A qualitative study on the perioperative experiences and demands of haemophilic arthropathy patients undergoing total joint replacement.

INTRODUCTION: Total joint replacement is the optimal treatment option for patients with severe haemophilic arthritis. Current research emphasizes patient-reported outcomes as a vital measure for evaluating surgical outcomes and patient satisfaction. Nevertheless, very limited information about the subjective experience of perioperative haemophiliacs in the literature, highlighting the need for exploration in this area. AIM: To investigate the psychological experiences and health demands of haemophilic arthropathy patients during the perioperative period of total joint replacement. DESIGN: Qualitative descriptive research with semistructured individual interviews. METHODS: From June to September 2023, nine patients with severe haemophilic arthropathy who underwent total joint replacement at a Haemophilia Diagnosis and Treatment Centre in China were interviewed for average 37 min per person. Data were analysed using the traditional content analysis method and reported following the consolidated criteria for reporting qualitative research. The study is reported according to the COREQ checklist. RESULTS: Interviews described two main themes: (1) emotional decline which involves preoperative overoptimism, early postoperative anxiety and disease uncertainty during the early independent rehabilitation. (2) wellness aspiration which includes rehabilitation support and spiritual healing. CONCLUSION: This study reveals the patients' significant psychological changes and their well-being aspiration, particularly out-of-hospital rehabilitation needs. Strengthening communication between multidisciplinary teams and patients, enhancing the involvement of nurses, broadening the scope of functions at primary Haemophilia Treatment Centres, and developing telerehabilitation, these concerted efforts may improve the overall treatment experience for patients.

Impact of Depressive Symptomology on Pain and Function during Recovery after Total Joint Arthroplasty.

OBJECTIVES: To determine the effect of preoperative depressive symptoms on patient-reported function and pain following total joint arthroplasty (TJA) after controlling for potential confounding factors; how depressive symptoms changed after TJA; and the impact of postoperative depressive symptoms on recovery. METHODS: A prospective cohort study undertaken in a metropolitan region in Canada enrolled 710 participants; 622 (87%) had complete 6-month data. Participants completed standardized measures preoperatively and at 1, 3, and 6 months postoperatively. The primary outcome was Western Ontario McMaster Osteoarthritis Index (WOMAC) pain and function. Three groups were created: depressive symptoms absent (n = 573, 82%), possible depressive symptoms (n = 58, 8%), and probable depressive symptoms (n = 68, 10%) using the Center for Epidemiologic Scale for Depression score. Risk-adjusted analyses examined the association between WOMAC change and the preoperative Center for Epidemiologic Scale for Depression score. RESULTS: After risk adjustment, preoperative possible and probable depressive symptomology was associated with postoperative WOMAC pain scores that were 7.6 and 11.7 points, respectively, worse and WOMAC function scores that were 8.8 and 14.3 points, respectively, worse than those without preoperative depressive symptoms. Depressive symptoms improved postoperatively; by 6 months post-TJA, only 34 (5%) participants screened as having probable depressive symptoms, whereas only 13(2%) had possible depressive symptoms. Postoperative WOMAC pain and function scores improved, but they were negatively affected by possible and probable depressive symptoms. CONCLUSIONS: Although depressive symptoms improve postoperatively, preoperative depressive symptoms, especially for those with probable depressive symptomology, may negatively affect postoperative pain and functional recovery even after risk adjustment.

Falls and fear of falling in older adults with total joint arthroplasty: a scoping review.

