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Young JJ, Zywiel MG, Skou ST, Chandran V, Davey JR, Gandhi R, Mahomed NN, Syed K, Veillette CJH, Rampersaud YR, Perruccio AV. Total Hip Arthroplasty Versus Education and Exercise: A Propensity-Matched Analysis of 266 Patients Who Have Hip Osteoarthritis. J Arthroplasty 2024; 39:S261-S269. [PMID: 38697319 DOI: 10.1016/j.arth.2024.04.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) for osteoarthritis (OA) is a major health system cost. Education and exercise (Edu + Ex) programs may reduce the number of THAs needed, but supporting data are limited. This study aimed to estimate the treatment effect of THA versus Edu + Ex on pain, function, and quality of life outcomes 3 and 12 months after treatment initiation for hip OA. METHODS Patients who had hip OA who underwent THA or an Edu + Ex program were included in this propensity-matched study. In 778 patients (Edu + Ex, n = 303; THA, n = 475), propensity scores were based on pretreatment characteristics, and patients were matched on a 1:1 ratio. Between-group treatment effects (pain, function, and quality of life) were estimated as the mean difference (MD) in change from pretreatment to 3-month and 12-month follow-up using linear mixed models. RESULTS The matched sample consisted of 266 patients (Edu + Ex, n = 133; THA, n = 133) who were balanced on all pretreatment characteristics except opioid use. At 12-month follow-up, THA resulted in significantly greater improvements in pain (MD 35.4; 95% confidence interval [CI] 31.4 to 39.4), function (MD 30.5; 95% CI 26.3 to 34.7), and quality of life (MD 33.6; 95% CI 28.8 to 38.4). Between 17% and 30% of patients receiving Edu + Ex experienced a surgical threshold for clinically meaningful improvement in outcomes, compared to 84% and 90% of THA patients. CONCLUSIONS A THA provides greater improvements in pain, function, and quality of life. A notable proportion of Edu + Ex patients had clinically meaningful improvements, suggesting Edu + Ex may result in THA deferral in some patients, but confirmatory trials are needed.
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Affiliation(s)
- James J Young
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Michael G Zywiel
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark; The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Vinod Chandran
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - J Rod Davey
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rajiv Gandhi
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nizar N Mahomed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Khalid Syed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Christian J H Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Ayers DC, Zheng H, Yang W, Yousef M. Gender Differences in Pain, Function, and Quality of Life Five Years Following Primary Total Knee Arthroplasty. J Arthroplasty 2024; 39:S100-S107. [PMID: 38640963 DOI: 10.1016/j.arth.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Multiple authors have sought to determine what patient characteristics influence outcomes after total knee arthroplasty (TKA). The impact of gender on outcomes after TKA remains controversial. Previous studies had less than 5 years of follow-up after TKA. The aim of this evaluation was to determine what differences in pain, function, and quality of life (QoL) exist between female and male patients 5 years after primary TKA. METHODS A prospective, multicenter cohort of 11,602 unilateral primary TKA patients (7,284 females and 4,318 males) was prospectively evaluated. All patients were enrolled in the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement. Demographic data, musculoskeletal and medical comorbid conditions, and patient-reported outcome measures, including the Knee Injury and Osteoarthritis Outcome (KOOS) and Short-Form (36-item) Health Survey mental component score (MCS) and physical component score (PCS) were collected preoperatively and at 5 years after TKA. Descriptive statistics were generated, and stratified by gender, and differences in pain, function, and QoL between female and male patients were evaluated. Multivariate regression models with a 95% confidence interval (CI) were used to assess the role of patient gender as a predictive factor for KOOS pain and function in daily living (ADL) scores reported 5 years after primary TKA, while adjusting for other variables. RESULTS Prior to surgery, female patients reported worse pain (KOOS pain 46 versus 52), function (KOOS ADL 53 versus 59), and QoL (KOOS QoL 26 versus 29) than male patients. The differences in preoperative scores ranged from 2.70 (KOOS QoL) to 6.12 (KOOS ADL). At 5 years after TKA, female patients reported slightly worse pain (87 versus 89), function (85 versus 87), and QoL (74 versus 75) when compared to male patients. The differences in the mean 5-year postoperative KOOS scores (range, 0.99 to 2.73), although statistically significant (P < .001), were clinically negligible. Female patients achieved greater improvement in pain (41 versus 37), function (32 versus 29), and QoL (48 versus 46) scores in comparison to male patients. Female patients also reported lower preoperative PCS global function (33 versus 35) scores, 5-year postoperative PCS scores (45 versus 46), and MCS global mental function scores (52 versus 54). Similarly, the differences in the 5-year postoperative Short-Form (36-item) Health Survey MCS and PCS scores were clinically negligible. Multivariate regression analysis showed that female gender was not independently predictive for either pain (β = -1.08; 95% CI [-1.25 to 1.03] [P = .85]) or function (β = 0.64; 95% CI [-0.51 to 1.79] [P = .28]) 5 years after surgery. CONCLUSIONS There are no clinically significant gender differences in pain, function, or QoL 5 years after TKA. Female patients typically have worse symptoms prior to surgery, improve more than male patients, and end up with pain, function, and QoL scores clinically equal to male patients. These data can enhance the shared decision-making process between female patients and surgeons and assist in setting appropriate patient expectations prior to TKA.
