ABSTRACT
BACKGROUND: Despite numerous scientific investigations, the tribological advantages of mobile bearing inserts have not been sustainably confirmed or refuted for modern knee prostheses in clinical studies. The purpose of this study was to compare fixed and mobile bearing inserts in order to draw conclusions regarding clinical benefits. METHODS: The present prospective single center cohort study of 2 non-randomized stratified groups consisted of 67 patients. All included patients received cemented total knee arthroplasty (Attune®) due to osteoarthritis. 34 patients were treated with a mobile and 33 patients with a fixed insert. The WOMAC score and the Visual Analogue Scale was used for the subjective assessment of success, while the Knee-Society-Score was used considering the Range of Motion for the objective assessment. The subjective and the clinical scores showed improvements for both compared groups postoperatively at 2 years of minimum follow-up. RESULTS: The overall postoperative results of the WOMAC score, the Knee-Society-Score and the Visual Analogue Scale presented no statistically difference between the compared groups (p > 0,05). The postoperative ROM showed a superior improvement of 13.2° ± 18.4° in the mobile-bearing group versus 4.9° ± 18.4° (p = 0.017) in the fixed-bearing group. The flexion of the knee joint was 114° ± 10.1° for the mobile-bearings and 109.2° ± 7.2° for fixed bearings (p = 0.012). CONCLUSION: According to the findings, both inserts showed overall promising postoperative results, in terms of objective as well as subjective parameters, without clinically relevant significant differences, except for ROM, which was superior in the mobile bearing group. The present clinical trial has been registered at the ISRCTN registry with the reverence number ISRCTN15117998 on 04/04/2022.
Subject(s)
Arthroplasty, Replacement, Knee , Osteoarthritis, Knee , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Cohort Studies , Humans , Osteoarthritis, Knee/surgery , Pain/surgery , Prospective Studies , Prosthesis Design , Range of Motion, ArticularABSTRACT
PURPOSE: The purpose of this study was to compare the clinical and functional outcome scores following total knee arthroplasty (TKA) with two different systems. The hypothesis was that there is a difference between patients receiving the newer design than those receiving the predecessor. METHODS: Two hundred patients who underwent TKA were randomized into two groups: patients received either Attune TKA or PFC Sigma (both DePuy Synthes, Warsaw, IN). Clinically, the Knee Society Knee and Function Scores (KS and FS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Range of Motion (ROM) and Visual Analogue Scale (VAS) were evaluated and compared between the groups 2 years after surgery. 158 patients (80 in the Attune group and 78 in the PFC Sigma group) were available for follow-up. RESULTS: Through bivariate analysis using parametric and non-parametric statistical tests, no significant differences in postoperative KS, FS, WOMAC, ROM or VAS between the two groups were detected. Both groups significantly improved regarding all evaluated endpoints 2 years after surgery. CONCLUSIONS: In the current study population, no difference in clinical outcome between the two systems was found. The expected benefits of design modifications could not be observed in clinical outcome scores 2 years postoperatively. Both designs are effective options for improving pain and function in end-stage osteoarthritis. LEVEL OF EVIDENCE: I.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Osteoarthritis, Knee/surgery , Aged , Female , Follow-Up Studies , Humans , Knee Joint/surgery , Knee Prosthesis , Male , Middle Aged , Pain/epidemiology , Pain Measurement , Postoperative Period , Prospective Studies , Range of Motion, Articular , Treatment OutcomeABSTRACT
INTRODUCTION: The aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA). HYPOTHESIS: Patients with PEM would have inferior post-operative outcome after THA. MATERIALS AND METHOD: We retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database. RESULTS: The prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly (p < 0.001) between PEM (median 7, range 1-36 days) and non PEM (median 1, range 1-22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7-23.1). CONCLUSION: We observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome.
