Cadera/Hip/Hüfte/Hanche: No sirve la puntuación WOMAC

Can the pre-operative Western Ontario and McMaster score predict patient satisfaction following total hip arthroplasty? 

Rogers, B. A., Alolabi, B., Carrothers, A. D., Kreder, H. J., Jenkinson, R. J.

Bone Joint J 2015;97-B:150–3.

In this study we evaluated whether pre-operative Western Ontario and McMaster Universities (WOMAC) osteoarthritis scores can predict satisfaction following total hip arthroplasty (THA).

Prospective data for a cohort of patients undergoing THA from two large academic centres were collected, and pre-operative and one-year post-operative WOMAC scores and a 25-point satisfaction questionnaire were obtained for 446 patients. Satisfaction scores were dichotomised into either improvement or deterioration. Scatter plots and Spearman’s rank correlation coefficient were used to describe the association between pre-operative WOMAC and one-year post-operative WOMAC scores and patient satisfaction. Satisfaction was compared using receiver operating characteristic (ROC) analysis against pre-operative, post-operative and WOMAC scores.

We found no relationship between pre-operative WOMAC scores and one-year post-operative WOMAC or satisfaction scores, with Spearman’s rank correlation coefficients of 0.16 and –0.05, respectively. The ROC analysis showed areas under the curve (AUC) of 0.54 (pre-operative WOMAC), 0.67 (post-operative WOMAC) and 0.43 ( WOMAC), respectively, for an improvement in satisfaction.

We conclude that the pre-operative WOMAC score does not predict the post-operative WOMAC score or patient satisfaction after THA, and that WOMAC scores can therefore not be used to prioritise patient care.

 

Rodilla/Knne: Van peor las PTR en enfermos con lesiones menos graves

Chronic non-orthopedic conditions more common in patients with less severe degenerative changes that have elected to undergo total knee arthroplasty

Cale A. Jacobs, Christian P. Christensen, Tharun Karthikeyan
J Arthroplasty: Published Online: February 06, 2015

DOI: http://dx.doi.org/10.1016/j.arth.2015.01.051

The purpose of this study was to determine whether the prevalence of chronic non-orthopedic conditions that may play a role in an abnormal pain response differ between patients based on the severity of degenerative changes at the time of surgery.

Of 1,020 OA knees that had undergone primary TKA with a minimum 2 year follow-up, we identified 117 (11.5%) that had less severe degenerative changes. The prevalence of dissatisfaction was significantly greater in less severe group compared to those with moderate or severe changes (18.8% vs. 9.3%, p = .003). Chronic non-orthopedic conditions were significantly more prevalent in the less severe group with 41.9% reporting depression/anxiety, 30.8% with fibromyalgia or low back pathology, and 12.8% with a prior traumatic brain injury or stroke.

General: Entrenamiento virtual para hacerlo bien

Fundamental arthroscopic skill differentiation with virtual reality simulation

Rose K, Pedowitz R.

Arthroscopy. 2015 Feb;31(2):299-305
doi: 10.1016/j.arthro.2014.08.016

Abstract

PURPOSE:
The purpose of this study was to investigate the use and validity of virtual reality modules as part of the educational approach to mastering arthroscopy in a safe environment by assessing the ability to distinguish between experience levels. Additionally, the study aimed to evaluate whether experts have greater ambidexterity than do novices.

METHODS:
Three virtual reality modules (Swemac/Augmented Reality Systems, Linkoping, Sweden) were created to test fundamental arthroscopic skills. Thirty participants-10 experts consisting of faculty, 10 intermediate participants consisting of orthopaedic residents, and 10 novices consisting of medical students-performed each exercise. Steady and Telescope was designed to train centering and image stability. Steady and Probe was designed to train basic triangulation. Track and Moving Target was designed to train coordinated motions of arthroscope and probe. Metrics reflecting speed, accuracy, and efficiency of motion were used to measure construct validity.

RESULTS:
Steady and Probe and Track a Moving Target both exhibited construct validity, with better performance by experts and intermediate participants than by novices (P < .05), whereas Steady and Telescope did not show validity. There was an overall trend toward better ambidexterity as a function of greater surgical experience, with experts consistently more proficient than novices throughout all 3 modules.

CONCLUSIONS:
This study represents a new way to assess basic arthroscopy skills using virtual reality modules developed through task deconstruction. Participants with the most arthroscopic experience performed better and were more consistent than novices on all 3 virtual reality modules. Greater arthroscopic experience correlates with more symmetry of ambidextrous performance. However, further adjustment of the modules may better simulate fundamental arthroscopic skills and discriminate between experience levels.

