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1.
J Arthroplasty ; 39(3): 600-605, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37717830

RESUMO

BACKGROUND: Infections, readmissions, and mortalities after total joint arthroplasty (TJA) are serious complications, and transfusions have been associated with increased complication rates following TJA. Certain populations, including women, Black patients, patients who have public insurance and older adults have higher risks of transfusion. Recently, there has been a decline in transfusion rates and a greater emphasis on equity in medicine. This study examined whether disparities in transfusion rates still exist and what variables influence rates over time. METHODS: We used a health care system database to identify 5,435 total knee arthroplasty (TKA) and 2,105 total hip arthroplasty (THA) patients from 2013 to 2021. Transfusion rates were 2.9 and 3.1% in the TKA and THA arthroplasty groups, respectively. White race represented 67.1 and 69.8% of the TKA and THA groups, respectively. Fisher exact and Wilcoxon rank sum tests were used to compare categorical and continuous variables. Multivariable logistic regressions were performed to predict transfusion rates within 5 days of surgery and adjust for potential confounders. RESULTS: Transfusion rates declined over time. However, Black patients had a higher rate of transfusion than White patients despite similar hemoglobin levels, 5.1 versus 1.8% (P < .001) in the TKA group and 4.1 versus 2.7% (P = .103) in the THA group. Following adjustment, the biggest factor associated with a higher transfusion risk in the TKA group was being Black (adjusted odds ratio = 2.2, 95% confidence interval = 1.55 to 3.13). CONCLUSIONS: Transfusion rates for TJA patients are declining; however, Black patients continued to receive transfusions at higher rates in patients receiving TKA.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Humanos , Feminino , Idoso , Estudos Retrospectivos , Transfusão de Sangue , Artroplastia do Joelho/efeitos adversos , Artroplastia de Quadril/efeitos adversos , Modelos Logísticos , Fatores de Risco , Complicações Pós-Operatórias/etiologia
2.
Arthroscopy ; 40(3): 922-927, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-37879516

RESUMO

PURPOSE: To describe the prevalence of randomized controlled trials (RCTs) in orthopaedic sports medicine-related journals reporting on the social determinants of health (SDOH) of their patient cohorts, including factors receiving less attention, such as education level, employment status, insurance status, and socioeconomic status. METHODS: The PubMed/MEDLINE database was used to search for RCTs between 2020 and 2022 from 3 high-impact orthopaedic sports medicine-related journals: American Journal of Sports Medicine, Arthroscopy, and Journal of Shoulder and Elbow Surgery. The following information was extracted from each article: age, sex/gender, body mass index, year published, corresponding author country, and self-reported SDOH factors (race, ethnicity, education level, employment status, insurance status, and socioeconomic status). RESULTS: A total of 189 articles were analyzed. Articles originated from 34 different countries, with the United States (n = 66) producing the greatest number of articles. Overall, age (n = 186; 98.4%) and sex/gender (n = 184; 97.4%) were the factors most commonly reported, followed by body mass index (n = 112; 59.3%), race (n = 17; 9.0%), ethnicity (n = 10; 5.3%), employment status (n = 9; 4.8%), insurance status (n = 7; 3.7%), and education level (n = 5; 2.6%). Socioeconomic status was not reported in any of the articles analyzed. Articles from the United States report on SDOH factors more frequently than international articles, most notably race (24.2% vs 0.8%, respectively) and ethnicity (15.2% and 0%, respectively). CONCLUSIONS: RCTs from 3 high-impact orthopaedic sports medicine journals infrequently report on SDOH. CLINICAL RELEVANCE: Better understanding patient SDOH factors in RCTs is important to help orthopaedic surgeons and other practitioners best apply study results to their patients, as well as help researchers and our field ensure that research is being done transparently with relevance to as many patients as possible.