Subject(s)
Arthroplasty, Replacement, Hip , Malnutrition , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/adverse effects , Humans , Length of Stay , Malnutrition/complications , Malnutrition/diagnosis , Malnutrition/epidemiology , Nutrition Assessment , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective StudiesABSTRACT
PURPOSE: Metaphyseal fixation in revision total knee arthroplasty (RTKA) is a very promising treatment option for extended bone defects. Currently published mid-term results remain limited. The purpose was to analyse the implant durability, the clinical and the radiological mid-term results in RTKA when using metaphyseal sleeves. METHODS: Clinical and radiological follow-up examinations were performed in 92 patients (93 knees) with RTKA using hybrid fixation technique (cementless sleeves and stem). Radiographic measurements regarding osseointegration at the bone-sleeve interface were performed and the range of motion (ROM), a subjective satisfaction score (SSS), the American Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the SF-36 Health survey were examined. Bone defects were analysed using the Anderson Orthopaedic Research Institute (AORI) classification. RESULTS: No knee had to be revised due to aseptic loosening at the time of the follow-up (mean 6.3 years ± 2.3, minimum 2 years). Satisfactory radiographic osseointegration at the sleeve/bone interface was detected in 96.1% of cases. 17 knees (18.2%) had to be re-revised, 15 of them due to a recurrent infection and 2 due to aseptic reasons (mediolateral instability and a periprosthetic fracture). The median of the ROM (96°), SSS (8), KSS (87), WOMAC (9), SF-36 MCS (55) and SF-36 PCS (38) showed very satisfying results. CONCLUSION: No case of aseptic loosening was found in this large series of RTKA with extended bone defects using metaphyseal sleeve fixation. In this large retrospective series, it has been shown that this technique is an excellent treatment option for extended bone defects in RTKA surgery. LEVEL OF EVIDENCE: Retrospective cohort study, level III.
Subject(s)
Arthroplasty, Replacement, Knee/instrumentation , Knee Prosthesis/statistics & numerical data , Osseointegration , Reoperation/instrumentation , Adult , Aged , Aged, 80 and over , Bone and Bones/surgery , Female , Humans , Knee Joint/surgery , Male , Middle Aged , Prosthesis Design , Radiography , Retrospective StudiesABSTRACT
PURPOSE: The purpose of this study was to provide a matched cohort comparison of clinical and functional outcome scores, range of motion and quality of life following unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). The hypothesis was that patients receiving UKA report better results than comparable patients who receive conventional TKA. METHODS: Clinical and functional results of 35 patients with medial end-stage osteoarthritis who had received a fixed-bearing UKA were compared with the results of 35 matched patients who had received a TKA from the same manufacturer by the same surgeon. Outcome scores were measured before surgery and at final follow-up using Tegner Activity Scale (TAS), range of motion (ROM) and Short Form 36 Health Survey (SF-36). The Knee Society Score (KSS) was assessed at final follow-up. The mean observation period was 2.3 years in both groups. RESULTS: The preoperative knee scores had no statistically significant differences between the two groups. Postoperatively, however, UKAs performed significantly better regarding TAS and ROM (4 vs. 3 and 118.4 vs. 103.7, respectively). The results of the SF-36 showed significantly better results for the UKA group in the mental component summary score and in the subscale of social function. CONCLUSIONS: The present study suggests that UKA is associated with higher activity level, higher quality of life, and greater ROM when compared with TKA on comparable patients. Prolonged clinical follow-up in a larger patient cohort with a randomised-controlled study design would be beneficial to confirm these findings. LEVEL OF EVIDENCE: III.
