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Nasu T, Yamanoi J, Kitagawa T. The Investigation of Preoperative Factors Associated With Postoperative Outcomes Following Total Knee Arthroplasty for Osteoarthritis: A Scoping Review. Cureus 2024; 16:e64989. [PMID: 39161506 PMCID: PMC11333026 DOI: 10.7759/cureus.64989] [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] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
This study aimed to investigate preoperative factors associated with non-home discharges from acute care hospitals in patients undergoing total knee arthroplasty (TKA) due to osteoarthritis. It was a scoping review focused on patients who received their first unilateral TKA for osteoarthritis. The research targeted observational studies that examined the destinations of patients post-surgery based on preoperative factors, with a literature search conducted in April 2023. Out of 3,255 identified papers, 28 met the eligibility criteria. A total of 26 preoperative factors were identified as potentially related to discharge destinations, including age, gender, comorbidities, and obesity. By selecting an appropriate discharge destination based on preoperative factors, there may be potential for more efficient use of medical resources. Future studies should consider preoperative factors in the context of national healthcare systems and lengths of hospital stay.
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Affiliation(s)
- Takafumi Nasu
- Department of Rehabilitation Medicine, Juko Osu Hospital, Nagoya, JPN
| | - Junya Yamanoi
- Department of Rehabilitation Medicine, Juko Osu Hospital, Nagoya, JPN
| | - Takashi Kitagawa
- Department of Physical Therapy, Shinshu University, Matsumoto, JPN
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Ouendi N, Avril E, Dervaux B, Pudlo P, Wallard L. Effectiveness of Telerehabilitation Programs in Elderly with Hip or Knee Arthroplasty: A Systematic Review. Telemed J E Health 2024; 30:1507-1521. [PMID: 38574249 DOI: 10.1089/tmj.2023.0622] [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] [Indexed: 04/06/2024] Open
Abstract
Background: Lower limb osteoarthritis (OA) often generates musculoskeletal pain causing functional impairment and decreasing mobility, autonomy, and quality of life. Patients with OA are commonly prescribed specific care for total hip arthroplasty or total knee arthroplasty (THA or TKA), when patients present symptoms that are refractory to nondrug treatments. Currently, when patients are discharged from orthopedic surgery, they are either referred to a rehabilitation department, or sent directly home with assistance such as remote monitoring by teleconsultation or a mobile application. In recent years, there has been an evolution in digital health and in particular telerehabilitation. To determine utility and effectiveness, the aim of this systematic review was to highlight and evaluate different telerehabilitation programs using new information and communication technologies. Methods: Five databases, ScienceDirect, PubMed, Web of Sciences, Scopus, and Google scholar, were searched until 30 June 30, 2023. All studies written in English and meeting our inclusion criteria were included. Databases were screened for "Total Hip Arthroplasty," "Total Knee Arthroplasty," "Total Hip Replacement," "Total Knee Replacement," "Rehabilitation," "Physical Activity," "Physiotherapy," "Telerehabilitation," "Telecommunication*," "Senior*," and "Elderly" in accordance with PRISMA-ScR guideline. Results: Fourteen articles were selected according to inclusion criteria. Telerehabilitation was offered in seven different ways (video call, applications smartphones, website, etc.). Assessments included were mainly quality of life questionnaires, perceived effort after exercises, field surveys on the tool experience, and physical tests to assess motor functions. Conclusion: This review highlights the importance and relevance of evaluating the contributions and limits of new health technologies to improve patient monitoring and thus enable better remote clinical care.