BACKGROUND: Patients waiting or recovering from total joint arthroplasty (TJA) are at risk for falls which can lead to restriction of activity and negatively impact recovery. The objective of this scoping review is to critically appraise and synthesize the evidence in the reported number of falls, fear of falling, and risk factors associated with falls in older patients waiting for or recovering from TJA. METHODS: Seven electronic databases were searched with no date limits and using language restriction (English). The inclusion criteria were 1) cohorts that included older adults 60+ years of age, 2) reported prevalence of falls, fear of falling, and/or risk factors for falls in patients who were waiting or recovering from TJA and 3) cross-sectional studies, cohort studies, and case control study designs. The quality assessment of selected articles was assessed using the SIGN Guidelines Checklist. RESULTS: Of the 866 citations identified, 12 studies met the inclusion criteria and were reviewed. Prevalence of falls in pre-operative TJA patients and post-operative TJA patients ranged from 23 to 63%, and 13 to 42%, respectively. Of those five studies that examined fear of falling, pre-operative TJA patients reported greater fear of falling than post-operative patients. Modifiable risk factors for falls included fear of falling, joint range of motion, and depression. CONCLUSIONS: An increased risk of falls in patients with TJA was reported both for patients waiting for and recovering from surgery. A number of modifiable risk factors were identified including fear of falling that could be targeted in fall prevention programs for TJA.

Association of joint replacement surgery with incident dementia diagnosis in German claims data.

ABSTRACTBackground:Cognitive decline is an important complication of joint replacement surgeries in senior people. METHODS: We determined incidence rates of dementia diagnosis following endoprosthetic joint replacement surgery (upper and lower extremities). The observation period covered up to 28 quarters using German claims data comprising 154,604 cases 65 years and older. Effects were controlled for cerebrovascular and vascular risk factors, age, sex, the presence of a diagnosis of delirium, and regular prescription of sedative or analgesic drugs (SAD). RESULTS: The rate of incident dementia diagnoses in people without joint replacement surgery was 21.34 per 1,000 person years, compared with 80.76 incident cases when joint replacement surgery was conducted during the quarter of the incident dementia diagnosis; rates declined to 21.77 incident cases 7 and more quarters after joint replacement surgery had taken place. This pattern was maintained when controlling for delirium diagnosis and regular prescription of SAD. Among 10,563 patients with at least one joint replacement surgery, patients with a diagnosis of delirium in the quarter of the surgery were at increased risk of a dementia diagnosis compared to patients without such a diagnosis (HR=2.00, p < 0.001). CONCLUSION: In people surviving the high-risk phase for dementia immediately after surgery, long-term risk of dementia may reach the level of those without surgery. These findings encourage consequent perioperative management to reduce the risk of dementia as well as prospective studies of potentially beneficial effects of joint replacement surgery on mid- to long-term recovery of mobility and cognition in geriatric patients.

Racial/Ethnic Disparity in Rates and Outcomes of Total Joint Arthroplasty.

Racial/ethnic disparity in total joint arthroplasty (TJA) has grown over the last two decades as studies have documented the widening gap between Blacks and Whites in TJA utilization rates despite the known benefits of TJA. Factors contributing to this disparity have been explored and include demographics, socioeconomic status, patient knowledge, patient preference, willingness to undergo TJA, patient expectation of post-arthroplasty outcome, religion/spirituality, and physician-patient interaction. Improvement in patient knowledge by effective physician-patient communication and other methods can possibly influence patient's perception of the procedure. Such interventions can provide patient-relevant data on benefits/risks and dispel myths related to benefits/risks of arthroplasty and possibly reduce this disparity. This review will summarize the literature on racial/ethnic disparity on TJA utilization and outcomes and the factors underlying this disparity.

Depression and anxiety after total joint replacement among older adults: a meta-analysis.

OBJECTIVE: Patients usually experience good physical recovery after total joint replacement (TJR); however, it is unclear whether mood also improves. The current meta-analysis examined changes in depression and anxiety following TJR in older (≥50 years) patients in order to address this gap in the literature. METHODS: Data from 26 studies (4045 TJR, 55 controls) that assessed depression and/or anxiety pre- and post-surgery in TJR patients, with or without a control group, were analyzed. Prevalence rates and Cohen's d effect sizes were used to evaluate changes in the prevalence and severity of depression/anxiety, respectively. RESULTS: Approximately 23% of TJR patients had clinically significant levels of depression prior to surgery, which decreased to 13% one year later. The prevalence of anxiety could not be evaluated due to the limited available data. TJR patients did not show any clinically meaningful reductions in symptoms of depression or anxiety, following surgery. Compared to controls, there was no difference in symptom progression over time; although only one study examined this. CONCLUSIONS: TJR patients appear to have higher rates of clinically significant symptoms of depression before and after surgery, compared to the general population, however more research with adequate control groups is needed to confirm this. Only a modest improvement in the severity of depression and anxiety symptoms was noted post-surgery. However, existing research is limited; preventing definite conclusions regarding the impact of TJR on mood.