Subject(s)
Arthroplasty, Replacement, Knee , Quality of Life , Range of Motion, Articular/physiology , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Arthroplasty, Replacement, Knee/statistics & numerical data , Case-Control Studies , HumansABSTRACT
PURPOSE: Our aim was to assess the outcome with respect to cumulative revision rates of unicompartmental knee arthroplasty (UKA) by comparing published literature and arthroplasty registry data. Our hypothesis was that there is a superior outcome of UKA described in dependent clinical studies compared to independent studies or arthroplasty registers. METHODS: A systematic review of all clinical studies on UKA in the past decade was conducted with the main endpoint revision rate. Revision rate was calculated as "revision per 100 component years (CY)". The respective data were analysed with regard to a potential difference of the percentage of performed revision surgeries as described in dependent and independent clinical studies. Clinical data were further compared to arthroplasty registers in a systematic search algorithm. RESULTS: In total, 48 study cohorts fulfilled our inclusion criteria and revealed 1.11 revisions per 100 CY. This corresponds to a revision rate of 11.1% after 10 years. No deviations with regard to revision rates for UKA among dependent and independent clinical literature were detected. Data from four arthroplasty registers showed lower survival rates after 10 years compared to published literature without being significant. CONCLUSIONS: The outcomes of UKA in dependent and independent clinical studies do not differ significantly and are in line with arthroplasty register datasets. We cannot confirm biased results and the authors recommend the use of UKAs in properly selected patients by experts in their field.
Subject(s)
Arthroplasty, Replacement, Knee , Reoperation/statistics & numerical data , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Arthroplasty, Replacement, Knee/statistics & numerical data , Humans , Knee/surgery , Registries , Treatment OutcomeABSTRACT
BACKGROUND: Bone loss is a severe problem in septic revision total knee arthroplasty (RTKA). The use of porous coated metaphyseal sleeves is a promising treatment option for metaphyseal bone defects. The currently published midterm results remain limited and no study has been focused exclusively on septic cases. Our aim was to determine the implant survivorship (with special focus on osseointegration) and the clinical and radiological midterm outcome of metaphyseal sleeve fixation in septic RTKA surgery (minimum follow-up of 2 years). METHODS: We performed a clinical and radiographic examination of 56 patients with a history of prosthetic joint infection who underwent 2-stage RTKA with the use of porous coated metaphyseal sleeves. These examinations included evaluation of the American Knee Society Score, the Western Ontario and McMaster Universities Osteoarthritis Index, the Short Form (SF-36) Health survey as well as radiographic measurement to determine whether successful osseointegration had been achieved. RESULTS: Nine patients (16%) had to be re-revised at the time of follow-up (mean, 5.3 years; range, 2-11.2), all due to reinfection. We did not encounter any cases of aseptic loosening. The mean range of motion (92°, SD ± 21°), subjective satisfaction score (7, SD ± 2), American Knee Society Score (76, SD ± 19), Western Ontario and McMaster Universities Osteoarthritis Index (70, SD ± 20), SF-36 mental component summary (55, SD ± 14), and SF-36 physical component summary (35, SD ± 9) have shown satisfying results. CONCLUSION: Metaphyseal sleeves have shown very promising midterm results regarding clinical scores, osseointegration, and aseptic loosening. Our results are the first analyzing exclusively septic indications and indicate that they are a reliable fixation option in all bone defect types in septic RTKA patients.
Subject(s)
Arthritis, Infectious/surgery , Arthroplasty, Replacement, Knee/instrumentation , Osseointegration , Prosthesis-Related Infections/surgery , Reoperation/instrumentation , Aged , Aged, 80 and over , Female , Health Surveys , Humans , Knee Joint , Knee Prosthesis , Male , Middle Aged , Physical Examination , Porosity , Prosthesis Design , RadiographyABSTRACT
Adipose tissue contains thermogenic adipocytes (i.e., brown and brite/beige) that oxidize nutrients at exceptionally high rates via nonshivering thermogenesis. Its recent discovery in adult humans has opened up new avenues to fight obesity and related disorders such as diabetes. Here, we identified miR-26a and -26b as key regulators of human white and brite adipocyte differentiation. Both microRNAs are upregulated in early adipogenesis, and their inhibition prevented lipid accumulation while their overexpression accelerated it. Intriguingly, miR-26a significantly induced pathways related to energy dissipation, shifted mitochondrial morphology toward that seen in brown adipocytes, and promoted uncoupled respiration by markedly increasing the hallmark protein of brown fat, uncoupling protein 1. By combining in silico target prediction, transcriptomics, and an RNA interference screen, we identified the sheddase ADAM metallopeptidase domain 17 (ADAM17) as a direct target of miR-26 that mediated the observed effects on white and brite adipogenesis. These results point to a novel, critical role for the miR-26 family and its downstream effector ADAM17 in human adipocyte differentiation by promoting characteristics of energy-dissipating thermogenic adipocytes.