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Affiliation(s)
- Nawel Ouendi
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
- Pôle SSR - Maison Sport Santé - Institut Jean Stablinski, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Eugénie Avril
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
| | - Benjamin Dervaux
- Pôle SSR - Maison Sport Santé - Institut Jean Stablinski, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Philippe Pudlo
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
| | - Laura Wallard
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
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Girard J, Epinette JA, Martinot P, Dartus J. French hip resurfacing registry: A study of 1650 cases. Orthop Traumatol Surg Res 2022; 108:103087. [PMID: 34597828 DOI: 10.1016/j.otsr.2021.103087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hip resurfacing has been the focus of many evaluations based on international registries but, to date, no prospective studies have evaluated this procedure in France. In 2015, the French Society for Orthopaedics and Traumatology (SoFCOT) and the French Hip and Knee Society concluded an agreement with the French Medicines Agency (ANSM) and French National Health Authority (HAS) to establish an exhaustive observational hip resurfacing registry. The primary objective of this study was to evaluate the hip resurfacing survival rate since the creation of the registry 5 years ago. The secondary objectives were to evaluate the clinical, functional, and radiological outcomes of hip resurfacing and to check the absence of specific complications related to this implant. HYPOTHESIS The hypothesis was that the registry survival rate was below 0.5% per year. METHODS Since 2015, data from all patients undergoing hip resurfacing were collected into a monitored database using the software suite OrthoWave. The following were collected for each patient: demographics, anthropometric characteristics, clinical parameters (Postel Merle d'Aubigné score, Harris Hip Score, Oxford Hip Score, and UCLA Activity Score), and radiological findings. Completeness of data collection was checked once a year. RESULTS In total, 1650 hip resurfacings in 1506 patients (1409 males and 97 females) with a mean age of 50.7 years (range, 17-70 years) were included. Mean follow-up was 3.8 years (range, 2-4.8 years). Mean completeness of data recording was 98.2%. All clinical scores improved significantly. Hip revision was required for 7 (0.4%) complications including 4 femoral neck fractures, 1 aseptic lymphocyte-dominant vasculitis-associated lesion with a large joint effusion, 1 femoral component loosening, and 1 delayed sepsis requiring bipolar removal. At 5 years, the survival rate without hip revision for any cause was 99.6% (95% confidence interval, 99.3-100%). DISCUSSION The short-term outcomes of patients in the French registry are encouraging in terms of complication and surgical revision rates. The near absence of complications related to metal-on-metal bearing surfaces demonstrates that the criteria used in France (at least 48mm head diameter, use of implants for which long-term data are available, and specific training of surgeons) ensure successful long-term outcomes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Julien Girard
- Service d'orthopédie C, hôpital Salengro, CHRU de Lille, Lille, France; EA 7369 - URePSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, University Lille, University Artois, University Littoral Côte d'Opale, 59000 Lille, France.
| | | | - Pierre Martinot
- Service d'orthopédie C, hôpital Salengro, CHRU de Lille, Lille, France
| | - Julien Dartus
- Service d'orthopédie C, hôpital Salengro, CHRU de Lille, Lille, France
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Evaluation of the Efficacy and Safety of an Exercise Program for Persons with Total Hip or Total Knee Replacement: Study Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136732. [PMID: 34201439 PMCID: PMC8268118 DOI: 10.3390/ijerph18136732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
Total hip replacement (THR) and total knee replacement (TKR) are among the most common elective surgical procedures. There is a large consensus on the importance of physical activity promotion for an active lifestyle in persons who underwent THR or TKR to prevent or mitigate disability and improve the quality of life (QoL) in the long term. However, there is no best practice in exercise and physical activity specifically designed for these persons. The present protocol aims to evaluate the efficacy and safety of an exercise program (6 month duration) designed for improving quality of life in people who had undergone THR or TKR. This paper describes a randomized controlled trial protocol that involves persons with THR or TKR. The participant will be randomly assigned to an intervention group or a control group. The intervention group will perform post-rehabilitation supervised training; the control group will be requested to follow the usual care. The primary outcome is QoL, measured with the Short-Form Health Survey (SF-36); Secondary outcomes are clinical, functional and lifestyle measures that may influence QoL. The results of this study could provide evidence for clinicians, exercise trainers, and policymakers toward a strategy that ensures safe and effective exercise physical activity after surgery.
