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Bellamy JL, Goodrich ER, Sabatini FM, Mounce SD, Ovadia SA, Kolin DA, Odum SM, Cohen-Rosenblum A, Landy DC. Systematic Review of Gender and Sex Terminology Use in Arthroplasty Research: There Is Room for Improvement. J Arthroplasty 2024:S0883-5403(24)00436-4. [PMID: 38734326 DOI: 10.1016/j.arth.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND There is increasing appreciation of the distinction between gender and sex as well as the importance of accurately reporting these constructs. Given recent attention regarding transgender and gender nonconforming (TGNC) and intersex identities, it is more necessary than ever to understand how to describe these identities in research. This study sought to investigate the use of gender- and sex-based terminology in arthroplasty research. METHODS The 5 leading orthopaedic journals publishing arthroplasty research were reviewed to identify the first twenty primary clinical research articles on an arthroplasty topic published after January 1, 2022. Use of gender- or sex-based terminology, whether use was discriminate, and whether stratification or adjustment based on gender or sex was performed, were recorded. RESULTS There were 98 of 100 articles that measured a construct of gender or sex. Of these, 15 articles used gender-based terminology, 45 used sex-based terminology, and 38 used a combination of gender- and sex-based terminology. Of the 38 articles using a combination of terminology, none did so discriminately. All articles presented gender and sex as binary variables, and 2 attempted to explicitly define how gender or sex were defined. Of the 98 articles, 31 used these variables for statistical adjustments, though only 6 reported stratified results. CONCLUSIONS Arthroplasty articles infrequently describe how gender or sex was measured, and frequently use this terminology interchangeably. Additionally, these articles rarely offer more than 2 options for capturing variation in sex and gender. Future research should be more precise in the treatment of these variables to improve the quality of results and ensure findings are patient-centered and inclusive.
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Affiliation(s)
- Jaime L Bellamy
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Ezra R Goodrich
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan
| | | | - Samuel D Mounce
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Steven A Ovadia
- Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - David A Kolin
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Susan M Odum
- OrthoCarolina Research Institute, Charlotte, North Carolina
| | - Anna Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, Louisiana
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Ghomrawi HMK, Golladay GJ, Riddle DL. A Proposed Conceptual Framework for Patient Selection for Knee Arthroplasty. J Bone Joint Surg Am 2024:00004623-990000000-01032. [PMID: 38442197 DOI: 10.2106/jbjs.23.00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Hassan M K Ghomrawi
- Departments of Surgery, Medicine (Rheumatology), and Pediatrics, and Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia
| | - Daniel L Riddle
- Departments of Physical Therapy, Orthopaedic Surgery, and Rheumatology, Virginia Commonwealth University, Richmond, Virginia
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Steinbeck V, Bischof AY, Schöner L, Langenberger B, Kuklinski D, Geissler A, Pross C, Busse R. Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains. Int J Equity Health 2024; 23:44. [PMID: 38413981 PMCID: PMC10900674 DOI: 10.1186/s12939-024-02131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression. METHODS The study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean). RESULTS Observed differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12. CONCLUSIONS Men experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities. TRIAL REGISTRATION German Register for Clinical Trials, DRKS00019916, 26 November 2019.
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Affiliation(s)
- Viktoria Steinbeck
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany.
| | - Anja Yvonne Bischof
- School of Medicine, Chair of Health Economics, Policy and Management, University of St. Gallen, St. Gallen, Switzerland
| | - Lukas Schöner
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
| | - Benedikt Langenberger
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
| | - David Kuklinski
- School of Medicine, Chair of Health Economics, Policy and Management, University of St. Gallen, St. Gallen, Switzerland
| | - Alexander Geissler
- School of Medicine, Chair of Health Economics, Policy and Management, University of St. Gallen, St. Gallen, Switzerland
| | - Christoph Pross
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
| | - Reinhard Busse
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Strasse Des 17 Juni 135, Berlin, 10623, Germany
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Paredes AC, Arendt-Nielsen L, Almeida A, Pinto PR. Sex moderates the association between quantitative sensory testing and acute and chronic pain after total knee/hip arthroplasty. Scand J Pain 2024; 24:sjpain-2024-0004. [PMID: 38683162 DOI: 10.1515/sjpain-2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/05/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Acute postsurgical pain (APSP) may persist over time and become chronic. Research on predictors for APSP and chronic postsurgical pain (CPSP) has produced inconsistent results. This observational study aimed to analyze psychological and psychophysical variables associated with APSP and CPSP after total knee or hip arthroplasty, and to explore the role of sex. METHODS Assessments were conducted before surgery, 48 h, and 3 months postsurgery, including questionnaires (sociodemographic, pain related, and psychological) and quantitative sensory testing (QST). Hierarchical linear regression models analyzed potential predictors of APSP and CPSP, and moderation analyses evaluated the role of sex. RESULTS The study included 63 participants undergoing total knee (34, 54%) or hip (29, 46%) arthroplasty. Thirty-one (49.2%) were female and 32 (50.8%) were male. APSP (48 h) was associated with impaired conditioned pain modulation (CPM) (β = 0.301, p = 0.019). CPSP (3 months) was associated with being female (β = 0.282, p = 0.029), longer presurgical pain duration (β = 0.353, p = 0.006), knee arthroplasty (β = -0.312, p = 0.015), higher APSP intensity (β = 373, p = 0.004), and impaired CPM (β = 0.126, p = 0.004). In multivariate analysis, these clinical variables were significant predictors of CPSP, unlike sex, and CPM (adj. R 2 = 0.349). Moderation analyses showed that wind-up ratio (WUR) was a significant predictor of APSP in men (WUR × sex: b = -1.373, p = 0.046) and CPM was a significant predictor of CPSP in women (CPM × sex: b = 1.625, p = 0.016). CONCLUSIONS Specific QST parameters could identify patients at risk for high-intensity APSP and CPSP, with sex as a moderator. This has important clinical implications for patient care, paving the way for developing tailored preventive pain management strategies.
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Affiliation(s)
- Ana C Paredes
- 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
- 2CA-Braga, Clinical Academic Center, Hospital de Braga, Braga, Portugal
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Selma Lagerløfs Vej 249, Gistrup 9260, Denmark
| | - 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
- 2CA-Braga, Clinical Academic Center, Hospital de Braga, Braga, Portugal
| | - Patrícia R Pinto
- 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
- 2CA-Braga, Clinical Academic Center, Hospital de Braga, Braga, Portugal
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Vella-Baldacchino M, Webb J, Selvarajah B, Chatha S, Davies A, Cobb JP, Liddle AD. Should we recommend patellofemoral arthroplasties to patients? Bone Jt Open 2023; 4:948-956. [PMID: 38096897 PMCID: PMC10721344 DOI: 10.1302/2633-1462.412.bjo-2023-0100.r1] [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] [Indexed: 12/18/2023] Open
Abstract
Aims With up to 40% of patients having patellofemoral joint osteoarthritis (PFJ OA), the two arthroplasty options are to replace solely the patellofemoral joint via patellofemoral arthroplasty (PFA), or the entire knee via total knee arthroplasty (TKA). The aim of this study was to assess postoperative success of second-generation PFAs compared to TKAs for patients treated for PFJ OA using patient-reported outcome measures (PROMs) and domains deemed important by patients following a patient and public involvement meeting. Methods MEDLINE, EMBASE via OVID, CINAHL, and EBSCO were searched from inception to January 2022. Any study addressing surgical treatment of primary patellofemoral joint OA using second generation PFA and TKA in patients aged above 18 years with follow-up data of 30 days were included. Studies relating to OA secondary to trauma were excluded. ROB-2 and ROBINS-I bias tools were used. Results A total of nine studies were included, made up of four randomized controlled trials (domain 1) and five cohort studies (domain 2). PROMs and knee function specific scores developed for reporting TKA were unable to detect any difference between PFA and TKA. There was no significant difference in complications between PFA and TKA. PFAs were found to have a better postoperative range of motion. Conclusion TKA and PFA are both viable options for patients with primary PFJ OA. Over time, we have seen an emphasis on patient satisfaction and better quality of life. Recommending sacrificing healthy medial and lateral compartments to treat patellofemoral joint arthritis should be given further thought.
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Affiliation(s)
| | | | | | | | - Andrew Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - Justin P. Cobb
- MSk Lab, Imperial College London, Department of Surgery & Cancer, Sir Michael Uren Hub, London, UK
| | - Alexander D. Liddle
- MSk Lab, Imperial College London, Department of Surgery & Cancer, Sir Michael Uren Hub, London, UK
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Lachance AD, Call C, Radford Z, Stoddard H, Sturgeon C, Babikian G, Rana A, McGrory BJ. Rural-Urban Differences in Hospital and Patient-Reported Outcomes Following Total Hip Arthroplasty. Arthroplast Today 2023; 23:101190. [PMID: 37731592 PMCID: PMC10507436 DOI: 10.1016/j.artd.2023.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 09/22/2023] Open
Abstract
Background Rural patients have unique health-care factors influencing outcomes of arthroplasty, hypothetically putting these patients at increased risk for complications following total joint arthroplasty. The aim of this study is to better understand differences in patient outcomes and satisfaction between rural and urban patients receiving care in an urban setting and to provide more equitable care. Methods A retrospective chart review was performed on patients undergoing primary total hip arthroplasty at a single large academic center between January 2013 and August 2020. Demographic, operative, and hospital outcomes were obtained from the institutional electronic medical record. Rurality was determined by rural-urban code (RUC) classifications by zip code with RUC codes 1-3 defined as urban and RUC 4-10 defined as rural. Results Patients from urban areas were more likely to visit the emergency department within 30 days postoperatively (P = .006) and be readmitted within 90 days (P < .001). However, unplanned (P < .001) admissions were higher in the rural group. There was no statistical difference in postoperative complications (P = .4). At 6 months, rural patients had higher patient-reported outcome measures (PROMs) including Hip Disability and Osteoarthritis Outcome Score total (P = .05), Hip Disability and Osteoarthritis Outcome Score interval (P = .05), self-reported functional improvement (P < .05), improvements in pain (P < .05), and that the surgery met expectations (P < .05). However, these values did not reach minimal clinically important difference. Conclusions There may be differences in emergency department visits, readmissions, and PROMs in rural vs urban populations undergoing total hip arthroplasty in an urban setting. Patient access to care and attitudes of rural patients toward health care may underlie these findings. Understanding differences in PROMs, satisfaction, and hospital-based outcomes based on rurality is essential to provide equitable arthroplasty care.
