RESUMO
AIMS: The aim of this study was to determine the general postoperative opioid consumption and rate of appropriate disposal of excess opioid prescriptions in patients undergoing primary unilateral total knee arthroplasty (TKA). PATIENTS AND METHODS: In total, 112 patients undergoing surgery with one of eight arthroplasty surgeons at a single specialty hospital were prospectively enrolled. Three patients were excluded for undergoing secondary procedures within six weeks. Daily pain levels and opioid consumption, quantity, and disposal patterns for leftover medications were collected for six weeks following surgery using a text-messaging platform. RESULTS: Overall, 103 of 109 patients (94.5%) completed the daily short message service (SMS) surveys. The mean oral morphine equivalents (OME) consumed during the six weeks post-surgery were 639.6 mg (sd 323.7; 20 to 1616) corresponding to 85.3 tablets of 5 mg oxycodone per patient. A total of 66 patients (64.1%) had stopped taking opioids within six weeks of surgery and had the mean equivalent of 18 oxycodone 5 mg tablets remaining. Only 17 patients (25.7%) appropriately disposed of leftover medications. CONCLUSION: These prospectively collected data provide a benchmark for general opioid consumption after uncomplicated primary unilateral TKA. Many patients are prescribed more opioids than they require, and leftover medication is infrequently disposed of appropriately, which increases the risk for illicit diversion. Cite this article: Bone Joint J 2019;101-B(7 Supple C):98-103.
Assuntos
Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Padrões de Prática Médica , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Estudos Prospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
AIMS: We report on the outcome of the Synergy cementless femoral stem with a minimum follow-up of 15 years (15 to 17). PATIENTS AND METHODS: A retrospective review was undertaken of a consecutive series of 112 routine primary cementless total hip arthroplasties (THAs) in 102 patients (112 hips). There were 60 female and 42 male patients with a mean age of 61 years (18 to 82) at the time of surgery. A total of 78 hips in the 69 patients remain in situ; nine hips in eight patients died before 15 years, and 16 hips in 16 patients were revised. Clinical outcome scores and radiographs were available for 94 hips in 85 patients. RESULTS: In all, four stems were revised. One stem was revised for aseptic loosening; two stems because of deep infection; and one because of periprosthetic femoral fracture. There was a significant improvement in all components of the Western Ontario and McMaster Universities Osteoarthritis Index score at the final follow-up (total: p < 0.001, pain: p < 0.001, stiffness: p < 0.001, function: p < 0.001). The mean Harris Hip Scores improved from 47 points (27 to 59) pre-operatively to 89 points (65 to 100) at the latest follow-up (p < 0.001). Kaplan-Meier survivorship, with stem revision for aseptic loosening as the endpoint, was 98.9% at 15 years (95% confidence interval (CI) 96.9 to 100, number at risk at 15 years: 90) and with stem revision for any reason was 95.7% (95% CI 91.7 to 99.8, number at risk at 15 years: 90). CONCLUSION: The Synergy cementless femoral stem demonstrates excellent survivorship and functional outcomes at 15 years. Cite this article: Bone Joint J 2017;99-B:29-36.
Assuntos
Artroplastia de Quadril/instrumentação , Cimentos Ósseos/uso terapêutico , Durapatita/uso terapêutico , Prótese de Quadril , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Cimentação/métodos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Desenho de Prótese , Falha de Prótese , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Adulto JovemRESUMO
Many aspects of total knee arthroplasty have changed since its inception. Modern prosthetic design, better fixation techniques, improved polyethylene wear characteristics and rehabilitation, have all contributed to a large change in revision rates. Arthroplasty patients now expect longevity of their prostheses and demand functional improvement to match. This has led to a re-examination of the long-held belief that mechanical alignment is instrumental to a successful outcome and a focus on restoring healthy joint kinematics. A combination of kinematic restoration and uncemented, adaptable fixation may hold the key to future advances.
Assuntos
Artroplastia do Joelho/métodos , Artropatias/prevenção & controle , Articulação do Joelho/fisiologia , Complicações Pós-Operatórias/prevenção & controle , Anormalidade Torcional/prevenção & controle , Artroplastia do Joelho/instrumentação , Fenômenos Biomecânicos , Humanos , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Recuperação de Função Fisiológica , Reoperação , Anormalidade Torcional/etiologia , Anormalidade Torcional/cirurgia , Torção MecânicaRESUMO
The aims of this study were to determine the functional impact and financial burden of isolated and recurrent dislocation after total hip arthroplasty (THA). Our secondary goal was to determine whether there was a difference between patients who were treated non-operatively and those who were treated operatively. We retrospectively reviewed 71 patients who had suffered dislocation of a primary THA. Their mean age was 67 years (41 to 92) and the mean follow-up was 3.8 years (2.1 to 8.2). Because patients with recurrent dislocation were three times more likely to undergo operative treatment (p < 0.0001), they ultimately had a significantly higher mean Harris Hip Score (HHS) (p = 0.0001), lower mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (p = 0.001) and a higher mean SF-12 score (p < 0.0001) than patients with a single dislocation. Likewise, those who underwent operative treatment had a higher mean HHS (p < 0.0001), lower mean WOMAC score (p < 0.0001) and a higher mean SF-12 score (p < 0.0001) than those who were treated non-operatively. Recurrent dislocation and operative treatment increased costs by 300% (£11 456; p < 0.0001) and 40% (£5217; p < 0.0001), respectively. The operative treatment of recurrent dislocation results in significantly better function than non-operative management. Moreover, the increase in costs for operative treatment is modest compared with that of non-operative measures.
