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Driscoll DA, Grubel J, Ong J, Chiu YF, Mandl LA, Cushner F, Parks ML, Gonzalez Della Valle A. Obesity Severity Does Not Associate With Rate, Timing, or Invasiveness of Early Reinterventions After Total Knee Arthroplasty. J Arthroplasty 2024; 39:S167-S173.e1. [PMID: 38428689 DOI: 10.1016/j.arth.2024.02.062] [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: 11/13/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The use of body mass index (BMI) cutoff values has been suggested for proceeding with total knee arthroplasty (TKA) in obese patients. However, the relationship between obesity severity and early reoperations after TKA is poorly defined. This study evaluated whether increased World Health Organization (WHO) obesity class was associated with risk, severity, and timing of reintervention within one year after TKA. METHODS There were 8,674 patients from our institution who had a BMI ≥ 30 and underwent unilateral TKA for primary osteoarthritis between 2016 and 2021. Patients were grouped by WHO obesity class: 4,456 class I (51.5%), 2,527 class II (29.2%), and 1,677 class III (19.4%). A chart review was performed to determine patient characteristics and identify patients who underwent any closed or open reintervention requiring anesthesia within the first postoperative year. Regression analyses were performed to identify variables associated with increased odds ratios (ORs) for requiring a reintervention, its timing, and invasiveness. RESULTS There were 158 patients (1.8%) who required at least one reintervention, and 15 patients (0.2%) required at least 2 reinterventions. Reintervention rates for obesity classes I, II, and III were 1.8% (n = 81), 2.0% (n = 51), and 1.4% (n = 23), respectively. There were 65 closed procedures (41.1%), 47 minor procedures (29.7%), 34 open with or without liner exchange (21.5%), and 12 revisions with component exchange (7.6%). Obesity class was not associated with reintervention rate (P = .3), timing (P = .36), or invasiveness (P = .93). Diabetes (odds ratio [OR] = 2.47; P = .008) was associated with a need for reintervention. Non-Caucasian race (OR = 1.7; P = .01) and Charlson comorbidity index (OR = 2.1; P = .008) were associated with earlier reintervention. No factors were associated with the invasiveness of reintervention. CONCLUSIONS The WHO obesity class did not associate with rate, timing, or invasiveness of reintervention after TKA in obese patients. These findings suggest that policies that restrict the indication for elective TKA based only on a BMI limit have limited efficacy in reducing early reintervention after TKA in obese patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel A Driscoll
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jacqueline Grubel
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Justin Ong
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, New York
| | - Fred Cushner
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Michael L Parks
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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Mercer L, Abhishek A, Kavirayani A, Ahmed A, Davidson A, Foulkes A, Jones C, Nash C, Rose-Parfitt E, Dhillon E, Zabate G, Twohig H, De Vere H, Scott J, Reynolds J, Holmes J, Hartley K, Warrier K, Nowak K, Parsons K, Bechman K, Bray L, Adikari M, Wood N, Faithfull N, Gullick N, Saha P, Heaton R, Deepak S, Hider S, Khalid S, Said SS, Ryan S, Kyle S, Raghuvanshi S, Tan SY, Shivamurthy V, Galloway J. The prescription and monitoring of conventional synthetic disease-modifying anti-rheumatic drugs: British Society for Rheumatology guideline scope. Rheumatol Adv Pract 2024; 8:rkae077. [PMID: 39006537 PMCID: PMC11239329 DOI: 10.1093/rap/rkae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/22/2024] [Indexed: 07/16/2024] Open
Abstract
This guideline will provide up-to-date, evidence-based recommendations on the safe use of non-biologic DMARDs, also called conventional synthetic DMARDs (csDMARD), across the full spectrum of autoimmune rheumatic diseases. The guideline will update the guideline published in 2017 and will be expanded to include people of all ages. Updated information on the monitoring of DMARDs and vaccinations will be included. The guideline will be developed using the methods and processes described in the British Society for Rheumatology's 'Creating clinical guidelines: our protocol', updated 2023.