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Affiliation(s)
| | | | - Zachary Radford
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Henry Stoddard
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
| | - Callahan Sturgeon
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
| | - George Babikian
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
| | - Adam Rana
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Maine Medical Center, Portland, ME, USA
| | - Brian J. McGrory
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Maine Medical Center, Portland, ME, USA
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7
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Metcalf RW, Rowe T, Tersteeg M, Dombrowski ME, Odum S, Otero JE. The Influence of Patient Sex on Outcomes Following One-Stage and Two-Stage Revision for Periprosthetic Joint Infection in Total Joint Arthroplasty. Antibiotics (Basel) 2023; 12:1392. [PMID: 37760688 PMCID: PMC10525713 DOI: 10.3390/antibiotics12091392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Although females have a higher rate of primary total joint arthroplasty (TJA), males have a higher rate of revision. The literature lacks studies examining the relationship between sex and outcomes following single and two-stage exchange for periprosthetic joint infection (PJI). The purpose of this study was to examine if differences exist in outcomes following revision for chronic PJI between sexes. A retrospective review was performed on all patients with an MSIS confirmed PJI who underwent a single or two-stage exchange at our institution from January 2010 to January 2021. Patient demographics, comorbidity characteristics, and outcomes were collected and compared between males and females. The primary outcome variable was disease-free survival at 1 year following definitive revision. Multivariable logistic regression analysis was performed to determine risk factors for failure. Of the 470 patients meeting final eligibility criteria, 250 were male and 226 were female (2 males and 4 females had a joint infection of either the contralateral side or a different joint and were treated as separate records). Of the patients in the cohort, 80% of the males (200/250) and 80% of the females (181/226) were found to be disease-free at 1-year follow-up (p > 0.99). Multivariable logistic regression analysis showed that nicotine use and diabetes, but not sex, were significant predictors of failure. Our study did not find a relationship between sex and outcome of revision for PJI. Further research is required to determine whether differences exist between males and females in the expression of PJI and outcomes following treatment.
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Affiliation(s)
- Rory W. Metcalf
- OrthoCarolina Research Institute, Charlotte, NC 28207, USA; (R.W.M.)
| | - Taylor Rowe
- OrthoCarolina Research Institute, Charlotte, NC 28207, USA; (R.W.M.)
| | - Megan Tersteeg
- Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | | | - Susan Odum
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
| | - Jesse E. Otero
- OrthoCarolina Hip & Knee Center, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
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Chao M, Manz WJ, Fink J, Coleman MM, Kadakia RJ, Bariteau JT. Body Mass Index (BMI) Cutoffs and Racial, Ethnic, Sex, or Age Disparities in Patients Treated With Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231184189. [PMID: 37484537 PMCID: PMC10359662 DOI: 10.1177/24730114231184189] [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] [Indexed: 07/25/2023] Open
Abstract
Background The rising prevalence of obesity among American adults has disproportionately affected Black adults and women. Furthermore, body mass index (BMI) has historically been used as a relative contraindication to many total joint arthroplasty (TJA) procedures, including total ankle arthroplasty. The purpose of this study was to investigate potential disparities in patient eligibility for total ankle arthroplasty based on race, ethnicity, sex, and age by applying commonly used BMI cutoffs to the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Methods Patients in the ACS-NSQIP database who underwent TAA from 2011 to 2020 were retrospectively reviewed in a cross-sectional analysis. BMI cutoffs of <50, <45, <40, and <35 were then applied. The eligibility rate for TAA was examined for each BMI cutoff, and findings were stratified by race, ethnicity, sex, and age. Independent t tests, chi-squared tests, and Fisher exact tests were performed to compare differences at an α = 0.05. Results A total of 1215 of 1865 TAA patients (65.1%) were included after applying the exclusion criteria. Black patients had disproportionately lower rates of eligibility at the most stringent BMI cutoff of <35 (P = .004). Hispanic patients had generally lower rates of eligibility across all BMI cutoffs. In contrast, Asian American and Pacific Islander patients had higher rates of eligibility at the BMI cutoffs of <35 (P = .033) and <40 (P = .039), and White non-Hispanic patients had higher rates of eligibility across all BMI cutoffs. Females had lower eligibility rates across all BMI cutoffs. Ineligible patients were also younger compared to eligible patients across all BMI cutoffs. Conclusion Stringent BMI cutoffs may disproportionately disqualify Black, female, and younger patients from receiving total ankle arthroplasty. Level of Evidence Level III, retrospective cross-sectional study.
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Affiliation(s)
- Myra Chao
- Emory University School of Medicine, Atlanta, GA, USA
| | - Wesley J. Manz
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Juliet Fink
- Emory University School of Medicine, Atlanta, GA, USA
| | - Michelle M. Coleman
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rishin J. Kadakia
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason T. Bariteau
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Moldovan F, Moldovan L, Bataga T. A Comprehensive Research on the Prevalence and Evolution Trend of Orthopedic Surgeries in Romania. Healthcare (Basel) 2023; 11:1866. [PMID: 37444700 DOI: 10.3390/healthcare11131866] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/03/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Accurate knowledge of the prevalence and trends of orthopedic surgeries can facilitate the design of medical plans for effective treatments. The National Endoprosthetic Registry (NER) in Romania provides statistics on endoprosthetic activity (hip, knee), cases of fractures and bone tumors as a result of the legal obligations to report interventions performed by all orthopedic traumatology hospitals/wards in the country. The aim of this study is to describe the annual volumes of orthopedic surgeries between 2001 and 2022 in Romania and analyze the current and future evolution trends of the studied surgeries, gender differences and regional differences based on a complete survey carried out at a national level. For the period 2001-2022, we extracted from the NER the annual volumes of orthopedic interventions performed. With these data, we studied the prevalence and estimated, with the support of an original calculation methodology, the variation trends of orthopedic surgeries in two situations: over the entire 21-year period, respectively, and over the period 2001-2020, which does not include the pandemic period. For hip replacement surgery and knee replacement surgery, we showed the prevalence by subcategory of interventions, gender distribution, regional prevalence and regional density calculated by the annual averages of the total number of cases reported per 100,000 people in the 40 counties of the country and the capital, Bucharest. We also determined the variations in hip and knee arthroplasty revision burdens, calculated as a percentage between the number of revisions and the number of primary interventions in the same period. We determined the regional densities of revision burdens. The total number of orthopedic surgeries in the period 2001-2022 was 1,557,247, of which 189,881 were hip replacement surgeries; 51,035 were knee replacement surgeries; 11,085 were revision hip arthroplasty; 1497 were revision knee arthroplasty; 541,440 were operated fractures; and 16,418 were operated bone tumors. The growth rates of surgical interventions are hip replacement surgery, +8.19%; knee replacement surgery, +19.55%; revision hip arthroplasty, +9.43%; and revision knee arthroplasty, +28.57%. With these data, we have estimated a doubling of the volume of primary and revision interventions of the hip until 2034 and the knee until 2027, respectively. Operated bone tumors register an annual decrease of -4.52% thanks to modern treatments. There are clear gender differences; for primary hip interventions, the proportion of women is 58.82%, and for knee interventions, the proportion of women is 76.42%. This is the first research that, with the support of exhaustive data from the NER, analyzes for the period 2001-2022 the annual number of orthopedic surgeries in Romania. It allows knowledge of the large, anticipated increases in orthopedic surgery and provides a quantitative basis for future policy decisions related to the need for medical personnel and material resources.