Subject(s)
Adipocytes, Brown/metabolism , Adipogenesis/genetics , MicroRNAs/metabolism , ADAM Proteins/metabolism , ADAM17 Protein , Adipocytes, Brown/cytology , Adipocytes, Brown/ultrastructure , Adipose Tissue, White/metabolism , Adipose Tissue, White/ultrastructure , Adult , Cell Differentiation/genetics , Child, Preschool , Cold Temperature , Computer Simulation , Humans , Infant , Ion Channels , Male , MicroRNAs/genetics , Mitochondria/metabolism , Mitochondria/ultrastructure , Mitochondrial Proteins , Signal Transduction/genetics , Transcriptome/genetics , Uncoupling Protein 1 , Up-Regulation/geneticsABSTRACT
BACKGROUND: Sportsmen's groin (SG) is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor in the absence of a groin hernia. Long-term results for laparoscopic inguinal hernia repair, especially data on health-related quality of life (HRQOL), are scant and there are no available data whatsoever on HRQOL after SG. The main goal of this study was to compare postoperative QOL data in the long term after transabdominal preperitoneal hernioplasty (TAPP) in groin hernia and SG patients with QOL data of a normal population. METHODS: This study included all patients (n = 559) who underwent TAPP repair between 2000 and 2005. Forty seven patients (8.4 %) were operated on for SG. We sent out the Short Form 36 Health Survey (SF-36) questionnaire for QOL evaluation. QOL data were compared with data from an age- and sex-matched normal population. RESULTS: Ultimately, 383 completed questionnaires were available for evaluation (69 % response rate). The mean follow-up time was 94 ± 20 months. In the SG group there were statistically significant differences in three subscales of the SF-36 and the mental component summary measure, showing better results for the SG group compared to the sex- and age-matched normal group data. There were no statistically significant differences between groin hernia patients and the sex- and age-matched normal population. CONCLUSION: TAPP repair for SG as well as groin hernia results in good HRQOL in the long term. Results for SG patients are comparable with QOL data of a normal population or even better.
Subject(s)
Athletes/psychology , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Laparoscopy/methods , Quality of Life , Adult , Aged , Female , Follow-Up Studies , Herniorrhaphy/psychology , Humans , Laparoscopy/psychology , Male , Middle Aged , Postoperative Period , Retrospective Studies , Surveys and Questionnaires , Time FactorsABSTRACT
BACKGROUND: This study aimed to present functional results and patient's health related quality of life (HRQOL) data ten years after volar locked plate fixation (VPF) of unstable intra-articular distal radial fractures (DRF). METHODS: Thirty-nine patients with a mean age of sixty-one years were operatively treated with VPF after intra-articular distal radial fractures. They were evaluated two, six, and ten years postoperatively according to the Gartland and Werley score. For subjective evaluation the Short Form 36 (SF-36) and the Disability of Arm, Shoulder and Hand (DASH) questionnaires were adopted. RESULTS: Overall, wrist function did not differ significantly two, six and ten years after the operation. Over 90% patients achieved "good" or "excellent" results ten years after surgery according to the Gartland and Werley score. Ten years postoperatively the results of the SF 36 did not differ significantly from the two- and six-year follow-up. Overall findings from the SF-36 did not differ significantly from the data of Austrian and American norm populations. Only in the subscale of mental health (MH) the ten-year follow-up did show significantly poorer results (p = 0.045) compared to the Austrian norm population. The median DASH scores did not show significant differences during the ten-year follow-up period. CONCLUSION: The ten-year results of this single-center study suggest that operative treatment of intra-articular DRF with volar locked plates is a useful and satisfactory therapy option, both in terms of function and HRQOL.