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Affiliation(s)
- David C Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Hua Zheng
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Wenyun Yang
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Mohamed Yousef
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, Massachusetts; Department of Orthopaedic Surgery, Sohag University, Sohag, Egypt
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Faig‐Martí J, Martínez‐Catasús A. Over a decade of experience in total knee arthroplasty with a multiradius design and fixed bearing at a single centre: Data from the Catalan Arthroplasty Registry. J Exp Orthop 2024; 11:e12076. [PMID: 38957226 PMCID: PMC11217669 DOI: 10.1002/jeo2.12076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/03/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose Arthroplasty registers can provide feedback information on the results of arthroplasties performed by a certain institution or surgeon. The use of real-world data to achieve real-world evidence can help evaluate the performance of the implants used and help counsel our patients. The main objective of our study was to determine the survivorship of the total knee implant we are currently using. Methods A retrospective cohort study of patients who received a total knee arthroplasty from January 2009 to December 2020 in our hospital was conducted, using data from the Catalan arthroplasty registry and the Catalan health service database. Demographic and surgical data were analysed using the Kaplan-Meier method, log-rank test and Cox proportional hazards models with the R Project software (p < 0.05). Results A total of 1336 total knee arthroplasties were included in the study, of which 992 were women. The causes for revision included aseptic loosening (17), infection (29), instability (13), patellar implantation (13), arthrofibrosis (5) and quadriceps tendon rupture (1).The cumulative risk for revision at 5 years using the Kaplan-Meier method was 6.0% and at 10 years 6.5%. Considering gender, this risk was 7.0% and 7.5% at 5 and 10 years, respectively, in women and 3.3% in men, both at 5 and 10 years (p = 0.009). A higher risk for revision in women was seen, which is considered statistically significant (p = 0.012). Conclusion Our survivorship results are comparable to those published in the literature, but with a higher revision risk in women that is only statistically significant for the whole group of reoperations and for patellar implantation, but not for the rest of the diagnoses. Level of Evidence Level IV.
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Affiliation(s)
- Jordi Faig‐Martí
- Orthopaedics DepartmentHospital Sant RafaelBarcelonaCataloniaSpain
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Young JJ, Zywiel MG, Skou ST, Chandran V, Davey JR, Gandhi R, Mahomed NN, Syed K, Veillette CJH, Rampersaud YR, Perruccio AV. Total Knee Arthroplasty Versus Education and Exercise for Knee Osteoarthritis: A Propensity-Matched Analysis. Arthritis Care Res (Hoboken) 2024; 76:682-690. [PMID: 38191793 DOI: 10.1002/acr.25293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE We estimate the treatment effect of total knee arthroplasty (TKA) versus an education and exercise (Edu+Ex) program on pain, function, and quality of life outcomes 3 and 12 months after treatment initiation for knee osteoarthritis (OA). METHODS Patients with knee OA who had undergone TKA were matched on a 1:1 ratio with participants in an Edu+Ex program based on a propensity score fitted to a range of pretreatment covariates. After matching, between-group differences in improvement (the treatment effect) in Knee Injury and Osteoarthritis Outcome Score 12-item version (0, worst to 100, best) pain, function, and quality of life from baseline to 3 and 12 months were estimated using linear mixed models, adjusting for unbalanced covariates, if any, after matching. RESULTS The matched sample consisted of 522 patients (Edu+Ex, n = 261; TKA, n = 261) who were balanced on all pretreatment characteristics. At 12-month follow-up, TKA resulted in significantly greater improvements in pain (mean difference [MD] 22.8; 95% confidence interval [95% CI] 19.7-25.8), function (MD 21.2; 95% CI 17.7-24.4), and quality of life (MD 18.3; 15.0-21.6). Even so, at least one-third of patients receiving Edu+Ex had a clinically meaningful improvement in outcomes at 12 months compared with 75% of patients with TKA. CONCLUSION TKA is associated with greater improvements in pain, function, and quality of life, but these findings also suggest that Edu+Ex may be a viable alternative to TKA in a meaningful proportion of patients, which may reduce overall TKA need. Confirmatory trials are needed.
