Are There Gender-Specific Errors in Restoration of Hip Biomechanics That Affect Outcome Following Total Hip Arthroplasty?

BACKGROUND: There are morphologic differences between males and females, which are currently underappreciated during total hip arthroplasty. We sought to assess whether these differences affected surgical process and subsequent outcome. METHODS: A total of 123 patients (75 females, 48 males) had preoperative and 1-year Oxford Hip Score (OHS) and pain scores recorded. Acetabular height and offset, femoral height and offset, and acetabular floor depth were measured on preoperative and postoperative X-rays and then compared to their normal opposite hip. Discrepancies between the replaced and normal hip X-ray measurements were then correlated with changes (the delta gain) in preoperative and 1-year postoperative OHS and pain scores. RESULTS: Postoperatively, females had significantly greater femoral height discrepancy (P = .023) which meant they were lengthened. This led to a reduced delta gain in OHS and pain score at 1 year. Males lost more acetabular offset than females (P = .002), leading to a medialized acetabular center and subsequently reduced delta gain in pain score at 1 year (P = .017). CONCLUSION: Females have a smaller femur leading to a bias toward a conservative (higher) neck cut compared with males and potential for femoral lengthening. Males have a greater acetabular floor depth compared with females and thus reaming to the true floor results in greater loss of acetabular offset. In this series, both scenarios led to reduced improvement in OHS and/or pain scores at 1 year.

Dietary patterns and hearing loss in older men enrolled in the Caerphilly Study.

The association between dietary patterns (DP) and prevalence of hearing loss in men enrolled in the Caerphilly Prospective Study was investigated. During 1979-1983, the study recruited 2512 men aged 45-59 years. At baseline, dietary data were collected using a semi-quantitative FFQ, and a 7-d weighed food intake (WI) in a 30 % subsample. Five years later, pure-tone unaided audiometric threshold was assessed at 0·5, 1, 2 and 4 kHz. Principal component analysis (PCA) identified three DP and multiple logistic and ordinal logistic regression models examined the association with hearing loss (defined as pure-tone average of frequencies 0·5, 1, 2 and 4 kHz >25 dB). Traditional, healthy and high-sugar/low-alcohol DP were found with both FFQ and WI data. With the FFQ data, fully adjusted models demonstrated significant inverse association between the healthy DP and hearing loss both as a dichotomous variable (OR=0·83; 95 % CI 0·77, 0·90; P<0·001) and as an ordinal variable (OR=0·87; 95 % CI 0·81, 0·94; P<0·001). With the WI data, fully adjusted models showed a significant and inverse association between the healthy DP and hearing loss (OR=0·85; 95 % CI 0·73, 0·99; P<0·03), and a significant association between the traditional DP (per fifth increase) and hearing loss both as a dichotomous variable (OR=1·18; 95 % CI 1·02, 1·35; P=0·02) and as an ordinal variable (OR=1·17; 95 % CI 1·03, 1·33; P=0·02). A healthy DP was significantly and inversely associated with hearing loss in older men. The role of diet in age-related hearing loss warrants further investigation.

Participating in a fruit and vegetable intervention trial improves longer term fruit and vegetable consumption and barriers to fruit and vegetable consumption: a follow-up of the ADIT study.

BACKGROUND: Fruit and vegetable (FV) based intervention studies can be effective in increasing short term FV consumption. However, the longer term efficacy of such interventions is still unclear. The aim of the current study was to examine the maintenance of change in FV consumption 18-months after cessation of a FV intervention and to examine the effect of participating in a FV intervention on barriers to FV consumption. METHODS: A follow-up of a randomised controlled FV trial in 83 older adults (habitually consuming ≤2 portions/day) was conducted. At baseline, participants were assigned to continue consuming ≤2 portions FV/day or consume ≥5 portions FV/day for 16-weeks. We assessed FV intake and barriers to FV consumption at baseline, end of intervention and 18-months post-intervention. RESULTS: At 18-months, mean FV intakes in both groups were greater than baseline. The 5 portions/day group continued to show greater increases in FV consumption at 18-months than the 2 portions/day group (p < 0.01). At 18-months, both groups reported greater liking (p < 0.01) and ease in consuming FV (p = 0.001) while difficulties with consuming FV decreased (p < 0.001). The 2 portions/day group reported greater awareness of FV recommendations at 18-months (p < 0.001). CONCLUSIONS: Participating in a FV intervention can lead to longer-term positive changes in FV consumption regardless of original group allocation. TRIAL REGISTRATION: Clinical Trials.gov NCT00858728 .

Twenty-year survivorship of a cemented mobile bearing Total Knee Arthroplasty.