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Michel M, Bryère J, Maravic M, Marcelli C. Knee replacement incidence and social deprivation: results from a French ecological study. Joint Bone Spine 2019; 86:637-641. [DOI: 10.1016/j.jbspin.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/05/2019] [Accepted: 03/13/2019] [Indexed: 12/20/2022]
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Knoedler MA, Jeffery MM, Philpot LM, Meier S, Almasri J, Shah ND, Borah BJ, Murad MH, Larson AN, Ebbert JO. Risk Factors Associated With Health Care Utilization and Costs of Patients Undergoing Lower Extremity Joint Replacement. Mayo Clin Proc Innov Qual Outcomes 2018; 2:248-256. [PMID: 30225458 PMCID: PMC6132211 DOI: 10.1016/j.mayocpiqo.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/24/2018] [Accepted: 06/04/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Comprehensive Care for Joint Replacement program implemented by the Centers for Medicare and Medicaid Services did not incorporate risk adjustment for lower extremity joint replacement (LEJR). Lack of adjustment places hospitals at financial risk and creates incentives for adverse patient selection. OBJECTIVE To identify patient-level risk factors associated with health care utilization and costs of patients undergoing LEJR. METHODS A comprehensive search of research databases from January 1, 1990, through January 31, 2016, was conducted. The databases included Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and SCOPUS and is reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search identified 2020 studies. Eligible studies focused on primary unilateral and bilateral LEJR. Independent reviewers determined study eligibility and extracted utilization and cost data. RESULTS Seventy-nine of 330 studies (24%) were included and were abstracted for analysis. Comorbidities, age, disease severity, and obesity were associated with increased costs. Increased number of comorbidities and age, presence of specific comorbidities, lower socioeconomic status, and female sex had evidence of increased length of stay. We found no significant association between indication for surgery and the likelihood of readmission. CONCLUSION Developing a risk adjustment model for LEJR that incorporates clinical variables may serve to reduce the likelihood of adverse patient selection and enhance appropriate reimbursement aligned with procedural complexity.
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Affiliation(s)
- Meghan A. Knoedler
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Molly M. Jeffery
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Lindsey M. Philpot
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Sarah Meier
- Manatt Health, Manatt, Phelps & Phillips LLP, Washington, DC
| | - Jehad Almasri
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Nilay D. Shah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Bijan J. Borah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - M. Hassan Murad
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - A. Noelle Larson
- Department of Orthopedic Surgery, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Jon O. Ebbert
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Kruse FM, Stadhouders NW, Adang EM, Groenewoud S, Jeurissen PPT. Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review. Int J Health Plann Manage 2018; 33:e434-e453. [PMID: 29498430 PMCID: PMC6033142 DOI: 10.1002/hpm.2502] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/18/2018] [Indexed: 11/07/2022] Open
Abstract
European countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social-economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for-profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector.
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Affiliation(s)
- Florien M Kruse
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niek W Stadhouders
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eddy M Adang
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stef Groenewoud
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Ministry of Health, Welfare, and Sport, The Hague, the Netherlands
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Discharge to Inpatient Facilities After Total Hip Arthroplasty Is Associated With Increased Postdischarge Morbidity. J Arthroplasty 2017; 32:S144-S149.e1. [PMID: 28455181 DOI: 10.1016/j.arth.2017.03.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/20/2017] [Accepted: 03/17/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Discharge disposition accounts for significant variability in costs after elective total hip arthroplasty (THA). Therefore, institutions must evaluate the short-term clinical outcomes associated with postdischarge care options. The present study intends to characterize the associations between short-term morbidity after primary THA and discharge destination. METHODS Primary elective unilateral THA cases performed for osteoarthritis were identified in the American College of Surgeons National Surgical Quality Improvement Program registry from 2011 to 2014. Propensity scores were used to adjust for selection bias in discharge destination, based on demographics, obesity class, preoperative functional status, modified Charlson comorbidity index, American Society of Anesthesiologists (ASA) class, and the presence of predischarge complications. Propensity-adjusted multivariate logistic regressions were used to examine associations between discharge destination and postdischarge complications, controlling for selection bias based on observable patient characteristics. RESULTS Among 54,837 THA cases included in the study, 40,576 (74%) were discharged home, and 14,261 (26%) were discharged to inpatient facilities. In multivariate propensity-adjusted analyses, patients discharged to continued inpatient care after THA were more likely to have septic complications (odds ratio, 2.34; 95% confidence interval, 1.58-3.45), urinary complications (1.51; 1.21-1.90), readmission (1.44; 1.29-1.59), wound complications (1.31; 1.09-1.57), and respiratory complications (1.93; 1.21-3.07). CONCLUSION Discharge to continued inpatient care following THA is associated with increased odds of postdischarge morbidity and unplanned readmission, after propensity score adjustment for predischarge characteristics. Additional research is needed on the impact of devoting resources toward facilitating discharge to home after THA.
