PCL Preservation vs. PCL Sacrifice: Comparing Patient Outcomes in Medial Congruent Total Knee Arthroplasty.

INTRODUCTION: The aim of this study was to compare outcomes and complication rates between posterior cruciate ligament (PCL) retention and excision utilizing a medial congruent (MC) polyethylene insert in total knee arthroplasty (TKA) in a specialized ambulatory surgery center (ASC) dedicated to hip and knee arthroplasty. MATERIALS & METHODS: A retrospective review was performed between May 2023 and October 2023 analyzing 398 patients who underwent primary MC TKA by high-volume joint arthroplasty surgeons (n=9) with either PCL preservation (n=264) or sacrifice (n=134) in a single free-standing ASC. Patients were matched chronologically on a 2:1 basis. Demographics, baseline function, 90 day complications, and patient reported outcomes were recorded for each patient. RESULTS: There were no differences in pre-op baseline function or patient-reported outcome measures (PROMs), Charlson Comorbidity Index (COI), or American Society of Anesthesiologists (ASA) class amongst patient groups. The PCL-preserve and PCL-sacrifice cohorts showed significant variation in 12 week post-op Knee injury and Osteoarthritis Outcome, Junior (KOOS, JR.) scores. Specifically, the number of patients who achieved the minimal clinically important difference (MCID) in KOOS, JR. scores was higher in the PCL-sacrifice group (p<0.05). Yet, no complications within the 90 day period were associated with PCL status and other patient-reported outcomes. CONCLUSION: This manuscript comparing outcomes between MC TKAs with PCL retention and sacrifice suggests that both techniques are viable options with similar functional outcomes, pain scores and complication rates which may have benefits in an ASC setting. The PCL-sacrifice group exhibited a statistically significant increase in patients who achieved the MCID in KOOS, JR. score compared to the PCL-preserving at early follow up. Future research should employ prospective, randomized designs to further validate these findings and explore long-term implications.

Coping equally: Equity of dyadic coping and depressive symptoms among adolescent couples.

INTRODUCTION: Many adolescents are in their first romantic relationship; at the same time, depressive symptoms generally increase during this developmental stage. In adults, equity of support in romantic relationships is associated with less depressive symptoms-especially in female partners, who are generally on "the losing side" of support transactions with male partners. This study examines whether equity of dyadic coping is associated with depressive symptoms in adolescent mixed-gender couples. We disentangle equity of positive and negative dyadic coping, as differential effects might arise. METHODS: Self-report data on dyadic coping and depressive symptoms were gathered from 124 mixed-gender couples aged between 16 and 21 years living in Switzerland between 2011 and 2013. Equity of dyadic coping was quantified by calculating the difference between received dyadic coping and provided dyadic coping for each partner separately. These difference scores and the overall level of dyadic coping were used to predict depressive symptoms in both partners using an Actor-Partner-Interdependence Model. RESULTS: For female adolescents, we found the expected curvilinear association between equity of negative dyadic coping behaviors and depressive symptoms (actor effect). Additionally, the female perception of equity of positive dyadic coping was correlated with less depressive symptoms in male partners (partner effect). For male adolescents, receiving more positive dyadic coping than they provided was associated with more depressive symptoms (actor effect). DISCUSSION: In female partners, results resembled those in adult mixed-gender couples. In male partners, results changed depending on the direction of inequity-possibly due to gender role development.

Evaluating Knee Recovery Beyond Patient Reports: A Comparative Study of Smart Implantable Device-Derived Gait Metrics Versus Patient-Reported Outcome Measures in Total Knee Arthroplasty.

