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van der Weegen W, Warren T, Das D, Agricola R, Timmers T, Siebelt M. Operative or Nonoperative Treatment is Predicted Accurately for Patients Who Have Hip Complaints Consulting an Orthopedic Surgeon Using Machine Learning Algorithms Trained With Prehospital Acquired History-Taking Data. J Arthroplasty 2024; 39:1173-1177.e6. [PMID: 38007205 DOI: 10.1016/j.arth.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Increasing numbers of patients suffering from hip osteoartritis will lead to increased orthopaedic health care consumption. Artificial intelligence might alleviate this problem, using Machine learning (ML) to optimize orthopaedic consultation workflow by predicting treatment strategy (non-operative or operative) prior to consultation. The purpose of this study was to assess ML accuracy in clinical practice, by comparing ML predictions to the outcome of clinical consultations. METHODS In this prospective clinical cohort study, adult patients referred for hip complaints between January 20th to February 20th 2023 were included. Patients completed a computer-assisted history taking (CAHT) form and using these CAHT answers, a ML-algorithm predicted non-operative or operative treatment outcome prior to in-hospital consultation. During consultation, orthopaedic surgeons and physician assistants were blinded to the prediction in 90 and unblinded in 29 cases. Consultation outcome (non-operative or operative) was compared to ML treatment prediction for all cases, and for blinded and unblinded conditions separately. Analysis was done on 119 consultations. RESULTS Overall treatment strategy prediction was correct in 101 cases (accuracy 85%, P < .0001). Non-operative treatment prediction (n = 71) was 97% correct versus 67% for operative treatment prediction (n = 48). Results from unblinded consultations (86.2% correct predictions,) were not statistically different from blinded consultations (84.4% correct, P > .05). CONCLUSIONS Machine Learning algorithms can predict non-operative or operative treatment for patients with hip complaints with high accuracy. This could facilitate scheduling of non-operative patients with physician assistants, and operative patients with orthopaedic surgeons including direct access to pre-operative screening, thereby optimizing usage of health care resources.
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Affiliation(s)
- Walter van der Weegen
- Department of Orthopedic Surgery, Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
| | | | - Dirk Das
- Department of Orthopedic Surgery, Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
| | - Rintje Agricola
- Department of Orthopedic Surgery, Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
| | - Thomas Timmers
- InteractiveStudios, Den Bosch, The Netherlands; IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel Siebelt
- Department of Orthopedic Surgery, Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
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van Melick N, van der Weegen W, van der Horst N, Bogie R. Double-leg and single-leg jump test reference values for athletes with and without anterior cruciate ligament reconstruction who play popular pivoting sports, including soccer and basketball: a scoping review. J Orthop Sports Phys Ther 2024:1-37. [PMID: 38506715 DOI: 10.2519/jospt.2024.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE: To synthesize and present reference values for double-leg and single-leg jump tests in healthy athletes who play pivoting sports, and athletes with anterior cruciate ligament reconstruction (ACLR) who play pivoting sports. DESIGN: scoping review. LITERATURE SEARCH: We searched PubMed, the Cochrane Library, MEDLINE, Embase and Web of Science until April 7, 2023. STUDY SELECTION CRITERIA: We included reference values in two different categories: (1) double-leg and/or single-leg jump test outcomes in pivoting-sport athletes with ACLR at a specific time point during rehabilitation, and (2) double-leg and/or single-leg jump test outcomes in healthy pivoting-sport athletes. DATA SYNTHESIS: We performed data synthesis for reference values from double-leg jump tests (squat jump and countermovement jump) and single-leg jump tests (vertical hop, single hop for distance, triple hop for distance, crossover hop for distance, medial triple hop for distance, lateral triple hop for distance, 6-meter timed hop, side hop, drop jump, and 10 second repeated hop) that were performed according to a standardized test description. We summarized the data for type of sport, sex, sport participation level and age group. RESULTS: Of the 27 included studies, 9 reported reference values from healthy soccer players, 6 from healthy basketball players, and 11 from other healthy pivoting-sport athletes. LSI dominant/non-dominant (LSI-D/ND) ranged between 97% to 106% for healthy soccer players, and between 99% to 120% for healthy basketball players. Four studies reported reference values from pivoting-sport athletes with ACLR from 7 to 10 months post-surgery. CONCLUSION: This scoping review summarizes double-leg and single-leg jump test reference values for athletes who play common pivoting sports, including soccer and basketball.