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Maravic M, Lasbleiz S, Roulot E, Beaudreuil J. Hospitalization for Dupuytren's disease: a French national descriptive analysis, 2002 to 2009. Orthop Traumatol Surg Res 2014; 100:589-92. [PMID: 25164352 DOI: 10.1016/j.otsr.2014.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 04/11/2014] [Accepted: 05/13/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The goal of this study is to describe hospitalization for treatment of Dupuytren's disease in France between 2002 and 2009. METHODS A repeated, annual, cross-sectional national survey of public and private French hospitals was performed between 2002 and 2009, with planned selection criteria for data extraction. Outcomes were age, sex, number of hospitalizations, length of stays, and types of surgical procedure. Types of surgical procedure included aponeurectomy, aponeurotomy, transplantation (skin graft), arthrolysis, amputation, arthrodesis, combined procedures. RESULTS The selected hospital stays represented 95% to 97% of all stays with Dupuytren's disease coded as the primary diagnosis. The hospitalizations involved mainly men in the 7th decade. The mean number of hospitalizations for Dupuytren's disease was 16,487, for between 7 and 8/10,000 total hospitalizations each year. Most of the hospitalizations for Dupuytren's disease were one-day stays in private settings. Over time, the mean length of hospital stay significantly shortened and the proportion of one-day stays significantly increased. Aponeurectomy was the most reported treatment. The distribution of aponeurectomy of 1 finger or ≥ 2 fingers was balanced. The performance of arthrolysis, transplantation, amputation and arthrodesis was low. CONCLUSIONS Despite of shortening of hospitals stays over time, hospitalization for surgery for Dupuytren's disease in France still represents a meaningful economic burden. LEVEL OF EVIDENCE Observational study II.
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Affiliation(s)
- M Maravic
- Département d'information médicale, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service de rhumatologie, université Paris 7, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Lasbleiz
- Service de rhumatologie, université Paris 7, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - E Roulot
- Service de rhumatologie, université Paris 7, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J Beaudreuil
- Service de rhumatologie, université Paris 7, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
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Oleske DM, Bonafede MM, Jick S, Ji M, Hall JA. Electronic health databases for epidemiological research on joint replacements: considerations when making cross-national comparisons. Ann Epidemiol 2014; 24:660-5. [PMID: 25088754 DOI: 10.1016/j.annepidem.2014.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 05/17/2014] [Accepted: 06/10/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to examine the rate of primary knee, hip, or shoulder replacement among persons with osteoarthritis (OA) of the knee by gender and age comparing two nations in similar periods using electronic health records, but with different health-care systems. METHODS Two electronic health care databases of anonymized information were used to construct cohorts of adults with OA of the knee from the United Kingdom (UK) and the United States. Patients were required to have activity in the database at least 6 months before the first diagnosis of knee OA ("index diagnosis") in the study period to ensure that the patient samples were eligible for medical evaluation. The outcomes (numerator) measured were primary knee, hip, or shoulder replacement or the composite of primary knee, hip, or shoulder replacement. The denominator was the person-time at risk computed from time from the date of the index diagnosis to the date of each outcome separately or to the end of the database period if no outcome was documented. RESULTS There were 93,146 subjects in the UK and 1,468,217 in the United States who were aged 18+ years and met the study eligibility criteria. The composite joint replacement rate (hip, knee, or shoulder) ranged from 11.89 per 100 person-years (PY) in the Unites States to 4.13 per 100 PY in the UK Primary knee replacements rates ranged from 10.38 per 100 PY in the Unites States to 3.40 per 100 PY in the UK and occurred at a somewhat higher rate in males than females in both countries. Both primary hip and shoulder replacement rates were higher in the Unites States than in the UK (hip: 1.19 per 100 PY and 0.76 per 100 PY; shoulder: 0.19 per 100 PY and 0.03 per 100 PY, respectively). The median time to a primary hip or knee replacement in the UK was approximately twice as long as in the Unites States. CONCLUSIONS Knee replacements are not an uncommon event in persons with knee OA occurring throughout the adult life span, with the rate steeply rising in both sexes until aged 75 years. Although the pattern of the age-specific joint replacement rates was similar between sexes, the magnitude of the rates was markedly lower in the UK.