BACKGROUND: Total Knee Arthroplasty (TKA) is frequently performed for advanced osteoarthritis, with patient-reported outcome measures (PROMs) traditionally reporting on efficacy. These subjective evaluations, although useful, may inaccurately reflect post-TKA activity levels. With technological advancements, smart implantable devices (SIDs) offer objective, real-time gait metrics, potentially providing a more accurate postoperative recovery assessment. This study compares these objective metrics with PROMs to evaluate TKA success more effectively. METHODS: We conducted a retrospective cohort study with 88 participants undergoing TKA using a SID. Eligible patients were aged 18 years or older and had advanced osteoarthritis. We excluded those who had bilateral TKAs, joint infections, or neuromuscular disease. The SID system collected daily gait metrics, including step count, distance traveled, walking speed, stride length, cadence, and functional knee range of motion. The PROMs, including Knee Injury and Osteoarthritis Outcome Score-Joint Replacement, Veterans Rand 12 Physical Component Summary, and Veterans Rand 12 Mental Component Summary, were analyzed against SID gait metrics. Among the 88 patients, 80 provided continuous data over 12 weeks. RESULTS: All gait metrics, except stride length, significantly increased at the 12-week point (P < .05). The PROMs also significantly improved postoperatively (P < .05). Initial low positive correlations between 12-week PROMs and SID metrics decreased after adjusting for demographic variables, leaving only weak correlations between the Veterans Rand 12 Physical Component Summary and Knee Injury and Osteoarthritis Outcome Score-Joint Replacement with functional knee range of motion (r = 0.389, P = .002; r = 0.311, P = .014, respectively), and Veterans Rand 12 Mental Component Summary with step count (r = 0.406, P = .001) and distance traveled (r = 0.376, P = .003). CONCLUSIONS: This study indicates that both PROMs and SID gait metrics show significant improvements post-TKA, though they correlate weakly with each other, suggesting a possible discrepancy between perceived recovery and actual functional improvement. The SID gait metrics might provide a valuable addition to traditional PROMs by offering an objective representation of physical capabilities unaffected by patient compliance or subjective perceptions of recovery. Further research is needed to validate these findings in larger populations and to explore whether integrating SID metrics can enhance long-term functional outcomes.

A Remote Physical Therapy Program Demonstrates Similar Outcomes Compared to In-Person, Supervised Physical Therapy After Same-Day Discharge Total Knee Arthroplasty: A Randomized Clinical Trial.

BACKGROUND: A growing number of total knee arthroplasty (TKA) patients are candidates for same-day discharge (SDD). Previous research has shown that internet-based remote physical therapy (RPT) can produce equivalent outcomes to supervised outpatient physical therapy (OPT) after TKA. We sought to compare outcomes between RPT and OPT in patients undergoing SDD TKA using an electronic remote perioperative management (ERPM) program. METHODS: Patients undergoing SDD TKA were enrolled in an ERPM program and randomized to ERPM + RPT or ERPM + OPT. Preoperative and 6-week functional assessments included knee range of motion, timed up and go, and 4-meter gait speed. Numerical Rating Scale pain scores were evaluated preoperatively, at 6 and 12 weeks, and satisfaction was assessed at 6, 12, and 52 weeks postoperatively. Participants completed the Veterans Rand 12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score preoperatively and at 6, 12, and 52 weeks postoperatively. OPT utilization was collected 90 days postoperatively. RESULTS: Of 197 initially randomized patients, 76 remained in the ERPM + RPT group and 95 in the ERPM + OPT group after withdrawals and crossovers. Baseline characteristics showed no differences between the 2 groups. No clinically relevant differences were observed in knee range of motion, Numerical Rating Scale pain, patient-reported outcomes, functional assessments, or satisfaction at any follow-up time. Participants in the ERPM + OPT group attended an average of 11.57 physical therapy sessions, incurring a total cost of $462.8 and 133 minutes of travel. Conversely, the ERPM + RPT group experienced no expenses or travel time. CONCLUSIONS: Patients in the ERPM + RPT group had similar outcomes, lower costs, and saved time compared to patients in the ERPM + OPT group after SDD TKA. Further analysis is needed to determine predictive indicators for crossovers.

Acceptability and feasibility of an intervention for Alaska Native and American Indian couples.

Objective: This acceptability and feasibility study assessed a previously tested movie discussion intervention culturally adapted for a tribal health setting. Background: Despite family and relationships being important in Alaska Native and American Indian (ANAI) cultures, social health interventions supporting committed ANAI couples have not been investigated. Couples watching and discussing movies can promote and sustain relationship health as effectively as intensive skill-building classes. Method: This study culturally adapted a movie discussion intervention. Multiple stakeholders guided adaptations, including changes to intervention duration, recommended movies, discussion guide, and study measures. Eligible participants were cohabitating adults in a committed relationship, with at least one person in the couple being ANAI. Participants watched and discussed movies over 4 weeks at home or in person. Study measures assessed demographics, relationship characteristics, and intervention acceptability and feasibility. Results: Twenty-three couples participated: 87% chose at-home participation, 70% completed the intervention. Almost 90% of couples felt comfortable discussing the movies, felt the discussion guide improved communication, and would recommend the intervention to other couples, but 26% were mildly stressed by the discussions. Conclusion: This intervention was a feasible and acceptable way to help ANAI couples maintain positive relationship features. Implications: This intervention could support ANAI couples in regions with limited access to behavioral health services.