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Affiliation(s)
- Nicky van Melick
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
| | | | | | - Rob Bogie
- Sports & Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
- Department of orthopedic surgery, Anna Hospital, Geldrop, the Netherlands
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Laksono RM, Siswagama TA, Nery FRP, van der Weegen W, Halim W. Pulsed Radiofrequency 2 Hz Preserves the Dorsal Root Ganglion Neuron Physiological Ca2+ Influx, Cytosolic ATP Level, Δψm, and pERK Compared to 4 Hz: An Insight on the Safety of Pulsed Radiofrequency in Pain Management [Response to Letter]. J Pain Res 2024; 17:911-912. [PMID: 38476876 PMCID: PMC10929250 DOI: 10.2147/jpr.s465923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
- Ristiawan Muji Laksono
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Taufiq Agus Siswagama
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Fa’urinda Riam Prabu Nery
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | | | - Willy Halim
- Medical Department, Faculty of Medicine, Brawijaya University, Malang, Indonesia
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Laksono RM, Siswagama TA, Nery FRP, van der Weegen W, Halim W. Pulsed Radiofrequency 2 Hz Preserves the Dorsal Root Ganglion Neuron Physiological Ca 2+ Influx, Cytosolic ATP Level, Δψm, and pERK Compared to 4 Hz: An Insight on the Safety of Pulsed Radiofrequency in Pain Management. J Pain Res 2023; 16:3643-3653. [PMID: 37928061 PMCID: PMC10625322 DOI: 10.2147/jpr.s424489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Background Pulsed radiofrequency (PRF) is beneficial for radicular pain and is commonly administered at pulse frequencies of 2 or 4 Hz. However, its effects on healthy neurons have not yet been widely studied. This study aims to determine the effect of PRF at 2 Hz and 4 Hz on the physiology of healthy dorsal root ganglion (DRG) neurons. Methods An in vitro experimental study was conducted using DRG neuron cultures divided into three groups. Control cells received no treatment, one cell group received 20 ms 2 Hz PRF for 360 s, and one cell group received a 4 Hz PRF 10 ms pulse for 360 s with similar energy. Ca2+ influx, mitochondrial membrane potential (Δψm), cytosolic Adenosine triphosphate (ATP), and phosphorylated extracellular signal-regulated kinase (pERK) levels were measured. The data were analyzed using the One-Way ANOVA variance with α=5%. Results DRG neurons exposed to PRF 2 Hz did not experience a significant change in Ca2+ influx, whereas PRF 4 Hz caused a significant decrease in Ca2+ influx compared to the basal level. PRF at 2 Hz did not cause a change in Δψm, whereas PRF at 4 Hz caused a significant decrease in Δψm (p<0.05). Both 2 and 4 Hz PRF resulted in a significant elevation in cytosolic ATP concentration, but the 2 Hz PRF had a higher cytosolic ATP than the 4 Hz group (p<0.05). Both 2 and 4 Hz did not show a significant difference in pERK intensity with respect to the control (p>0.05), indicating that there was no significant neuron activation. Conclusion Both frequencies did not significantly activate DRG neurons, but with similar energy delivery, PRF 2 Hz preserved the physiological properties of healthy neurons better than PRF 4 Hz did. A 2 Hz PRF is the preferred frequency in clinical applications for neuron-targeted therapy.