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Affiliation(s)
- James J Young
- University Health Network, Toronto, Ontario, Canada, and University of Southern Denmark, Odense, Denmark
| | - Michael G Zywiel
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Vinod Chandran
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - J Rod Davey
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Rajiv Gandhi
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Nizar N Mahomed
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Khalid Syed
- University Health Network, Toronto, Ontario, Canada
| | | | - Y Raja Rampersaud
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- University Health Network and University of Toronto, Toronto, Ontario, Canada
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5
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Choi YS, Chang MJ, Shin YB, Kim TW, Chang CB, Kang SB. The Relationship between Western Ontario and McMaster Universities Osteoarthritis Index Score and Satisfaction after Total Knee Arthroplasty Changes Over Time. J Knee Surg 2024; 37:374-380. [PMID: 37380042 DOI: 10.1055/a-2119-3403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
This study aimed to determine whether there was a relationship between preoperative patient-reported outcome measures (PROMs) and satisfaction after total knee arthroplasty (TKA), and whether there was a relationship between the amount of improvement in PROM or final PROM and satisfaction and whether that relationship differed 1 and 2 years after TKA. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and satisfaction of 267 limbs who underwent TKA were analyzed. Logistic regression analysis was performed to determine whether there was a relationship between preoperative WOMAC or improvement in WOMAC or final WOMAC and satisfaction at 1 and 2 years after TKA. Pearson and Filon's z test was performed to determine whether there was a difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. There was no significant relationship between preoperative WOMAC and satisfaction. A higher improvement in WOMAC total score and better final WOMAC total scores at 1 and 2 years after TKA were related to greater satisfaction. At 1 year after TKA, there was no significant difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. However, 2 years after TKA, the final WOMAC function and total score were more related to satisfaction than the amount of improvement in WOMAC function and total score. In the early postoperative period, there was no difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC, whereas over time, the final WOMAC was more related to satisfaction.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Bin Shin
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, South Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Young JJ, Kongsted A, Hartvigsen J, Roos EM, Ammendolia C, Skou ST, Grønne DT, Jensen RK. Associations between comorbid lumbar spinal stenosis symptoms and treatment outcomes in 6,813 patients with knee or hip osteoarthritis following a patient education and exercise therapy program. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100324. [PMID: 36561495 PMCID: PMC9763512 DOI: 10.1016/j.ocarto.2022.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Objective People with knee or hip osteoarthritis (OA) can experience comorbid lumbar spinal stenosis (LSS), but the impact on treatment outcomes is unknown. The aim of this study was to investigate associations between comorbid LSS symptoms and changes in pain, function, and quality of life following a patient education and exercise therapy program. Design This was a longitudinal analysis of 6813 participants in the Good Life with osteoArthritis in Denmark (GLA:D®) program; a structured patient education and exercise therapy program for knee and hip OA. Participants were classified as having comorbid LSS symptoms based on self-report symptom items. Linear mixed models were used to assess differences in change in pain, function, and quality of life outcomes (0 worst to 100 best) at 3- and 12-month follow-up. Results 15% and 23% of knee and hip OA participants had comorbid LSS symptoms, respectively. Knee participants with comorbid LSS symptoms had smaller improvement in pain at 3-months (-1.7, 95% CI -3.3 to -0.1) and hip participants with comorbid LSS symptoms had greater improvement in function at 3- (2.5, 95% CI 0.5 to 5.0) and 12-months (3.8, 95% CI 0.9 to 6.6), when compared to those without LSS symptoms. These differences were not clinically significant and no differences in other outcomes were observed. Conclusion Knee or hip OA patients with comorbid LSS symptoms should expect similar improvements in knee- or hip-related pain, function, and quality of life outcomes when undergoing a patient education and exercise therapy program compared to those without LSS symptoms.