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Affiliation(s)
- Louise Mercer
- Department of Rheumatology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - Abhishek Abhishek
- Academic Rheumatology, City Hospital Nottingham, University of Nottingham, Nottingham, UK
- Nottingham NIHR BRC, Nottingham, UK
| | - Akhila Kavirayani
- Paediatric Rheumatology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alison Ahmed
- Department of Rheumatology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyme, UK
| | - Alan Davidson
- Community Rheumatology, Modality LLP, Birmingham, UK
| | - Amy Foulkes
- Department of Dermatopharmacology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Claire Jones
- Medicines Management, Powys Teaching Health Board, Brecon, Powys, UK
| | - Clare Nash
- Pharmacy Department, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Emily Rose-Parfitt
- Department of Rheumatology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Emmandeep Dhillon
- Department of Rheumatology, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Genevieve Zabate
- Rheumatic Diseases Unit, Western General Hospital NHS Lothian, Edinburgh, UK
| | | | - Hope De Vere
- Department of Rheumatology, Gloucestershire Hospitals NHS Foundation Trust, UK
| | - Jennifer Scott
- Department of Hepatology and Gastroenterology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - John Reynolds
- Institute of Inflammation and Ageing, University of Birmingham Research Labs, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - Julia Holmes
- Expert by Experience, Versus Arthritis Fellowship Expert Committee Member
| | - Karen Hartley
- Department of Pharmacy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Kishore Warrier
- Paediatric and Adolescent Rheumatology, Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kataryzna Nowak
- Department of Rheumatology, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Katie Bechman
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Lisa Bray
- Department of Paediatrics, St Richard’s Hospital, Chichester, UK
| | - Madura Adikari
- Department of Rheumatology, Rotherham General Hospital, Rotherham NHS Foundation Trust, Rotherham, UK
| | | | - Nicola Faithfull
- Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Children’s Hospital, Birmingham, UK
| | - Nicola Gullick
- Department of Rheumatology, University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Pratyasha Saha
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norfolk, UK
| | - Rebecca Heaton
- Department of Rheumatology, Stockport NHS Foundation Trust, Stockport, UK
| | - Samundeeswari Deepak
- Paediatric & Adolescent Rheumatology, Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Samantha Hider
- School of Medicine, Keele University, Keele, UK
- Department of Rheumatology, Haywood Hospital, Midlands Partnership Foundation Trust, Stoke-on-Trent, UK
| | - Sameena Khalid
- Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Sanaa Suleiman Said
- Department of Internal Medicine, State University of Zanzibar, Tunguu, Zanzibar, Tanzania
| | - Sarah Ryan
- Department of Rheumatology, Midlands Partnership University NHS Foundation Trust, Stoke-on-Trent, UK
| | - Stuart Kyle
- Department of Rheumatology, North Devon District Hospital, Royal Devon University, Devon, UK
| | - Subhra Raghuvanshi
- Department of Rheumatology, Wrexham Maelor Hospital, Betsi Cadawaladr University Hospital, Wrexham, UK
| | - Su-Yin Tan
- Department of Rheumatology, NHS Tayside, Dundee, UK
| | - Vinay Shivamurthy
- Department of Rheumatology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - James Galloway
- Centre for Rheumatic Diseases, King’s College London, London, UK
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Wei W, Tang H, Luo Y, Yan S, Ji Q, Liu Z, Li H, Wu F, Yang S, Yang X. Efficacy of virtual reality exercise in knee osteoarthritis rehabilitation: a systematic review and meta-analysis. Front Physiol 2024; 15:1424815. [PMID: 38962070 PMCID: PMC11220424 DOI: 10.3389/fphys.2024.1424815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Background This systematic review and meta-analysis aims to investigate the effects of virtual reality (VR) exercise compared to traditional rehabilitation on pain, function, and muscle strength in patients with knee osteoarthritis (KOA). Additionally, the study explores the mechanisms by which VR exercise contributes to the rehabilitation of KOA patients. Methods We systematically searched PubMed, the Cochrane Library, Embase, Web of Science, Scopus, and PEDro according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search spanned from the library construction to 24 May 2024, focusing on randomized controlled trials Primary outcomes included pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and muscle strength. Meta-analysis was conducted using RevMan (version 5.4) and Stata (version 14.0). The bias risk of included studies was assessed using the Cochrane RoB 2.0 tool, while the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results This meta-analysis and systematic review included nine studies involving 456 KOA patients. The results indicated that VR exercise significantly improved pain scores (SMD, -1.53; 95% CI: -2.50 to -0.55; p = 0.002), WOMAC total score (MD, -14.79; 95% CI: -28.26 to -1.33; p = 0.03), WOMAC pain score (MD, -0.93; 95% CI: -1.52 to -0.34; p = 0.002), knee extensor strength (SMD, 0.51; 95% CI: 0.14 to 0.87; p = 0.006), and knee flexor strength (SMD, 0.65; 95% CI: 0.28 to 1.01; p = 0.0005), but not significantly for WOMAC stiffness (MD, -0.01; 95% CI: -1.21 to 1.19; p = 0.99) and physical function (MD, -0.35; 95% CI: -0.79 to -0.09; p = 0.12). Conclusion VR exercise significantly alleviates pain, enhances muscle strength and WOMAC total score in KOA patients, but improvements in joint stiffness and physical function are not significant. However, the current number of studies is limited, necessitating further research to expand on the present findings. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024540061, identifier CRD42024540061.