Preoperative Predictors of Pain Catastrophizing, Anxiety, and Depression in Patients Undergoing Total Joint Arthroplasty.

BACKGROUND: The relationship between pain catastrophizing and emotional disorders including anxiety and depression in osteoarthritic patients undergoing total joint arthroplasty (TJA) is an emerging area of study. The purpose of this study was to examine the association of these factors with preoperative patient characteristics. METHODS: A prospective cohort study of preoperative TJA patients using the Pain Catastrophizing Scale (PCS) and Hospital Anxiety and Depression Scale (HADS-A/HADS-D) was conducted. Preoperative measures included visual analog pain scale (VAS), Harris Hip and Knee Society scores, Oxford Score, and Kellgren-Lawrence grade. Logistic and quantile regression were used to assess the relationship between preoperative characteristics and PCS or HADS, adjusting for covariate effects. RESULTS: We recruited 463 TJA patients. VAS pain (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.04-1.45) and Oxford (OR 1.13; 95% CI 1.07-1.20) were significant predictors for PCS and its subdomains excluding rumination. Oxford was the only significant predictor for abnormal HADS-A (OR 1.10; 95% CI 1.04-1.17). VAS pain (OR 1.27; 95% CI 1.02-1.52) and Oxford (OR 1.09; 95% CI 1.01-1.17) were significant predictors for abnormal HADS-D. The quantile regression showed similar patterns of association, with female gender, younger age, and higher ASA also associated with HADS-A. CONCLUSION: The most important predictor of catastrophizing, anxiety and/or depression in TJA patients is preoperative pain and poor subjective function. At-risk patients include those with increased pain and generally good clinical function, as well as younger women with significant comorbidities. Such patients should be identified and targeted psychological therapy implemented preoperatively to optimize coping strategies and adaptive behavior to mitigate potential for inferior TJA outcomes including pain and patient dissatisfaction.

The associations of illness perceptions and self-efficacy with psychological well-being of patients in preparation for joint replacement surgery.

Patient well-being on referral to surgery likely affects their surgical experience yet few studies examine pre-surgical correlates of well-being. Guided by the Common Sense Model of Self-Regulation and Social Cognitive theory, this study examined whether illness and emotional representations, general and domain self-efficacy were associated with pre-surgical well-being. The pre-surgical assessment of a three-wave prospective study is reported. Fifty-four hip and knee replacements patients (mean age = 69.33; SD = 8.57) were recruited in the pre-surgery educational clinic at a UK general hospital. Patients completed a questionnaire-pack including the Revised Illness Perceptions Questionnaire, the General Self-Efficacy Scale, the Self-Efficacy for Rehabilitation Outcome Scale, the Falls-Efficacy Scale, and the Short Form of Psychological Well-Being Index. Multiple hierarchical regression analyses showed that above and beyond demographic and clinical characteristics, negative emotional representations were associated with lower psychological well-being while strong general self-efficacy beliefs were positively related to psychological well-being. Independent of demographic and clinical characteristics, joint replacement patients' psychological well-being was associated with their cognitions and emotional reactions to their condition before surgery. Early interventions could potentially target these modifiable factors to improve pre-surgical well-being in this group of patients, with potential for additional post-surgical benefit.

[Sports Activity Following Joint Arthroplasty: Experiences and Expectations of Elderly Patients--Findings from a Qualitative Content Analysis of Guided Interviews]. / Sportliche Aktivität nach Gelenkersatz: Erfahrungen und Erwartungen älterer Rehabilitanden- Ergebnisse einer qualitativen Inhaltsanalyse leitfadengestützter Interviews.