Are changes in marital satisfaction sustained and steady, or sporadic and dramatic?

Although prominent theories of intimate relationships, and couples themselves, often conceive of relationships as fluctuating widely in their degree of closeness, longitudinal studies generally describe partners' satisfaction as stable and continuous or as steadily declining over time. The increasing use of group-based trajectory models (GBTMs) to identify distinct classes of change has reinforced this characterization, but these models fail to account for individual differences within classes and within-person variability across classes and may thus misrepresent how couples' satisfaction changes. The goal of the current analyses was to determine whether accounting for these additional sources of variance through growth mixture models (GMMs) alters characterizations of satisfaction changes over time. Applied to longitudinal data from 12 independent studies of first-married couples (combined N = 1,249 couples), GMMs that allowed for class-specific individual differences and within-person variability fit the data better than the GBTMs that constrained these to be equal across classes. Most notably, considerable within-person variability was evident within each class, consistent with the idea that spouses do indeed fluctuate in their satisfaction. Spouses who dissolved their marriages were 3.8-5.7 times more likely to be in classes characterized by greater volatility in satisfaction. Because the early years of marriage appear to be characterized by within-person fluctuations in satisfaction, time-varying correlates of these fluctuations are likely to be at least as important as time-invariant correlates in explaining why some marriages thrive where others falter. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Lasting Declines in Couples' Social Network Interactions in the First Years of COVID.

Since the onset of COVID-19, a rise in loneliness has raised concerns about the social impact of lockdowns and distancing mandates. Yet, to date, the effects of the pandemic on social networks have been studied only indirectly. To evaluate how the pandemic affected social networks, the current analyses analyzed five waves of detailed social network interviews conducted before and during the first 18 months of the pandemic in a sample especially vulnerable to contracting the virus: mostly non-White couples (243 husbands and 250 wives) recruited from lower income neighborhoods. Pre-COVID interviews asked spouses to name 24 individuals with whom they interact regularly. Post-COVID interviews indicated a nearly 50% decline in face-to-face interactions and a nearly 40% decline in virtual interactions, with little recovery over the first 18 months of the pandemic. Compared with less affluent couples, those with higher incomes maintained more of their network relationships, especially when virtual interactions were taken into account.

Stability and change in newlyweds' social networks over the first years of marriage.

Marriage sanctifies the relationship between two spouses, but what happens to their relationships with family, friends, and others who comprise their social networks? Scholarly accounts disagree about whether couples' networks strengthen, weaken, or remain stable in the years after marriage. To reconcile competing perspectives, marriage licenses from lower income communities were used to recruit 462 spouses (231 couples) in their first marriages. Each spouse independently provided data on 24 network members with whom they interact regularly (over 11,000 network members). These data were used to calculate 14 dimensions of each spouse's social network, and networks were assessed in this way three times over the first 18 months of marriage. Over time, spouses' networks grew to include more of each other's family members, more married and financially secure individuals and more members with whom they reported good relationships. For husbands, proportions of their own friends and their wives' friends declined. Proportions of own family and members providing support did not change. With rare exceptions, these changes were not moderated by premarital parenthood, cohabitation, or relationship duration. Thus, regardless of a couples' premarital history, getting married itself appears to be associated with specific changes in spouses' social networks. Yet whether those changes broaden or narrow their networks depends on where in the network one looks. Illuminating how relationships between spouses are shaped by relationships outside the marriage therefore requires multifaceted assessments that are capable of distinguishing among discrete elements of couples' social networks. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The "Inside-Out" Anterior Osteotomy of the Proximal Femur via the Direct Anterior Approach in Revision Hip Arthroplasty.