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Affiliation(s)
- Denise M Oleske
- Global Surveillance and Pharmacoepidemiology, AbbVie, North Chicago, IL.
| | | | - Susan Jick
- The Boston Collaborative Drug Surveillance Program, The Boston University School of Public Health, Lexington, MA
| | - Ming Ji
- Medical Safety Evaluation, AbbVie, North Chicago, IL
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Coudeyre E, Eschalier B, Descamps S, Claeys A, Boisgard S, Noirfalize C, Gerbaud L. Transcultural validation of the Risk Assessment and Predictor Tool (RAPT) to predict discharge outcomes after total hip replacement. Ann Phys Rehabil Med 2014; 57:169-84. [PMID: 24717404 DOI: 10.1016/j.rehab.2014.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/16/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the relevance of the RAPT (Risk Assessment and Prediction Tool), among a cohort of patients undergoing total hip arthroplasty (THA). METHOD Prospective study of a cohort of patients evaluated before and after THA. The difference between the postoperative orientation predicted by the RAPT and the real one is assessed. Clinical, environmental and psychosocial criteria that could significantly change the orientation are discussed. RESULTS One hundred and thirty-four patients (94 women and 40 men) were included. The average age was 71.6 (±10) years. Primary hip osteoarthritis was the indication for surgery in 78% of cases. The average length of stay in the surgery ward was 10 (±3) days. It was significantly higher for patients referred to a rehabilitation ward (P<0.0001). Sixty-six percent of patients were referred to a rehabilitation ward and 34% returned directly home. The average length of stay in rehabilitation ward was 27 (±13) days. The validity of the RAPT as a help decision tool has been confirmed. Thus, a low RAPT score was significantly associated with more frequent referral to a rehabilitation ward, conversely, a high RAPT score is significantly related to more frequent direct return to home. CONCLUSION This study confirmed the usefulness of the RAPT to help in patient orientation decision after total hip arthroplasty. The patient preference remains the main variable for orientation after THA. By the way, the patient preference must not be integrated into the RAPT, but need to be collected and be discussed with the patient.
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Affiliation(s)
- E Coudeyre
- Physical medicine and rehabilitation (PM&R) department, hôpital Nord, CHU de Clermont-Ferrand, route de Chateaugay, BP 30056, 63118 Cébazat, France.
| | - B Eschalier
- Département de médecine générale, faculté de médecine, université d'Auvergne, 63000 Clermont-Ferrand, France
| | - S Descamps
- Service de chirurgie orthopédique, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - A Claeys
- Physical medicine and rehabilitation (PM&R) department, hôpital Nord, CHU de Clermont-Ferrand, route de Chateaugay, BP 30056, 63118 Cébazat, France
| | - S Boisgard
- Service de chirurgie orthopédique, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - C Noirfalize
- Service de santé publique, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - L Gerbaud
- Service de santé publique, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
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Unay K, Akcal MA, Gokcen B, Akan K, Esenkaya I, Poyanlı O. The relationship between intra-articular meniscal, chondral, and ACL lesions: finding from 1,774 knee arthroscopy patients and evaluation by gender. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1255-62. [PMID: 24077939 DOI: 10.1007/s00590-013-1309-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/27/2013] [Indexed: 01/26/2023]
Abstract
Knowing the relationship between diagnoses is important in knee arthroscopy in terms of defining possible treatment modalities preoperatively. The purpose of our study was to define the diagnoses made intraoperatively through knee arthroscopy and the relationships between them. We evaluated the results of knee arthroscopies performed over a 10-year period. The sites and sizes of chondral lesions, the existence of anterior cruciate ligament (ACL) injury, and the sites of meniscal lesions were noted for a total of 1,774 patients. The relationships between these lesions were evaluated statistically. Chondral lesions and posterior medial meniscal tears were predominant in females, whereas complete ACL tears were predominant in males. ACL tears were commonly accompanied by medial and lateral meniscal bucket-handle tears. In cases with advanced chondral lesions, medial and lateral posterior meniscal and lateral anterior meniscal tears were more common. According to our results, posterior tears of the medial menisci, medial and lateral femoral condyles, lateral tibial plateau type 3 or 4 cartilage lesions, and the rate of diagnostic arthroscopy were higher in females, while middle substance and bucket-handle tears of medial menisci and total rupture of the ACL were more common in males. ACL injuries were seen to coexist with medial or lateral menisci bucket-handle tears, with no relationship between the site or size of the chondral lesions. A relationship between medial and lateral meniscal tears and the site of femoral and tibial chondral surface lesions was detected.
