Patient reported outcomes in three hundred and twenty eight bilateral total knee replacement cases (simultaneous versus staged arthroplasty) using the Oxford Knee Score.

PURPOSE: Despite bilateral knee replacement being frequently performed, little data is available to inform on the relative outcomes of each knee for individual patients. The purpose of this study was to compare these outcomes in a series of bilateral total knee replacements (TKRs) performed either simultaneously or at a staged interval. METHODS: We compared outcomes measured by the Oxford Knee Score (OKS; /48) in a series of 656 bilateral TKRs (328 patients). One hundred and fifty-six TKRs were simultaneous and 500 TKRs staged. RESULTS: Of the staged patients, in 164 (65.6 %) the post-operative OKS in their second TKR matched the first, it was worse in 57 (22.8 %) and better in 29 (11.6 %). The trend was towards a worse OKS in the second staged TKR (p = 0.003). Mean improvement was similar in simultaneous cases to the first staged TKR (24.3 vs. 24.0; p = 0.883) but significantly less in second staged TKRs (20.2; p < 0.001) due to higher pre-operative scores. CONCLUSIONS: Individual patients attained a comparable post-operative score in both their knees, independent of age, pre-operative function and the duration of any staging interval.

The effect of tibial component sizing on patient reported outcome measures following uncemented total knee replacement.

UNLABELLED: When performing total knee replacement (TKR), surgeons are required to decide on the most appropriate size of tibial component. As implants are predominantly selected from incremental sizes of a preferred design, it may be necessary for a surgeon to slightly under or oversize the component. There are concerns that overhang could lead to pain from irritation of soft tissues, and an undersized component could lead to subsidence and failure. Patient reported outcome measures were recorded in 154 TKRs at one year postoperatively (in 100 TKRs) and five years post-operatively (in 54 TKRs) in 138 patients. The Oxford Knee Score (OKS), WOMAC and SF-12 were recorded, and a composite pain score was derived from the OKS and WOMAC pain questions. Tibial component size and position were assessed on scaled radiographs and implants were grouped into anatomic sized tibial component (78 TKRs), undersized component (48 TKRs), minor overhang one to three mm (10 TKRs) or major overhang ≥ 3 mm (18 TKRs). There was no statistically significant difference between the mean post-operative OKS, WOMAC, SF-12 or composite pain score of each group. Furthermore, localisation of the site of pain did not correlate with medial or lateral overhang of the tibial component. Our results suggest that tibial component overhang or undersizing is not detrimental to outcome measures or pain. LEVEL OF EVIDENCE: II.

Symptom interpretation and quality of life in patients with irritable bowel syndrome.

BACKGROUND: Patients with irritable bowel syndrome (IBS) are often believed to attribute unexplained symptoms to physical disorders. We tested this hypothesis by assessing symptom interpretation, symptom severity, and quality of life in patients attending hospital gastroenterology clinics. AIM: The main aims of this study were: to assess the symptom attributional styles of hospital gastroenterological outpatients with IBS and non-IBS disorders in comparison with unselected patients attending their GP; to establish the relationships between attributional style, quality of life, and IBS severity score in hospital gastroenterology outpatients; and to test the hypothesis that the IBS severity score correlates with a somatising style of symptom attribution. DESIGN OF STUDY: Systematic quantitative analysis. SETTING: General practice and gastroenterology outpatient clincs. METHOD: Patients attending hospital gastroenterology clinics were recruited prospectively and completed validated questionnaires. These were the Medical Outcome Survey (MOS SF-36), the IBS Severity Score, and the Symptom Interpretation Questionnaire (SIQ). The latter measures the tendency to interpret somatic symptoms in three ways: as a physical disorder (somatising attributional style), as an emotional response to stress (psychologising attributional style), or as a normal experience (normalising attributional style). The diagnosis of IBS was based on the Rome II criteria; the control groups comprised gastroenterology outpatients with non-IBS diagnoses and unselected patients attending general practice. RESULTS: Quality of life in IBS patients attending hospital outpatients (n = 32, male:female ratio 9:23) was not significantly different from that of non-IBS patients (n = 70, male:female ratio 32:38). In all patient groups, the normalising style of symptom interpretation predominated; psychologising styles correlated with impaired quality of life in the mental health domains. In IBS patients, the tendency to seek a psychological explanation for physical symptoms correlated significantly with the severity of the abdominal pain. CONCLUSIONS: Symptom interpretation does not differ between IBS and non-IBS patients referred to hospital gastroenterology clinics. The tendency to attribute somatic symptoms to a physical disorder does not explain why only a minority of IBS subjects seek medical attention. The idea that most IBS patients are committed to a somatic explanation of symptoms appears to be a myth.