Assuntos
Ortopedia , Medicina Esportiva , Humanos , Artroscopia , Ensaios Clínicos Controlados Aleatórios como Assunto , Determinantes Sociais da Saúde , Estados Unidos
3.
Cureus ; 15(11): e49492, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38152796

RESUMO

A 53-year-old patient was admitted to the emergency department, presenting with fever, generalized weakness, and various myalgias and arthralgias lasting over seven days. Based upon the patient's worsening symptoms, elevated white blood cell count with neutrophilia and overall presentation, she was initially treated for an infectious cause and prescribed various antibiotics and antipyretic medications. As the patient's condition continued to worsen throughout the initial days of her intake, she was tested for a variety of infections, including coronavirus disease 2019 (COVID-19), Streptococcus, and influenza, and was administered a viral respiratory panel, all of which resulted negative. Upon the development of an evanescent rash on hospital day 9, as well as other symptoms including sore throat, arthritis, and an elevated fever present for over a week, a rheumatology consult now expressed concern for a possible case of Adult-Onset Still's Disease (AOSD). In line with the current treatment used for AOSD and the absence of all other infectious causes, the patient discontinued antibiotic treatment and was started on 125 milligrams of intravenous methylprednisolone every six hours. The patient showed minor improvements in symptoms over the next 24 hours but soon became refractory to treatment, resulting from multiorgan damage, and expired on hospital day 13.

4.
Orthop Clin North Am ; 54(4): 359-368, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37718075

RESUMO

Total Knee Arthroplasty is associated with significant postoperative pain that can limit functional outcomes and patient satisfaction. In recent years, the standard of care for postoperative pain management has reduced reliance on opioids in favor of multimodal analgesia. These regimens consist of systemic medications such as COX-2 inhibitors, acetaminophen, corticosteroids, and gabapentinoids, as well as regional and local approaches such as peripheral nerve blocks and local infiltrative analgesics. Newer therapies, such as cryoneurolysis, are still being studied but have shown promising results. Additional studies are needed to determine the ideal pain regimen that will optimize pain control and eliminate the need for postoperative opioids.


Assuntos
Analgésicos Opioides , Artroplastia do Joelho , Humanos , Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Acetaminofen/uso terapêutico
5.
J Arthroplasty ; 38(11): 2324-2327.e4, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37286057

RESUMO

BACKGROUND: More than 700,000 people in the United States undergo total knee arthroplasty (TKA) each year. Chronic venous insufficiency (CVI) affects 5% to 30% of adults, sometimes resulting in leg ulceration. These CVI cases in TKAs have been associated with worse outcomes; however, we found no study differentiating CVI severity. METHODS: This retrospective study analyzed TKA outcomes at one institution from 2011 to 2021 using patient-specific codes. Analyses included short-term complications (< 90 days postoperative), long-term complications (< 2 years), and CVI status (yes/no; simple/complex/unclassified). Complex CVI consisted of pain, ulceration, inflammation, and/or other complications. Revisions within 2 years and readmissions within 90 days post-TKA were assessed. Composite complications included short-term and long-term complications, revisions, and readmissions. Multivariable logistic regressions predicted complication (any/long/short) as a function of CVI status (yes/no; simple/complex) and potential confounding variables. Of 7,665 patients, 741 (9.7%) had CVI. Among CVI patients, 247 (33.3%) had simple CVI, 233 (31.4%) had complex CVI, and 261 (35.2%) had unclassified CVI. RESULTS: There was no difference in CVI versus control in composite complications (P = .722), short-term complications (P = .786), long-term complications (P = .15), revisions (P = .964), or readmissions (P = .438) postadjustment. Composite complication rates were 14.0% without CVI, 16.7% with complex CVI, and 9.3% with simple CVI. Complication rates differed between simple and complex CVI (P = .035). CONCLUSION: Overall, CVI did not affect postoperative complications versus control. Patients who have complex CVI are at higher risk for post-TKA complications compared to those who have simple CVI.


Assuntos
Artroplastia do Joelho , Insuficiência Venosa , Adulto , Humanos , Estados Unidos , Artroplastia do Joelho/efeitos adversos , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Insuficiência Venosa/complicações , Insuficiência Venosa/cirurgia , Readmissão do Paciente
6.
Surg Technol Int ; 422023 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-37311570

RESUMO

Cryoneurolysis is a minimally invasive procedure that utilizes extreme cold temperature to achieve thermal neurolysis of peripheral sensory nerves. This study aimed to evaluate the safety of cryoneurolysis as a preoperative treatment for total knee arthroplasty (TKA) and assess the incidence of major and minor wound complications associated with the procedure. A retrospective chart review was conducted on 357 patients who underwent cryoanalgesia within two weeks of their scheduled TKA. The study found that cryoneurolysis as a preoperative treatment for TKA did not demonstrate an increased incidence of major complications, including acute periprosthetic joint infections, skin necrosis, or permanent treatment site nerve damage/neuroma compared to published rates of infection. Complications were minimal, with only three cases of infection and five cases of superficial cellulitis observed; however, none were directly attributable to the cryoneurolysis procedure. These findings are encouraging and suggest that cryoneurolysis is a relatively safe adjunct procedure with a similar risk of major or minor complications when used as a preoperative treatment for TKA.