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Affiliation(s)
- Koray Unay
- Goztepe Training and Research Hospital, Orthopaedics and Traumatology Clinic, Medeniyet University, Istanbul, Turkey
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Piscitelli P, Iolascon G, Di Tanna G, Bizzi E, Chitano G, Argentiero A, Neglia C, Giolli L, Distante A, Gimigliano R, Brandi ML, Migliore A. Socioeconomic burden of total joint arthroplasty for symptomatic hip and knee osteoarthritis in the Italian population: a 5-year analysis based on hospitalization records. Arthritis Care Res (Hoboken) 2012; 64:1320-7. [PMID: 22511508 DOI: 10.1002/acr.21706] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the burden of total joint arthroplasties (TJAs) performed for symptomatic hip and knee osteoarthritis (OA) in the Italian population. METHODS We analyzed national hospitalizations and diagnosis-related group databases to compute incidence, annual percent change (APC), direct costs, and working days lost between 2001 and 2005 following TJA due to OA. RESULTS In 2005, we recorded a total of 41,816 (APC +5.4; 95% confidence interval [95% CI] 5.1-5.8) and 44,051 (APC +13.4; 95% CI 13.1-13.8) hip and knee arthroplasties, respectively. Women represented the majority of patients undergoing TJA procedures (female:male ratio 1.7:1 for hip arthroplasties and 2.9:1 for knee arthroplasties). When analyzing the data by age groups, most of the patients were in the age groups 65-74 years and ≥75 years, although the highest increases were observed in those ages <65 years. Revisions accounted for 6,387 (APC +4.9; 95% CI 4.0-5.7) and 2,295 (APC +17.4; 95% CI 15.7-19.2) procedures for the hip and knee, respectively. Loss of working days in patients ages <65 years was estimated between 805,000 and 1 million days. Hospital costs increased from 741 million to 1 billion euros over the 5-year period (from 412 to 538 million euros for hip arthroplasties and from 329 to 517 million euros for knee arthroplasties). Rehabilitation costs increased from 228 to 322 million euros. Postoperative complications were estimated between 3.1 and 4.4 million euros. The average costs per patient were 16,835 and 15,358 euros for hip and knee arthroplasties, respectively. CONCLUSION The socioeconomic burden of TJAs performed for symptomatic OA in Italy is remarkable and calls for the adoption of proper preventive measures.
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Haematoma of pectineus muscle after total hip arthroplasty. Ann Phys Rehabil Med 2011; 54:293-7. [PMID: 21715235 DOI: 10.1016/j.rehab.2011.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 12/10/2010] [Accepted: 04/18/2011] [Indexed: 11/23/2022]
Abstract
The complications of total hip arthroplasty (THA) during the immediate postoperative period consist mainly in dislocation of the prosthesis, haematomas under antocoagulants, early infections, dismantling of osteotomy, neurological injury, heterotopic ossification and delayed restoration of the range of motion of the hip joint. We present here an infrequently described case of haematoma of the pectineus muscle following THA. Haematomas are not described in literature except in rare cases of compressive haematoma associated with neurological injury. In our case, the intraoperative blood losses were not particularly massive, there were no anticoagulation accident or postoperative trauma and no secondary deglobulinization. The question to be considered is that of a possible stretching of the pectineus during hip dislocation, and possibly during the surgical procedures for the implementation of the prosthesis with increased length, as it is the case here. Haematomas of the pectineus are probably underdiagnosed as they imitate other, more known, symptomatologies.
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Jimenez-Garcıa R, Villanueva-Martınez M, Fernandez-de-Las-Penas C, Hernandez-Barrera V, Rıos-Luna A, Garrido PC, de Andres AL, Jimenez-Trujillo I, Montero JSR, Gil-de-Miguel A. Trends in primary total hip arthroplasty in Spain from 2001 to 2008: evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality. BMC Musculoskelet Disord 2011; 12:43. [PMID: 21306615 PMCID: PMC3041728 DOI: 10.1186/1471-2474-12-43] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 02/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS), costs and in-hospital mortality (IHM) of patients undergoing primary total hip arthroplasty (THA) over an 8-year study period in Spain. METHODS We selected all surgical admissions in individuals aged ≥ 40 years who had received a primary THA (ICD-9-CM procedure code 81.51) between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index.Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM. RESULTS We identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p < 0.001). In 2001, 81% of patients had a Charlson Index of 0, 18.4% of 1-2, and 0.6% > 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p < 0.001). The mean LOHS was 13 days in 2001 and decreased to 10.45 days in 2008 (p < 0.001). During the period studied, the mean cost per patient increased from 6,634 to 9,474 Euros. Multivariate analysis shows that from 2001 to 2008 the incidence of THA hospitalizations has significantly increased for both sexes and only men showed a significant reduction in IHM after THA. CONCLUSIONS The current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.