OBJECTIVE: The study investigated specific motives and barriers of sports activities in elderly patients with hip or knee arthroplasty. METHODS: We conducted guided interviews and analysed them by content analysis. RESULTS: 7 women and 8 men were interviewed. In total, we coded 520 passages; on average 34.7 (SD=11.1) per interview. Our findings document severe preoperative handicaps and identified a variety of sports activities which were practiced before treatment. The most emphasized motive was the social function of sports. The main barriers were the self-definition as a sick and elderly person and insecurity and concerns over the course of illness and healing. Very constraining advises on sports activities without consideration of the individual experience in sports were not perceived as helpful. CONCLUSION: Counselling on sports activities following joint replacement needs to consider individual motives, barriers and previous sports experience in order to be perceived as supportive.

Patient factors in referral choice for total joint replacement surgery.

BACKGROUND: Although the option of next available surgeon can be found on surgeon referral forms for total joint replacement surgery, its selection varies across surgical practices. OBJECTIVES: Objectives are to assess the determinants of (a) a patient's request for a particular surgeon; and (b) the actual referral to a specific versus the next available surgeon. METHODS: Questionnaires were mailed to 306 consecutive patients referred to orthopedic surgeons. We assessed quality of life (Oxford Hip and Knee scores, Short Form-12, EuroQol 5D, Pain Visual Analogue Scale), referral experience, and the importance of surgeon choice, surgeon reputation, and wait time. We used logistic regression to build models for the 2 objectives. RESULTS: We obtained 176 respondents (response rate, 58%), 60% female, 65% knee patients, mean age of 65 years, with no significant differences between responders versus nonresponders. Forty-three percent requested a particular surgeon. Seventy-one percent were referred to a specific surgeon. Patients who rated surgeon choice as very/extremely important [adjusted odds ratio (OR), 6.54; 95% confidence interval (CI), 2.57-16.64] and with household incomes of $90,000+ versus <$30,000 (OR, 5.74; 95% CI, 1.56-21.03) were more likely to request a particular surgeon. Hip patients (OR, 3.03; 95% CI, 1.18-7.78), better Physical Component Summary-12 (OR, 1.29; 95% CI, 1.02-1.63), and patients who rated surgeon choice as very/extremely important (OR, 3.88; 95% CI, 1.56-9.70) were more likely to be referred to a specific surgeon. CONCLUSIONS: Most patients want some choice in the referral decision. Providing sufficient information is important, so that patients are aware of their choices and can make an informed choice. Some patients prefer a particular surgeon despite longer wait times.

Demographics and perioperative outcome in patients with depression and anxiety undergoing total joint arthroplasty: a population-based study.

BACKGROUND: Depression and anxiety are highly prevalent psychiatric disorders. However, little is known about their impact on outcomes in the perioperative setting. This study is intended to gain insight into epidemiology and effects on perioperative morbidity, mortality, length of hospital stay, discharge and cost. METHODS: We obtained the National Inpatient Sample from the Hospital Cost and Utilization Project for each year between 2000 and 2008. Entries indicating the performance of primary total hip and knee arthroplasty were identified and separated into four groups: (1) those with concomitant diagnosis of depression or (2) anxiety, (3) both, and (4) none of these diagnoses. The incidence of major complications, non-routine discharge, length, and cost of hospitalization were assessed. Regression analysis was performed to identify if psychiatric comorbidity was an independent risk factor for each outcome. RESULTS: We identified 1,212,493 patients undergoing arthroplasty between 2000 and 2008. The prevalence of depression and anxiety significantly increased over time. Patients with either condition had higher hospital charges, rates of non-routine discharges and comorbidity index. Depression or anxiety were associated with significantly decreased adjusted odds for in-hospital mortality (OR = 0.53, p = 0.0147; OR = 0.58, p = 0.0064). The risk of developing a major complication was slightly lower in patients with depression, anxiety or both (OR=0.95, p = 0.0738; OR = 0.95, p = 0.0259; OR = 0.94, p = 0.7349). CONCLUSIONS: Patients suffering from depression, anxiety, or both require more healthcare resources in a perioperative setting. However, lower short-term mortality in spite of higher comorbidity burden and without extensive changes in perioperative complication profile indicates better outcome for this group of patients.