7.
J Exp Orthop ; 10(1): 20, 2023 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-36806032

RESUMO

PURPOSE: Modern multimodal analgesia has been shown to significantly reduce opioid use following total knee arthroplasty (TKA). This study was conducted to determine if changing TKA discharge opioid prescriptions from automatic to upon request resulted in more opioid free recoveries without compromising pain control. METHODS: Between December 2019 and August 2021, an orthopedic surgeon performed 144 primary unilateral TKAs; patients received the same multimodal analgesia protocol except for postoperative opioid prescribing. The first consecutively-treated cohort automatically received an opioid prescription following discharge (automatic group) and the second cohort received opioid prescriptions only upon request (upon request group). Opioid prescription data were derived from a prescription monitoring program and patient-reported outcomes (PROs) were collected preoperatively and at 2 and 12 weeks postoperatively. RESULTS: A higher percentage of the upon request group was opioid free 3 months after TKA compared with the automatic group (55.6% vs 4.3%, p < 0.0001) without compromising pain or function. Among opioid-naïve patients, 72% in the upon request group were opioid free after TKA compared with 5.4% in the automatic group. Opioid prescribing was not significantly reduced among opioid-experienced patients regardless of the pain protocol. CONCLUSION: Requiring patients to request opioid prescriptions following TKA resulted in a higher rate of opioid free TKA, especially among opioid-naïve patients, without increasing pain compared with offering all patients an initial opioid prescription. LEVEL OF EVIDENCE: Level III.

8.
J Arthroplasty ; 38(7): 1224-1229.e1, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36690188

RESUMO

BACKGROUND: Prior studies have shown disparities in utilization of primary and revision total hip arthroplasty (THA). However, little is known about patient population differences associated with elective and nonelective surgery. Therefore, the aim of this study was to explore factors that influence primary utilization and revision risk of THA based on surgery indication. METHODS: Data were obtained from 7,543 patients who had a primary THA from 2014 to 2020 in a database, which consists of multiple health partner systems in Louisiana and Texas. Of these patients, 602 patients (8%) underwent nonelective THA. THA was classified as "elective" or "nonelective" if the patient had a diagnosis of hip osteoarthritis or femoral neck fracture, respectively. RESULTS: After multivariable logistic regression, nonelective THA was associated with alcohol dependence, lower body mass index (BMI), women, and increased age and number of comorbid conditions. No racial or ethnic differences were observed for the utilization of primary THA. Of the 262 patients who underwent revision surgery, patients who underwent THA for nonelective etiologies had an increased odds of revision within 3 years of primary THA (odds ratio (OR) = 1.66, 95% Confidence Interval (CI) = 1.06-2.58, P-value = .025). After multivariable logistic regression, patients who had tobacco usage (adjusted odds ratio (aOR) = 1.36, 95% CI = 1.04-1.78, P-value = .024), alcohol dependence (aOR = 2.46, 95% CI = 1.45-4.15, P-value = .001), and public insurance (OR = 2.08, 95% CI = 1.18-3.70, P-value = .026) had an increased risk of reoperation. CONCLUSION: Demographic and social factors impact the utilization of elective and nonelective primary THA and subsequent revision surgery. Orthopaedic surgeons should focus on preoperative counseling for tobacco and alcohol cessation as these are modifiable risk factors to directly decrease reoperation risk.