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Affiliation(s)
- Rodrigo Jimenez-Garcıa
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain.
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Coudeyre E, Claus D, Ristori JM. [Patient education for osteoarthritis]. Presse Med 2010; 39:1195-200. [PMID: 20843650 DOI: 10.1016/j.lpm.2009.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 10/12/2009] [Indexed: 11/18/2022] Open
Abstract
Therapeutic education is part of the nonpharmacological management of osteoarthritis (OA) both at the medical and surgical phase. The aim of education at an early stage of OA is to change patients' lifestyle, especially the regular practice of physical activity and weight reduction. When a surgical option is considered, the aim of education is to hasten patient recovery, improve autonomy after surgery, facilitate the return home and reduce the rate of transfer to a rehabilitation unit. Like other nonpharmacological treatment, therapeutic education implementation seems insufficient for OA management. One way to improve therapeutic education in the management of OA could be to propose dedicated continuing medical education programs supported by specific economic sources for health care professionals.
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Affiliation(s)
- Emmanuel Coudeyre
- Clermont université, université d'Auvergne, 63000 Clermont-Ferrand, France.
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Impact of self-care programs for lower limb osteoarthritis and influence of patients’ beliefs. Ann Phys Rehabil Med 2010; 53:434-50. [DOI: 10.1016/j.rehab.2010.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 07/06/2010] [Accepted: 07/07/2010] [Indexed: 11/19/2022]
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Gremeaux V, Renault J, Pardon L, Deley G, Lepers R, Casillas JM. Low-frequency electric muscle stimulation combined with physical therapy after total hip arthroplasty for hip osteoarthritis in elderly patients: a randomized controlled trial. Arch Phys Med Rehabil 2009; 89:2265-73. [PMID: 19061737 DOI: 10.1016/j.apmr.2008.05.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 05/07/2008] [Accepted: 05/19/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the effects of low-frequency electric muscle stimulation associated with usual physiotherapy on functional outcome after total hip arthroplasty (THA) for hip osteoarthritis (OA) in elderly subjects. DESIGN Randomized controlled trial; pre- and posttreatment measurements. SETTING Hospital rehabilitation department. PARTICIPANTS Subjects (N=29) referred to the rehabilitation department after THA for hip OA. INTERVENTIONS The intervention group (n=16; 78+/-8 y) received simultaneous low-frequency electric muscle stimulation of bilateral quadriceps and calf muscles (highest tolerated intensity, 1h session, 5 d/wk, for 5 weeks) associated with conventional physical therapy including resistance training. The control group (n=13; 76+/-10 y) received conventional physical therapy alone (25 sessions). MAIN OUTCOME MEASURES Maximal isometric strength of knee extensors, FIM instrument, before and after; a six-minute walk test and a 200 m fast walk test, after; length of stay (LOS). RESULTS Low-frequency electric muscle stimulation was well tolerated. It resulted in a greater improvement in strength of knee extensors on the operated side (77% vs 23%; P<.01), leading to a better balance of muscle strength between the operated and nonoperated limb. The low-frequency electric muscle stimulation group also showed a greater improvement in FIM scores, though improvements in the walk tests were similar for the 2 groups, as was LOS. CONCLUSIONS Low-frequency electric muscle stimulation is a safe, well-tolerated therapy after THA for hip OA. It improves knee extensor strength, which is one of the factors leading to greater functional independence after THA.
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Affiliation(s)
- Vincent Gremeaux
- Pôle Rééducation-Réadaptation, Centre Hospitalier Universitaire de Dijon, INSERM, U887, Dijon, France.