Factors that influence provider selection for elective total joint arthroplasty.

BACKGROUND: The growth of consumer-directed health plans has sparked increased demand for information regarding the cost and quality of healthcare services, including total joint arthroplasty (TJA). However, the factors that influence patients' choice of provider when pursuing elective orthopaedic care, such as TJA, are poorly understood. QUESTIONS/PURPOSES: We evaluated the factors patients consider when selecting an orthopaedic surgeon and hospital for TJA. METHODS: Two hundred fifty-one patients who sought treatment from either an academic or community-based orthopaedic practice for primary TJA completed a 37-item survey using a 5-point Likert scale rating ("unimportant" to "very important") regarding seven established clinical and nonclinical dimensions of care patients considered when selecting a provider and hospital. RESULT: Patients rated physician manner (average Likert, 4.7) and physician quality (eg, outcomes) (average Likert, 4.6) as most important in their selection of surgeon and hospital for TJA. Despite the expressed importance of surgeon and hospital quality, only 46% of patients were able to find useful information to compare outcomes among surgeons, and 47% for hospitals that perform TJA. CONCLUSIONS: Our findings suggest physician manner and surgical outcomes are the most important considerations for patients when choosing a provider for elective TJA. Cost sharing is the least important criterion patients considered. Patients expressed high motivation to seek out provider quality information but indicated accessible and actionable sources of information are lacking. Future efforts should be directed at developing clinically relevant, easily interpretable, objective, risk-adjusted measures of physician and hospital quality.

Patient perception and knowledge on total joint replacement surgery.

OBJECTIVES: To study patients' perceptions and knowledge about total joint replacement surgery. DESIGN; Cross-sectional survey. SETTING; University teaching hospital, Hong Kong. PATIENTS: Three hundred consecutive patients with the diagnosis of osteoarthritis or inflammatory arthritis attending the out-patient clinic from June 2010 to May 2011. MAIN OUTCOME MEASURES: Patients' knowledge and how they got the knowledge about total joint replacement surgery, and concerns about the outcome of such operations. RESULTS: Whilst 94% of the patients knew about total joint replacement surgery, 77% obtained such knowledge from their friends and relatives. The three most common concerns related to this type of operation were whether they might: be wheelchair bound after surgery (64%), need to be taken care of by others for more than 3 months (61%), and have post-surgery complications (54%). Most of them recognised the advantages of the surgery, 82% knew about good pain relief after surgery, and 87% realised that total joint replacement surgery could improve their mobility. Patients did not have a realistic idea regarding the survival of the prosthesis; 41% thought the prosthesis might last for less than 10 years and 34% had no idea about its longevity. CONCLUSION; Patients did recognise the advantages of total joint replacement surgery in treating arthritis. However, they had many concerns about its outcome that warrant clarification. Public education on these aspects is necessary to address concerns, and may be achieved in cooperation with the media.

Reliability of patient-reported functional outcome in a joint replacement registry. A comparison of primary responders and non-responders in the Danish Shoulder Arthroplasty Registry.

BACKGROUND AND PURPOSE: Patient-reported outcome measures (PROMs) are used by some arthroplasty registries to evaluate results after surgery, but non-response may bias the results. The aim was to identify a potential bias in the outcome scores of subgroups in a cohort of patients from the Danish Shoulder Arthroplasty Registry (DSR) and to characterize non-responders. METHODS: Patient-reported outcome of 787 patients operated in 2008 was assessed 12 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder (WOOS) index. In January 2012, non-responders and incomplete responders were sent a postal reminder. Non-responders to the postal reminder were contacted by telephone. Total WOOS score and WOOS subscales were compared for initial responders (n = 509), responders to the postal reminder (n = 156), and responders after telephone contact (n = 27). The predefined variables age, sex, diagnosis, geographical region, and reoperation rate were compared for responding and non-responding cohorts. RESULTS: A postal reminder increased the response rate from 65% (6% incomplete) to 80% (3% incomplete) and telephone contact resulted in a further increase to 82% (2% incomplete). We did not find any statistically significant differences in total WOOS score or in any of the WOOS subscales between responders to the original questionnaire, responders to the postal reminder, and responders after telephone contact. However, a trend of worse outcome for non-responders was found. The response rate was lower in younger patients. INTERPRETATION: Non-responders did not appear to bias the overall results after shoulder replacement despite a trend of worse outcome for a subgroup of non-responders. As response rates rose markedly by the use of postal reminders, we recommend the use of reminders in arthroplasty registries using PROMs.