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Affiliation(s)
- James J. Young
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada,Corresponding author. Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark.
| | - Alice Kongsted
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Chiropractic Knowledge Hub, 5230, Odense, Denmark
| | - Jan Hartvigsen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Chiropractic Knowledge Hub, 5230, Odense, Denmark
| | - Ewa M. Roos
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark
| | - Carlo Ammendolia
- Rebecca MacDonald Centre for Arthritis and Autoimmune Diseases, Mount Sinai Hospital, Toronto, Canada,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Søren T. Skou
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
| | - Dorte T. Grønne
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark
| | - Rikke Krüger Jensen
- Centre for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark,Chiropractic Knowledge Hub, 5230, Odense, Denmark
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Swiggett SJ, Mannino A, Vakharia RM, Ehiorobo JO, Roche MW, Mont MA, Erez O. Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty. J Knee Surg 2022; 35:1306-1311. [PMID: 33545731 DOI: 10.1055/s-0041-1723014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Males and females were filtered separately and matched according to age and various medical comorbidities leading to 1,590,626 patients equally distributed. Primary outcomes analyzed included 90-day medical complications, LOSs, 90-day readmission rates, in addition to day of surgery and total global 90-day episode of care costs. Pearson's chi-square analyses were used to compare medical complications and readmission rates. Welch's t-tests were used to test for significance in matching outcomes and costs. A p-value of less than 0.01 was considered statistically significant. Males had a smaller risk of complications than women (1.35 vs. 1.40%, p < 0.006) and higher rates of implant-related complications (2.28 vs. 1.99%, p < 0.0001). Mean LOSs were lower for males: 3.16 versus 3.34 days (p < 0.0001). The 90-day readmission rates were higher in men (9.67 vs. 8.12%, p < 0.0001). This study demonstrated that males undergoing primary TKA have lower medical complications and shorter LOSs then their female counterparts. However, males have higher implant-related complications, readmission rates, and costs of care.
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Affiliation(s)
- Samuel J Swiggett
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Angelo Mannino
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Martin W Roche
- Department of Orthopaedic Surgery, Holy Cross Hospital, Ft. Lauderdale, Florida
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, Manhattan, New York
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
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8
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Perruccio AV, Roos EM, Skou ST, Grønne DT, Davis AM. Factors Influencing Pain Response Following Patient Education and Supervised Exercise in Male and Female Subjects With Hip Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 75:1140-1146. [PMID: 35587461 DOI: 10.1002/acr.24954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To understand factors associated with pain intensity responder status following nonsurgical hip osteoarthritis (OA) intervention, according to sex. METHODS Data were from individuals with hip OA participating in the Danish Good Life With Osteoarthritis in Denmark 8-week education and exercise program. The following factors were recorded at program entry: age; education; mental well-being; comorbidities; body mass index; symptoms in hip, knee, and low back; and program-specific factors including education sessions, former participant lectures, and supervised exercise sessions. Pain intensity was recorded at baseline and at month 3 (post-program) on a 0-100-mm visual analog scale. Response was defined as pain intensity improvement of ≥30% from baseline to post-program. Logistic regression was used and conducted separately in male and female subjects. RESULTS The sample included 791 men and 2,253 women. Female subjects had a mean baseline pain score of 47.2 of 100 (95% confidence interval [95% CI] 46.4-48.1) and male subjects had a score of 41.7 (95% CI 40.3-43.1). By post-program, the proportion of pain responders was 50.4% among women and 45.8% among men (difference P = 0.025). Among women, program-specific factors (attending former participant lectures and more supervised exercise sessions) were positively associated with pain response, as were better mental well-being and fewer comorbidities, while symptoms in other joints/sites were associated with a decreased likelihood of response. Among men, program-specific factors were not associated with response, while better mental well-being and fewer comorbidities were associated with being a responder. CONCLUSION Findings suggest that the influence of some factors on pain response differ for male and female subjects and point to a potential need for targeted approaches for men and women who may require different key messages/approaches from health care providers.