Osteotomy techniques used for wide exposure during femoral component revision include the extended trochanteric osteotomy and its modifications. We describe an anterior proximal femur osteotomy technique starting from the inside of the femoral canal at the bone-implant interface and heading outward. The technique is used in conjunction with the extended direct anterior approach and allows direct access to and visualization of the anterior, medial, and lateral bone-implant interfaces. This technique is most useful for the removal of collared, fully hydroxyapatite-coated double-tapered femoral stems, in which bone-implant interfaces need to be accessed for removal of a well-osseointegrated hip arthroplasty implant.

Typologies of duocentric networks among low-income newlywed couples.

The social networks surrounding intimate couples provide them with bonding and bridging social capital and have been theorized to be associated with their well-being and relationship quality. These networks are multidimensional, featuring compositional (e.g., the proportion of family members vs. friends) and structural characteristics (e.g., density, degree of overlap between spouses' networks). Most previous studies of couple networks are based on partners' global ratings of their network characteristics or network data collected from one member of the dyad. This study presents the analysis of "duocentric networks" or the combined personal networks of both members of a couple, collected from 207 mixed-sex newlywed couples living in low-income neighborhoods of Harris County, TX. We conducted a pattern-centric analysis of compositional and structural features to identify distinct types of couple networks. We identified five qualitatively distinct network types (wife family-focused, husband family-focused, shared friends, wife friend-focused, and extremely disconnected). Couples' network types were associated with the quality of the relationships between couples and their network contacts (e.g., emotional support) but not with the quality of the couples' relationship with each other. We argue that duocentric networks provide appropriate data for measuring bonding and bridging capital in couple networks.

State minimum wage increases delay marriage and reduce divorce among low-wage households.

Objective: To estimate the effects of state-level changes in the minimum wage on marriage and divorce among low-wage earners. Background: Proponents of raising the minimum wage highlight the potential benefits of increased earnings for low-income families, yet to date research on the effects of raising the minimum wage has focused almost exclusively on economic outcomes. No research has yet documented whether these changes actually affect marriage and divorce. Method: Using the Current Population Survey and the American Community Survey, this project applied a quasi-experimental difference-in-difference method to exploit similarities between states that have, and have not, raised their minimum wage. Results: Across data sources, among men and women earning low wages, a one-dollar increase in the state minimum wage predicts a 3%-6% decline in marriage entry and a 7%-15% decline in divorce one and 2 years later. Conclusion: Both changes are likely to strengthen low-income families, and are substantially larger effects than those obtained by federal policies directly targeting interpersonal dynamics within low-income couples. Implications: Government policies that reduce stress on couples and facilitate their access to resources may improve family outcomes, invisibly and without making additional demands on the time of couples who are already strained.

Three tests of the Vulnerability-Stress-Adaptation Model: Independent prediction, mediation, and generalizability.

Objective: Efforts to understand why some marriages thrive while others falter are (a) not well integrated conceptually and (b) rely heavily on data collected from White middle-class samples. The Vulnerability-Stress-Adaptation Model (VSA; Karney and Bradbury, 1995) is used here to integrate prior efforts and is tested using data collected from couples living with low incomes. Background: The VSA Model assumes (a) that enduring vulnerabilities, stress, and couple communication account for unique variance in relationship satisfaction, (b) that communication mediates the effects of vulnerabilities and stress on satisfaction, and (c) that the predictors of satisfaction generalize across socioeconomic levels. To date, these assumptions remain untested. Materials and methods: With 388 couples from diverse backgrounds (88% Black or Hispanic), we used latent variable structural equation models to examine enduring vulnerabilities, chronic stress, and observed communication as predictors of 4-wave, 27-month satisfaction trajectories, first as main effects and then interacting with a validated 10-item index of sociodemographic risk. Results: (a) The three variable sets independently predict satisfaction trajectories; (b) couple communication does not mediate the effects of enduring vulnerabilities or stress on satisfaction; and (c) in 19% of tests, effects were stronger among couples with higher sociodemographic risk. Conclusion: Effects of established predictor domains on satisfaction replicate in a diverse sample of newlywed couples, and most findings generalize across levels of sociodemographic risk. The failure of couple communication to mediate effects of enduring personal vulnerabilities and stress raises new questions about how these two domains undermine committed partnerships.

Effects of hurricane harvey on trajectories of hostile conflict among newlywed couples.