Pressure pain threshold and oral health-related quality of life implications of patients with alloplastic temporomandibular joint replacement--a prospective study.

PURPOSE: Alloplastic total temporomandibular joint replacement (TJR) for end-stage disease, congenital disorders, and after ablative surgery has been shown improve function and to decrease pain. The purpose of this study was to evaluate the pain pressure threshold (PPT) and oral health-related quality of life (OHRQoL) in patients undergoing alloplastic TJR. MATERIALS AND METHODS: Subjects requiring TJR from May 2007 through February 2011 were enrolled in the study. The PPT and OHRQoL were measured preoperatively and 2, 6, and 12 months postoperatively. The primary predictor variable was postoperative time (preoperatively and 2, 6, and 12 months postoperatively). The primary outcome variables were the PPT and OHRQoL. RESULTS: Seventeen subjects requiring TJR were enrolled in and completed the required 12-month follow-up. There was no difference in the PPT at any time point. There was a significant improvement in the OHRQoL domain of psychological discomfort (P = .04) at 12 months. Facial pain intensity, temporomandibular joint pain, mandibular function, and diet were also significantly improved at 12 months (P = .001). CONCLUSION: Alloplastic TJR appears to decrease pain, improve function and diet, and decrease psychological discomfort.

Individual risk profiles for postoperative delirium after joint replacement surgery.

BACKGROUND: Delirium occurs in nearly half of older patients after joint replacement surgery. However, risk profiles for developing delirium have not been established. OBJECTIVE: We sought to identify risk profiles for delirium in patients following joint replacement surgery. METHOD: Based on data from a randomized, double-blind, placebo-controlled trial of olanzapine (10 mg) as delirium prophylaxis in 400 patients (67-81 years old) undergoing hip or knee replacement surgery, we performed a signal detection analysis to develop risk profiles for postsurgical delirium (using baseline patient characteristics, iatrogenic factors, and physiologic response parameters). RESULTS: Olanzapine reduced the incidence of delirium by 63% relative to placebo. Among patients receiving placebo, those with an ASA class = 3 and age ≥ 74 years had a 64% risk of delirium. Those with ASA class < 3 still had a 67% risk of delirium if postoperative oxygen saturation was < 95%. Patients who received olanzapine had an 83% risk of developing delirium if they received ≥ 42.5 mg equivalents of intra-operative morphine, were ≥ 74 years old, and had a mean arterial pressure (MAP) < 90 mm Hg at the presurgical screening visit. Patients with the lowest risk (6%) of developing delirium received olanzapine had a hematocrit ≥ 28%, and a presurgical MAP ≥ 90. CONCLUSION: Although use of prophylactic olanzapine reduced the incidence of delirium, subsets of patients remained likely to develop delirium. The risk of developing delirium may be reduced through prophylactic dispensation of olanzapine, maintaining optimal perfusion and oxygenation, and limiting intra-operative opioids.

Long-term results and patient satisfaction after shoulder resurfacing.