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Affiliation(s)
- Anthony V Perruccio
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Naestved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | | | - Aileen M Davis
- University Health Network, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Brown-Taylor L, Bordner H, Glaws K, Vasileff WK, Walrod B, Di Stasi S. Prevalence of low back pain and related disability in patients with femoroacetabular impingement syndrome. PM R 2022; 14:8-18. [PMID: 33583131 DOI: 10.1002/pmrj.12572] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Low back pain (LBP) has been associated with worse hip function for persons with femoroacetabular impingement syndrome (FAIS). Reports are limited to surgical populations and based on the presence or absence of LBP, regardless of pain severity. OBJECTIVES To report the prevalence of clinically significant LBP for persons with FAIS; compare demographics, pain, and function between those with and without clinically significant LBP; and evaluate relationships between hip function and both LBP-related disability and LBP severity. We hypothesized that participants with LBP would be older, have higher body mass index (BMI), and report worse groin pain, longer symptom duration, and worse hip function. We hypothesized that worse LBP-related disability and LBP severity would be related to worse hip function. DESIGN Observational cross-sectional study. SETTING Hip preservation clinic. PARTICIPANTS 158 persons with FAIS. INTERVENTIONS n/a MAIN OUTCOME MEASURE(S): Visual analog pain scales (VAS 0-100) were used to categorize participants with (≥30) and without (<30) clinically significant LBP. Age, sex, BMI, pain severity and duration, and hip function (33-item Hip Outcome Tool [iHOT33]) were compared between those with and without clinically significant LBP. Correlations were evaluated between the modified Oswestry Disability Index (ODI) and iHOT33, ODI and groin pain severity, LBP severity and iHOT33, and LBP and groin pain severity. RESULTS Sixty percent of participants reported clinically significant LBP (n = 95). These participants reported worse iHOT33 scores (mean difference: 10.1 points) than those without clinically significant LBP (p = .001). Worse ODI scores were associated with worse iHOT33 scores (P < .001; ρ = -0.74). Significant relationships were also observed between (1) ODI and groin pain, (2) LBP and iHOT33, and (3) LBP and groin pain, but the magnitudes of these correlations were weak (ρ ≤ 0.36). CONCLUSIONS Clinically significant LBP is highly prevalent in persons with FAIS and is associated with worse hip function. Worse LBP-related disability, but not LBP severity, was strongly associated with worse hip function.
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Affiliation(s)
- Lindsey Brown-Taylor
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.,Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Haley Bordner
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kathryn Glaws
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - W Kelton Vasileff
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Bryant Walrod
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Family Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
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10
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Perruccio AV, Wong JT, Badley EM, Power JD, Yip C, Rampersaud YR. Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 8:100092. [PMID: 35141656 PMCID: PMC8820018 DOI: 10.1016/j.xnsj.2021.100092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Anthony V. Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network; Toronto, ON, Canada
- Arthritis Community Research and Evaluation Unit, University Health Network; Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto; Toronto, ON, Canada
- Corresponding author at: Krembil Research Institute, 399 Bathurst St. - MP10-302, Toronto, ON M5T 2S8, Canada
| | - Jessica T.Y. Wong
- Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada
| | - Elizabeth M. Badley
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network; Toronto, ON, Canada
- Arthritis Community Research and Evaluation Unit, University Health Network; Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada
| | - J. Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network; Toronto, ON, Canada
| | - Calvin Yip
- Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada
| | - Y. Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network; Toronto, ON, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto; Toronto, ON, Canada
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11
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Zhang LK, Zhu FB, Gao HH, Zhang L, Quan RF. Is intraoperative corticosteroid a good choice for postoperative pain relief in total joint arthroplasty? A meta-analysis of 11 randomized controlled trials. Medicine (Baltimore) 2021; 100:e27468. [PMID: 34622874 PMCID: PMC8500626 DOI: 10.1097/md.0000000000027468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 09/18/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Effective postoperative analgesia is of great significance for postoperative rehabilitation. This meta-analysis aimed to investigate the efficacy of corticosteroid on pain following total joint arthroplasty. METHOD PubMed (1996-December 2020), Embase (1996-December 2020), and the Cochrane Library (CENTRAL, December 2020) were searched and a total of 11 randomized controlled trials met our inclusion criteria. RESULTS Eleven randomized controlled trials met the inclusion criteria. Pooled data indicated the corticosteroid group was effective compared to the control group in terms of the visual analogue scale at rest (P < .05) and movement (P < .05), the total morphine equivalent consumption (P < .05), and the length of stay (P < .05), without increasing the risk of periprosthetic joint infection (P = .74) and the length of stay (P = .32). CONCLUSIONS Compared to the control group, intraoperative corticosteroid was benefit to the pain management in total joint arthroplasty.