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Affiliation(s)
- Flaviu Moldovan
- Orthopedics-Traumatology Department, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Liviu Moldovan
- Faculty of Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Tiberiu Bataga
- Orthopedics-Traumatology Department, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
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10
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Witkam R, Verstappen SMM, Gwinnutt JM, Cook MJ, O'Neill TW, Cooper R, Humphreys J. The association between lower socioeconomic position and functional limitations is partially mediated by obesity in older adults with symptomatic knee osteoarthritis: Findings from the English Longitudinal Study of Ageing. Front Public Health 2022; 10:1053304. [PMID: 36600944 PMCID: PMC9806847 DOI: 10.3389/fpubh.2022.1053304] [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: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To assess the longitudinal associations of socioeconomic position (SEP) with functional limitations and knee joint replacement surgery (JRS) in people with symptomatic knee osteoarthritis (OA), and whether body mass index (BMI) mediated these relationships. Methods Data came from the English Longitudinal Study of Ageing, a national longitudinal panel study of adults aged ≥50 years. A total of 1,499 participants (62.3% female; mean age 66.5 (standard deviation (SD) 9.4) years; 47.4% obese) self-reporting an OA diagnosis and knee pain, with at least one BMI measurement were included. Mixed effect models estimated longitudinal associations of each SEP variable (education, occupation, income, wealth and deprivation index) and obesity (BMI ≥30.0 kg/m2) with repeated measures of functional limitations. Cox regression analyses estimated associations between SEP indicators and obesity at baseline and risk of knee JRS at follow-up. Structural equation modeling estimated any mediating effects of BMI on these relationships. Results Lower SEP and obesity at baseline were associated with increased odds of functional limitations in people with knee OA [e.g., difficulty walking 100 yards: no qualification vs. degree adjOR 4.33 (95% CI 2.20, 8.55) and obesity vs. no obesity adjOR 3.06 (95% CI 2.14, 4.37); similar associations were found for the other SEP indicators]. A small proportion of the association between lower SEP and functional limitations could be explained by BMI (6.2-12.5%). Those with lower income, lower wealth and higher deprivation were less likely to have knee JRS [e.g., adjHR most vs. least deprived 0.37 (95% CI 0.19, 0.73)]; however, no clear association was found for education and occupation. Obesity was associated with increased hazards of having knee JRS [adjHR 1.87 (95% CI 1.32, 2.66)]. As the direction of the associations for SEP and obesity with knee JRS were in opposite directions, no mediation analyses were performed. Conclusions Lower SEP was associated with increased odds of functional limitations but lower hazards of knee JRS among people with knee OA, potentially indicating underutilization of JRS in those with lower SEP. Obesity partially mediated the relationship between lower SEP and increased odds of functional limitations, suggesting adiposity as a potential interventional target.
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Affiliation(s)
- Rozemarijn Witkam
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Suzanne M. M. Verstappen
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom,*Correspondence: Suzanne M. M. Verstappen
| | - James M. Gwinnutt
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Michael J. Cook
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Terence W. O'Neill
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom,AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jennifer Humphreys
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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11
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Torrente-Jimenez RS, Feijoo-Cid M, Rivero-Santana AJ, Perestelo-Pérez L, Torres-Castaño A, Ramos-García V, Bilbao A, Serrano-Aguilar P. Gender differences in the decision-making process for undergoing total knee replacement. PATIENT EDUCATION AND COUNSELING 2022; 105:3459-3465. [PMID: 36075809 DOI: 10.1016/j.pec.2022.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess gender differences in the decision-making process for treatment of knee osteoarthritis (OA). METHODS A secondary analysis of a randomized trial was conducted (n = 193). Knowledge of OA and total knee replacement (TKR), decisional conflict, satisfaction with the decision-making process, treatment preference and TKR uptake 6 months later were compared by gender. Multivariate regression models were developed to identify gender-specific predictors. RESULTS Women showed less knowledge (MD = -7.68, 95% CI: -13.9, -1.46, p = 0.016), reported less satisfaction (MD = -6.95, 95% CI: -11.7, -2.23, p = 0.004) and gave more importance to avoiding surgery (U = 2.09, p = 0.019). In women, more importance attributed to the time needed to relieve symptoms significantly reduced the odds of surgery (OR = 0.76, p = 0.016). CONCLUSION The provision of information and/or promotion of shared decision-making could be of lower quality in female patients, although other explanations such as differences in information needs or preference for involvement in decision-making cannot be ruled out with the current evidence. Given the study's limitations, especially regarding the sample size, further confirmation is needed. PRACTICE IMPLICATIONS A systematic, shared decision-making approach in consultation is needed to avoid potential gender-based biases.
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Affiliation(s)
| | - Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Grup de Recerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain.
| | - Amado Javier Rivero-Santana
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - Lilisbeth Perestelo-Pérez
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Canary Islands, Spain.
| | - Alezandra Torres-Castaño
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - Vanesa Ramos-García
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain.
| | - Amaia Bilbao
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain.
| | - Pedro Serrano-Aguilar
- Health Services Research on Chronic Patients Network (REDISSEC), Spain; Evaluation Unit of the Canary Islands Health Service (SESCS), Canary Islands, Spain.
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12
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Rahman R, Xu AL, Dhanjani SA, Zhang B, Nayar SK, Humbyrd CJ, LaPorte D. Does Time to Imaging and Surgery for Distal Radius Fractures Vary based on Geographic Socioeconomic Disadvantage? Hand (N Y) 2022; 17:95S-102S. [PMID: 35189731 PMCID: PMC9793622 DOI: 10.1177/15589447221075669] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND While disparities in aspects of distal radius fracture (DRF) management and orthopedics at large have been studied, disparities in time to DRF evaluation and treatment are unknown. We sought to determine if geographic socioeconomic disadvantage is associated with time to imaging in the emergency department (ED) and time to surgery for DRFs. METHODS We performed a time-to-event analysis of 105 patients undergoing DRF surgery after ED triage within our hospital system between January 1, 2015, and January 1, 2020. Area Deprivation Index (ADI) national percentile was used as the metric of geographic socioeconomic disadvantage for each patient's ZIP code of residence. We performed Cox regression analysis to determine hazard ratios to undergo DRF imaging and surgery for patients in each ADI group, adjusting for potential confounders, α = 0.05. RESULTS There was no association between geographic socioeconomic disadvantage and time to DRF imaging, after adjusting for confounders. However, compared to patients from the least disadvantaged areas, patients from the most disadvantaged areas (ADI Quartiles 3 and 4) had an adjusted hazard ratio for surgery of 0.55 [0.32, 0.94] (P = .03), and were thus 45% [6%, 68%] less likely to undergo surgery for DRF at any time following ED triage. CONCLUSIONS Operative patients from more socioeconomically disadvantaged neighborhoods see disparities in time to surgery for DRF. Equitable access to timely surgical care is needed and may be improved with increased access to orthopedic surgeons, patient education, support in navigating the health system, and improved continuity of fracture care. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Rafa Rahman
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Amy L. Xu
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | | | - Bo Zhang
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Suresh K. Nayar
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | | | - Dawn LaPorte
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
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13
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Petrie KA, Chen JN, Miears H, Grimes JS, Zumwalt M. Gender Differences in Seeking Health Care and Postintervention Pain Outcomes in Foot and Ankle Orthopedic Patients. WOMEN'S HEALTH REPORTS 2022; 3:500-507. [PMID: 35652003 PMCID: PMC9148655 DOI: 10.1089/whr.2021.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/13/2022]
Abstract
Background: Materials and Methods: Results: Conclusions:
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Affiliation(s)
- Kyla A. Petrie
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jason N. Chen
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Hunter Miears
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Jerry Speight Grimes
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Mimi Zumwalt
- Department of Orthopedic Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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14
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Greaves L, Ritz SA. Sex, Gender and Health: Mapping the Landscape of Research and Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052563. [PMID: 35270255 PMCID: PMC8909483 DOI: 10.3390/ijerph19052563] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 02/06/2023]
Abstract
Including sex and gender considerations in health research is considered essential by many funders and is very useful for policy makers, program developers, clinicians, consumers and other end users. While longstanding confusions and conflations of terminology in the sex and gender field are well documented, newer conceptual confusions and conflations continue to emerge. Contemporary social demands for improved health and equity, as well as increased interest in precision healthcare and medicine, have made obvious the need for sex and gender science, sex and gender-based analyses (SGBA+), considerations of intersectionality, and equity, diversity and inclusion initiatives (EDI) to broaden representation among participants and diversify research agendas. But without a shared and precise understanding of these conceptual areas, fields of study, and approaches and their inter-relationships, more conflation and confusion can occur. This article sets out these areas and argues for more precise operationalization of sex- and gender-related factors in health research and policy initiatives in order to advance these varied agendas in mutually supportive ways.
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Affiliation(s)
- Lorraine Greaves
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| | - Stacey A. Ritz
- Department of Pathology & Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada;
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15
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The Effect of Preoperative Education Prior to Hip or Knee Arthroplasty on Immediate Postoperative Outcomes. Orthop Nurs 2022; 41:4-12. [PMID: 35045535 DOI: 10.1097/nor.0000000000000814] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
There is ample research demonstrating improved patient outcomes when using an enhanced recovery program. However, the literature reporting the impact of preoperative education alone prior to hip and knee arthroplasty is conflicting. With the number of these surgical procedures expected to increase in the next few years, the identification of strategies that positively impact outcomes is important. The aim of this study was to evaluate immediate postoperative physical therapy (PT) performance following a total hip or knee arthroplasty in patients who attended a preoperative education class compared with those who did not. This study was a retrospective chart review of 707 hip and knee arthroplasty patients, comparing outcomes based on preoperative educational session attendance. Demographics, comorbidities, length of stay (LOS), discharge disposition, and PT performance were collected from the chart review. Patients who attended the preoperative education class had significantly greater ambulation distances (p < .001), greater degrees of knee flexion (p < .001), and greater degrees of hip flexion (p = .012) on postoperative Day 1. Both hip (p < .001) and knee (p < .001) patients who attended the class had a significantly shorter LOS. The cost benefit analysis indicated a savings of $921.57 in direct costs per knee arthroplasty in those who attended a class. Patients who received preoperative education had greater mobility in the immediate postoperative period and reduced LOS for both hip and knee arthroplasties. Based on this study's results, preoperative education is effective in improving outcomes and reducing the cost of hip and knee arthroplasties.