Assuntos
Alcoolismo , Artroplastia de Quadril , Osteoartrite do Quadril , Humanos , Feminino , Artroplastia de Quadril/efeitos adversos , Alcoolismo/etiologia , Alcoolismo/cirurgia , Fatores de Risco , Osteoartrite do Quadril/cirurgia , Osteoartrite do Quadril/etiologia , Texas , Reoperação , Estudos Retrospectivos
9.
Instr Course Lect ; 72: 89-98, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36534849

RESUMO

Entrepreneurship and innovation are cornerstones of the economy and move healthcare forward. Most physicians have little experience or knowledge in developing and commercializing novel concepts and ideas. It is important to focus on structured thinking concepts, fundraising, intellectual property, FDA regulations, and initial incorporation and teambuilding strategies. There are various aspects of creating ideas and moving them from notes scribbled on a napkin to a product or service, which can then be integrated into the economic fabric of the healthcare system. Surgeon founders and innovators can then share key aspects any surgeon should consider when becoming an entrepreneur.


Assuntos
Cirurgiões Ortopédicos , Cirurgiões , Humanos , Empreendedorismo , Atenção à Saúde
10.
J Arthroplasty ; 38(3): 573-577, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36257508

RESUMO

BACKGROUND: The impact of social determinants of health (SDOH) has been documented in orthopaedic literature. However, there is a lack of data on the inclusion of these variables in orthopaedic studies. Our aim was to investigate how many total hip arthroplasties and total knee arthroplasties randomized controlled trials report SDOH variables such as race, ethnicity, insurance, income, and education within the manuscript. METHODS: A systematic review was conducted on a PubMed search for randomized controlled trials published from 2017 to 2019 in the Journal of Bone and Joint Surgery, Journal of Arthroplasty, Clinical Orthopaedics and Related Research, and Osteoarthritis and Cartilage. Data collected included publication year, type of surgery, and the inclusion of race, ethnicity, insurance, income, and education. RESULTS: Of the 72 manuscripts included in the study, 5.6% of the manuscripts mentioned race, 4.2% included race within the demographic table, and 1.4% included ethnicity in the demographic table. Overall, only 5 studies discussed any one of the variables studied and none included any SDOH variables in their multivariable regressions. There were no statistically significant differences on inclusion across journal year (P value = .78), journal name (P value = 1.00), or surgery type (P value = .555). CONCLUSION: Our findings identify a major shortcoming in the inclusion of SDOH variables in total knee arthroplasty/total hip arthroplasty publications. Their exclusion may be indirectly perpetuating disparities if research that does not use representative patient samples is used in creating health policies and national standards. LEVEL OF EVIDENCE: Level V.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Humanos , Etnicidade , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Orthopedics ; 46(2): 93-97, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36476176

RESUMO

Despite increased pressure to capture patient-reported outcome measures for at least 1 year following total joint arthroplasty (TJA), follow-up rates during the first year after TJA are typically lower than desired and may result in biased findings if data are not missing at random. We conducted a retrospective review of medical records of primary total knee arthroplasty patients treated by a single surgeon at an urban academic private hospital. Main measures were demographics (sex, age, race, and insurance), body mass index, travel distance to clinic, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Multivariable regression analyses were performed to identify patient characteristics associated with attendance at follow-up visits and predictors of attendance at 6-month follow-up. Among the 205 study patients, follow-up visit attendance declined from a high of 95.7% at day 14 to lows of 69.2% at 6 months and 64.4% at 1 year. Attendance at the previously scheduled follow-up visit was a statistically significant predictor of attendance at 3-month (P=.0015), 6-month (P=.0002), and 1-year (P<.0001) follow-up visits, and travel distance was significantly associated with attending the 1-year follow-up visit (P=.042). Patients with the most favorable KOOS Symptom, Pain, and Function in daily living subscale scores at 3-month follow-up were significantly less likely to attend the 6-month follow-up visit than patients with the least favorable KOOS scores. Prospective studies are needed to identify the full range of factors that may contribute to high rates of loss to follow-up after TJA, which should be of concern to researchers, clinicians, and hospitals. [Orthopedics. 2023;46(2):93-97.].