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Affiliation(s)
- Lu-kai Zhang
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Fang-bing Zhu
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Huan-huan Gao
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Lei Zhang
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Ren-fu Quan
- Department of Orthopaedics, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang Province, People's Republic of China
- Department of Orthopedics, Affiliated Jiangnan Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
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12
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Hu H, Liu W, Liu Y, Pan J, Zheng X. Association of depressive symptoms and risk of knee pain: the moderating effect of sex. BMC Musculoskelet Disord 2021; 22:640. [PMID: 34311715 PMCID: PMC8314447 DOI: 10.1186/s12891-021-04511-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Depression has been shown in some studies to be associated with knee pain. Females were widely recognized as more vulnerable to depression and knee pain than males. However, the role of sex in this correlation was under-researched. This study aimed to investigate the association between depressive symptoms and subsequent knee pain, as well as whether and how sex would moderate this association based on a four-wave (Wave 1 in 2010–2011, Wave 2 in 2013, Wave 3 in 2015, and Wave 4 in 2018) longitudinal study among middle-aged and elderly Chinese adults. Methods Seventeen thousand seven hundred eight participants were recruited and followed in the China Health and Retirement Longitudinal Study (CHARLS). Ten thousand four hundred fifty-one entered the final analysis based on the inclusion and exclusion criteria. Knee pain was assessed by self-report. Depressive symptoms were evaluated using the validated 10-item Center for Epidemiological Studies-Depression Scale (CESD-10). Cox proportional hazards models were used to calculate hazard ratios with 95% confidence intervals (CIs) after controlling potential confounders to examine the association between depressive symptoms and subsequent incident and persistent knee pain. Non-linear association of depressive symptoms score (CESD-10) and risk of knee pain was also investigated via applying 3-knotted restricted cubic spline regression. An interaction term of depressive symptoms status and sex was added to investigate the moderating effect of sex on the relationship between depressive symptoms status and the risk of knee pain. Results The median follow-up time was seven years for all the outcomes. Participants with depressive symptoms were 1.45 times (95% CI: 1.34–1.56) and 2.16 times (95% CI: 1.85–2.52) more likely to develop the incident and persistent knee pain after multivariable were adjusted, compared with those without depressive symptoms. There was a non-linear association between CESD-10 score and risk of knee pain. Compared with females, males had an enhanced correlation between depressive symptoms status and knee pain (multivariable-adjusted HR: 1.22, 95% CI: 1.05–1.42 and HR: 1.57, 95% CI: 1.14–2.17 for the incident and persistent knee pain, respectively). Conclusion Depressive symptoms are independently associated with an excess risk of knee pain, with a stronger correlation for males than females among middle-aged and elderly Chinese adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04511-2. This study investigated the incidence of knee pain, the correlation of depressive symptoms with knee pain, and the moderating effect of sex on this correlation in a nationally representative cohort of middle-aged and elderly Chinese adults. Results suggested that depressive symptoms were associated with an excess risk of knee pain, with a stronger correlation for males than females.
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Affiliation(s)
- Haiyan Hu
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Wenjun Liu
- Department of Spine Surgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China.,Department of Spine Surgery, Yichang Central People's Hospital, Yichang, 443003, Hubei, China
| | - Yang Liu
- Department of Spine Surgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China.,Department of Spine Surgery, Yichang Central People's Hospital, Yichang, 443003, Hubei, China
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China. .,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Xiaozuo Zheng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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13
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Fonseca-Rodrigues D, Rodrigues A, Martins T, Pinto J, Amorim D, Almeida A, Pinto-Ribeiro F. Correlation between pain severity and levels of anxiety and depression in osteoarthritis patients: a systematic review and meta-analysis. Rheumatology (Oxford) 2021; 61:53-75. [PMID: 34152386 DOI: 10.1093/rheumatology/keab512] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Osteoarthritis (OA) is a chronic degenerative musculoskeletal disease that causes articular damage and chronic pain, with a prevalence of up to 50% in individuals >60 years of age. Patients suffering from chronic painful conditions, including OA, also frequently report anxiety or depression. A systematic review and meta-analysis were performed to assess the correlation between pain severity and depressive and anxious symptomatology in OA patients. METHODS A systematic search was conducted using four databases (PubMed, Medline, Scopus, and Web of Science) from inception up to 14th January of 2020. We included original articles evaluating pain severity and anxiety and/or depression severity in OA-diagnosed patients. Detailed data were extracted from each study, including patients' characteristics and pain, anxiety, and depression severity. When available, the Pearson correlation coefficient between pain and depression severity and pain and anxiety severity was collected and a meta-analysis of random effects was applied. RESULTS This systematic review included 121 studies, with a total of 38085 participants. The mean age was 64.3 years old and subjects were predominantly female (63%). The most used scale to evaluate pain severity was the Western Ontario and the McMaster Universities Osteoarthritis Index, while for anxiety and depression, the Hospital Anxiety and Depression Scale was the most used. The meta-analysis showed a moderate positive correlation between pain severity and both anxious (r = 0.31, p < 0.001) and depressive symptomatology (r = 0.36, p < 0.001). CONCLUSIONS Our results demonstrate a significant correlation between pain and depression/anxiety severity in OA patients, highlighting the need for its routine evaluation by clinicians.