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16
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Götz JS, Benditz A, Reinhard J, Schindler M, Zeman F, Grifka J, Greimel F, Leiss F. Influence of Anxiety/Depression, Age, Gender and ASA on 1-Year Follow-Up Outcomes Following Total Hip and Knee Arthroplasty in 5447 Patients. J Clin Med 2021; 10:jcm10143095. [PMID: 34300261 PMCID: PMC8305027 DOI: 10.3390/jcm10143095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: There are many factors influencing the outcome after total joint arthroplasty (TJA). In particular, patient-related factors such as age, gender, ASA (American Society of Anesthesiologists), or preoperative anxiety/depression have become increasingly important. The aim of this study was to examine the association of these parameters with 1-year postoperative outcomes after total knee and total hip arthroplasty (TKA, THA). Methods: A retrospective cohort of 5447 TJA patients was evaluated by pre- and postoperative analysis of EQ-5D, EQ-VAS and WOMAC Score. Furthermore, major focus was put on the association between age, gender, ASA, preoperative anxiety/depression and outcome parameters. Results: 53.3% (2903/5447) of all patients were identified with anxiety/depression at time of surgery. In the analysis, patients without anxiety/depression showed statistically significantly (p < 0.05) better EQ-5D, EQ-VAS and WOMAC scores. In addition, patients with ASA 2 or 3 and age over 70 years showed statistically significantly (p < 0.01) worse EQ-5D and WOMAC scores. Gender did not influence the postoperative EQ-5D and WOMAC results, but men had significantly better EQ-VAS scores than women in this study. Conclusion: Preoperative anxiety/depression symptoms show worse clinical outcomes 1 year postoperatively after TJA. Other outcome-influencing factors are higher age and ASA 2 or 3. In the future, such patients should be identified, and as far as applicable, a treatment of anxiety/depression or comorbidities should be implemented preoperatively of the surgical procedure to improve clinical outcomes.
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Affiliation(s)
- Julia Sabrina Götz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Melanie Schindler
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
- Correspondence:
| | - Franziska Leiss
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
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17
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Gema A, Irianto KA, Setiawati R. Femoral Stem Subsidence and its Associated Factors after Cementless Bipolar Hemiarthroplasty in Geriatric Patients. Malays Orthop J 2021; 15:63-71. [PMID: 33880150 PMCID: PMC8043629 DOI: 10.5704/moj.2103.010] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction Early femoral stem subsidence has been a concern as a predictor of the beginning of implant loosening, especially on cementless hip arthroplasty implants. This study aimed to determine the factors that affect femoral stem subsidence and outcome following hemiarthroplasty in the geriatric population. Materials and Methods This is a retrospective study of 179 patients who underwent cementless bipolar hemiarthroplasty during the 2011-2019 period at an orthopaedic and traumatology hospital. Data on the patient's demography, pre-operative American Society Anaesthesiologist (ASA) score, body mass index (BMI), canal flare index (CFI), Dorr classification, and stem alignment were obtained. The primary outcomes were post-operative femoral stem subsidence, post-operative pain, and functional outcome using Harris Hip Score (HHS). Statistical analysis was conducted to identify risk factors associated with the primary outcome. Results The mean femoral stem subsidence was 2.16 ±3.4 mm. The mean post-operative Visual Analog Score (VAS) on follow-up was 1.38 ± 1. Mean HHS on follow-up was 85.28±10.3. American Society Anaesthesiologist score 3 (p = 0.011, OR = 2.77) and varus alignment (p=0.039, OR = 6.963) were related to worse stem subsidence. Otherwise, neutral alignment (p = 0.045 and OR = 0.405) gave protection against femoral stem subsidence. The female gender (p = 0.014, OR 2.53) was associated with postoperative pain onset. Neutral alignment had significant relationship with functional outcomes (p = 0.01; OR 0.33). Conclusion A higher ASA score and varus stem alignment were related to a higher risk of femoral stem subsidence. Meanwhile, neutral stem alignment had a protective effect on the femoral stem subsidence and outcome.
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Affiliation(s)
- A Gema
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
| | - K A Irianto
- Department of Orthopaedic and Traumatology, Universitas Airlangga, Surabaya, Indonesia
| | - R Setiawati
- Department of Radiology, Universitas Airlangga, Surabaya, Indonesia
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18
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Rahman R, Canner JK, Haut ER, Humbyrd CJ. Is Geographic Socioeconomic Disadvantage Associated with the Rate of THA in Medicare-aged Patients? Clin Orthop Relat Res 2021; 479:575-585. [PMID: 32947286 PMCID: PMC7899604 DOI: 10.1097/corr.0000000000001493] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Disparities in THA use may lead to inequitable care. Prior research has focused on disparities based on individual-level and isolated socioeconomic and demographic variables. To our knowledge, the role of composite, community-level geographic socioeconomic disadvantage has not been studied in the United States. As disparities persist, exploring the potential underlying drivers of these inequities may help in developing more targeted recommendations on how to achieve equitable THA use. QUESTIONS/PURPOSES (1) Is geographic socioeconomic disadvantage associated with decreased THA rates in Medicare-aged patients? (2) Do these associations persist after adjusting for differences in gender, race, ethnicity, and proximity to hospitals performing THA? METHODS In a study with a cross-sectional design, using population-based data from five-digit ZIP codes in Maryland, USA, from July 1, 2012 to March 31, 2019, we included all inpatient and outpatient primary THAs performed in individuals 65 years of age or older at acute-care hospitals in Maryland, as reported in the Health Services Cost Review Commission database. This database was selected because it provided the five-digit ZIP code data necessary to answer our study question. We excluded THAs performed for nonelective indications. We examined the annual rate of THA in our study population for each Maryland ZIP code, adjusted for differences across areas in distributions of gender, race, ethnicity, and distance to the nearest hospital performing THAs. Four hundred fourteen ZIP codes were included, with an overall mean ± SD THA rate of 371 ± 243 per 100,000 persons 65 years or older, a rate similar to that previously reported in individuals aged 65 to 84 in the United States. Statistical significance was assessed at α = 0.05. RESULTS THA rates were higher in more affluent areas, with the following mean rates per 100,000 persons 65 years or older: 422 ± 259 in the least socioeconomically disadvantaged quartile, 339 ± 223 in the second-least disadvantaged, 277 ± 179 in the second-most disadvantaged, and 214 ± 179 in the most-disadvantaged quartile (p < 0.001). After adjustment for distributions in gender, race, ethnicity, and hospital proximity, we found that geographic socioeconomic disadvantage was still associated with THA rate. Compared with the least-disadvantaged quartile, the second-least disadvantaged quartile had 63 fewer THAs per 100,000 people (95% confidence interval 12 to 114), the second-most disadvantaged quartile had 136 fewer THAs (95% CI 62 to 211), and the most-disadvantaged quartile had 183 fewer THAs (95% CI 41 to 325). CONCLUSION Geographic socioeconomic disadvantage may be the underlying driver of disparities in THA use. Although our study does not determine the "correct" rate of THA, our findings support increasing access to elective orthopaedic surgery in disadvantaged geographic communities, compared with prior research and efforts that have studied and intervened on the basis of isolated factors such as race and gender. Increasing access to orthopaedic surgeons in disadvantaged neighborhoods, educating physicians about when surgical referral is appropriate, and educating patients from these geographic communities about the risks and benefits of THA may improve equitable orthopaedic care across neighborhoods. Future studies should explore disparities in rates of appropriate THA and the role of density of orthopaedic surgeons in an area. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Rafa Rahman
- R. Rahman, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- J. K. Canner, Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Division of Acute Care Surgery, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Anesthesiology and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Emergency Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, The Armstrong Institute for Patient Safety and Quality, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- C. J. Humbyrd, Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph K Canner
- R. Rahman, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- J. K. Canner, Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Division of Acute Care Surgery, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Anesthesiology and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Emergency Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, The Armstrong Institute for Patient Safety and Quality, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- C. J. Humbyrd, Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elliott R Haut
- R. Rahman, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- J. K. Canner, Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Division of Acute Care Surgery, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Anesthesiology and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Emergency Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, The Armstrong Institute for Patient Safety and Quality, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- C. J. Humbyrd, Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Casey J Humbyrd
- R. Rahman, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- J. K. Canner, Johns Hopkins Surgery Center for Outcomes Research, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Division of Acute Care Surgery, Department of Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Anesthesiology and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Emergency Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, The Armstrong Institute for Patient Safety and Quality, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
- E. R. Haut, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- C. J. Humbyrd, Department of Orthopaedic Surgery, the Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Zhang D, Blazar P, Earp BE. Factors Associated With Surgical Treatment of Nondisplaced or Minimally Displaced Scaphoid Waist Fractures. J Hand Surg Am 2021; 46:209-214.e1. [PMID: 33288391 DOI: 10.1016/j.jhsa.2020.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2020] [Accepted: 10/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether there are identifiable factors associated with the surgical treatment of nondisplaced or minimally displaced scaphoid waist fractures. METHODS We identified 50 patients who underwent nonsurgical treatment and 67 patients who underwent surgical treatment of nondisplaced or minimally displaced scaphoid waist fractures at 2 tertiary care referral centers in a single metropolitan area in the United States between January 2010 and March 2019. Bivariate analysis was used to screen for factors associated with surgical treatment. Multivariable stepwise logistic regression was used to determine factors associated with surgical treatment of a nondisplaced or minimally displaced scaphoid fracture. RESULTS Multivariable logistic regression analysis showed that male sex (odds ratio = 2.80; 95% confidence interval, 1.20-6.52) and employed status (odds ratio = 3.12, 95% confidence interval, 1.24-7.85) were associated with surgical treatment of nondisplaced or minimally displaced scaphoid waist fractures. CONCLUSIONS Male and employed patients have increased odds of undergoing scaphoid surgery for nondisplaced or minimally displaced waist fractures compared with female and unemployed patients. These differences may represent patient preference, surgeon counseling, or a combination. Further study is needed to understand the etiology of this sex difference. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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20
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Assessing Preoperative Risk Factors With Sex Disparities in Total Joint Arthroplasty Patients and Financial Outcomes From the National Inpatient Sample Database. J Am Acad Orthop Surg 2020; 28:e969-e976. [PMID: 32015251 DOI: 10.5435/jaaos-d-19-00716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Disparities in the healthcare system imply potential risks for vulnerable groups whose needs are not appropriately met. Total joint arthroplasty (TJA) is successful in treating end-stage arthritis, resulting in increased demand for the procedure, however remains underused in both sexes, especially in women. Although multiple studies assessed the differences in postoperative morbidities between sexes, there remains a lack in understanding patients' preoperative clinical profile and nonclinical demographics. The aim of this study is to provide a population-based epidemiologic assessment of preoperative risk factors and sex disparities and assess differences in outcomes following TJA. METHODS The National Inpatient Sample database from 2006 to 2011 was analyzed. Patients who underwent primary total knee and hip arthroplasty were identified and stratified into two cohorts of male and female, and demographic data and comorbidities were collected. Postoperative complications, length of stay, total charges, and discharge destination were measured for matched cohorts. RESULTS Female patients present for TJAs at an older average age, are less likely to present with AIDS, alcohol abuse, coagulopathy, congestive heart failure, drug abuse, liver disease, peripheral vascular disease, and renal failure, and are more likely to present with anemia, autoimmune disorders, chronic obstructive pulmonary disease, depression, obesity, and valvular disease. Postoperatively, the average length of stay for female patients was markedly higher (3.52 versus 3.39) and a lower percentage went home (59% versus 73%). Overall, female patients experience greater odds of any complication while in-patient. DISCUSSION This study highlighted sex differences in areas that could account for the underuse of the procedure in both sexes, with women affected to a greater extent. Understanding these factors will help address the unmet needs of both sexes after TJA by encouraging future studies and provider education to ensure that all patients are able to access the necessary procedures for pain relief and functional improvement.