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Boutron I, Rannou F, Jardinaud-Lopez M, Meric G, Revel M, Poiraudeau S. Disability and quality of life of patients with knee or hip osteoarthritis in the primary care setting and factors associated with general practitioners' indication for prosthetic replacement within 1 year. Osteoarthritis Cartilage 2008; 16:1024-31. [PMID: 18276169 DOI: 10.1016/j.joca.2008.01.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Accepted: 01/06/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess disability and health-related quality of life (HRQoL) of patients with knee or hip OA in primary care and to determine factors associated with GPs' opinion that their patients will need prosthetic replacement within 1 year after the consultation. DESIGN A cross-sectional national survey. SETTING Primary care in France. PARTICIPANTS 1471 GPs and 4183 patients with hip or knee OA. MEASURES Pain on an 11-point numeric scale (0-10), disability on the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) (1-100) and Lequesne index (0-24), and quality of life on the Medical Outcomes Study 36-item Short Form (MOS SF-36; 0-100). RESULTS We analyzed records of 4121 patients (2540 knee, 1581 hip OA). Patients with knee or hip OA exhibited high and similar levels of pain (5.2+/-2.1 and 5.3+/-2.3) and disability (Lequesne score: 12.0+/-4.2 and 11.8+/-4.3; WOMAC score: 45.7+/-19.3 and 45.2+/-17.3) The decrease in HRQoL was similar for patients with either location of the disease. GPs more often considered that their patients with hip OA would need prosthetic replacement within 1 year (28.1%) than those with knee OA (15.8%). Most factors associated with GPs' opinion were identified for both locations of disease and were related to disability and pain levels. CONCLUSIONS In the primary care setting, patients with knee or hip OA have similar, high disability levels and substantially low HRQoL. Patients' disability seems to play a central role in GPs' opinion of the need for their patients with either type of OA to undergo prosthetic replacement within 1 year.
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Westby MD, Kennedy D, Jones D, Jones A, Doyle-Waters MM, Backman C. Post-acute physiotherapy for primary total knee arthroplasty. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Marie D. Westby
- Mary Pack Arthritis Program; 895 West 10th Ave Vancouver BC Canada V5Z 1L7
| | - Deborah Kennedy
- Holland Orthopaedic and Arthritic Centre; Department of Rehabilitation; 43 Wellesley St East Toronto Ontario Canada M4Y 1H1
| | - Dina Jones
- West Virginia University; Department of Orthopaedics; One Medical Center Drive PO Box 9196 Morgantown West Virginia USA
| | - Anamaria Jones
- Arthritis Research Centre of Canada; 895 West 10th Avenue Vancouver BC Canada V5Z 1L7
| | - M. Madeleine Doyle-Waters
- Centre for Clinical Epidemiology and Evaluation; VGH Research Pavilion, Vancouver Coastal Health 810 West 10th Avenue Vancouver BC Canada V5Z 1L8
| | - Catherine Backman
- University of British Columbia; Department of Occupational Science and Occupational Therapy; T325-2211 Wesbrook Mall Vancouver BC Canada V6T 2B5
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Coudeyre E, Lefevre-Colau MM, Griffon A, Camilleri A, Ribinik P, Revel M, Rannou F. Is there predictive criteria for transfer of patients to a rehabilitation ward after hip and knee total arthroplasty? Elaboration of French clinical practice guidelines. ACTA ACUST UNITED AC 2007; 50:327-36; 317-26. [PMID: 17498832 DOI: 10.1016/j.annrmp.2007.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 04/02/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop clinical practice guidelines concerning predictive criteria for transfer of patients to a rehabilitation ward after hip and knee total arthroplasty. METHOD The SOFMER (French Physical Medicine and Rehabilitation Society) methodology, associating a systematic literature review, collection of everyday clinical practice, and external review by a multidisciplinary expert panel, was used. RESULTS From systematic literature review and collection of French professional practice, we cannot distinguish the patients undergoing THA and TKA who can transfer to a rehabilitation ward. For both types of patients, the main criteria determining transfer are demographic criteria such as older age or female sex; psychosocial and environmental criteria such as living alone, feeling unable to return home directly (pre-operative education could modify this criterion); and surgeon advice based on the pre and post-operative clinical and functional status. CONCLUSION Studies with good methodological quality are urgently needed to evaluate the use of predictive tools such as the RAPT, separating THA and TKA, and using as parameters of assessment functional status and handicap reduction.
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Affiliation(s)
- E Coudeyre
- Centre de médecine physique et réadaptation Notre-Dame, BP 86, 4, avenue Joseph-Claussat, 63404 Chamalières cedex, France
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Lefevre-Colau MM, Coudeyre E, Griffon A, Camilleri A, Ribinik P, Revel M, Rannou F. Existe-t-il des critères d'orientation vers un centre de rééducation après la pose d'une prothèse totale de hanche ou de genou? Élaboration de recommandations françaises pour la pratique clinique. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.annrmp.2007.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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