Subject(s)
Bone Plates , Fracture Fixation, Internal/instrumentation , Quality of Life , Radius Fractures/surgery , Adult , Aged , Aged, 80 and over , Austria , Disability Evaluation , Female , Follow-Up Studies , Humans , Male , Mental Health , Middle Aged , Prosthesis Design , Radius Fractures/diagnosis , Radius Fractures/physiopathology , Radius Fractures/psychology , Recovery of Function , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
Metabolomic profiles of tissues could greatly contribute to advancements in personalized medicine but are influenced by differences in adopted preanalytical procedures; nonhomogeneous pre- and post-excision ischemia times are potential sources of variability. In this study, we monitored the impact of ischemia on the metabolic profiles, acquired with high-resolution magic-angle-spinning (1)H NMR, of 162 human liver samples collected during and up to 6 h after routine surgery. The profiles changed significantly as a function of intraoperative warm ischemia (WI) and postresection cold ischemia (CI) time, with significant variations in the concentration of the same 16 metabolites. Therefore, a tight control of the preanalytical phase is essential for reliable metabolomic analyses of liver diseases. The NMR profiles provide a reliable "fingerprint" of ischemia and have predictive value: the best-performing predictive models are found to discriminate extreme time points of CI (0' vs 360 ') in the training set with cross-validation accuracy of ~90%; samples in the validation cohort can discriminate short (≤60') from long (≥180') CI with an accuracy of ~80%. For WI, the corresponding figures are 95.6 and 92%, respectively. Therefore, ischemia NMR profiles might become a tool for tissue quality control in biobanks.
Subject(s)
Carcinoma/metabolism , Colonic Neoplasms/metabolism , Liver Neoplasms/metabolism , Liver/metabolism , Metabolome , Biomarkers/metabolism , Carcinoma/secondary , Carcinoma/surgery , Cold Ischemia , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Humans , Liver/pathology , Liver/surgery , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Magnetic Resonance Spectroscopy , Models, Statistical , Time Factors , Warm IschemiaABSTRACT
Obesity is strongly associated with mortality and morbidity, but there is a lack of data on its impact on health-related quality of life (HRQoL) across different age groups. Therefore, this study's objective was to determine the association between body mass index (BMI) and HRQoL in the Austrian adult population based on age groups using the 36-Item Short Form (SF-36) survey. METHODS: The SF-36 survey was sent to 500 randomly assigned Austrian adults (response rate: 80.6%). This study assessed HRQoL subscale and component scores based on gender, level of education, smoking status, and alcohol consumption in 403 participants. RESULTS: Increasing BMI is associated with a negative impact on all domains of physical health and social function. The study uncovered substantial variations in the impact of increasing BMI on HRQoL across different age groups, with a pronounced effect observed in the physical components, particularly among individuals aged 65-74. CONCLUSIONS: BMI is negatively associated with the physical aspects of HRQoL and social function, affecting various adult age groups differently. Consequently, our results emphasize assessing different age groups and possible influencing factors on HRQoL, such as BMI, for further optimization in designing prevention programs against obesity.