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Choong ALC, Shadbolt C, Dowsey MM, Choong PFM. Sex-based differences in the outcomes of total hip and knee arthroplasty: a narrative review. ANZ J Surg 2020; 91:553-557. [PMID: 32954641 DOI: 10.1111/ans.16299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022]
Abstract
Total joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis, which aims to alleviate pain and improve function and mobility. Despite the remarkable success of TJA, complications can arise, leading to unplanned hospital readmission, implant failure, morbidity and mortality. Recently, there has been a growing interest in analysing sex-based differences in diseases and response to medical interventions. This review summaries evidence pertaining to the widening gap between men and women regarding the utilization and outcome of TJA surgery. Interactions between sex and patient-reported outcome, implant failure and medical complication are complex and often demonstrate conflicting results. Significantly, there is a global consensus that men are at a higher risk of developing prosthetic joint infection following joint arthroplasty. Guided by the literature, there is a clear need for standardized methods of collecting, analysing and reporting sex-specific data to improve outcomes for both men and women who undergo TJA.
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Affiliation(s)
- Annabelle L C Choong
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
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MacLean MA, Touchette CJ, Han JH, Christie SD, Pickett GE. Gender differences in the surgical management of lumbar degenerative disease: a scoping review. J Neurosurg Spine 2020; 32:799-816. [PMID: 32005013 DOI: 10.3171/2019.11.spine19896] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite efforts toward achieving gender equality in clinical trial enrollment, females are often underrepresented, and gender-specific data analysis is often unavailable. Identifying and reducing gender bias in medical decision-making and outcome reporting may facilitate equitable healthcare delivery. Gender disparity in the utilization of surgical therapy has been exemplified in the orthopedic literature through studies of total joint arthroplasty. A paucity of literature is available to guide the management of lumbar degenerative disease, which stratifies on the basis of demographic factors. The objective of this study was to systematically map and synthesize the adult surgical literature regarding gender differences in pre- and postoperative patient-reported clinical assessment scores for patients with lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis). METHODS A systematic scoping review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, Embase, and the Cochrane Registry of Controlled Trials were searched from inception to September 2018. Study characteristics including patient demographics, diagnoses, procedures, and pre- and postoperative clinical assessment scores (pain, disability, and health-related quality of life [HRQoL]) were collected. RESULTS Thirty articles were identified, accounting for 32,951 patients. Six studies accounted for 84% of patients; 5 of the 6 studies were published by European groups. The most common lumbar degenerative conditions were disc herniation (59.0%), disc degeneration (20.3%), and spinal canal stenosis (15.9%). The majority of studies reported worse preoperative pain (93.3%), disability (81.3%), and HRQoL (75%) among females. The remainder reported equivalent preoperative scores between males and females. The majority of studies (63.3%) did not report preoperative duration of symptoms, and this represents a limitation of the data. Eighty percent of studies found that females had worse absolute postoperative scores in at least one outcome category (pain, disability, or HRQoL). The remainder reported equivalent absolute postoperative scores between males and females. Seventy-three percent of studies reported either an equivalent or greater interval change for females. CONCLUSIONS Female patients undergoing surgery for lumbar degenerative disease (disc degeneration, disc herniation, spondylolisthesis, and spinal canal stenosis) have worse absolute preoperative pain, disability, and HRQoL. Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males. Further studies should examine gender differences in preoperative workup and clinical course.
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Affiliation(s)
- Mark A MacLean
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Charles J Touchette
- 2Division of Neurosurgery, Universitaire de Sherbrooke, Centre de recherche du Centre Hospitalier, Sherbrooke, Quebec, Canada
| | - Jae H Han
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Sean D Christie
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
| | - Gwynedd E Pickett
- 1Division of Neurosurgery, Dalhousie University QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; and
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Lazaridou A, Koulouris A, Dorado K, Chai P, Edwards RR, Schreiber KL. The Impact of a Daily Yoga Program for Women with Fibromyalgia. Int J Yoga 2019; 12:206-217. [PMID: 31543629 PMCID: PMC6746047 DOI: 10.4103/ijoy.ijoy_72_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Fibromyalgia (FM) is characterized by widespread pain, sleep disturbance, negative affect, and stress and is notably difficult to treat. Individuals with FM have lower physical activity and endorse fears that exercise may worsen pain. Gentle daily yoga practice may allow a gradual increase in activity and positively impact many of these FM symptoms. This qualitative study investigated the impact of participation in a pilot trial of group and daily individual home yoga intervention on women with FM. Materials and Methods: Fifteen individuals participated in telephone interviews after participating in the yoga intervention, which included semi-structured questions to elicit insights and impressions of their experience. Responses were systematically coded and themes identified. Results: Five themes were identified: (1) physical/body perceptual changes, (2) practices affecting pain, (3) emotional changes, (4) practice motivators and barriers, and (5) group effect. Participants not only reported reductions in FM symptoms, including pain and stress, but also a positive impact on mood, sleep, and self-confidence. Conclusions: Participants enumerated both physical and psychological impact of starting yoga practice. Specific helpful poses and practices and important barriers were identified. Group practice and social connection with others with other FM patients was an important benefit to participants.
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Affiliation(s)
- Asimina Lazaridou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra Koulouris
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen Dorado
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Chai
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Teufer B, Nußbaumer-Streit B, Ebenberger A, Titscher V, Conrad S, Langer G, Töws I, Gartlehner G. [GRADE equity guidelines 1: Considering health equity in GRADE guideline development - introduction and rationale]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 146:53-59. [PMID: 31537503 DOI: 10.1016/j.zefq.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for developing clinical, public health, and health system guidelines. This article is a German translation of the original version published in English. STUDY DESIGN AND SETTING We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve. RESULTS We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation. CONCLUSION Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development.
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Affiliation(s)
- Birgit Teufer
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich.