BACKGROUND: Increasing numbers of Total Knee Arthroplasty (TKA) operations are carried out worldwide each year. This brings with it an ever-increasing revision burden and it is therefore important to appreciate both the functional outcome and survivorship of established arthroplasties when considering new designs. We aim to evaluate the long-term survivorship of a fully cemented mobile bearing Total Knee Arthroplasty. METHODS: This study prospectively analyses the 20-year survivorship of a cohort of 487 consecutive patients who underwent cemented TKA under the care of a single surgeon using the Low Contact Stress (LCS) rotating platform (RP) implant. These patients were followed up prospectively with patient reported and functional outcomes recorded at regular intervals postoperatively. RESULTS: Five hundred and forty-two consecutive primary TKAs were carried out in 487 patients. A total of 139 knees (25.6%) were reviewed at 20 years post-operation. Overall cumulative survivorship, using revision for any reason as primary endpoint, was 98.0%. Mean Knee Society Scores for the patient cohort were 87.3 (Clinical score) and 52.5 (Functional score). Eleven (2.0%) were revised within 20 years - two for aseptic loosening, two for unexplained pain, five secondary patellar resurfacings for anterior knee pain, one for late infection and one liner exchange following spin-out. CONCLUSION: This series demonstrates excellent survivorship and satisfactory outcome of a cemented mobile bearing TKA at 20 years.

No difference in gait kinematics or kinetics between limbs in bilateral total hip replacement patients at long-term follow-up.

BACKGROUND: Previous studies report that gait parameters of patients following total hip replacement improve from pre-operative levels, although in most cases do not reach those of normal subjects. However, studies are generally of unilateral total hip replacement patients at short-term follow-up. There have been no reports of 3D gait kinematics and kinetics in patients with bilateral total hip replacements at long-term follow-up. The aim of this study was to compare temporospatial parameters and 3D lower limb gait kinematics and kinetics at long-term follow-up between limbs and against controls for patients who have undergone staged bilateral total hip replacement. METHODS: 3D gait analysis was performed on 13 patients who had undergone bilateral total hip replacement, at an average follow-up of 10.1 (first hip) and 9.3 years (second hip), and a normal elderly control group comprising 10 subjects. FINDINGS: Knee flexion/extension range of motion was marginally greater in Hip 2 (p = 0.049) compared to Hip 1 by 3.2°. There were no other significant differences in temporospatial parameters or a range of lower limb kinematics or kinetics between the first and second operated hip. Multiple gait parameters were significantly worse for both hips compared to age-matched normal individuals. INTERPRETATION: Although symmetrical biomechanical recovery was achieved, significant gait deficiencies remain in both hips compared to normal controls. These deficits may provide targets for enhanced rehabilitation programs.

Factors Affecting Hearing Aid Adoption and Use: A Qualitative Study.

BACKGROUND: Despite a high prevalence of age-related hearing loss in older people, there is an unexplained low level of hearing aid adoption and use. Further research is required to determine the reason because hearing aids can vastly improve the quality of life for those with hearing loss. PURPOSE: The aim of this study was to explore factors associated with hearing aid adoption and use, and to determine whether these differed between groups with different hearing aid use behaviors. RESEARCH DESIGN: Individual face-to-face semistructured interviews. STUDY SAMPLE: Three groups of older people with hearing loss in Northern Ireland were recruited: (1) regular hearing aid users (n = 12), (2) irregular hearing aid users (n = 10), and (3) hearing aid nonowners (n = 10). DATA COLLECTION AND ANALYSIS: Qualitative thematic analysis, using principles of grounded theory, was used to code the data and extract emerging themes for each of the three groups to distinguish similarities and differences between the groups. One-way analysis of variance and χ² tests were used to determine the difference in continuous and categorical variables, respectively, between the three groups. RESULTS: Similar themes emerged across the three groups: the complexity of low hearing aid use and attitudes to hearing loss/hearing aid use. A third theme, inadequacy of audiology services, was identified in both groups using hearing aids. Older age people having more severe hearing loss and longer duration of hearing aid ownership were associated with greater hearing aid adoption and use. CONCLUSIONS: Similar themes emerged from qualitative analysis across groups of people with hearing loss. More information for those with hearing loss and those with hearing aids and scheduled follow-up appointments for those with hearing aids are essential to improve hearing aid adoption and use in older people. Further research should focus on the most suitable methods of distributing this information and how often follow-up appointments should take place to achieve optimal hearing aid adoption and use.

Biomarker-based corticosteroid adjustment in severe asthma: a modified Delphi consensus.

UK asthma physicians are supportive of biomarker-based steroid adjustment, but European physicians need more evidence http://ow.ly/sTrf30my3jw.