Natural disasters have been purported to increase, and decrease, hostile conflict in intimate relationships, but heavy reliance on retrospective designs prohibits strong tests of these contrasting perspectives. The present study aims to resolve this ambiguity using a sample of newlywed couples from Houston, Texas who reported their levels of hostile conflict three times before and three times after experiencing Hurricane Harvey. Latent growth curve piecewise regression models showed that robust declines in conflict prior to the hurricane were slowed after the hurricane hit, such that posthurricane conflict slopes flattened and became nonsignificant. Thus, by disrupting natural declines in conflict that occur in the early years of marriage, Hurricane Harvey appears to have been detrimental for couples. Factors examined in relation to hostile conflict (including personality traits, adverse childhood events, stress, and relationship satisfaction) were similar in their predictive power prior to and following the hurricane, suggesting that the hurricane did not markedly alter which couples were most prone to hostile interactions. Implications for understanding relationships in the context of natural disasters are outlined. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Fixation vs Arthroplasty for Femoral Neck Fracture in Patients Aged 40-59 Years: A Propensity-Score-Matched Analysis.

Background: Internal fixation (IF) has historically been favored for the treatment of femoral neck fractures (FNFs) in young, nongeriatric patients. However, recent literature reporting high reoperation rates among those receiving IF, taken in conjunction with favorable survivorship of modern bearing surfaces in total hip arthroplasty (THA), has begun to question this paradigm. Our study sought to compare outcomes between IF and THA for FNFs in patients aged 40-59 years. Methods: Using the Truven MarketScan Database, we performed a retrospective propensity-score-matched cohort study on patients aged 40-59 years who underwent surgical management of an isolated FNF (THA or IF). Patients with pathologic fracture were not included. Analysis was conducted on patients aged 40-49 and 50-59 years separately. A subgroup analysis was performed on those patients with 1 year and 3 years of follow-up. Multivariate analysis, controlling for baseline patient information, was then performed. Results: Seven hundred sevety-eight 40- to 49-year-old patients and 3470 50- to 59-year-old matched patients (IF and THA) were included in this study. A multivariate analysis found that patients aged 40-49 years who underwent IF were at higher odds of both 1-year (odds ratio 2.35, 95% confidence interval 1.22-4.54, P = .011) and 3-year (odds ratio 5.68, 95% confidence interval 2.21-14.60, P < .001) reoperation. Similar results were found in those aged 50-59 years. While complication rates were similar, postoperative anemia and 90-day visits to the emergency room were more common after THA in both age cohorts. Conclusions: While THA is associated with increased postoperative anemia and resource utilization compared with IF, patients aged 40-59 years who undergo IF for FNF are at increased risk of reoperation in the first 3 postoperative years. This information should be used to assist in shared decision-making with patients in this age group.

Use of a threaded-coupled femoral extraction device allows for higher extraction force when compared to loop or vice grip devices; A potted stem analysis.

BACKGROUND: Extraction of a well-fixed femoral stem during revision total hip arthroplasty presents a technical challenge to the operating surgeon. The option of several stem designs during implantation necessitates the availability of extraction tools to be utilised intra-operatively. This study aims to compare the amount of axial force generated from using a threaded-coupled extraction device, loop extraction device, and vice-grip universal extraction set on a potted total hip arthroplasty stem construct. METHODS: A size 7 Stryker Accolade® II femoral stem (Stryker, Mahwah, NJ) was potted within a 5.20 cm inner diameter polyvinyl chloride pipe using a potting medium with tensile strength and lap shear of 1000psi. This construct was coupled to a material testing system whose force transducer was calibrated to a recording speed of 1000 frames per second. The extractors were coupled to the potted stem, and a force of 1.32 J was applied ten times sequentially to each construct. Force was recorded in Newtons. RESULTS: The maximum average force for the threaded, loop, and Shukla extractors was 111.46 ± 1.77 N, 90.22 ± 0.87 N, and 64.70 ± 9.03 N (p < 0.01). Loss of coupling was not experienced with any extractor. CONCLUSION: Within our study, the forces observed per constant load when utilising a threaded-coupled extraction device that attaches to the shoulder of the implant were significantly higher than those seen when using an extraction device that couples to the neck of the femoral stem.

Blood Eosinophils in Chinese COPD Participants and Response to Treatment with Combination Low-Dose Theophylline and Prednisone: A Post-Hoc Analysis of the TASCS Trial.