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Affiliation(s)
- Diana Fonseca-Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - André Rodrigues
- School of Medicine, University of Minho, Braga, Portugal.,Anesthesiology Department, Coimbra Hospital and Universitary Centre (CHUC), Praceta Prof. Mota Pinto, Coimbra, Portugal
| | - Teresa Martins
- School of Medicine, University of Minho, Braga, Portugal
| | - Joana Pinto
- School of Medicine, University of Minho, Braga, Portugal
| | - Diana Amorim
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,School of Medicine, University of Minho, Braga, Portugal
| | - Filipa Pinto-Ribeiro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,School of Medicine, University of Minho, Braga, Portugal
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14
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Bielajew BJ, Donahue RP, Espinosa MG, Arzi B, Wang D, Hatcher DC, Paschos NK, Wong MEK, Hu JC, Athanasiou KA. Knee orthopedics as a template for the temporomandibular joint. Cell Rep Med 2021; 2:100241. [PMID: 34095872 PMCID: PMC8149366 DOI: 10.1016/j.xcrm.2021.100241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although the knee joint and temporomandibular joint (TMJ) experience similar incidence of cartilage ailments, the knee orthopedics field has greater funding and more effective end-stage treatment options. Translational research has resulted in the development of tissue-engineered products for knee cartilage repair, but the same is not true for TMJ cartilages. Here, we examine the anatomy and pathology of the joints, compare current treatments and products for cartilage afflictions, and explore ways to accelerate the TMJ field. We examine disparities, such as a 6-fold higher article count and 2,000-fold higher total joint replacement frequency in the knee compared to the TMJ, despite similarities in osteoarthritis incidence. Using knee orthopedics as a template, basic and translational research will drive the development and implementation of clinical products for the TMJ. With more funding opportunities, training programs, and federal guidance, millions of people afflicted with TMJ disorders could benefit from novel, life-changing therapeutics.
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Affiliation(s)
- Benjamin J Bielajew
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Ryan P Donahue
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - M Gabriela Espinosa
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Dean Wang
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | | | - Nikolaos K Paschos
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark E K Wong
- Department of Oral and Maxillofacial Surgery, University of Texas School of Dentistry, Houston, TX, USA
| | - Jerry C Hu
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
| | - Kyriacos A Athanasiou
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA
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15
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Collett G, Insley AP, Michaelis S, Shaji S, Feierstein B, Martell JR. Reduction of Opioid Use With Enhanced Recovery Program for Total Knee Arthroplasty. Fed Pract 2021; 38:212-219. [PMID: 34177230 DOI: 10.12788/fp.0124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Adequate pain control after total knee arthroplasty (TKA) is critically important to achieve early mobilization, shorten the length of hospital stay, and reduce postoperative complications. At Veterans Affairs North Texas Health Care System (VANTHCS) in Dallas, we implemented a multidisciplinary enhanced recovery after surgery (ERAS) protocol to deal with increasing length of stay and postoperative pain. We hypothesize that this protocol will reduce the overall opioid burden and decrease inpatient hospital length of stay in our TKA population. Methods A retrospective review of all TKAs performed by a single surgeon at VANTHCS from 2013 to 2018 was conducted. A postoperative ERAS protocol was implemented in 2016. We compared perioperative opioid use and LOS between cohorts before and after protocol implementation. Results Inpatient length of stay between cohorts was reduced from 66.8 hours for the standard of care (SOC) period to 22.3 hours in the ERAS cohort. Inpatient opioid use measured by total oral morphine equivalent doses averaged 169.5 mg and 66.7 mg for SOC and ERAS cohorts, respectively (P = .0001). Intraoperative use of opioids decreased from 57.4 mg in the SOC cohort to 10.5 mg in the ERAS cohort (P = .0001). Postanesthesia care unit (PACU) opioid use decreased from 13.6 mg (SOC) to 1.3 mg (ERAS) (P = .0002). There was no significant difference in complications between cohorts (P = .09). Conclusions Initiating a multidisciplinary ERAS protocol for TKA at VANTHCS significantly reduced inpatient length of stay and perioperative opioid use with no deleterious effects on complication rates. The ERAS protocol has major medical and financial implications for our unique VA population and the VA health care system.
