Discordance of global assessment between the patients and physicians predicts 9-year pain-related outcomes in rheumatoid arthritis patients.

Introduction: Perspectives regarding the disease state often differ between patients with rheumatoid arthritis (RA) and physicians. The aim of the present longitudinal cohort study was to investigate the impact of the discordance in global assessments between patients and physicians on 9-year pain-related outcomes in patients with rheumatoid arthritis. Method: Sixty-eight consecutive outpatients with rheumatoid arthritis on their first visit to a tertiary center were included. Baseline measurements included demographic data, drugs used, disease activity, and a modified Health Assessment Questionnaire (mHAQ). Discordance in global assessment between patients and physicians at baseline was defined as 10 mm higher in the patient global assessment (PGA) than in the physician global assessment. A 9-year follow-up assessment included pain intensity, the European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) scale, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and Pain Self-Efficacy Questionnaire (PSEQ). Results: The number of patients with discordance was 26 (38%) in 68 patients. Patients with a 10 mm higher PGA than the physician global assessment at baseline measurements had significantly worse pain intensity, PCS score, PSEQ score, and EQ-5D-3L score measurements at the 9-year follow-up than those with concordance. A higher mHAQ score and 10 mm higher PGA at baseline were significantly independently associated with the EQ-5D-3L scale score and pain intensity at the 9-year follow-up. Conclusion: This longitudinal cohort study suggested that discordance in global assessment between patients and physicians modestly predicted worse 9-year pain-related outcomes in patients with rheumatoid arthritis.

Evaluation of phase stability in zirconia femoral heads from different manufacturers after in vitro testing or in vivo retrieval.

Yttria-stabilized zirconia femoral heads from 3 different manufacturers were tested in vitro with respect to their phase stability and compared with retrieved zirconia heads. The monoclinic content on the surface of unused heads was analyzed by confocal Raman spectroscopy after exposure for increasing times to moist atmosphere. The increase in monoclinic content was then plotted as a function of geometric location on the head surface of the head and compared with that measured at similar locations after in vivo exposure. Profiles of residual stress associated to polymorphic transformation were also measured from the collected Raman spectra. A striking finding was that, in some samples, polymorphic transformation occurred since the very early stage of the environmental exposure even if those samples belonged to new-generation products.

Use of hydroxyapatite ceramics for treatment of nonunited osseous defect after open fracture of lower limbs.

INTRODUCTION: Osseous defects in nonunited open fracture of the lower limbs are difficult to treat. Autogenous bone grafting is a promising treatment options, but a finite amount of autogenous bone graft is available from each individual and donor site morbidity remains a problem. These limitations have prompted the development and use of synthetic biomaterials such as hydroxyapatite (HA) ceramics. However, little information is available regarding the challenging cases such as nonunited open fractures The purpose of the present study is to evaluate the outcomes associated with the treatment of osseous defects in nonunited open fracture using novel HA ceramics. METHODS: Twelve bones (4 femora and 8 tibias) in 11 patients (10 men and 1 woman), with an average age of 49.1 (range 19-71) years, with nonunited osseous defects after open fracture were treated by the grafting of HA ceramics alone or with autogenous iliac bone followed by internal or external fixation. RESULTS: The patients were followed for an average of 25.2 months in average (range 10.3 -58.1 months). Finally, 11 of 12 fractures united clinically and radiographically, while one fracture required a second procedure for additional autogenous iliac bone grafting. The average time to union from the index surgery was 5.6 months (median 5.3 months, range 2.3-11 months.). Radiographs showed good incorporation of grafted HA into the host bone in most of the united cases. As a complication, transient wound drainage was found in two cases. CONCLUSION: The current protocol using the HA ceramics appears to be safe and efficacious for the treatment of osseous defects after the open fractures.

Phase transformation of a new generation yttria-stabilized zirconia femoral head after total hip arthroplasty.

We examined a new-generation yttria-stabilized zirconia head manufactured by NGK 1 year after total hip arthroplasty. Monoclinic content of the retrieved head was twice that of the unused head at the pole and equator. A fourfold increase in monoclinic content was observed at 5 mm below the equator. Transformation from the tetragonal phase to the monoclinic phase occurred in the new generation zirconia with alumina doping within a relatively short period in vivo.

Proximal femoral bone mineral density after resurfacing total hip arthroplasty and after standard stem-type cementless total hip arthroplasty, both having similar neck preservation and the same articulation type.

To examine whether the Freeman cementless total hip arthroplasty (THA), with femoral neck preservation and a large metal head, can prevent stress shielding in a manner similar to resurfacing THA, we compared femoral bone mineral density (BMD) change in 10 resurfacing THA patients (group A) and 16 cementless THA patients (group B). Six and twelve months postoperatively, the mean BMD ratio in zone 1 was significantly higher in group A (97% +/- 10%, 95% +/- 11%) than in group B (79% +/- 15%, 77% +/- 20%); at 12 months, the mean BMD ratio in zone 7 was significantly higher in group A (104% +/- 15%) than in group B (84% +/- 21%). The cementless THA might not be a substitute for the resurfacing THA with respect to prevention of proximal femoral bone loss at the femoral neck, although it may prevent some major complications after resurfacing THA such as neck fracture and avascular necrosis of the femoral head.