Subject(s)
Obesity , Quality of Life , Adult , Humans , Body Mass Index , Cross-Sectional Studies , Obesity/epidemiology , Alcohol DrinkingABSTRACT
BACKGROUND AND AIMS: Post-operative hyperbilirubinaemia in patients undergoing liver resections is associated with high morbidity and mortality. Apart from different known factors responsible for the development of post-operative jaundice, little is known about the role of hepatobiliary transport systems in the pathogenesis of post-operative jaundice in humans after liver resection. METHODS: Two liver tissue samples were taken from 14 patients undergoing liver resection before and after Pringle manoeuvre. Patients were retrospectively divided into two groups according to post-operative bilirubin serum levels. The two groups were analysed comparing the results of hepatobiliary transporter [Na-taurocholate cotransporter (NTCP); multidrug resistance gene/phospholipid export pump(MDR3); bile salt export pump (BSEP); canalicular bile salt export pump (MRP2)], heat shock protein 70 (HSP70) expression as well as the results of routinely taken post-operative liver chemistry tests. RESULTS: Patients with low post-operative bilirubin had lower levels of NTCP, MDR3 and BSEP mRNA compared to those with high bilirubin after Pringle manoeuvre. HSP70 levels were significantly higher after ischaemia-reperfusion (IR) injury in both groups resulting in 4.5-fold median increase. Baseline median mRNA expression of all four transporters prior to Pringle manoeuvre tended to be lower in the low bilirubin group whereas expression of HSP70 was higher in the low bilirubin group compared to the high bilirubin group. DISCUSSION: Higher mRNA levels of HSP70 in the low bilirubin group could indicate a possible protective effect of high HSP70 levels against IR injury. Although the exact role of hepatobiliary transport systems in the development of post-operative hyper bilirubinemia is not yet completely understood, this study provides new insights into the molecular aspects of post-operative jaundice after liver surgery.
Subject(s)
Carrier Proteins/metabolism , Hepatectomy , Jaundice/metabolism , Liver Neoplasms/metabolism , ATP Binding Cassette Transporter, Subfamily B/genetics , ATP Binding Cassette Transporter, Subfamily B/metabolism , ATP Binding Cassette Transporter, Subfamily B, Member 11 , ATP-Binding Cassette Transporters/genetics , ATP-Binding Cassette Transporters/metabolism , Aged , Bilirubin/blood , Carrier Proteins/genetics , Female , Gene Expression , HSP70 Heat-Shock Proteins/genetics , HSP70 Heat-Shock Proteins/metabolism , Humans , Jaundice/genetics , Jaundice/pathology , Liver Function Tests , Liver Neoplasms/genetics , Liver Neoplasms/secondary , Male , Middle Aged , Multidrug Resistance-Associated Protein 2 , Multidrug Resistance-Associated Proteins/genetics , Multidrug Resistance-Associated Proteins/metabolism , Organic Anion Transporters, Sodium-Dependent/genetics , Organic Anion Transporters, Sodium-Dependent/metabolism , Postoperative Complications , Retrospective Studies , Symporters/genetics , Symporters/metabolismABSTRACT
BACKGROUND: Intramedullary nailing of pertrochanteric femoral fractures has grown in popularity over the past 2 decades likely because this procedure is associated with a low risk for postoperative morbidity and a fast recovery of function. The evaluation of outcomes associated with pertrochanteric nailing has mainly been based on objective measures. The purpose of the present study is to correlate patients' health-related quality of life results after intramedullary nailing of pertrochanteric fractures with objective outcome measures. METHODS: We conducted a single-center study including 62 patients (mean age 80 ± 10 years) with pertrochanteric fractures treated with a Gamma 3 Nail. Health related quality of life was measured using the Short Form-36. These results were compared to both US and Austrian age and sex-adjusted population norms. The objective outcome measures studied at one year postoperatively included Harris Hip Score, range of motion, leg length, body mass index, neck-shaft angle and grade of osteoarthritis. RESULTS: According to the Harris Hip Score 43 patients (67%) had excellent or good results. There was no significant difference in the average neck-shaft angle comparing affected hip to non-affected hip at 12 months postoperatively. The average osteoarthritis score, for both the injured and uninjured hip, did not differ significantly. We found significant differences between the bodily pain, social functioning and mental health subscales and two summary scores of the Short-Form 36 in comparison to Austrian population norms. Complication rate was 8%. CONCLUSIONS: The results of this study confirm that intramedullary nailing with the use of a Gamma Nail is a safe treatment option for stable and unstable pertrochanteric fractures. Despite good functional and radiographic results we noticed a substantial fall off in patients' quality of life up to 12 months after operation.