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Affiliation(s)
- Ristiawan Muji Laksono
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Taufiq Agus Siswagama
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | - Fa’urinda Riam Prabu Nery
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Brawijaya University, Dr. Saiful Anwar General Hospital, Malang, Indonesia
| | | | - Willy Halim
- Medical Department, Faculty of Medicine, Brawijaya University, Malang, Indonesia
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Laksono RM, Siswagama TA, Asmoro AA, Sjahrir H, Musba AM, Halim W, der Weegen WV, Vissers K. Identifying pain problems, healthcare professional perceptions, expectations and challenges in multidisciplinary pain center establishment. Pain Manag 2023; 13:385-395. [PMID: 37458192 DOI: 10.2217/pmt-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Aim: Before establishing a multidisciplinary pain center (MPC), the pain problem, healthcare professionals (HCP) perceptions, expectations and the potential challenges of MPC establishment need to be identified. Methods: A quantitative survey study of 1058 Indonesian HCPs. The study uses a national inquiry sent by the International Association for the Study of Pain (IASP) chapter for pain. Results: 99.0% of respondents had met patients with pain as the primary complaint and acute pain as the most common complaint. Insufficient pain management in Indonesian healthcare, insufficient pain epidemiological data and unaware HCP about MPC become problems of pain management in Indonesia. However, most HCP agreed that health facilities should have MPC. Financial issues (insufficient patient insurance) were considered the most important barrier for referring patients to MPC. Conclusion: The identified core problem, HCP perceptions, expectations and challenges of MPC establishment should become a consideration in the strategic planning of MPC establishment.
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Affiliation(s)
- Ristiawan M Laksono
- Department of Anesthesiology & Intensive Therapy, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Taufiq A Siswagama
- Department of Anesthesiology & Intensive Therapy, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Aswoco A Asmoro
- Department of Anesthesiology & Intensive Therapy, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Hasan Sjahrir
- Department of Neurology, Faculty of Medicine, Sumatera Utara University, Medan, Indonesia
| | - Andi Mt Musba
- Department of Anesthesiology, Intensive Care & Pain Management, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Willy Halim
- Department of Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | | | - Kris Vissers
- Department of Anesthesiology, Pain & Palliative Medicine, Radboud University Medical Centre, The Netherlands
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Kornuijt A, de Vries L, van der Weegen W, Hillen RJ, Bogie R, Stokman R, van Kampen D. Direct active rehabilitation after reverse total shoulder arthroplasty: an international multicentre prospective cohort safety study with 1-year follow up. BMJ Open 2023; 13:e070934. [PMID: 37072366 PMCID: PMC10124285 DOI: 10.1136/bmjopen-2022-070934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVES To gain insight in the safety of direct active rehabilitation without immobilisation in patients undergoing reverse total shoulder arthroplasty without subscapularis reattachment, measured by the occurrence of complications until 1-year follow up. Next, to explore improvement in shoulder function and in patient-reported outcome measures. DESIGN An international multicentre prospective cohort safety study. SETTING Patients indicated for reverse total shoulder arthroplasty, visiting the orthopaedics outpatient clinic at two hospitals in the Netherlands and one hospital in Curaçao between January 2019 and July 2021, were selected. PARTICIPANTS 100 patients (68% female, mean age 74±7.0 years) undergoing unilateral primary shoulder replacement were included if: ≥50 years, diagnosed with shoulder osteoarthritis, rotator cuff arthropathy or avascular necrosis, and selected for reverse total shoulder arthroplasty. A sling was used for only 1 day, followed by a progressive active rehabilitation for ≥12 weeks with no precautions. MAIN OUTCOME MEASURES Complications, range of motion and patient-reported outcome measures (Oxford Shoulder Score, Pain Numeric Rating Scale and EuroQol-5D for quality of life). Patients were evaluated preoperatively and 6 weeks, 3 months and 1 year postoperatively. RESULTS In total, 17 complications were registered (17.0%) including five (5.0%) categorised as potentially related to the rehabilitation strategy: one dislocation, one acromion fracture and three cases with persistent pain. Anteflexion, abduction and external rotation, pain scores and the Oxford Shoulder Score all improved significantly (p<0.05) at all time points compared with preoperative. Quality of life improved significantly from 3 months onwards. These secondary outcomes improved further until 1 year postoperatively. CONCLUSION Direct active rehabilitation after reverse total shoulder arthroplasty seems to be safe and effective. Potentially, this approach will lead to less dependent patients and faster recovery. Larger studies, preferably including a control group, should corroborate our results. TRIAL REGISTRATION NUMBER NL7656.