BACKGROUND AND OBJECTIVES: The burden of chronic obstructive pulmonary disease (COPD) disproportionately affects patients in low to middle-income countries. Although the Theophylline and Steroids in COPD Study (TASCS) showed no clinical benefit from administering low-dose theophylline and prednisone in COPD patients compared to placebo, it was hypothesized that those with elevated blood eosinophil counts would receive clinical benefit from the intervention. METHODS: This was a post-hoc analysis of the TASCS dataset - a double-blinded, placebo-controlled trial conducted in patients with moderate-severe COPD in China. Participants were allocated 1:1:1 to low-dose oral theophylline (100mg bd) and prednisone (5mg qd; PrT), theophylline (100mg bd) and prednisone-matched placebo (TP), or double-matched placebo (DP) groups and followed-up for 48 weeks. A baseline count of ≥300 eosinophils/µL blood was categorized as elevated/eosinophilic, and the primary outcome was the annualized moderate-severe exacerbation rate. RESULTS: Of 1487 participants eligible for analysis, 325 (22%) were eosinophilic. These participants were predominantly male (82%), had a mean (SD) age of 64 (±8) years and a predicted forced expiratory volume in 1s (FEV1) of 43% (±16). The annualized moderate-severe exacerbation rate was significantly higher in the PrT group compared to the pooled results of the TP and DP groups (incidence rate ratio = 1.6; ([95% CI 1.06-1.76]) p = 0.016). Changes in spirometry values and reported disease impact scores (St. George's Respiratory Questionnaire and COPD Assessment Test) at week 48 were not significantly different between groups. CONCLUSION: Combination low-dose theophylline and prednisone was associated with a significant increase in the annual moderate-severe exacerbation rate in participants with a blood eosinophil count ≥300 cells/µL compared to placebo.

Medicaid Payer Status Is Associated With Increased 90-Day Resource Utilization, Reoperation, and Infection Following Aseptic Revision Total Hip Arthroplasty.

Background: Prior literature has demonstrated increased resource utilization and perioperative complications in patients with a Medicaid payor status undergoing primary total hip and knee arthroplasty. This relationship has yet to be explored in patients undergoing revision total hip arthroplasty (rTHA). Methods: The National Readmissions Database was queried from 2010 to 2015 for all patients undergoing aseptic rTHA. 90-day complication data were collected, and patients were separated into two cohorts based on insurance payor type: Medicaid and non-Medicaid. Patients were propensity score matched 2:1 on a number of comorbid and operative characteristics. The relationship between Medicaid payor status and postoperative outcomes was then assessed using binomial logistic regression analysis. Results: 3,110 Medicaid patients were identified and matched to 6,175 non-Medicaid patients. Medicaid patients had increased odds of an early prosthetic joint infection (Odds Ratio [OR] 1.29, p=0.019), superficial surgical site infection (OR: 1.48, p=0.003), and early reoperation (OR: 1.18, p=0.045). Medicaid patients also experienced higher odds of readmissions, extended length of stay, non-home discharge status, and medical complications. Finally, the Medicaid cohort had a $3,332 (95% CI: 2,412-4,253, p<0.001) increased adjusted total cost of care when compared to the non-Medicaid cohort. Conclusion: This study identifies the Medicaid payor status as an independent risk factor for increased resource utilization, reoperation, and infection in the early postoperative period for patients undergoing rTHA. This relationship is likely due to an interplay of multiple variables, including socioeconomic status and access to care. Level of Evidence: IV.

Rural Hospital Designation Is Associated With Increased Complications and Resource Utilization After Primary Total Hip Arthroplasty: A Matched Case-Control Study.