BACKGROUND: Shoulder resurfacing has regained popularity in recent years. This report presents the long-term (>20 years) results of this procedure with regard to patient satisfaction and implant survival. MATERIALS AND METHODS: We followed up 61 patients who underwent shoulder resurfacing procedures (74 shoulders) for a minimum of 20 years or until death (7 additional patients were lost to follow-up). The mean patient age at the time of surgery was 58 years. There were 41 total resurfacing procedures and 33 hemi-resurfacing procedures. The humeral component consisted of a cup with a short central peg that was placed either with or without cement. The glenoid was resurfaced with a cemented polyethylene or polyurethane component. RESULTS: Patient satisfaction was 95%, and the survivorship of the humeral prostheses was 96%. There were no periprosthetic fractures, dislocations, or infections. Two humeral components were revised to stemmed prostheses (one for loosening and one for unexplained pain), and one was revised from a cementless to a cemented resurfacing prosthesis. Twelve cemented polyethylene glenoid prostheses had radiolucencies, but only three produced symptoms requiring revision surgery; three polyurethane glenoid prostheses showed severe wear radiographically, but none was loose or required revision surgery. There were 7 revision procedures, 6 with good results. CONCLUSIONS: Shoulder resurfacing is a successful procedure for the majority of patients, with high rates of patient satisfaction, long-term survivorship of the humeral prosthesis, and few complications.

Joint Awareness after Patellofemoral Arthroplasty Evaluated with the Forgotten Joint Score: A Comparison Study.

OBJECTIVE: The aim of the present study was to compare the forgotten joint score (FJS) in patients with isolated patellofemoral osteoarthritis who underwent patellofemoral arthroplasty (PFA) versus those who underwent total knee arthroplasty (TKA) and to analyze the predictors of the FJS after PFA. METHODS: From January 2014 to December 2017, a retrospective cohort study of 56 consecutive patients with isolated patellofemoral osteoarthritis underwent PFA and were included in the PFA group. The patients in the PFA group were matched in a 1:1 ratio based on age, sex, body mass index (BMI), and follow-up duration; 56 patients with isolated patellofemoral osteoarthritis underwent cruciate-retaining TKA (TKA group). The FJS, range of motion of the knee, and Knee Society Score were assessed at 1 and 3 years postoperatively. In addition, the associations between the potential influencing factors (age, sex, BMI, and preoperative Iwano score of the patellofemoral joint) and the FJS were analyzed using multiple linear regression in the PFA group. RESULTS: There were no significant differences between the PFA and TKA groups regarding age (P = 0.316), sex (P = 0.832), BMI (P = 0.447), and follow-up duration (P = 0.625). Postoperatively, the range of motion of the knee and Knee Society Score was significantly higher in the PFA group than the TKA group at both follow-up points (P < 0.05). The PFA group had a significantly higher mean FJS than the TKA group at 1 year postoperatively (62.9 ± 12.3 vs 54.1 ± 14.2, P = 0.034) and 3 years postoperatively (63.3 ± 14.1 vs 55.6 ± 16.4, P = 0.042). In the PFA group, multiple linear regression analysis showed that older age was positively correlated with the FJS, while a higher BMI was negatively correlated with the FJS. CONCLUSION: The patients with isolated patellofemoral osteoarthritis who underwent PFA were more likely to forget the artificial joint and, consequently, may experience a higher degree of satisfaction. In addition, we identified two preoperative patient-related factors (age and BMI) that may predict the FJS after PFA, which might help in chosing the most appropriate operation.

Preoperative Nutritional Status and Risk for Subsyndromal Delirium in Older Adults Following Joint Replacement Surgery.

BACKGROUND: Subsyndromal delirium following surgery in older adults is related to increased lengths of hospital stay and increased admissions to long-term care. Impaired nutrition increases risk for delirium, but its relationship to subsyndromal delirium remains unclear. PURPOSE: This correlational study examined the relationship between nutritional status and subsyndromal delirium in older adults. METHODS: Assessments for subsyndromal delirium in 53 adults 65 years or older were completed for three consecutive days following joint replacement surgery. Relationships between nutritional status and subsyndromal delirium were analyzed. Level of significance for all tests was set at p ≤ .05. RESULTS: Participants' scores from the Mini Nutritional Assessment screen were significantly related (p = .05) to subsyndromal delirium severity after accounting for variability posed by age and cognition status. CONCLUSION: When preoperative risk assessment of older adults indicates nutritional risk, preoperative optimization may improve effectiveness of delirium prevention efforts.