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Affiliation(s)
- Anke Kornuijt
- Sports and Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
| | - Lieke de Vries
- Orthopedic Surgery, Dijklander Hospital, Hoorn/Purmerend, the Netherlands
| | | | - Robert Jan Hillen
- Orthopedic Surgery, Dijklander Hospital, Hoorn/Purmerend, the Netherlands
| | - Rob Bogie
- Sports and Orthopedics Research Centre, Anna Hospital, Geldrop, the Netherlands
| | - Remco Stokman
- Orthopedic Surgery, Curaçao Medical Center, Willemstad, Curaçao
| | - Derk van Kampen
- Orthopedic Surgery, Dijklander Hospital, Hoorn/Purmerend, the Netherlands
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Pronk Y, van der Weegen W, Schreurs BW, Pilot P. Quality of total hip arthroplasty health care based on four years of patient-reported outcomes in the Netherlands. Health Qual Life Outcomes 2023; 21:24. [PMID: 36918879 PMCID: PMC10011788 DOI: 10.1186/s12955-023-02104-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Joint arthroplasty registries have incorporated patient-reported outcomes (PROs) to evaluate outcomes from a patients' perspective to improve total hip arthroplasty (THA). To draw valid conclusions on PROs, a minimum response rate (RR) of 60% is advised. This study investigated (1) if the quality of THA health care based on PROs improved over the years in the Netherlands, (2) if RRs improved over the years, and (3) difference in PROs over the years in hospitals with RR ≥ 60% compared to RR < 60%. METHODS Longitudinal study with publicly available datasets from 2016 to 2019. Primary outcome was increase/decrease in PRO change scores including 95%CI ranges over the years between preoperatively and 3 months postoperatively (pre-3 m), and 12 months postoperatively (pre-12 m). Improved quality of health care was arbitrary defined as when ≥ 3 of 4 included scores or ranges were statistically significant improved. Secondary outcome was increase/decrease in RRs over the years. Subgroups RR ≥ 60% and RR < 60% were compared. RESULTS Hospitals (%) collecting THA PROs increased from 78 to 92%. EQ VAS change score increased over the years, and 95%CI ranges of EQ VAS, EQ-5D descriptive system and NRS pain during activity decreased over the years at pre-3 m (p < 0.05). All THA pre-12 m PRO change scores and 95%CI ranges remained equal (p > 0.05). Pre-3 m RR remained equal (around 43%, p = 0.107) and pre-12 m RR decreased 9% (49% to 40%, p = 0.008). Pre-3 m subgroup RR ≥ 60% was too small to analyse (5%). No difference was found between pre-12 m subgroups (RR ≥ 60% = 16%), p > 0.05). CONCLUSIONS Quality of THA health care based on PROs seems equal in the Netherlands between 2016 and 2019. Although more hospitals participated in PRO collection, low RRs with large IQRs are observed and only 16% of the hospitals achieved the advised RR ≥ 60%. Multiple recommendations are provided to improve PRO collection and use.
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Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA, Mill, The Netherlands
| | - Walter van der Weegen
- Department of Orthopaedic Surgery, Sports & Orthopaedics Research Centre, Sint Anna Ziekenhuis, Bogardeind 2, 5664 EH, Geldrop, The Netherlands.
| | - Berend Willem Schreurs
- Department of Orthopaedic Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6562 GA, Nijmegen, The Netherlands.,Landelijke Registratie Orthopedische Implantaten (LROI), Bruistensingel 230, 5232 AD, 's-Hertogenbosch, The Netherlands
| | - Peter Pilot
- IMUKA, Kanaalstraat 10, 6116 AD, Roosteren, The Netherlands
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van der Weegen W, Das D, Vrints K, Agricola R, Siebelt M. A 20 mg dose of dexamethasone does not reduce the proportion of joint replacement patients needing rescue analgesia: a matched cohort study. Ann Jt 2023; 8:4. [PMID: 38529231 PMCID: PMC10929338 DOI: 10.21037/aoj-22-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/23/2022] [Indexed: 03/27/2024]
Abstract
Background Consistent pain control after total joint replacement (TJR) has not yet been reached in all patients managed with a multimodal analgesia regime. Questions remain on dosage and timing of analgesics. Glucocorticoids such as dexamethasone are considered most powerful in reducing the surgery-induced inflammatory response with most pain studies using a 6-12 mg dose. Reviews agree that additional glucocorticoids may provide more analgesia, but a dose-finding analysis is limited. The primary aim of this study was to determine if a high, single preoperative dose of dexamethasone resulted in a reduced need for rescue analgesics during the first 24 hours after TJR when compared to a standard 8 mg dose of dexamethasone. Methods A cohort study in which 59 patients who received 20 mg dexamethasone intravenously just prior to incision were matched 1:1 to patients who received a standard 8 mg dose. Consecutive elective hip and knee replacement patients managed by one anaesthesiologist were included in the high dose group between June 2019 and March 2020. Patients were matched for arthroplasty