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Affiliation(s)
- Garen Collett
- is former Chief of Orthopaedic Surgery; and are Nurse Anesthetists in the Anesthesia Management Departmental; all at Veterans Affairs North Texas Health Care System in Dallas. is a PGY-5 Resident, and John Martell is an Associate Professor both at University of Texas Southwestern Medical Center in Dallas. is a Nurse Anesthetist at NorthStar Anesthesia, City Hospital at White Rock in Dallas. is a Physician Assistant, Orthopaedic Surgery Service at James A. Haley Veterans' Hospital in Tampa, Florida
| | - Allison P Insley
- is former Chief of Orthopaedic Surgery; and are Nurse Anesthetists in the Anesthesia Management Departmental; all at Veterans Affairs North Texas Health Care System in Dallas. is a PGY-5 Resident, and John Martell is an Associate Professor both at University of Texas Southwestern Medical Center in Dallas. is a Nurse Anesthetist at NorthStar Anesthesia, City Hospital at White Rock in Dallas. is a Physician Assistant, Orthopaedic Surgery Service at James A. Haley Veterans' Hospital in Tampa, Florida
| | - Secherre Michaelis
- is former Chief of Orthopaedic Surgery; and are Nurse Anesthetists in the Anesthesia Management Departmental; all at Veterans Affairs North Texas Health Care System in Dallas. is a PGY-5 Resident, and John Martell is an Associate Professor both at University of Texas Southwestern Medical Center in Dallas. is a Nurse Anesthetist at NorthStar Anesthesia, City Hospital at White Rock in Dallas. is a Physician Assistant, Orthopaedic Surgery Service at James A. Haley Veterans' Hospital in Tampa, Florida
| | - Sheryl Shaji
- is former Chief of Orthopaedic Surgery; and are Nurse Anesthetists in the Anesthesia Management Departmental; all at Veterans Affairs North Texas Health Care System in Dallas. is a PGY-5 Resident, and John Martell is an Associate Professor both at University of Texas Southwestern Medical Center in Dallas. is a Nurse Anesthetist at NorthStar Anesthesia, City Hospital at White Rock in Dallas. is a Physician Assistant, Orthopaedic Surgery Service at James A. Haley Veterans' Hospital in Tampa, Florida
| | - Bobbi Feierstein
- is former Chief of Orthopaedic Surgery; and are Nurse Anesthetists in the Anesthesia Management Departmental; all at Veterans Affairs North Texas Health Care System in Dallas. is a PGY-5 Resident, and John Martell is an Associate Professor both at University of Texas Southwestern Medical Center in Dallas. is a Nurse Anesthetist at NorthStar Anesthesia, City Hospital at White Rock in Dallas. is a Physician Assistant, Orthopaedic Surgery Service at James A. Haley Veterans' Hospital in Tampa, Florida
| | - John R Martell
- is former Chief of Orthopaedic Surgery; and are Nurse Anesthetists in the Anesthesia Management Departmental; all at Veterans Affairs North Texas Health Care System in Dallas. is a PGY-5 Resident, and John Martell is an Associate Professor both at University of Texas Southwestern Medical Center in Dallas. is a Nurse Anesthetist at NorthStar Anesthesia, City Hospital at White Rock in Dallas. is a Physician Assistant, Orthopaedic Surgery Service at James A. Haley Veterans' Hospital in Tampa, Florida
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16
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Schmerzen nach totalem Kniegelenkersatz: Welche Rolle spielt das
Geschlecht? AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1265-3798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obwohl der totale Kniegelenkersatz eine wirksame Therapie der Gonarthrose
darstellt, berichtet ein erheblicher Anteil der operierten Patienten
über nur geringfügige Verbesserungen oder sogar
anhaltende Schmerzen. Welche präoperativen Faktoren für
ein ungünstige Operationsergebnis prädisponieren und
welche Rolle das Geschlecht diesbezüglich spielt, untersuchte
nun ein Team kanadischer Forscher.
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17
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Sex does not clinically influence the functional outcome of total knee arthroplasty but females have a lower rate of satisfaction with pain relief. Knee Surg Relat Res 2020; 32:32. [PMID: 32660629 PMCID: PMC7301486 DOI: 10.1186/s43019-020-00048-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background The aims were to assess whether sex had a clinically significant independent influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Short Form (SF-) 12 scores and patient satisfaction at 1 year. Methods A retrospective cohort of 3510 primary TKA were identified. Patient demographics, comorbidities, WOMAC and SF-12 scores were collected preoperatively and 1 year postoperatively. Patient satisfaction were assessed at 1 year. Results There were 1584 males and 1926 females. The preoperative WOMAC and SF-12 scores were significantly (p < 0.001) worse in females but were not greater than the minimal clinically important difference (MCID). When adjustments had been made for confounding differences, females showed a significantly greater improvement in their function (1.5 points, p = 0.03) and total (1.5 points, p = 0.03) WOMAC scores compared to males, but these were not greater than the MCID. When adjustments had been made for confounding differences, females were less likely to be satisfied with their pain relief (p = 0.03) relative to males. Conclusion Sex does not clinically influence the knee specific outcome (WOMAC) or overall generic (SF-12) health 1 year after TKA. However, satisfaction with pain relief after TKA was significantly less likely in female patients. Level of evidence II Prognostic retrospective cohort study.
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