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Seguimentos , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento
12.
J Knee Surg ; 36(7): 792-800, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35213921

RESUMO

The purpose of this study is to identify predictors of disparities in patient-reported outcome measures (PROMs) before and after arthroscopic meniscectomy. Knee injury and Osteoarthritis Outcome Score (KOOS) was used in this study. All patients who underwent single-knee arthroscopic meniscectomy from January 2012 to March 2018 performed by a single surgeon at an academic safety-net hospital were identified. We excluded patients who had undergone ipsilateral previous knee surgery, bilateral meniscectomy, or concomitant ligament, cartilage, or osteotomy procedures, and those with severe radiographic osteoarthritis in the operated knee, missing preoperative data, or military insurance. Data abstracted from medical records included demographics (age, sex, race, insurance type), clinical characteristics (body mass index, Charlson comorbidity index, and Kellgren-Lawrence [KL] grade), procedure codes, and KOOS assessed before and 90 days after surgery. Multivariable analyses investigated the associations between patient characteristics and the KOOS Pain, other Symptoms, and Function in activities of daily living (ADL) subscales. Among 251 eligible patients, most were female (65.5%), half were of nonwhite race (50.2%), and almost one third were insured by Medicaid (28.6%). Medicaid and black race were statistically significant (p < 0.05) predictors of worse preoperative values for all three KOOS subscales. Medicaid insurance also predicted a lower likelihood of successful surgery, defined as meeting the 10-point minimal clinically important difference, for the KOOS symptoms (p < 0.05) and KOOS ADL (p < 0.05) subscales. Compared with patients without definitive evidence of radiographic osteoarthrosis (KL grade 1), those with moderate radiographic osteoarthritis (KL grade 3) were less likely to have a successful surgical outcome (p < 0.05 for all subscales). Worse preoperative KOOS values predicted worse postoperative KOOS values (p < 0.001 for all subscales) and a lower likelihood of surgical success (p < 0.01 for all subscales). Insurance-based disparities in access to orthopaedic care for meniscus tears may explain worse preoperative PROMs and lower success rates of meniscectomy among Medicaid patients. Patients with meniscus tears and radiological and/or magnetic resonance imaging evidence of osteoarthritis should be carefully evaluated to determine the appropriateness of arthroscopic meniscectomy.


Assuntos
Meniscectomia , Osteoartrite , Humanos , Feminino , Masculino , Meniscectomia/métodos , Atividades Cotidianas , Articulação do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente
13.
Artigo em Inglês | MEDLINE | ID: mdl-36094457

RESUMO

BACKGROUND: Mobile app-based neuromuscular electrical stimulation (NMES) is a promising treatment of knee osteoarthritis as previously demonstrated in a 12-week, randomized, double-blind, sham-controlled, multicenter trial (parent study). METHODS: Sixty-four of the 253 patients with knee osteoarthrosis who completed the 12-week parent study were enrolled in a 14-week extension study during which they continued to receive double-blind, home-based NMES (two 20-minute daily sessions, 5 d/wk) with either the original device ("active NMES") or a low-voltage version ("sham NMES"). All subjects who enrolled in the extension study comprised the intent-to-treat population and subjects who applied NMES (compliance monitored through the mobile app and a remote portal) for at least 2,800 minutes (14-week device usage) comprised the per-protocol therapy compliant population. RESULTS: In the per-protocol therapy compliant population, the active NMES group (n = 21) had a higher reduction in Visual Analog Scale Nominated Activity (64.7% versus 24.3%, P = 0.020) and Visual Analog Scale Nominated Activity improvement ≥50% (76.2% versus 12.5%, P = 0.002) than the sham NMES group (n = 8). Outcomes were not markedly different between groups in the intent-to-treat population. DISCUSSION: Applying NMES therapy for an additional 14 weeks (totaling 26 weeks) resulted in notable and clinically meaningful pain relief when patients were fully compliant with NMES.


Assuntos
Terapia por Estimulação Elétrica , Aplicativos Móveis , Osteoartrite do Joelho , Método Duplo-Cego , Terapia por Estimulação Elétrica/métodos , Humanos , Osteoartrite do Joelho/terapia , Medição da Dor
14.
J Am Acad Orthop Surg ; 30(21): e1402-e1410, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-35947828