type, gender, age, anaesthesia type and pre-operative pain. Patients with opioid use before surgery or with diabetes mellitus were excluded. Oxynorm rescues analgesics (number of times given and dosage) usage during hospitalization was retrieved from the electronic nursing files. Results There were no significant differences between groups in gender distribution, mean age and body mass index (BMI), in American Society of Anesthesiologists (ASA), type of arthroplasty, anaesthesia type and pre-operative pain score. In the 20 mg group 54 patients (91.5%) needed oxynorm during hospitalization versus 58 (98.3%) in the 8 mg group (P=0.09). High dose group patients received a median of 5 mg [interquartile range (IQR): 0] oxynorm versus 5 mg (IQR: 0) in the standard dose group (P=0.70). Conclusions In this matched cohort study there was no difference in the proportion of patients needing rescue analgesics during hospitalization between the group of patients who preoperatively received 20 mg dexamethasone and the group of patients who received 8 mg. Future blinded randomized controlled trials are needed to further investigate the effect of different glucocorticoids dosages on pain after joint replacement surgery.
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Affiliation(s)
| | - Dirk Das
- Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
| | - Katleen Vrints
- Department of Anesthesiology, Geldrop, St. Anna Hospital, Geldrop, The Netherlands
| | - Rintje Agricola
- Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michiel Siebelt
- Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, The Netherlands
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Timmers T, van der Weegen W, Janssen L, Kremer J, Kool RB. Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics. JMIR Form Res 2022; 6:e39637. [PMID: 36326799 PMCID: PMC9672996 DOI: 10.2196/39637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients’ priorities. Objective In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app’s content. Conclusions In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app’s content from the patient’s perspective. Given the growing emphasis on patients’ self-management, it is crucial that the information they receive is not only relevant from a health care provider’s perspective but also aligns with what really matters to patients. Trial Registration Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295
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Affiliation(s)
- Thomas Timmers
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Interactive Studios, Den Bosch, Netherlands
| | | | | | - Jan Kremer
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rudolf Bertijn Kool
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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van Eck J, Liu WY, Goosen JHM, Rijnen WHC, van der Zwaard BC, Heesterbeek P, van der Weegen W. Higher 1-year risk of implant removal for culture-positive than for culture-negative DAIR patients following 359 primary hip or knee arthroplasties. J Bone Jt Infect 2022; 7:143-149. [PMID: 35937090 PMCID: PMC9350853 DOI: 10.5194/jbji-7-143-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/08/2022] [Indexed: 11/11/2022] Open
Abstract
Background and purpose: To date, the value of culture results after
debridement, antibiotics, and implant retention (DAIR) for early (suspected)
prosthetic joint infection (PJI) as risk indicators in terms of prosthesis
retention is not clear. At the 1-year follow-up, the relative risk of prosthesis
removal was determined for culture-positive and culture-negative DAIR patients
after primary total hip or knee arthroplasty. The secondary aim of this work was
to explore differences in patient characteristics, infection characteristics,
and outcomes between these two groups. Methods: A retrospective
regional registry study was performed in a group of 359 patients (positive
cultures: n=299; negative cultures: n=60) undergoing DAIR for high suspicion of early PJI in the period
from 2014 to 2019. Differences in patient characteristics, the number of
deceased patients, and the number of subsequent DAIR treatments between the
culture-positive and culture-negative DAIR groups were analysed using
independent t tests, Mann–Whitney U tests, Pearson's chi-square tests, and Fisher's exact tests.
Results: The overall implant survival rate following DAIR was
89 %. The relative risk of prosthesis removal was 7.4 times higher (95 %
confidence interval (CI) 1.0–53.1) in the culture-positive DAIR group (37 of
299, 12.4 %) compared with the culture-negative DAIR group (1 of 60, 1.7 %). The
culture-positive group had a higher body mass index (p=0.034), a rate of wound leakage of >10 d (p=0.016), and more subsequent DAIR treatments (p=0.006). Interpretation: As implant survival results
after DAIR are favourable, the threshold to perform a DAIR procedure for early
(suspected) PJI should be low in order to retain the prosthesis. A DAIR
procedure in the case of negative cultures does not seem to have unfavourable
results in terms of prosthesis retention.