BACKGROUND: As the prevalence of hip osteoarthritis increases, the demand for total hip arthroplasty (THA) has grown. It is known that patients in rural and urban geographic locations undergo THA at similar rates. This study explores the relationship between geographic location and postoperative outcomes. METHODS: In this retrospective cohort study, the Truven MarketScan database was used to identify patients who underwent primary THA between January 2010 and December 2018. Patients with prior hip fracture, infection, and/or avascular necrosis were excluded. Two cohorts were created based on geographic locations: urban vs rural (rural denotes any incorporated place with fewer than 2500 inhabitants). Age, gender, and obesity were used for one-to-one matching between cohorts. Patient demographics, medical comorbidities, postoperative complications, and resource utilization were statistically compared between the cohorts using multivariate conditional logistic regression. RESULTS: In total, 18,712 patients were included for analysis (9356 per cohort). After matching, there were no significant differences in comorbidities between cohorts. The following were more common in rural patients: dislocation within 1 year (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.08-1.41, P < .001), revision within 1 year (OR 1.17, 95% CI 1.05-1.32, P = .027), and prosthetic joint infection (OR 1.14, 95% CI 1.04-1.34, P = .033). Similarly, rural patients had higher odds of 30-day readmission (OR 1.31, 95% CI 1.09-1.56, P = .041), 90-day readmission (OR 1.41, 95% CI 1.26-1.71, P = .023), and extended length of stay (≥3 days; OR 1.52, 95% CI 1.22-1.81, P < .001). CONCLUSION: THA in rural patients is associated with increased cost, healthcare utilization, and complications compared to urban patients. Standardization between geographic areas could reduce this discrepancy.

Preoperative opioid use is a risk factor for complication following revision total hip arthroplasty.

BACKGROUND: The demand for revision total hip arthroplasty (THA) procedures continues to increase. A growing body of evidence in primary THA suggests that preoperative opioid use confers increased risk for complication. However, it is unknown whether the same is true for patients undergoing revision procedures. The purpose of this study was to investigate whether or not there was a relationship between preoperative opioid use and surgical complications, medical complications, and healthcare utilisation following revision THA. METHODS: This is a retrospective cohort study using the Truven Marketscan database. Patients undergoing revision THA were identified. Preoperative opioid prescriptions were queried for 1 year preoperatively and were used to divide patients into cohorts based on temporality and quantity of opioid use. This included an opioid naïve group as well as an "opioid holiday" group (6 months opioid naïve period after chronic use). Demographic and complication data were collected and both univariate and multivariate analysis was then performed. RESULTS: 62.5% of patients had received an opioid prescription in the year preceding surgery. Patients with continuous preoperative opioid use had higher odds of the following: infection (superficial or deep surgical site infection; OR 1.29; 95% CI, 1.03-1.62, p = 0.029), wound complication (OR 1.36; 95% CI, 1.02-1.82, p = 0.037), sepsis (OR 1.90; 95% CI 1.08-3.34, p = 0.026), and revision surgery (OR 1.54, 95% CI, 1.28-1.85, p < 0.001). This group also had higher care utilisation including extended length of stay, non-home discharge, 90-day readmission, and emergency room visits (p < 0.001). An opioid holiday mitigated some of this increased risk as this cohort has baseline (i.e. same as opioid naïve) risk (p > 0.05 for all comparison). CONCLUSIONS: Opioid use prior to revision THA is common and is associated with increased risk of postoperative complication. Given that risk was reduced by a preoperative opioid holiday, this represents a modifiable risk factor which should be discussed and addressed preoperatively to optimise outcomes.

ERS statement: a core outcome set for clinical trials evaluating the management of COPD exacerbations.

Clinical trials evaluating the management of acute exacerbations of COPD assess heterogeneous outcomes, often omitting those that are clinically relevant or more important to patients. We have developed a core outcome set, a consensus-based minimum set of important outcomes that we recommend are evaluated in all future clinical trials on exacerbations management, to improve their quality and comparability. COPD exacerbations outcomes were identified through methodological systematic reviews and qualitative interviews with 86 patients from 11 countries globally. The most critical outcomes were prioritised for inclusion in the core outcome set through a two-round Delphi survey completed by 1063 participants (256 patients, 488 health professionals and 319 clinical academics) from 88 countries in five continents. Two global, multi-stakeholder, virtual consensus meetings were conducted to 1) finalise the core outcome set and 2) prioritise a single measurement instrument to be used for evaluating each of the prioritised outcomes. Consensus was informed by rigorous methodological systematic reviews. The views of patients with COPD were accounted for at all stages of the project. Survival, treatment success, breathlessness, quality of life, activities of daily living, the need for a higher level of care, arterial blood gases, disease progression, future exacerbations and hospital admissions, treatment safety and adherence were all included in the core outcome set. Focused methodological research was recommended to further validate and optimise some of the selected measurement instruments. The panel did not consider the prioritised set of outcomes and associated measurement instruments to be burdensome for patients and health professionals to use.