| | - Barbara Nußbaumer-Streit
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Agnes Ebenberger
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Viktoria Titscher
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Susann Conrad
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland
| | - Gero Langer
- Institut für Gesundheits- und Pflegewissenschaft, German Center for Evidence-based Nursing »sapere aude«, Halle (Saale), Deutschland
| | - Ingrid Töws
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Gerald Gartlehner
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich; RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
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Foucher KC, Chmell SJ, Courtney CA. Duration of symptoms is associated with conditioned pain modulation and somatosensory measures in knee osteoarthritis. J Orthop Res 2019; 37:136-142. [PMID: 30325066 DOI: 10.1002/jor.24159] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/12/2018] [Indexed: 02/04/2023]
Abstract
Impaired descending pain inhibition has been linked to chronic pain and poorer patient outcomes. Vibration perception threshold (VPT) has also been observed and linked to radiographic stage of OA. However, it is not known how duration of symptoms may influence these neurophysiological measures. Our purpose was to evaluate the relationship between duration of symptoms and conditioned pain modulation (CPM), a measure of descending pain inhibition, and VPT, and to determine whether these relationships differed in men and women seeking orthopedic care. We evaluated 18 men and 27 women with moderate to severe knee OA. We assessed CPM using a submaximal-effort tourniquet test: Pressure pain threshold (PPT) at the symptomatic knee was evaluated before and after a noxious stimulus. CPM impairment was indicated by a ratio of pre-to-post stimulus PPT ≥1. VPT was assessed using a biothesiometer at the medial femoral condyle. We used chi-square, t-tests and Pearson correlations to address study questions. 72% of men, but only 44% of women had CPM impairment. Duration of symptoms was associated with CPM impairment in women (R = 0.566, p = 0.003) but not men (R = 0.366, p = 0.135). Duration of symptoms was also associated with VPT in both men (R = 0.580, p = 0.012) and women (R = 0.406, p = 0.039). These results suggest that longer duration of knee OA may predict more severe pain sensitization and that important sex differences exist in descending pain inhibition in people with chronic knee OA that may affect disease and course of treatment in male and female patients. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois
| | - Samuel J Chmell
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Carol A Courtney
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois
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Billig JI, Sterbenz JM, Zhong L, Chung KC. Gender Disparities in Preoperative Resource Use for Wrist Arthroscopy. Plast Reconstr Surg 2018; 142:1267-1274. [PMID: 30511980 PMCID: PMC6282178 DOI: 10.1097/prs.0000000000004840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although national efforts to minimize gender biases exist, gender differences in surgery persist. This study aims to investigate gender differences in preoperative resource use of patients undergoing wrist arthroscopy for nontraumatic wrist pain. METHODS Patients who underwent a wrist arthroscopy for nontraumatic pain from 2009 to 2015 were selected from the Truven MarketScan databases. Demographic and preoperative resource use data were recorded. Multivariable regression models were performed to examine the relationship between gender and preoperative resource use and to investigate the cost of these services. RESULTS A total of 8792 patients, 3805 men and 4987 women, met our inclusion criteria. Women were less likely to use imaging modalities preoperatively (OR, 0.08; 95 percent CI, 0.07 to 1.00; p = 0.02). However, women used more occupational therapy (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.002), nonnarcotic analgesia (OR, 1.2; 95 percent CI, 1.1 to 1.3; p = 0.001), and narcotic analgesia (OR, 1.6; 95 percent CI, 1.5 to 1.8; p < 0.001). Preoperative costs during the 12 months before surgery were similar between genders ($1308 versus $1367, respectively; p = 0.07). However, women accrued more costs from occupational therapy ($130 versus $93; p = 0.003), and nonnarcotic ($65 versus $46; p < 0.001) and narcotic medications ($568 versus $197; p < 0.001). CONCLUSIONS Significant gender differences exist in the preoperative care for patients undergoing wrist arthroscopy. Men use more imaging, implying more intense preoperative investigation for wrist pain, whereas women use more conservative measures, highlighting possible implicit provider biases in preoperative management and potential gender differences in disease presentation.
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Affiliation(s)
- Jessica I. Billig
- Co-First Author, Resident, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Jennifer M. Sterbenz
- Co-First Author, Research Assistant, Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Lin Zhong
- Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Dean for Faculty Affairs, University of Michigan Medical School, Ann Arbor, MI
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Brunner JH, Foucher KC. Sex specific associations between biomechanical recovery and clinical recovery after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2018; 59:167-173. [PMID: 30266024 DOI: 10.1016/j.clinbiomech.2018.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/10/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are sex-specific gait differences in men and women before and after total hip arthroplasty (THA) but we do not know their impact on clinical outcomes. The objective of this study was to identify sex-specific associations between pre- and postoperative changes in pain and function and (i) gait mechanics, (ii) passive range of motion, and (iii) abductor strength. METHODS Pre- and one-year postoperative data were identified from a data repository (n = 124; 64 Women; Age 61 (SD 10); BMI 29 (SD 5)). We used linear regression analysis to identify sex-specific associations between Harris Hip Score pain and function subscores, and sagittal plane hip kinematics and 3D hip kinetics during gait, hip abductor strength, and passive hip range of motion (RoM). FINDINGS Combinations of biomechanical variables predicted up to 24% of the variation in pain improvement and up to 27% of the variation in functional improvement. In men, increased peak external rotation moments were associated with pain improvement. Passive flexion RoM and peak extension moments were associated with functional improvement. In women, increased passive adduction RoM and peak external rotation moments were associated with pain improvement. Peak adduction moments and passive flexion RoM were associated with functional improvement. INTERPRETATIONS The different associations between improvement in clinical outcomes and improvement in gait, passive RoM, and abductor strength suggest that the biomechanical path to recovery may be different in men and women.
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Affiliation(s)
- J Heather Brunner
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.
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Foucher KC. Sex-specific hip osteoarthritis-associated gait abnormalities: Alterations in dynamic hip abductor function differ in men and women. Clin Biomech (Bristol, Avon) 2017; 48:24-29. [PMID: 28708989 DOI: 10.1016/j.clinbiomech.2017.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip osteoarthritis results in abnormal gait mechanics, but it is not known whether abnormalities are the same in men and women. The hypothesis tested was that gait abnormalities are different in men and women with hip osteoarthritis vs. sex-specific asymptomatic groups. METHODS 150 subjects with mild through severe radiographic hip osteoarthritis and 159 asymptomatic subjects were identified from an Institutional Review Board-approved motion analysis data repository. Sagittal plane hip range of motion and peak external moments about the hip, in all three planes, averaged from normal speed walking trials, were compared for men and women, with and without hip osteoarthritis using analysis of variance. FINDINGS There were significant sex by group interactions for the external peak hip adduction and external rotation moments (P=0.009-0.045). Although asymptomatic women had peak adduction and external rotation moments that were respectively 12% higher and 23% lower than asymptomatic men (P=0.026-0.037), these variables did not differ between men and women with hip osteoarthritis (P≥0.684). The osteoarthritis vs. asymptomatic group difference in the peak hip adduction moment was 45% larger in women than in men. The osteoarthritis vs. asymptomatic group difference in the peak hip external rotation moment was 55% larger for men than for women (P<0.001). Sex did not influence the association between radiographic severity and gait variables. INTERPRETATION Normal sex differences in gait were not seen in hip osteoarthritis. Sex-specific adaptations may reflect different aspects of hip abductor function. Men and women with hip osteoarthritis may require different interventions to improve function.
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Affiliation(s)
- Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, USA.
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Robinson J, Shin JI, Dowdell JE, Moucha CS, Chen DD. Impact of Gender on 30-Day Complications After Primary Total Joint Arthroplasty. J Arthroplasty 2017; 32:2370-2374. [PMID: 28366312 DOI: 10.1016/j.arth.2017.03.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/25/2017] [Accepted: 03/02/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Impact of gender on 30-day complications has been investigated in other surgical procedures but has not yet been studied in total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS Patients who received THA or TKA from 2012 to 2014 were identified in the National Surgical Quality Improvement Program database. Patients were divided into 2 groups based on gender. Bivariate and multivariate analyses were performed to assess associations between gender and patient factors and complications after THA or TKA and to assess whether gender was an independent risk factor. RESULTS THA patients consisted of 45.1% male and 54.9% female. In a multivariate analysis, female gender was found to be a protective factor for mortality, sepsis, cardiovascular complications, unplanned reintubation, and renal complications and as an independent risk factor for urinary tract infection, blood transfusion, and nonhome discharge after THA. TKA patients consisted of 36.7% male and 62.3% female. Multivariate analysis revealed female gender as a protective factor for sepsis, cardiovascular complications, and renal complications and as an independent risk factor for urinary tract infection, blood transfusion, and nonhome discharge after TKA. CONCLUSION There are discrepancies in the THA or TKA complications based on gender, and the multivariate analyses confirmed gender as an independent risk factor for certain complications. Physicians should be mindful of patient's gender for better risk stratification and informed consent.
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Affiliation(s)
- Jonathan Robinson
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John I Shin
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James E Dowdell
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Calin S Moucha
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Darwin D Chen
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale. J Clin Epidemiol 2017; 90:59-67. [PMID: 28412464 PMCID: PMC5675012 DOI: 10.1016/j.jclinepi.2017.01.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 01/11/2017] [Accepted: 01/26/2017] [Indexed: 11/26/2022]
Abstract
Objectives This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for development of clinical, public health, and health system guidelines. Study Design and Setting We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve. Results We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation. Conclusion Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development.
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Cram P, Hawker G, Matelski J, Ravi B, Pugely A, Gandhi R, Jackson T. Disparities in Knee and Hip Arthroplasty Outcomes: an Observational Analysis of the ACS-NSQIP Clinical Registry. J Racial Ethn Health Disparities 2017; 5:151-161. [PMID: 28342028 DOI: 10.1007/s40615-017-0352-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Disparities in total joint arthroplasty (TJA) have largely been studied in single center studies and using administrative data. Our objective was to investigate differences in TJA outcomes in white men, black men, white women, and black women using a large international registry. METHODS We used 2010-2013 data from the ACS-NSQIP to identify four groups of adults (white men, black men, white women, black women) who underwent primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). We compared differences in (1) surgical complications (mortality, pulmonary embolism, wound infection, sepsis, blood loss requiring transfusion, myocardial infarction, pneumonia, acute renal failure, and a composite representing occurrence of one or more adverse outcomes) and (2) discharge to a nursing home. RESULTS We identified 62,075 TKA and 39,334 THA patients. For TKA, 35.3% were white men, 57.2% white women, 1.9% black men, and 5.6% black women. White and black women were significantly more likely to experience our composite outcome when compared to their male counterparts (16.5 and 14.1% for white women and white men; P < .001) (18.3 and 14.3% for black women and black men; P = .002); higher complications for women were explained by higher transfusion rates in women (14.9 vs 12.2% for white women and men, 16.4 vs 11.7% for black; P < .001 for both). For TKA, blacks (compared to whites) and women (compared to men) were significantly more likely to be discharged to a nursing home. Results were similar for THA. CONCLUSIONS In contrast to prior studies, we found that complications after primary TJA were generally similar among white and black men and women with the exception of markedly higher transfusion rates among women of both racial groups.
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Affiliation(s)
- Peter Cram
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada.