RESUMO

INTRODUCTION: The objective of our study was to investigate the association of safety-net hospital (SNH) status with the use of premium technologies in total hip arthroplasty (THA) using the American Academy of Orthopaedic Surgeons American Joint Replacement Registry. METHODS: Premium technology was defined as having one or more of the following three characteristics: ceramic femoral head, dual mobility (DM) bearing, or surgery conducted with robotic assistance (RA). Patients of all ages were included and subdivided into ceramic femoral head, DM, and RA cohorts. SNH status (based on disproportionate share data), patient demographics, geographical region, hospital size, and teaching affiliation were assessed. Multivariate regression analysis was conducted to analyze any notable associations. RESULTS: A total of 624,933 THAs between SNHs and non-SNHs were available for analysis. Based on the three different premium technology categories, there were 551,838 THAs for ceramic femoral head utilization analysis, 601,223 THAs for DM utilization analysis, and 199,250 THAs for RA utilization analysis. SNHs were associated with less use of DM and RA (odds ratio [OR] 0.53 P < 0.0001, 0.39 P < 0.0001, respectively). No difference was observed in ceramic femoral head utilization between SNHs and non-SNHs. Patient age was significantly associated with less utilization of all three premium THA technologies (ceramic: OR 0.43 P < 0.0001; DM: OR 0.93 P < 0.0001, RA: OR 0.89 P < 0.001). Teaching hospitals were significantly associated with increased utilization of premium THA technologies (ceramic: OR 1.23 P < 0.0001, DM: OR 1.62 P < 0.0001, RA: OR 5.33 P < 0.001). CONCLUSION: Premium THA technologies are becoming increasingly used across the US healthcare system; however, that growth is not equal in hospitals with marginalized patient populations. The utilization of ceramic femoral heads is becoming increasingly common across healthcare systems suggesting that ceramic femoral heads may no longer be considered premium technology but rather standard THA care. LEVEL OF EVIDENCE: Level III.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Humanos , Desenho de Prótese , Hospitais de Ensino , Tecnologia , Reoperação , Falha de Prótese
15.
Sci Rep ; 12(1): 12896, 2022 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-35902667

RESUMO

Knee osteoarthritis (OA) involves peri-articular sarcopenia. The infrapatellar articularis genu (AG) links to the quadriceps femoris (QF) and can be sampled from discarded tissue during arthroplasty. We predict disuse-mediated changes in AG myofiber type ratio and atrophy similar to reports on the QF during OA. OA AGs (n = 40) were preserved and grouped by poor (≤ 85°; n = 11), fair (90°-110°; n = 19), and good (≥ 115°; n = 10) range of motion (ROM). Immunolabeling of slow and fast myosin heavy chains in AG sections allowed comparing distribution and cross-sectional area (CSA) of type-I (T1) and type-II (T2) myofibers between groups and associating to ROM. T1/T2 ratios in fair and poor ROM groups was consistent with those published in OA QF. Increasing mean ± SD T2 percentages from good (43.31 ± 11.76), to fair (50.96 ± 5.85), and poor (60.02 ± 8.29) ROM groups was significant between poor versus fair (p = 0.018) and good (p < 0.0001) in association with ROM deficits (r = - 0.729; p < 0.0001). T1 and T2 CSA decreased with worsening ROM, which associates with lower symptom scores (r = 0.3198; p = 0.0472). In-depth evaluation of the OA AG as a surrogate for the OA QF relative to serum and/or synovial fluid biomarkers of sarcopenia could refine diagnostics of peri-articular muscle health to guide individualized strength rehabilitation after surgery.


Assuntos
Osteoartrite do Joelho , Sarcopenia , Humanos , Articulação do Joelho/patologia , Osteoartrite do Joelho/cirurgia , Músculo Quadríceps , Amplitude de Movimento Articular , Sarcopenia/patologia
16.
J Bone Joint Surg Am ; 104(14): 1244-1249, 2022 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-35856928