Subject(s)
Bone Nails , Femoral Fractures/psychology , Femoral Fractures/surgery , Quality of Life/psychology , Aged , Aged, 80 and over , Bone Nails/psychology , Bone Nails/standards , Female , Femoral Fractures/diagnostic imaging , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Radiography , Surveys and Questionnaires , Treatment OutcomeABSTRACT
BACKGROUND: Environmental stimuli and well-being are considered to be significant factors in patients' rehabilitation. The aim of this study was to describe the effect of colors and art in hospital rooms on patients' recovery after total hip or knee arthroplasty. METHODS: We performed a prospective randomized, controlled study including 80 patients. The intervention group was randomized to colored patient rooms while the control group received medical care in conventional patient rooms. Data were collected preoperatively and postoperatively (3 and 6 days after operation). We measured mood, anxiety and depression, quality of life (QOL) and pain. RESULTS: Significantly better QOL summary scores were measured in the intervention group (6 days postoperative) compared to the control group (physical component summary score 37.1⯱ 5.0 vs. 34.1⯱ 6.7; pâ¯= 0.029 and mental component summary score 51.6⯱ 6.6 vs. 47.2⯱ 8.4; pâ¯= 0.015). Postoperatively, we found decreased total mood scores in both groups showing better results for the intervention group without significant differences (pâ¯= 0.353; pâ¯= 0.711). CONCLUSION: The use of colors in hospital rooms is an effective intervention to improve well-being and to enhance faster rehabilitation. We could demonstrate a positive effect of colors on patients' postoperative QOL.
Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Arthroplasty, Replacement, Hip/rehabilitation , Color , Humans , Patients' Rooms , Prospective Studies , Quality of Life , Treatment OutcomeABSTRACT
AIMS: The aim of this prospective study was to assess the long-term clinical, radiological, functional, and quality of life (QoL)-related outcome of patients treated with the synthetic Ligament Advanced Reinforcement System (LARS) device for anterior cruciate ligament (ACL) rupture. METHODS: A total of 41 patients who underwent ACL reconstruction with the LARS device (mean age 39.8 years (SD 12.1 ); 32% females (n = 13)) were prospectively included between August 2001 and March 2005. MRI scans and radiographs were performed at a median follow-up of 2.0 years (interquartile range (IQR) 1.3 to 3.0; n = 40) and 12.8 years (IQR 12.1 to 13.8; n = 22). Functional and QoL-related outcome was assessed in 29 patients at a median follow-up of 12.8 years (IQR 12.0 to 14.0) and clinically reconfirmed at latest median follow-up of 16.5 years (IQR 15.5 to 17.9). International Knee Documentation Committee (IKDC) and Tegner scores were obtained pre- and postoperatively, and Lysholm score postoperatively only. At latest follow-up, range of motion, knee stability tests, 36-Item Short Form Health Survey (SF-36), and IKDC scores were ascertained. Complications and reoperations during follow-up were documented. RESULTS: Cumulative complication rate was 66% (n = 27), with 11 developing within one year from surgery and 16 after one year (including five patients with both early and late complications). Ten graft failures (24%) and eight cases of reactive synovitis were observed (20%). All 11 patients with early complications and ten with late complications underwent reoperation (including five with another surgical procedure for early complications), amounting to a cumulative reoperation rate of 51% (n = 21). Revision ACL reconstruction was performed in one patient (2.4%). Median IKDC at latest follow-up was 89.7 (IQR 78.2 to 93.1), being significantly worse in the event of previous complications. Lachman test was positive in 56% (n = 15) of reconstructed knees. All norm-based SF-36 items were at or above median at latest follow-up, and did not differ depending on development of complications. CONCLUSION: Despite good functional and QoL-related results in the long term, the cumulative complication rate of 66%, including graft failures and reactive synovitis, has to be viewed with great concern. Cite this article: Bone Joint J 2022;104-B(2):242-248.