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Abstract
BACKGROUND National and international guidelines lack consistency on how to screen metal-on-metal (MoM) hip arthroplasty patients for adverse reactions to metal debris (ARMD). Long-term outcomes of MoM hip arthroplasty are scarce, hindering further development of such guidelines. We present the clinical, radiological and ARMD status of 158 cases of hip resurfacing with >10 years follow-up. METHODS A prospective analysis of a cohort of 298 consecutive hip resurfacing procedures was performed at a single institution. All patients underwent MARS-MRI scanning for pseudotumour screening at least once, regardless of symptoms. Implant survival and reasons for revision were analysed for all patients. Clinical, radiological and MARS-MRI results were analysed for 158 unrevised procedures with >10 years follow-up. RESULTS The implant survival was 85.9% at 14.5 years (95% CI, 81.9-90.6) with revision for all causes as endpoint and 92.3% with MoM disease-related revisions excluded (95% CI, 88.2-95.0). Of the 158 cases with >10 years follow-up, 1 had elevated metal ion levels, 29 had a stable C1 pseudotumour and 6 a stable C2 pseudotumour. All pseudotumours were observed within 3 years after initiating our intensified ARMD screening (2011), with no new pseudotumours observed after that period. CONCLUSIONS We suggest that follow-up of MoM hip resurfacing patients beyond 10 years after surgery can be done with large intervals (i.e. every 5 years), and only earlier if a patient becomes symptomatic.
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Affiliation(s)
| | - Henk Hoekstra
- Department of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | - Koen Brakel
- Department of Radiology, St. Anna Hospital, Geldrop, The Netherlands
| | - Thea Sijbesma
- Department of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
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Kamp MC, Liu WY, Goosen JHM, Rijnen WHC, van Steenbergen LN, van der Weegen W. Mismatch in Capture of Periprosthetic Joint Infections Between the Dutch Arthroplasty Register (LROI) and a Detailed Regional Periprosthetic Joint Infection Registry. J Arthroplasty 2022; 37:126-131. [PMID: 34563434 DOI: 10.1016/j.arth.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND National arthroplasty registries are important sources for periprosthetic joint infection (PJI) data and report an average incidence ranging from 0.5% to 2.0%. However, studies have shown that PJI incidence in national arthroplasty registries may be underestimated. Therefore, the incidence of PJI in the Dutch Arthroplasty Register (LROI) was evaluated. METHODS We matched revisions due to infection within 90 days of index procedure in the LROI database (prospectively registered in 2014-2018) with acute PJI cases registered in a Regional Infection Cohort (RIC) and vice versa. The RIC comprised of 1 university hospital, 3 large orthopedic teaching hospitals and 4 general district hospitals, representing 11.3% of all Dutch arthroplasty procedures with a similar case mix. RESULTS From the 352 acute PJIs in the RIC, 166 (47%) were registered in the LROI. Of the 186 confirmed PJI cases not registered in the LROI, 51% (n = 95) were a unregistered Debridement, Antibiotics, and Implant Retention procedure without component exchange. The remaining missing PJI cases (n = 91, 49%) were of administrative origin. The acute PJI incidence in the RIC was 1%, compared to a 0.6% incidence of revision <90 days due to infection from LROI data. CONCLUSION Besides unregistered Debridement, Antibiotics, and Implant Retention procedures without component exchange, administrative errors are an important source of missing PJI data for the LROI, leading to underestimation of PJI incidence in the Netherlands. A national arthroplasty complication registry, linked to the LROI, might decrease the number of missing PJI cases. Although our study concerns Dutch data, it supports the scarce literature on PJI incidence obtained from national arthroplasty registries, which also reports an underestimation.