CLINICAL RELEVANCE:
Arthroscopy training is a critical element of orthopaedic surgery resident training. Developing techniques to safely and effectively train these skills is critical for patient safety and resident education.

Ciencia/Science: ¡Un glioma de tanto hablar por el móvil!

Mobile phone and cordless phone use and the risk for glioma – Analysis of pooled case-control studies in Sweden, 1997–2003 and 2007–2009

Lennart Hardell, Michael Carlberg

Pathophysiology

Available online 29 October 2014, doi:10.1016/j.pathophys.2014.10.001

In Press

Abstract

We made a pooled analysis of two case-control studies on malignant brain tumours with patients diagnosed during 1997–2003 and 2007–2009.

They were aged 20–80 years and 18–75 years, respectively, at the time of diagnosis. Only cases with histopathological verification of the tumour were included. Population-based controls, matched on age and gender, were used. Exposures were assessed by questionnaire. The whole reference group was used in the unconditional regression analysis adjusted for gender, age, year of diagnosis, and socio-economic index.

In total, 1498 (89%) cases and 3530 (87%) controls participated. Mobile phone use increased the risk of glioma, OR = 1.3, 95% CI = 1.1–1.6 overall, increasing to OR = 3.0, 95% CI = 1.7–5.2 in the >25 year latency group. Use of cordless phones increased the risk to OR = 1.4, 95% CI = 1.1–1.7, with highest risk in the >15–20 years latency group yielding OR = 1.7, 95% CI = 1.1–2.5. The OR increased statistically significant both per 100 h of cumulative use, and per year of latency for mobile and cordless phone use. Highest ORs overall were found for ipsilateral mobile or cordless phone use, OR = 1.8, 95% CI = 1.4–2.2 and OR = 1.7, 95% CI = 1.3–2.1, respectively.

The highest risk was found for glioma in the temporal lobe. First use of mobile or cordless phone before the age of 20 gave higher OR for glioma than in later age groups.

Keywords

Ipsilateral25 years latencyTime since first exposureGliomaWireless phones

Rodilla/Knee: Ahorrar reinfusión de sangre con tranexámico

Effect of a Single Injection of Tranexamic Acid on Blood Loss after Primary Hybrid TKA

Yoshinori Ishii, Hideo Noguchi, Junko Sato, Chiduru Tsuchiya, Shin-ichi Toyabe

The Knee
Available online 17 January 2015

Background
Control of perioperative blood loss is important in total knee arthroplasty (TKA), especially cementless or hybrid TKA. There is increasing interest in the use of tranexamic acid (TXA) for this purpose; however, studies to date have mainly evaluated the effects of various TXA administration regimens on patients who underwent cemented TKA. We sought to determine (1) whether administration of TXA reduces blood loss after hybrid TKA, and (2) whether an autologous blood reinfusion system is necessary in TKA patients who are treated with TXA.

Methods
Ninety-five patients (100 knees) who underwent hybrid primary TKA (cemented tibia, uncemented femur) were included in this study. The initial 50 knees were treated without TXA and the following 50 were treated with TXA. Intravenous TXA (1000mg) was administered shortly before deflation of the tourniquet. All continuous variables are expressed as median values.

Results
Total volumes of blood lost at postoperative 1day were 590ml and 150ml and autotransfusion of collected blood was performed in 88 % and 16% of patients in the without and with TXA groups, respectively. A median volume of 400ml of collected blood was returned to the patients in the without TXA group, and 0ml to the patients in the with TXA group. The calculated volumes of blood lost were 761ml and 683ml (p=0.2250), respectively.

Conclusions
One intravenous injection of 1000mg TXA may help to control postoperative blood loss and reduce the need for postoperative autologous blood reinfusion after hybrid TKA.

Levels of evidence: Level II. 

Rodilla/Knee: Se supone que deberíamos avanzar

Are outcomes after total knee arthroplasty worsening over time? A time-trends study of activity limitation and pain outcomes

Singh JA, Lewallen DG

BMC Musculoskelet Disord 2014.:440.

Abstract

BACKGROUND

To examine whether function and pain outcomes of patients undergoing primary total knee arthroplasty (TKA) are changing over time.

METHODS

The Mayo Clinic Total Joint Registry provided data for time-trends in preoperative and 2-year post-operative activity limitation and pain in primary TKA patients from 1993-2005. We used chi-square test and analysis for variance, as appropriate. Multivariable-adjusted analyses were done using logistic regression.

