that arthroscopic implantation of a biodegradable balloon spacer in the subacromial space significantly reduces pain and improves activities of daily living in patients with massive RCT during 1 year of follow-up. The specific contribution of the balloon with respect to improved clinical outcome needs further study, ideally in a randomized controlled trial.


Assuntos
Implantes Absorvíveis , Implantação de Prótese/métodos , Lesões do Manguito Rotador/cirurgia , Atividades Cotidianas , Idoso , Artroscopia , Desbridamento , Feminino , Seguimentos , Humanos , Imobilização , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Desenho de Prótese , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Tenotomia , Resultado do Tratamento
5.
Musculoskelet Surg ; 101(1): 85-89, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27915404

RESUMO

PURPOSE: Reverse shoulder arthroplasty becomes more widely used as treatment for patients with complex cuff arthropathy. Theoretically, a higher retroversion of the humeral component leads to an increase in external rotation ROM and a decrease in internal rotation ROM. There is no consensus in optimal retroversion orientation. We retrospectively describe the effect of retroversion of the humeral component. We hypothesize that 20° humeral retroversion improves postoperative ROM, strength or clinical outcome scores compared to neutral retroversion. METHODS: A retrospective clinical study is performed. An Aequalis reverse shoulder prosthesis was placed in 65 shoulders from 58 patients with a mean age of 73.8 years (95% CI 72.0-75.6). Between October 2006 and May 2012, the humeral component was placed in neutral retroversion in 36 shoulders (55%). From June 2012 to June 2014, it was placed in 20° retroversion in 29 shoulders (45%). After a mean follow-up of 36 months with a minimum of 12 months, patients were invited for a study visit. ROM, strength, Constant-Murley and Oxford Scores were measured. RESULTS: ROM, strength and Constant-Murley and Oxford Scores did not differ significantly between both groups. CONCLUSIONS: With the Aequalis prosthesis, no significant effect of 0° or 20° retroversion on external and internal rotation ROM, strength or functional outcome scores was found.


Assuntos
Artroplastia de Substituição/métodos , Prótese Articular , Amplitude de Movimento Articular , Lesões do Manguito Rotador/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Úmero/cirurgia , Masculino , Estudos Retrospectivos , Ombro/cirurgia , Resultado do Tratamento
6.
Musculoskelet Surg ; 100(2): 121-6, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26984229

RESUMO

PURPOSE: Reverse shoulder arthroplasty becomes more widely used as a treatment for patients with painful cuff arthropathy. As a part of the deltopectoral approach, the subscapularis tendon, if present, is (partly) detached. There is no consensus on repair of the tendon after placement of the prosthesis. We retrospectively describe the clinical effects of subscapularis tendon reattachment. Our hypothesis was that subscapularis repair has no clinical effects on range of motion and functional outcome scores. METHODS: A retrospective clinical study is performed. An Aequalis reverse shoulder prosthesis (Tornier, Montbonnot, France) was placed in 65 patients with a mean age of 73.8 years (range 47-90). In 40 patients (61.5 %), the quality of the tendon was initially insufficient for repair. The subscapularis was repaired in 25 patients (38.5 %). After a mean follow-up of 36 months with a minimum of 12 months, an ultrasound examination of the subscapularis was performed in patients with a repaired tendon. Range of motion, strength, Constant-Murley and Oxford scores were measured. RESULTS: On ultrasound examination, 10 (40 %) out of 25 repaired subscapularis tendons were still sufficient. Postoperatively, range of motion, strength, Constant-Murley and Oxford scores did not differ significantly between repair with present tendon, repair with absent tendon or no repair. CONCLUSION: In reverse shoulder arthroplasty, no significant differences on range of motion, functional outcome scores or strength were found between subscapularis repair or no repair, whether the tendon healed at follow-up or not.


Assuntos
Artroplastia do Ombro/métodos , Tendões/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Modelos Biológicos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Manguito Rotador/cirurgia , Tendões/diagnóstico por imagem
7.
Bone Joint J ; 95-B(9): 1222-6, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23997136

RESUMO

As it remains unproven that hypermobility of the first tarsometatarsal joint (TMTJ-1) is a significant factor in hallux valgus deformity, the necessity for including arthrodesis of TMTJ-1 as part of a surgical correction of a hallux valgus is questionable. In order to evaluate the role of this arthrodesis on the long-term outcome of hallux valgus surgery, a prospective, blinded, randomised study with long-term follow-up was performed, comparing the Lapidus procedure (which includes such an arthrodesis) with a simple Hohmann distal closing wedge metatarsal osteotomy. The study cohort comprised 101 feet in 87 patients: 50 feet were treated with a Hohmann procedure and 51 with a Lapidus procedure. Hypermobility of TMTJ-1 was assessed pre-operatively by clinical examination. After a mean of 9.25 years (7.25 to 11.42), 91 feet in 77 patients were available for follow-up. There was no difference in clinical or radiological outcome between the two procedures. Also, there was no difference in outcome between the two procedures in the subgroup clinically assessed as hypermobile. This study does not support the theory that a hallux valgus deformity in a patient with a clinically assessed hypermobile TMTJ-1 joint requires fusion of the first tarso-metatarsal joint.