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Affiliation(s)
- Maud C Kamp
- Sports & Orthopedics Research Centre, St. Anna Hospital, Geldrop, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherlands
| | - Wai-Yan Liu
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands
| | - Jon H M Goosen
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Wim H C Rijnen
- Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Pronk Y, Pilot P, van der Weegen W, Brinkman JM, Schreurs BW. A Patient-Reported Outcome Tool to Triage Total Hip Arthroplasty Patients to Hospital or Video Consultation: Pilot Study With Expert Panels and a Cohort of 1228 Patients. JMIR Form Res 2021; 5:e31232. [PMID: 34931989 PMCID: PMC8726038 DOI: 10.2196/31232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The digital transformation in health care has been accelerated by the COVID-19 pandemic. Video consultation has become the alternative for hospital consultation. It remains unknown how to select patients suitable for video consultation. OBJECTIVE This study aimed to develop a tool based on patient-reported outcomes (PROs) to triage total hip arthroplasty (THA) patients to hospital or video consultation. METHODS A pilot study with expert panels and a retrospective cohort with prospectively collected data from 1228 THA patients was executed. The primary outcome was a PRO triage tool to allocate THA patients to hospital or video consultation 6 weeks postoperatively. Expert panels defined the criteria and selected the patient-reported outcome measure (PROM) questions including thresholds. Data were divided into training and test cohorts. Distribution, floor effect, correlation, responsiveness, PRO patient journey, and homogeneity of the selected questions were investigated in the training cohort. The test cohort was used to provide an unbiased evaluation of the final triage tool. RESULTS The expert panels selected moderate or severe pain and using 2 crutches as the triage tool criteria. PROM questions included in the final triage tool were numeric rating scale (NRS) pain during activity, 3-level version of the EuroQol 5 dimensions (EQ-5D-3L) questions 1 and 4, and Oxford Hip Score (OHS) questions 6, 8, and 12. Of the training cohort, 201 (201/703, 28.6%) patients needed a hospital consultation, which was statistically equal to the 150 (150/463, 32.4%) patients in the test cohort who needed a hospital consultation (P=.19). CONCLUSIONS A PRO triage tool based on moderate or severe pain and using 2 crutches was developed. Around 70% of THA patients could safely have a video consultation, and 30% needed a hospital consultation 6 weeks postoperatively. This tool is promising for selecting patients for video consultation while using an existing PROM infrastructure.
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Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, Netherlands
| | | | | | | | - Berend Willem Schreurs
- Department of Orthopaedic Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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Liebrand B, Brakel K, Boon A, van der Weegen W, Wal SVD, Vissers KC. Diagnostic treatment-level discrepancies in patients with lumbosacral radicular pain and lumbar spine anomalies. Reg Anesth Pain Med 2021; 47:177-182. [PMID: 34921051 DOI: 10.1136/rapm-2021-103174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lumbosacral transitional vertebra can result in an anomalous number of lumbar vertebrae associated with wrong level treatment. The primary aim of this study was to characterize discrepancies between reported referring levels and levels from MRI reports with treated levels. The secondary aim was to analyze interobserver variability between a pain physician and a radiologist when determining levels and classifying lumbosacral transitional vertebrae. METHODS Between February 2016 and October 2019, a retrospective case series of prospectively collected data of the affected levels mentioned in referrals, MRI reports and treated levels was performed. The counting process, level determination, classification of lumbosacral transitional vertebrae and a secondary control were carried out by independent researchers using a standard methodology. RESULTS Of the 2443 referrals, 143 patients had an anomalous number of lumbar vertebrae; of these, 114 were included for analysis. The vertebral level noted in the patient's file, in the referral, and the reported level of treatment differed in 40% of these cases. The vertebral level between the MRI reports and treatment differed in 46% of cases. The interobserver reliability (radiologist vs pain physician) for classifying a transitional vertebra was fair ((κ=0.40) and was substantial (κ=0.70) when counting the vertebrae. CONCLUSION In the presence of lumbar spine anomalies, we report a high prevalence of discrepancies between referral levels and MRI pathological findings with treatment levels. Further research is needed to better understand clinical implications.