Subject(s)
Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction/instrumentation , Adult , Aged , Anterior Cruciate Ligament Injuries/diagnostic imaging , Anterior Cruciate Ligament Reconstruction/methods , Female , Follow-Up Studies , Humans , Linear Models , Male , Middle Aged , Patient Reported Outcome Measures , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Quality of Life , Radiography , Recovery of Function , Reoperation/statistics & numerical data , Treatment OutcomeABSTRACT
INTRODUCTION: Liver metastases originating from various types of sarcoma are a rare reason for hepatic resection. So far, even multicentre studies do hardly provide statistically relevant sample sizes. Thus, review of available data can provide surgeons with useful information in similar cases. Therefore, this study can be regarded more as a contribution to this pool of data than as a stand-alone paper. PATIENTS AND METHODS: The study includes 10 women and five men who underwent subtotal hepatic resection for solitary (n = 4) and multiple (n = 11) liver metastases originating from sarcoma. The median tumour diameter was 60 mm (range 20-200 mm). RESULTS: Morbidity was 33%. One patient died within 30 days after surgery. Resection was complete (R0) in 67%. Median overall survival was 33.6 months, 5-year survival 27%. The use of Pringle manoeuvre was significantly associated with poorer outcome (p = 0.014) and shorter period of recurrence-free survival (p = 0.012). Diameter of liver lesion over 50 mm showed significantly shorter recurrence-free survival (p = 0.042). CONCLUSION: Hepatic resection may be beneficial in patients with isolated sarcoma metastasis in the liver.
Subject(s)
Bone Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Sarcoma/secondary , Bone Neoplasms/mortality , Bone Neoplasms/therapy , Chemotherapy, Adjuvant , Combined Modality Therapy , Disease-Free Survival , Female , Follow-Up Studies , Hepatectomy/methods , Hepatectomy/mortality , Humans , Liver Neoplasms/mortality , Male , Neoplasm Invasiveness/pathology , Risk Assessment , Sarcoma/mortality , Sarcoma/therapy , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: An acromiohumeral interval narrower than 6 mm has been considered pathologic and strongly indicative for rotator cuff tears by numerous authors. This prospective study assessed interobserver and intraobserver variability in the radiographic measurement of the acromiohumeral interval. MATERIAL AND METHODS: Five board-certified orthopedic surgeons independently reviewed 58 blinded, standardized anteroposterior shoulder radiographs. The acromiohumeral interval was measured in millimeters. The 5 investigators classified each image a second time in random order. RESULTS: After the same 58 radiographs had been evaluated by the 5 investigators at both examination time points, no significant differences were noted in the interobserver and intraobserver measurements (P < .05). The respective maximum interobserver and intraobserver differences were 4 and 3 mm (range, 0-4 mm). CONCLUSION: The assessment of the acromiohumeral interval using standardized anteroposterior radiographs is a reliable and reproducible method of measurement. LEVEL OF EVIDENCE: Level 1; Investigating a diagnostic test.
Subject(s)
Acromion/diagnostic imaging , Humerus/diagnostic imaging , Radiography/standards , Shoulder Joint/diagnostic imaging , Acromion/anatomy & histology , Adult , Aged , Analysis of Variance , Cohort Studies , Female , Humans , Humerus/anatomy & histology , Male , Middle Aged , Observer Variation , Probability , Prospective Studies , Sensitivity and Specificity , Shoulder Joint/anatomy & histology , Statistics, NonparametricABSTRACT
BACKGROUND: We conducted a survey to determine whether hernia surgeons follow evidence-based medicine (EBM) criteria in their daily routine. METHODS: All chiefs of general surgery in Styria (Austria) received a short, simple, two-page, 10-item questionnaire. RESULTS: We analyzed completed surveys from 15 departments reporting 2441 hernia repairs with a mean patient age of 57.5 +/- 11.6 years. Although five techniques accounted for 96.6% of procedures, the frequency of use of each technique varied considerably among the hospitals. There were high numbers of laparoscopic (36.8%) and sutured (19.9%) repairs. CONCLUSIONS: Because of the great variance among the evaluated hospitals as to surgical methods and indications, this survey showed that inguinal hernia surgery does not currently comply with EBM.