Longitudinal quality of life improvement in underserved rural youth with obesity.

OBJECTIVE: ACT! (Actively Changing Together) is a family- and community-based intervention targeting youth with obesity. The objective of this study was to establish the longitudinal impact on Health-Related Quality of Life (HRQoL) as well as the relationship with anthropometric and demographic factors. METHODS: Youth (n = 75) aged 8-14 years meeting criteria for overweight or obesity were referred to the programme. Twelve, 90-min classes in English and Spanish were held at the YMCA. Demographics and anthropometrics were assessed, as well as HRQoL that was measured with the child-reported Pediatric Quality of Life Inventory (PedsQL™) 4.0 Generic Core Scale. Data was collected at three follow-up points after completion of the intervention: initial follow-up (n = 65), 6 (n = 41) and 12 months (n = 25). Analysis included paired dependent t-tests between baseline and follow-up, and Pearson's correlations on HRQoL, anthropometric and demographic data. RESULTS: PedsQL scores significantly improved from baseline to all follow-up timepoints (initial follow-up immediately following the intervention, and 6 and 12 months post intervention). Over time, body mass index Z-Score and per cent body fat displayed various points of significance and strengthening correlations. CONCLUSIONS: Longitudinal improvements in HRQoL were sustained up to 12 months following a family- and community-based intervention in this underserved population. Anthropometric measures continuously correlated with and contributed to HRQoL outcomes.

The effect of varus and valgus deformity on results of cementless mobile bearing TKA.

We aimed to determine whether preoperative angular deformity affects survivorship or postoperative alignment after cementless mobile bearing total knee arthroplasty. Nine hundred seventeen knees were grouped according to preoperative mechanical alignment: normal, 0-5 degrees ; abnormal, 6-10 degrees ; severely abnormal, >10 degrees. Ten-year survival estimates were 89.7% for the severely abnormal alignment group, 95.5% for the abnormal alignment group, and 94.9% for the normal alignment group. Postoperatively, normal alignment was restored in 95.6% of knees in the severely abnormal group and 94.5% of knees in the abnormal group. For the normal alignment group, 99.2% of knees remained normally aligned after TKA. These differences in postoperative alignment may explain the severely abnormal alignment group's inferior survivorship outcome. This study shows that cementless mobile bearing implants can be successfully used in a wide range of angulated deformed knees, although preoperatively deformed knees did not do as well as preoperatively undeformed knees.

Clinical results of primary low contact stress cementless total knee arthroplasty.

The published clinical and radiographic outcomes data for primary cementless low-contact stress (LCS) total knee arthroplasty (TKA) were examined. The majority of patients (92.6%) were pain free or had only mild pain, and excellent or good knee scores (99.1%) at follow-up. Patella difficulties and significant radiolucent lines were rare, occurring in less than 1% of patients. The average range of motion (ROM) for patients without a history of previous knee surgeries was 112.1 degrees. Previous knee procedures had a negative impact on ROM. Overall, primary cementless LCS TKA achieves excellent clinical nd radiographic results.

The long-term results of a metal-backed mobile bearing patella.

UNLABELLED: Enthusiasm for metal-backed patella has waned because of the high incidence of complications. Considering that perhaps all metal-backed patellae may not be the same, 256 primary consecutive metal-backed mobile bearing TKAs done between May 1985 and January 1989 were retrospectively reviewed to evaluate the results of a unique mobile bearing metal-backed patella. There were four complications (1.6%). Three patella were revised for polyethylene complications and one well-functioning component was removed at the time of revision of the tibial polyethylene to facilitate range of motion and wound closure. No patella was revised for loosening, subluxation, or dislocation. Our results show that all metal-backed patella are not the same and that compared with the high incidence of failure of fixed bearing metal-backed patellae, the use of the anatomic mobile bearing metal-backed patella can produce excellent, durable long-term clinical and radiographic results with a low incidence (1.6%) of complications. Life table survivorship using revision for any reason as the end point was 97% (95% confidence interval, 93%-100%) at a maximum of 19 years. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Uncemented rotating-platform total knee replacement: a five to twelve-year follow-up study.