- Division of General Internal Medicine, Sinai Health System and University Health Network, Toronto General Hospital, Eaton 14th Floor, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
- Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
| | - Gillian Hawker
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - John Matelski
- Division of General Internal Medicine, Sinai Health System and University Health Network, Toronto General Hospital, Eaton 14th Floor, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Bheeshma Ravi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Andrew Pugely
- Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - Rajiv Gandhi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - Timothy Jackson
- Division of General Surgery, University Health Network, Toronto, ON, Canada
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Whitlock KG, Piponov HI, Shah SH, Wang OJ, Gonzalez MH. Gender Role in Total Knee Arthroplasty: A Retrospective Analysis of Perioperative Outcomes in US Patients. J Arthroplasty 2016; 31:2736-2740. [PMID: 27344350 DOI: 10.1016/j.arth.2016.05.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Women present later than men for total knee arthroplasty (TKA) with more severe osteoarthritic disease but achieve comparable functional improvement and implant survival and also lower rates of revision. Despite these findings, there is significant underutilization of the procedure for women compared to men. METHODS We conducted a retrospective study to address the lack of information in the literature concerning the immediate and short-term perioperative outcomes between genders. The National Hospital Discharge Survey was evaluated between 2001 and 2010 for men and women undergoing primary TKA in the United States. Differences in gender, patient demographics, comorbidities, complications, length of stay, and discharge disposition were analyzed and identified. RESULTS The growth in TKA was 145% for men and 131% for women over the 10-year period. Women presented with significantly higher rates of obesity, morbid obesity, postoperative transfusion rate, and length of stay. In contrast, men showed a greater proportion of diabetes, postoperative wound infections, and increased mortality rates. Males were also more likely to be discharged to home, whereas females were more likely to be discharged to rehabilitation facilities. CONCLUSION Our findings provide important insight into the perioperative outcomes that may be influencing gender disparity in TKA.
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Affiliation(s)
- Keith G Whitlock
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
| | - Hristo I Piponov
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
| | - Sapan H Shah
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
| | - Olivia J Wang
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
| | - Mark H Gonzalez
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
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Alley MC, Mason AS, Tybor DJ, Pevear ME, Baratz MD, Smith EL. Ethnic Barriers to Utilization of Total Joint Arthroplasty Among Chinese Immigrants in the United States. J Arthroplasty 2016; 31:1873-1877.e2. [PMID: 27026646 DOI: 10.1016/j.arth.2016.02.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Previous studies have documented disparities in total joint arthroplasty (TJA) utilization among African American and Hispanic patients, but utilization among non-English-speaking Chinese patients in the United States has not been studied. METHODS To quantify the utilization rate and detect ethnic factors effecting TJA utilization in non-English-speaking Chinese patients, data were gathered prospectively from the practice of a single fellowship-trained Caucasian surgeon from October 2012 to February 2013. A customized survey was drafted and validated in collaboration with a social scientist. Questions assessed demography, lifestyle factors, socioeconomic status, language skills, cultural beliefs, and prior experience with surgery. Surveys were administered in patients' native language and were collected in a blinded fashion. RESULTS Overall, 269 patients were surveyed (157 Caucasian and 65 Chinese), 85 of which were recommended surgery (42 Caucasian and 26 Chinese). Seventy-six percent of Caucasian patients elected surgery, compared to 35% of Chinese patients. A multivariate logistic regression showed Chinese ethnicity to be a significant predictor of surgical decision after controlling for age, gender, socioeconomic status, and education. Several questions drafted to detect cultural differences in the aforementioned 6 categories were answered significantly differently (P < .05, chi-square). CONCLUSION Language, lack of familiarity with surgery, lack of TJA knowledge, family members' role in decision making, and preference for a doctor of the same race may contribute to decreased utilization of TJA in this population. We believe a better understanding of the cultural beliefs and behaviors of Chinese patients will help physicians provide more optimal care to this patient population.
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Affiliation(s)
| | - Andrew S Mason
- Class of 2018, Tufts University School of Medicine, Boston, Massachusetts
| | - David J Tybor
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Mary E Pevear
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts
| | - Michael D Baratz
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts
| | - Eric L Smith
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts
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Barrington JW, Lovald ST, Ong KL, Watson HN, Emerson RH. How Do Demographic, Surgical, Patient, and Cultural Factors Affect Pain Control After Unicompartmental Knee Arthroplasty? A Multivariable Regression Analysis. J Arthroplasty 2016; 31:97-101. [PMID: 27118354 DOI: 10.1016/j.arth.2016.03.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/11/2016] [Accepted: 03/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Controlling pain after unicompartmental knee arthroplasty (UKA) is essential for improving patient satisfaction, minimizing complications, and early rehabilitation. There is little literature available evaluating the effect of both treatment and patient characteristics on in-hospital pain after UKA. The purpose of this study was to examine the effect of patient and treatment characteristics on in-hospital pain after UKA. This study also evaluated the role of analgesic cocktail (traditional periarticular injection cocktail "[PAI]" vs cocktail including liposomal bupivacaine "[LBUP]"). METHODS The study sample included 442 consecutive UKA cases performed between December 2011 and August 2013. The primary outcome measures were the average Visual Analog Scale pain score and the percent of pain scores during hospitalization that were 0, that is, "no pain." Multivariable regression analyses were implemented to investigate associations between patient demographics and analgesic group with the outcomes. For the analgesic groups, the "PAI" group received injections of a cocktail including Marcaine, ketorolac, and morphine, the "LBUP" group received injections of LBUP. RESULTS Postoperative pain was higher in females (P < .001) and younger patients (P = .002). The patient group treated with LBUP injection technique had similar overall average Visual Analog Scale pain scores to patients in the PAI group (P = .729); however, there was also a significant improvement in pain scores over time (as the study progressed) for patients in the LBUP group relative to the PAI group (P = .003), potentially indicating better outcomes with more experience with the injection technique. When compared individually by day, the LBUP group had lower pain scores from day 1 to 3 (P < .024). CONCLUSION The results showed that in patients undergoing UKA, postoperative pain was lower in males, older patients, patients with lower body mass index, and those treated with LBUP over the study period. Understanding these associations is necessary to effectively manage pain and encourage earlier ambulation and physiotherapy after UKA.
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Postoperative Pain After Primary Total Knee Arthroplasty: Comparison of Local Injection Analgesic Cocktails and the Role of Demographic and Surgical Factors. J Arthroplasty 2016; 31:288-92. [PMID: 27318410 DOI: 10.1016/j.arth.2016.05.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/14/2016] [Accepted: 05/02/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It has been reported that pain-related outcomes after total knee arthroplasty (TKA) may vary with different analgesic techniques and with patient demographics. The purposes of this study were to compare local infiltration of regular bupivacaine (periarticular infiltration [PAI] group) vs liposomal bupivacaine (LBUP group) and to examine the effect of patient characteristics on postoperative pain after TKA. METHODS The study sample included 665 consecutive TKA cases performed between December 2011 and August 2013. The primary outcome measures were the average visual analog scale (VAS) pain score and the percent of VAS pain scores that indicated no pain. Multivariable regression analyses investigated the effect of age, race, ethnicity, body mass index, gender, surgeon, and analgesic protocol on outcomes. For the analgesic groups, the "PAI" group received injections of a cocktail including bupivacaine, ketorolac, and morphine, whereas the "LBUP" group received injections of LBUP. RESULTS The regression analysis demonstrated that postoperative pain was higher in females (P < .001) and younger patients (P < .001). Although overall average VAS pain scores were not significantly different, when specific postoperative days were evaluated, the LBUP group had lower pain scores from day 1 to 5 (P < .014). There were no differences in VAS scores based on patient body mass index (P = .250), race (P = .205), or ethnicity (P = .961) in this sample. CONCLUSION This multivariate regression analysis study showed that in patients undergoing primary TKA, postoperative pain was lower in males, older patients, and those treated with LBUP. Awareness of these factors may assist in developing patient-specific multimodal postoperative pain and education protocols that reduce opioid reliance and related adverse events.
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Rosenbaum AJ, Uhl RL, Rankin EA, Mulligan MT. Social and Cultural Barriers: Understanding Musculoskeletal Health Literacy: AOA Critical Issues. J Bone Joint Surg Am 2016; 98:607-15. [PMID: 27053590 DOI: 10.2106/jbjs.o.00718] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Institute of Medicine considers limited health literacy a "silent epidemic," as approximately half of Americans lack the competencies necessary for making informed decisions regarding their health. Limited health literacy substantially impedes the effective dissemination and comprehension of relevant health information, and also complicates communication, compromises care, and leads to worse patient outcomes. Poor health, early death, and worse control of chronic conditions have also been associated with limited health literacy. Unfortunately, physicians often struggle to identify those with limited health literacy, which can have adverse effects on the physician-patient relationship. In this article, we discuss the meaning of health literacy,the risk factors for and consequences of limited health literacy, orthopaedic-specific implications and investigations, and the strategies orthopaedic surgeons can utilize to improve health literacy and communication.