Assuntos
Artroplastia de Quadril/métodos , Luxação do Quadril/economia , Luxação do Quadril/terapia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Retratamento , Estudos RetrospectivosRESUMO
If a surgeon is faced with altered lesser trochanter anatomy when revising the femoral component in revision total hip replacement, a peri-prosthetic fracture, or Paprosky type IIIb or type IV femoral bone loss, a modular tapered stem offers the advantages of accurately controlling femoral version and length. The splines of the taper allow rotational control, and improve the fit in femoral canals with diaphyseal bone loss. In general, two centimetres of diaphyseal contact is all that is needed to gain stability with modular tapered stems. By allowing the proximal body trial to rotate on a well-fixed distal segment during trial reduction, appropriate anteversion can be obtained in order to improve intra-operative stability, and decrease the dislocation risk. However, modular stems should not be used for all femoral revisions, as implant fracture and corrosion at modular junctions can still occur.
Assuntos
Artroplastia de Quadril/instrumentação , Fêmur/patologia , Fêmur/cirurgia , Prótese de Quadril , Desenho de Prótese , Feminino , Luxação do Quadril/prevenção & controle , Humanos , Instabilidade Articular/prevenção & controle , Masculino , Fraturas Periprotéticas/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Falha de Prótese , Reoperação , Resultado do TratamentoRESUMO
An 81-year-old woman presented with a fracture in the left femur. She had well-fixed bilateral hip replacements and had received long-term bisphosphonate treatment. Prolonged bisphosphonate use has been recently linked with atypical subtrochanteric and diaphyseal femoral fractures. While the current definition of an atypical fracture of the femur excludes peri-prosthetic fractures, this case suggests that they do occur and should be considered in patients with severe osteopenia. Union of the fracture followed cessation of bisphosphonates and treatment with teriparatide. Thus, this case calls into question whether prophylactic intramedullary nailing is sufficient alone to treat early or completed atypical femoral fractures.
Assuntos
Alendronato/efeitos adversos , Conservadores da Densidade Óssea/efeitos adversos , Fraturas do Fêmur/induzido quimicamente , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/induzido quimicamente , Idoso de 80 Anos ou mais , Alendronato/administração & dosagem , Artroplastia de Quadril , Conservadores da Densidade Óssea/administração & dosagem , Conservadores da Densidade Óssea/uso terapêutico , Esquema de Medicação , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Humanos , Osteoporose Pós-Menopausa/tratamento farmacológico , Fraturas Periprotéticas/diagnóstico por imagem , Radiografia , Teriparatida/uso terapêuticoRESUMO
The purpose of this study was to compare the amount of acetabular bone removed during hip resurfacing (HR) and cementless total hip replacement (THR), after controlling for the diameter of the patient's native femoral head. Based on a power analysis, 64 consecutive patients (68 hips) undergoing HR or THR were prospectively enrolled in the study. The following data were recorded intra-operatively: the diameter of the native femoral head, the largest reamer used, the final size of the acetabular component, the size of the prosthetic femoral head and whether a decision was made to increase the size of the acetabular component in order to accommodate a larger prosthetic femoral head. Results were compared using two-sided, independent samples Student's t-tests. A statistically significant difference was seen in the mean ratio of the size of the acetabular component to the diameter of the native femoral head (HR: 1.05 (SD 0.04) versus THR: 1.09 (SD 0.05); p < 0.001) and largest acetabular reamer used to the diameter of the native femoral head (HR: 1.03 (SD 0.04) versus THR: 1.09 (SD 0.05); p < 0.001). The ratios varied minimally when the groups were subdivided by gender, age and obesity. The decision to increase the size of the acetabular component to accommodate a larger femoral head occurred more often in the THR group (27% versus 9%). Despite the emphasis on avoiding damage to the femoral neck during HR, the ratio of the size of the acetabular component to the diameter of the native femoral head was larger in cementless THR than in HR.
Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Fêmur/cirurgia , Feminino , Prótese de Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Insufficient physical activity (PA) is considered a critical contributor to childhood overweight. Parents are a key in influencing their child's PA through various mechanisms of PA parenting, including support, restriction of PA and facilitation of enrolment in PA classes or activities. However, study findings are difficult to compare because instruments vary in terms of constructs, psychometric assessment and type of PA assessed. The goal of the current review was to identify existing PA parenting questionnaires and report on the validation of these measures through findings of their psychometric performance and correlation to youth's PA. The search of eligible studies was restricted to instruments with multiple items. Eleven unique PA parenting questionnaires were identified, and 46 studies that used these instruments were included. Extracted data include sample characteristics, as well as type and assessment methods of parental influence and PA. Findings highlight the tremendous variation in the conceptualization and measurement of PA parenting, common use of non-validated instruments and lack of comprehensive measures. The development of theory-based PA parenting measures (preferably multidimensional) should be prioritized to guide the study of the parental role in promoting child's PA as well as the design of family-based PA interventions.