BACKGROUND: Mobile-bearing knee designs represent an alternative to conventional fixed-bearing total knee arthroplasty. We present the results of a prospective, intermediate-term clinical follow-up study of the bicruciate ligament-sacrificing porous-coated Low Contact Stress rotating-platform total knee design. METHODS: Between February 1984 and January 1994, 528 uncemented primary knee replacements were performed in 421 patients. All patellae were resurfaced with use of the Low Contact Stress rotating patellar component. The average age of the patients at the time of the index procedure was sixty-nine years. The study group included 261 women and 160 men. Patients were evaluated at three months, six months, and yearly thereafter with use of the 100-point New Jersey Orthopaedic Hospital knee-scoring system. In addition, a radiographic analysis of the tibial, femoral, and patellar components was performed at each interval. RESULTS: There were twenty-nine failures that resulted in revision. The Kaplan-Meier estimate of implant survival at twelve years was 89.5% (95% confidence interval, 83.4% to 95.6%). The total clinical scores improved significantly compared with the preoperative scores for the first twelve months postoperatively and then plateaued. Three hundred and twenty-one knees had adequate radiographic follow-up (average, 8.1 years; range, five to twelve years). Zonal radiographic analysis revealed ninety-three instances of radiolucent lines (eighty-two of which measured <1 mm in width), with the greatest number of radiolucent lines (thirty-nine) being located around the tibial tray stem. None of these lines were deemed to be progressive, and no knee with a radiolucent line that measured >2 mm was revised because of failure. CONCLUSIONS: This first-generation uncemented, mobile-bearing, bicruciate ligament-sacrificing knee replacement was associated with a good survival rate and demonstrated clinical efficacy during the five to twelve-year follow-up interval. .

The clinical history and development of the low contact stress total knee arthroplasty.

Contemporary total knee arthroplasty (TKA) has evolved over the past 30 years as a result of early prosthetic design failure. Hinge-type implants demonstrated a high loosening rate because of overconstraint. Curved-on-flat prostheses, which were popular in the late 1970s, became associated with a high incidence of polyethylene failure. The Low Contact Stress (LCS) Total Knee System (DePuy Orthopaedics Inc, Warsaw, Ind), a mobile-bearing knee arthroplasty design, was introduced in 1977. The LCS Total Knee System, now in its 25th year without alterations in articular geometry, has demonstrated clinical success and has had an impact on evolving prosthetic designs. Introduced in 2001, the LCS Complete Total Knee System provides further refinements in patient fit without changing the fundamental design principles. Surgeons are cautioned to use a well-proven clinical design, as biomechanical variations critically impact clinical outcomes.

Midterm results of mobile-bearing total knee arthroplasty in patients younger than 65 years.

This study evaluated 117 patients younger than 65 years (average, 56 years) in whom mobile-bearing total knee arthroplasties were inserted. All patellae were resurfaced with a mobile-bearing patella implant. Followup averaged 102 months (range, 60-171 months). The average knee score was 91 points, with a pain score of 27 points (possible 30 points). There were eight (7%) revision surgeries in this series, with four malpositioned implants, one infection, and one case of osteolysis. Two patients had bearing revisions for bearing dislocation and polyethylene wear. Survivorship at 14 years was 88%.

The Rotating Platform Mobile Bearing Total Knee Arthroplasty.

The recent evolution of total knee arthroplasty (TKA) has been substantial and unlike that of total hip arthroplasty (THA). The current THA technique is similar to that initially developed and perfected by Professor John Charnley in the mid 1960s. The ball-and-socket articulation of the hip is simple and reproducible biomechanically. The long term (20 years and longer) results with total hip arthroplasty have been very satisfactory. The THA prosthetic designs of today remain similar to those of years past. Improvements have been in biomaterials, methods of fixation and surgical technique. The total knee arthroplasty prostheses of today differ greatly from their predecessors.

The rotating platform mobile bearing total knee arthroplasty.

The recent evolution of total knee arthroplasty (TKA) has been substantial and unlike that of total hip arthroplasty (THA). The current THA technique is similar to that initially developed and perfected by Professor John Charnley in the mid 1960s. The ball-and-socket articulation of the hip is simple and reproducible biomechanically. The long term (20 years and longer) results with total hip arthroplasty have been very satisfactory. The THA prosthetic designs of today remain similar to those of years past. Improvements have been in biomaterials, methods of fixation and surgical technique. The total knee arthroplasty prostheses of today differ greatly from their predecessors.

Comparison of range of motion after posterior cruciate ligament retention or sacrifice with a mobile bearing total knee arthroplasty.

This study evaluated factors affecting range of motion at 24 months in 782 total knee arthroplasties (TKAs) performed between 1983 and 1987 in a nonrandomized, multicenter clinical trial by 17 independent surgeons. A mobile bearing prosthesis was used with either a posterior cruciate ligament (PCL)-retaining or PCL-sacrificing technique. Age and gender did not reveal any differences in outcome. For individual surgeons, the outcome was highly variable and did not reflect the number of cases performed. Postoperative range of motion was greater for the PCL-retaining implant; however, there was also a significant difference in the preoperative motion compared with the PCL-sacrificing device. Postoperative motion improved from preoperative for the whole group. Preoperative motion groups of < 90 degrees gained 28 degrees, 90 degrees to 105 degrees gained 15 degrees, and > 105 degrees lost 1 degree. The change in motion for patients without prior surgery was greater than for those with prior surgery.