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Affiliation(s)
- Andrew J Rosenbaum
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| | - Richard L Uhl
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
| | | | - Michael T Mulligan
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
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Doull M, Welch V, Puil L, Runnels V, Coen SE, Shea B, O’Neill J, Borkhoff C, Tudiver S, Boscoe M. Development and evaluation of 'briefing notes' as a novel knowledge translation tool to aid the implementation of sex/gender analysis in systematic reviews: a pilot study. PLoS One 2014; 9:e110786. [PMID: 25372876 PMCID: PMC4220945 DOI: 10.1371/journal.pone.0110786] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/17/2014] [Indexed: 12/12/2022] Open
Abstract
Background There is increasing recognition of sex/gender differences in health and the importance of identifying differential effects of interventions for men and women. Yet, to whom the research evidence does or does not apply, with regard to sex/gender, is often insufficiently answered. This is also true for systematic reviews which synthesize results of primary studies. A lack of analysis and reporting of evidence on sex/gender raises concerns about the applicability of systematic reviews. To bridge this gap, this pilot study aimed to translate knowledge about sex/gender analysis (SGA) into a user-friendly ‘briefing note’ format and evaluate its potential in aiding the implementation of SGA in systematic reviews. Methods Our Sex/Gender Methods Group used an interactive process to translate knowledge about sex/gender into briefing notes, a concise communication tool used by policy and decision makers. The briefing notes were developed in collaboration with three Cochrane Collaboration review groups (HIV/AIDS, Hypertension, and Musculoskeletal) who were also the target knowledge users of the briefing notes. Briefing note development was informed by existing systematic review checklists, literature on sex/gender, in-person and virtual meetings, and consultation with topic experts. Finally, we held a workshop for potential users to evaluate the notes. Results Each briefing note provides tailored guidance on considering sex/gender to reviewers who are planning or conducting systematic reviews and includes the rationale for considering sex/gender, with examples specific to each review group’s focus. Review authors found that the briefing notes provided welcome guidance on implementing SGA that was clear and concise, but also identified conceptual and implementation challenges. Conclusions Sex/gender briefing notes are a promising knowledge translation tool. By encouraging sex/gender analysis and equity considerations in systematic reviews, the briefing notes can assist systematic reviewers in ensuring the applicability of research evidence, with the goal of improved health outcomes for diverse populations.
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Affiliation(s)
- Marion Doull
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Vivian Welch
- Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lorri Puil
- Therapeutics Initiative, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vivien Runnels
- Globalization and Health Research Unit, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie E. Coen
- Department of Geography, Queen’s University, Mackintosh-Corry Hall, Kingston, Ontario, Canada
| | - Beverley Shea
- Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer O’Neill
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Cornelia Borkhoff
- Division of Pediatric Medicine, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sari Tudiver
- Researcher/Consultant on Gender and Health, Ottawa, Ontario, Canada
| | - Madeline Boscoe
- Reach Community Health Centre, Vancouver, British Columbia, Canada
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Sarcoma Care in an Urban Health-care System: Which Factors Lead to Variance of Care? J Racial Ethn Health Disparities 2014. [DOI: 10.1007/s40615-013-0005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Piriou P, Mabit C, Bonnevialle P, Peronne E, Versier G. Are gender-specific femoral implants for total knee arthroplasty necessary? J Arthroplasty 2014; 29:742-8. [PMID: 24140276 DOI: 10.1016/j.arth.2013.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/21/2013] [Accepted: 09/11/2013] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to determine the effect of gender on epiphyseal morphology and using this information to determine if an implant product line with a single width provides sufficient bone coverage for the entire population of knees being replaced. Morphology of the distal femoral epiphysis from 420 continuous knees was acquired with a surgical navigation system during primary TKA. A three-dimensional model of the distal femur was generated and used to determine the anterioposterior (AP) and mediolateral (ML) dimensions on 19 different virtual knee sections. Female knees had smaller AP and ML dimensions than male knees. The ML width of the distal femoral epiphysis was associated with femur length, not gender. Measurements derived from surgical navigation confirm that distal femoral epiphysis dimensions are related to femur length only independently of gender.
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Affiliation(s)
| | - Christian Mabit
- Orthopedic and Trauma Surgery Department, Dupuytren University Hospital, Limoges, France
| | - Paul Bonnevialle
- Musculoskeletal Institute at CHU Toulouse, Purpan Orthopedics and Trauma Unit, Place Baylac, Toulouse, France
| | - Etienne Peronne
- La Châtaigneraie Clinic, Rue de la Châtaigneraie, Beaumont, France
| | - Gilbert Versier
- Orthopedic Surgery Department, Bégin Military Hospital, Saint Mandé, France
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Banerjee D, Illingworth KD, Novicoff WM, Scaife SL, Jones BK, Saleh KJ. Rural vs. urban utilization of total joint arthroplasty. J Arthroplasty 2013; 28:888-91. [PMID: 23541869 DOI: 10.1016/j.arth.2012.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 08/23/2012] [Accepted: 09/05/2012] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to analyze the association between patient demographics and hospital demographics on utilization of total joint arthroplasty in rural and urban populations from the National Inpatient Sample database. Any patient that was discharged after a primary total hip or primary total knee arthroplasty was included in this study. Results showed that rural patients living in a Northeastern hospital region compared to West, less than 65 years of age, females, Blacks and Hispanics were less likely to undergo total joint arthroplasty compared to their urban counterparts. Rural patient were more likely to undergo total joint arthroplasty compared to their urban counterparts if they were in the Midwest and had Medicare as their primary payer provider.
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Affiliation(s)
- Devraj Banerjee
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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Abstract
Osteoarthritis is a disease that progresses over time and culminates in the destruction of articular cartilage and joints. Thus, with an increasing elderly population the treatment of knee osteoarthritis has become a major healthcare issue. It has been shown that women are more severely impacted by knee osteoarthritis. Differences in knee anatomy, kinematics, previous knee injury, and hormonal influences may play a role. Sex difference with respect to osteoarthritis presentation, treatment, and the allocation of resources also exists. In general, women present for treatment in more advanced stages of osteoarthritis and have more debilitating pain than their male counterparts. In addition, healthcare providers are more likely to recommend total joint arthroplasty for their male patients. Understanding how and why these gender differences occur is instrumental in formulating an inclusive strategy for combating osteoarthritis in the future.
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Affiliation(s)
- Sharon L Hame
- Division of Sports Medicine, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave. CHS 76-126, Los Angeles, CA, 90095, USA,
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Martin CT, Callaghan JJ, Liu SS, Gao Y, Johnston RC. Disparity in preoperative patient factors between insurance types in total joint arthroplasty. Orthopedics 2012; 35:e1798-803. [PMID: 23218639 DOI: 10.3928/01477447-20121120-27] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Equity in health care has become a focal point of debate. However, the disparity between insurance payer types in total joint arthroplasty is poorly defined. The authors identified 1312 consecutive patients who underwent elective primary total hip or knee arthroplasty with available preoperative Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index surveys and stratified them into groups based on insurance type (Iowa Care [a state-run insurance program for patients who are indigent], Medicare, Medicaid, or private insurance) to compare demographics, access to care, and functional data. Significance was a P value less than .05 after a Turkey-Kramer adjustment for multiple comparisons. A multivariate analysis identified independent predictors of Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index preoperative functional status. Few differences existed between patients with Iowa Care and Medicaid, but both groups had significantly lower Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index scores across every category compared with patients with Medicare or private insurance (P<.05 for each comparison). In addition, patients with Iowa Care and Medicaid had a higher incidence of current smoking and higher mean body mass index and traveled an average of 29 to 30 miles farther for access to care (P<.05 for each comparison). Payer type was an independent predictor of preoperative Short Form 36 and Western Ontario and McMaster University Osteoarthritis Index functional scores in the multivariate analysis (P<.02). Significant differences exist between payer types in total joint arthroplasty. Further research is necessary to better inform health policy decisions.
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Affiliation(s)
- Christopher T Martin
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 01029 JPP, Iowa City, IA 52242, USA
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31827525d3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ackerman IN, Busija L. Access to self-management education, conservative treatment and surgery for arthritis according to socioeconomic status. Best Pract Res Clin Rheumatol 2012; 26:561-83. [DOI: 10.1016/j.berh.2012.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 08/16/2012] [Indexed: 10/27/2022]
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Barnabe C, Bessette L, Flanagan C, Leclercq S, Steiman A, Kalache F, Kung T, Pope JE, Haraoui B, Hochman J, Mosher D, Thorne C, Bykerk V. Sex differences in pain scores and localization in inflammatory arthritis: a systematic review and metaanalysis. J Rheumatol 2012; 39:1221-30. [PMID: 22505697 DOI: 10.3899/jrheum.111393] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To systematically identify and examine reports of sex-stratified pain measurements in patients with inflammatory arthritis. METHODS Data sources included PubMed (1950 to April 2010), Embase (1980 to April 2010), and manual searches of reference lists and conference abstracts. We included cohort studies and randomized trials comparing pain scores, treatment efficacy at reducing pain, or pain localization, between females and males with inflammatory arthritis [rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis, and reactive arthritis]. RESULTS Twenty-six cohorts and 1 randomized trial reported sex-stratified pain scores, and all but 1 cohort identified worse pain scores at enrollment in females. In a metaanalysis of mean visual analog scale (VAS) scores (0 to 10) in 16 RA cohort studies (reporting on 21,612 females and 6871 males), the standardized mean difference in VAS was 0.21 (95% CI 0.16, 0.26). Treatment with disease-modifying therapy results in improvement in mean scores for both sexes; however, female absolute scores remain higher. In 12 spondyloarthropathy cohorts reporting pain localization, females develop more peripheral arthritis during their disease course (68.9% vs 51.2%) but less inflammatory back pain (50.6% vs 66.4%). CONCLUSION We identified important sex differences in pain scores in inflammatory arthritis, with higher pain levels in females. In spondyloarthritis, females develop more peripheral arthritis and have less frequent spinal involvement compared to males. These differences may affect a clinician's perception of disease severity and activity, and thus influence management decisions.
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Affiliation(s)
- Cheryl Barnabe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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