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Affiliation(s)
- Wei Wei
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haiting Tang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Luo
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shichang Yan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qipei Ji
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhixiang Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huaqiang Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fei Wu
- School of Foreign Languages, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shenqiao Yang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Yang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Goodman SM, Mannstadt I, Gibbons JAB, Rajan M, Bass A, Russell L, Mehta B, Figgie M, Parks ML, Venkatachalam S, Nowell WB, Brantner C, Lui G, Card A, Leung P, Tischler H, Young SR, Navarro-Millán I. Healthcare disparities: patients' perspectives on barriers to joint replacement. BMC Musculoskelet Disord 2023; 24:976. [PMID: 38110904 PMCID: PMC10726517 DOI: 10.1186/s12891-023-07096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE Racial and ethnic disparities in arthroplasty utilization are evident, but the reasons are not known. We aimed to identify concerns that may contribute to barriers to arthroplasty from the patient's perspective. METHODS We identified patients' concerns about arthroplasty by performing a mixed methods study. Themes identified during semi-structured interviews with Black and Hispanic patients with advanced symptomatic hip or knee arthritis were used to develop a questionnaire to quantify and prioritize their concerns. Multiple linear and logistic regression analyses were conducted to determine the association between race/ethnicity and the importance of each theme. Models were adjusted for sex, insurance, education, HOOS, JR/KOOS, JR, and discussion of joint replacement with a doctor. RESULTS Interviews with eight participants reached saturation and provided five themes used to develop a survey answered by 738 (24%) participants; 75.5% White, 10.3% Black, 8.7% Hispanic, 3.9% Asian/Other. Responses were significantly different between groups (p < 0.05). Themes identified were "Trust in the surgeon" "Recovery", "Cost/Insurance", "Surgical outcome", and "Personal suitability/timing". Compared to Whites, Blacks were two-fold, Hispanics four-fold more likely to rate "Trust in the surgeon" as very/extremely important. Blacks were almost three times and Hispanics over six times more likely to rate "Recovery" as very/extremely important. CONCLUSION We identified factors of importance to patients that may contribute to barriers to arthroplasty, with marked differences between Blacks, Hispanics, and Whites.
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Affiliation(s)
- Susan M Goodman
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA.
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Insa Mannstadt
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - J Alex B Gibbons
- Department of Medicine, Columbia University Vagelos Physician of College and Surgeons, New York, NY, USA
| | - Mangala Rajan
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Anne Bass
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Linda Russell
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Bella Mehta
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Mark Figgie
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Michael L Parks
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | | | | | - Collin Brantner
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Geyanne Lui
- Department of Medicine, New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York, NY, USA
| | - Andrea Card
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Peggy Leung
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Henry Tischler
- Department of Orthopedic Surgery, New York-Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Sarah R Young
- Department of Social Work, Binghamton University, Binghamton, NY, USA
| | - Iris Navarro-Millán
- Department of Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Rheumatology, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
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