RESUMO

BACKGROUND: Although there have been calls for the routine reporting of patient demographics associated with health disparities, including race, ethnicity, and socioeconomic status (SES), in published research, the extent to which these variables are reported in orthopaedic journals remains unclear. METHODS: We identified and examined all research articles with human cohorts published in 2019 in the 2 highest-ranked U.S. general orthopaedics journals, Clinical Orthopaedics and Related Research and The Journal of Bone & Joint Surgery. Excluded from analysis were studies with no U.S.-based institution and those that did not report any demographic data. Articles were reviewed to determine study type; reporting of race, ethnicity, and any of 3 SES variables (i.e., income, education, and health-care insurance); and the inclusion of these demographics in multivariable analyses. RESULTS: A total of 156 articles met the inclusion criteria. Of these, 56 (35.9%) reported patient race and 24 (15.4%) reported patient ethnicity. Income was reported in 13 (8.3%) of the articles, education in 23 (14.7%), and health insurance in 18 (11.5%). Of the 97 papers that reported results of multivariable analyses, 30 (30.9%) included race in the analysis and 21 (21.6%) reported significance associated with race. Income, education, and health insurance were included in multivariable analyses in 7 (7.2%), 11 (11.3%), and 10 (10.3%) of the articles, respectively. CONCLUSIONS: Race, ethnicity, and SES were infrequently reported and analyzed within articles published in 2 of the top orthopaedic journals. This problem may be remedied if orthopaedic journals impose standards for the reporting and analysis of patient demographics in studies with human cohorts. CLINICAL RELEVANCE: Failure to report key demographics makes it difficult for practitioners to determine whether study results apply to their patient populations. In addition, when orthopaedic interventions are evaluated without accounting for potential disparities by demographics, clinicians may incorrectly assume that the overall benefits and risks reported in studies apply equally to all patients.


Assuntos
Ortopedia , Publicações Periódicas como Assunto , Bibliometria , Etnicidade , Humanos , Classe Social
17.
Arthroplast Today ; 15: 125-131, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35514364

RESUMO

Background: Knee osteoarthritis (OA) is a widespread and debilitating disease that continues to plague patients. Over the past decade, neuromuscular electrical stimulation (NMES) therapy has shown promise in alleviating knee OA-related symptoms. This study sought to evaluate the efficacy and safety of a home-based NMES therapy for reduction of pain, stiffness, and function associated with knee OA. Material and methods: A randomized, sham-controlled, double-blind, multicenter trial was conducted with 12-week follow-up in 156 knee OA patients receiving either home-based NMES therapy or a modified low-voltage NMES therapy. Outcome measures including knee pain, stiffness, and functionality were collected at baseline through week 12 after the therapy. The primary endpoint was the percentage change from baseline (PCFB) in the Visual Analog Scale (VAS) pain for a patient-nominated physical activity. Secondary endpoints included VAS for general knee pain, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score Joint Replacement, and isometric quadriceps strength test. Results: A clinically meaningful reduction for VAS Nominated Activity was higher in the per-protocol treatment-compliant NMES group than that in the sham low-voltage NMES group at week 12 (PCFB of 42.8% vs 38.6%, P = .562). This was similarly true for the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale (PCFBs of 36.8% vs 26.6%, P = .038). Similar trends and reductions of pain were observed for VAS General, Knee Injury and Osteoarthritis Outcome Score Joint Replacement Pain subscale, and isometric quadriceps strength. Conclusion: Home-based NMES treatment resulted in a clinically meaningful reduction of knee pain, stiffness, and knee functional improvements at week 12 compared with sham NMES treatment.

18.
Arch Osteoporos ; 17(1): 34, 2022 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-35150320

RESUMO

Bone mineral density screening and clinical risk factors are important to stratify individuals for increased risk of fracture. In a population with no history of fractures or baseline bone density measurement, black women were less likely to be screened than white counterparts prior to hip fracture. PURPOSE: To evaluate overall BMD (bone mineral density) screening rates within two years of hip fracture and to identify any disparities for osteoporosis screening or treatment in a female cohort who were eligible for screening under insurance and national recommendations. METHODS: Data were obtained from 1,109 female patients listed in the Research Action for Health Network (REACHnet) database, which consists of multiple health partner systems in Louisiana and Texas. Patients < 65 years old or with a history of hip fracture or osteoporosis diagnosis, screening or treatment more than 2 years before hip fracture were removed. RESULTS: Only 223 (20.1%) females were screened within the two years prior to hip fracture. Additionally, only 23 (10%) of the screened patients received treatment, despite 187 (86.6%) patients being diagnosed with osteoporosis or osteopenia. Screening rates reached a maximum of 27.9% in the 75-80 age group, while the 90 + age group had the lowest screening rates of 12%. We found a quadratic relationship between age and screening rates, indicating that the screening rate increases in age until age 72 and then decreases starkly. After adjusting for potential confounders, we found that black patients had significantly decreased screening rates compared to white patients (adjusted OR = .454, 95% CI = .227-.908, p value = .026) which held in general and for patient ages 65-97. CONCLUSION: Despite national recommendations, overall BMD screening rates among women prior to hip fracture are low. If individuals are not initially screened when eligible, they are less likely to ever be screened prior to fracture. Clinicians should address racial disparities by recommending more screening to otherwise healthy black patients above the age of 65. Lastly, treatment rates need to increase among those diagnosed with osteoporosis since all patients went on to hip fracture.