Assuntos
Artrodese/métodos , Hallux Valgus/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
8.
Res Dev Disabil ; 33(1): 45-53, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22093647

RESUMO

Anticipatory gaze behaviour during interceptive movements was investigated in children with Spastic Unilateral Cerebral Palsy (SUCP), and related to the side of the intracerebral lesion. Five children with lesions of the right hemisphere (RHL) and five children with lesions of the left hemisphere (LHL) had to walk towards and intercept a ball that moved perpendicular to the walking path. Interception accuracy and gaze patterns were measured in a no-occlusion and occlusion condition, in which the ball was occluded from view for half of its trajectory. There was a clear support for a relationship between gaze behaviour and success in interception performance, with some evidence for the presence of anticipatory gaze behaviour. There were also differences in gaze behaviour between children with RHL and children with LHL that might be related to planning, but these did not affect interception accuracy. It is concluded that gaze behaviour during interceptive movements is anticipatory, and at least partly dependent on the lesional side.


Assuntos
Paralisia Cerebral/fisiopatologia , Movimentos Oculares , Percepção de Movimento , Adolescente , Fenômenos Biomecânicos , Criança , Feminino , Humanos , Masculino , Desempenho Psicomotor , Análise e Desempenho de Tarefas
9.
J Head Trauma Rehabil ; 26(5): 384-91, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21321512

RESUMO

BACKGROUND: Heterotopic ossification (HO) is a frequent complication after traumatic brain injury (TBI). The current preliminary study is intended to provide additional data on the potential roles that brain injury severity, concomitant orthopaedic trauma, and specific intensive care complicating events may play in the prediction of HO in patients who have sustained severe TBI. METHODS: A prospective cohort study in patients with severe TBI. RESULTS: Ninety-seven of the 176 patients were eligible for follow-up; 13 patients (13%) developed 19 clinically relevant HOs at 1 or more sites. Univariate analysis indicated that patients with HO remained in coma longer (P < .001) and were ventilated during a longer period (P = .002). Autonomic dysregulation (relative risk = 6.11, 95% confidence interval: 2.53-14.76) and surgically treated extremity fractures (relative risk = 5.02, 95% confidence interval: 1.68-15.04) also showed significant associations with the development of HO. CONCLUSION: Prolonged coma duration and mechanical ventilation, coexistent surgically treated bone fractures and clinical signs of autonomic dysregulation should be given further consideration as potential risk factors for developing clinically relevant HO. Larger-scale studies are needed to develop a valid risk profile that takes into account the interrelationships between variables.


Assuntos
Lesões Encefálicas/complicações , Ossificação Heterotópica/etiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença , Índices de Gravidade do Trauma
10.
Disabil Rehabil ; 32(18): 1527-37, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20594115

RESUMO

PURPOSE: To determine the type of visual information used by children with spastic unilateral cerebral palsy (SUCP) in order to intercept a ball and to verify whether this information was dependent on the side of the lesion. More specifically, it was examined whether the interception was controlled on the basis of a time or a distance strategy, initiating the catch when the ball is at a fixed time interval or at a fixed distance from the point of interception. METHODS: Three groups of children were included. Children with either a left sided (LHL) or a right sided lesion (RHL) and children without a lesion [typically developing (TD)] intercepted a ball from a conveyor belt. In order to intercept the ball successfully they had to walk and to reach for the ball at the interception point 4 m away. RESULTS: Children with LHL had a longer decision time and started their reach movement earlier. In 56% of the children with LHL a distance strategy was observed, while in the TD and the children with RHL predominantly a time strategy was found. CONCLUSIONS: The side of the lesion influences the visual information used to initiate interceptive actions.


Assuntos
Paralisia Cerebral/fisiopatologia , Hemiplegia/fisiopatologia , Percepção de Movimento/fisiologia , Desempenho Psicomotor/fisiologia , Criança , Humanos , Caminhada/fisiologia
11.
Neurosci Lett ; 432(1): 7-12, 2008 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-18178007

RESUMO

The aims of the study are to determine the presence of adjustments in walking behaviour of children with Spastic Hemiparetic Cerebral Palsy (SHCP) during the interception of a moving ball and, whether the angle between the ball and the participant is kept constant. This would support the use of the so-called bearing angle (BA) strategy in interception of the object. Children with left hemisphere damage intercepted a ball from a conveyor belt at three different velocities, from a frontal or lateral orientation and with their impaired or less-impaired hand. The participants walked from a distance of 4m perpendicularly to the belt. Children seemed to have less successful trials when grasping with the impaired hand. The results showed that the walking velocity was adjusted to the ball velocity. When they grasped with the impaired hand, children initially moved faster to the interception point, while closer to the belt significant slower. The BA showed less variation over the trajectory when the children grasped with their less-impaired hand or when the ball velocity increased. It was concluded that children with SHCP were able to take their impairment into account as indicated by adjustments in walking behaviour. However, these adjustments in walking velocity were not sufficient to compensate totally for the limited reaching ability in the impaired hand. As a result of these adjustments, the amount of variation from the constant BA seemed to deviate more from typically developing children when grasping with impaired hand than when grasping with less-impaired hand.


Assuntos
Paralisia Cerebral/fisiopatologia , Paresia/fisiopatologia , Desempenho Psicomotor/fisiologia , Adaptação Fisiológica/fisiologia , Adolescente , Criança , Mãos/fisiologia , Força da Mão/fisiologia , Humanos , Atividade Motora/fisiologia , Gravação de Videoteipe , Caminhada/fisiologia
12.
Nucleic Acids Res ; 11(9): 2893-905, 1983 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-6856480

RESUMO

A single-helical B-type geometry is presented based on 1H NMR observations on d(TATA) and several other small single-helical DNA fragments. The structure is extended to one complete turn of double-helical DNA and its characteristics are compared with other known B-type structures.


Assuntos
Conformação de Ácido Nucleico , Oligodesoxirribonucleotídeos , Oligonucleotídeos , Poli dA-dT , Polidesoxirribonucleotídeos , Espectroscopia de Ressonância Magnética
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