RESULTS

In a cohort of 7,229 patients who underwent primary TKA during 1993-2005, mean age was 68.4 years (standard deviation (SD), 9.8), mean BMI was 31.1 (SD, 6.0) and 55% were women. Crude estimates showed that preoperative moderate-severe overall limitation were seen in 7.3% fewer patients and preoperative moderate-severe pain in 2.7% more patients in 2002-05, compared to 1992-95 (p < 0.001 for both). At 2-years, crude estimates indicated that compared to 1992-95, moderate-severe post-TKA overall limitation was seen in 4.7% more patients and moderate-severe post-TKA pain in 3.6% more patients in 2002-05, both statistically significant (p ≤ 0.018) and clinically meaningful. In multivariable-adjusted analyses that adjusted for age, sex, anxiety, depression, Deyo-Charlson index, body mass index and preoperative pain/limitation, patients had worse outcomes 2-year post-TKA in 2002-2005 compared to 1993-95 with an odds ratio (95% confidence interval (CI); p-value) of 1.34 (95% CI: 1.02, 1.76, p = 0.037) for moderate-severe activity limitation and 1.79 (95% CI: 1.17, 2.75, p = 0.007) for moderate-severe pain.

CONCLUSION

Patient-reported function and pain outcomes after primary TKA have worsened over the study period 1993-95 to 2002-05. This time-trend is independent of changes in preoperative pain/limitation and certain patient characteristics.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301928/pdf/

Hombro/Shoulder: se gana igual, reparando el manguito a los 50 y a los 70

Comparison of Functional Gains After Arthroscopic Rotator Cuff Repair in Patients Over 70 Years of Age Versus Patients Under 50 Years of Age: A Prospective Multicenter Study
Constantina Moraiti, Pablo Valle, Ali Maqdes, Omar Boughebri, Chourky Dib, Giannis Giakas, B.Sc., Jean Kany, Kamil Elkholti, Jérôme Garret, Denis Katz, Franck Marie Leclère, Philippe Valenti, M.D.correspondenceemail
Received: July 7, 2013; Accepted: August 26, 2014; Published Online: November 11, 2014
Arthroscopy: The Journal of Arthroscopy and Related Surgery
February 2015Volume 31, Issue 2, Pages 184–190
Purpose
To assess rotator cuff rupture characteristics and evaluate healing and the functional outcome after arthroscopic repair in patients older than 70 years versus patients younger than 50 years.

Methods
We conducted a multicenter, prospective, comparative study of 40 patients younger than 50 years (group A) and 40 patients older than 70 years (group B) treated with arthroscopic rotator cuff repair. Patients older than 70 years were operated on only if symptoms persisted after 6 months of conservative treatment, whereas patients younger than 50 years were operated on regardless of any persistent symptoms. Imaging consisted of preoperative magnetic resonance imaging and postoperative ultrasound. Preoperative and postoperative function was evaluated with Constant and modified Constant scores. Patient satisfaction was also assessed. The evaluations were performed at least 1 year postoperatively.

Results
No patient was lost to follow-up. The incidence of both supraspinatus and infraspinatus tears was greater in group B. Greater retraction in the frontal plane and greater fatty infiltration were observed in group B. The Constant score was significantly improved in both groups (51 ± 12.32 preoperatively v 77.18 ± 11.02 postoperatively in group A and 48.8 ± 10.97 preoperatively v 74.6 ± 12.02 postoperatively in group B, P < .05). The improvement was similar in both groups. The modified Constant score was also significantly improved in both groups (57.48 ± 18.23 preoperatively v 81.35 ± 19.75 postoperatively in group A and 63.09 ± 14.96 preoperatively v 95.62 ± 17.61 postoperatively in group B, P < .05). The improvement was greater for group B (P < .05). Partial rerupture of the rotator cuff occurred in 2 cases in group A and 5 cases in group B. Complete rerupture was observed in 2 patients in group B. In group A, 29 patients (72.5%) were very satisfied, 8 (20%) were satisfied, and 3 (7.5%) were less satisfied. In group B, 33 patients (82.5%) were very satisfied, 6 (15%) were satisfied, and only 1 (2.5%) was less satisfied.

Conclusions
Rotator cuff tears are characterized by greater retraction in the frontal plane and greater fatty infiltration in patients older than 70 years compared with patients younger than 50 years. After arthroscopic repair, healing is greater for patients younger than 50 years. Functional gain is at least equal between the 2 groups.
Level of Evidence: Level IV, therapeutic case series.