Assuntos
Fraturas do Quadril , Osteoporose , Idoso , Idoso de 80 Anos ou mais , População Negra , Densidade Óssea , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/prevenção & controle , Humanos , Programas de Rastreamento , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia
19.
J Orthop Res ; 40(3): 584-594, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33913554

RESUMO

This study tests if differences exist in the severity of synovial fibrosis between patients undergoing total knee arthroplasty (TKA) for osteoarthritis (OA) to help explain disparate deficits in pre- and postoperative range of motion (ROM) between patient groups. 117 knee OA patients were grouped by women (n = 74) and men (n = 43) or those who self-reported as Black (n = 48) or White (n = 69). ROM was measured pre- and post-TKA. Condyles and synovium collected during TKA were scored histologically for OA severity and synovitis. Fibrosis was measured from picrosirius-stained sections of the synovium. Data were analyzed using Mann-Whitney, parametric, and Spearman's rho tests with alpha at 0.05. We found no significant differences between patient age, BMI, radiographic scores, or deformity type when grouped by sex or race, or between metrics or OA severity when grouped by sex. Notably, higher synovitis was measured in women (p = .039) than men. White patients had greater ROM before (p = 0.46) and after surgery (p = .021) relative to Black patients. Fibrosis, but not OA severity and synovitis scores, for the total patient sample negatively correlated with preoperative (r s = -0.330; p = .0003) but not postoperative (rs = -0.032; p = .7627) ROM. Black patients manifested more fibrosis than White patients (p = <.0001), without significant differences between sexes. Statement of Clinical Significance: Coupled with histological scoring, measuring perioperative differences in synovial fibrosis against ROM may refine OA classification and justify the in-depth preoperative assessment of the knee as a whole. Such individualized analyses could guide personalized strategies to relieve symptomatic OA when TKA is not readily accessible and promote equitable TKA outcomes.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Sinovite , Feminino , Fibrose , Humanos , Articulação do Joelho/patologia , Masculino , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Sinovite/patologia
20.
J Clin Rheumatol ; 28(2): e359-e362, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33657591

RESUMO

BACKGROUND/OBJECTIVE: The objective of this study was to identify patient and disease characteristics associated with the symptomatic severity of knee osteoarthritis (OA) at the time of initial knee OA diagnosis by an orthopedist. METHODS: This medical records review included patients initially diagnosed with knee OA during 2016 to 2017 by a single orthopedic surgeon in a university-based tertiary care setting. All variables were assessed at first OA diagnosis. Main outcomes were subscales of the Knee Injury and Osteoarthritis Outcome Score-Pain, other Symptoms, knee-related quality of life, and function in daily living. Multivariable regression analyses examined the following predictors of main outcomes: sex, race, age, insurance type, body mass index, Charlson comorbidity index, and radiographic OA severity (Kellgren-Lawrence grade). RESULTS: Of the 559 patients included in the study, most were African American (52.1%), female (71.7%), and had severe radiographic OA (Kellgren-Lawrence grade, 4; 68.7%). Female sex, African American racial/ethnic group, Medicaid insurance, younger age, and severe radiographic OA were independently statistically significantly associated with worse symptoms, pain, and function (p < 0.05 for all). Body mass index and Charlson comorbidity index were not statistically significant predictors of any outcome. CONCLUSIONS: This study identified disparities in the perception of knee OA problems at initial orthopedist diagnosis based on sex, age, race, insurance, and radiographic OA severity. Because most of these variables are also associated with more rapid progression of OA, identifying their biopsychosocial underpinnings may help determine which interventions are most likely to redress these disparities and delay progression to end-stage knee OA.


Assuntos
Osteoartrite do Joelho , Negro ou Afro-Americano , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Qualidade de Vida , Encaminhamento e Consulta , Índice de Gravidade de Doença
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