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Affiliation(s)
- Bart Liebrand
- Department of Anaesthesiology and Pain Medicine, St Anna Hospital, Geldrop, The Netherlands
| | - Koen Brakel
- Department of Radiology, St Anna Hospital, Geldrop, The Netherlands
| | - Arthur Boon
- Department of Neurology, St Anna Hospital, Geldrop, The Netherlands
| | | | - Selina van der Wal
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kris Cp Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
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Pronk Y, van der Weegen W, Vos R, Brinkman JM, van Heerwaarden RJ, Pilot P. What is the minimum response rate on patient-reported outcome measures needed to adequately evaluate total hip arthroplasties? Health Qual Life Outcomes 2020; 18:379. [PMID: 33267842 PMCID: PMC7709349 DOI: 10.1186/s12955-020-01628-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/16/2020] [Indexed: 12/30/2022] Open
Abstract
Background Unknown is which response rate on patient-reported outcome measures (PROMs) is needed to both obtain an accurate outcome and ensure generalizability in evaluating total hip arthroplasty (THA) procedures. Without an evidence based minimum response rate (MRR) on THA PROMs, it is possible that hospitals report invalid patient-reported outcomes (PROs) due to a too low response rate. Alternatively, hospitals may invest too much in achieving an unnecessary high response rate. The aim of this study is to gain an insight into the MRR on PROMs needed to adequately evaluate THA procedures from a clinical perspective. Methods Retrospective study on prospective collected data of primary, elective THA procedures was performed. MRR was investigated for each PROM (NRS pain at rest, NRS pain during activity, EQ-5D-3L, HOOS-PS, anchor function, OHS, anchor pain and NRS satisfaction) separately to calculate the primary outcome: MRR for the THA PROMs set. MRR on a PROM needed to have (condition 1.) similar PRO change score (3 month score minus preoperative score) including confidence interval, (condition 2.) maintaining the influence of each change score predictor and (condition 3.) equal distribution of each predictor, as those of a 100% PROM response rate group. Per PROM, a 100%-group was identified with all patients having the PRO change score. Randomly assessed groups of 90% till 10% response rate (in total 90 groups) were compared with the 100%-group. Linear mixed model analyses and linear regressions were executed. Results The MRR for the THA PROMs set was 100% (range: 70–100% per PROM). The first condition resulted in a MRR of 60%, the second condition in a MRR of 100% and the third condition in a MRR of 10%. Conclusions A 100% response rate on PROMs is needed in order to adequately evaluate THA procedures from a clinical perspective. All stakeholders using THA PROs should be aware that 100% of the THA patients should respond on both preoperative and 3 month postoperative PROMs. For now, taking the first step in improving evaluation of THA for quality control by achieving at least two of the three conditions of MRR, advised is to require a response rate on PROMs of 60% as the lower limit.
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Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA, Mill, The Netherlands.
| | - Walter van der Weegen
- Department of Orthopaedic Surgery, Sint Anna Ziekenhuis, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, Maastricht University, P. Debyeplein 1, 6229 HA, Maastricht, The Netherlands
| | - Justus-Martijn Brinkman
- Department of Orthopaedic Surgery, Kliniek ViaSana, Hoogveldseweg 1, 5451 AA, Mill, The Netherlands
| | | | - Peter Pilot
- Stichting IMA, Kanaaldijk 10, 6116 AD, Roosteren, The Netherlands
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van Essen T, Kornuijt A, de Vries LMA, Stokman R, van der Weegen W, Bogie R, Hillen RJ, van Kampen DA. Fast track rehabilitation after reversed total shoulder arthroplasty: a protocol for an international multicentre prospective cohort study. BMJ Open 2020; 10:e034934. [PMID: 32819933 PMCID: PMC7440714 DOI: 10.1136/bmjopen-2019-034934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The use of reversed total shoulder arthroplasty (rTSA) has increased because of an increasing number of indications for this procedure and by ageing of the population. Usual postoperative care consists of immobilisation of the shoulder for a period of 2-6 weeks to allow healing of the subscapularis tendon and protection of the joint. However, new literature proved that reattachment of the subscapularis tendon is unnecessary. Therefore we hypothesised that immobilisation of the shoulder is not necessary and patients can start safely with mobilisation on the first postoperative day. We expect this fast track protocol to be safe and result in better short-term and long-term functional outcomes. METHODS AND ANALYSIS In our prospective cohort, we will include at least 75 patients aged 50 years and older indicated for rTSA, with acute fracture treatment as an exclusion criterion. Patients will be selected and operated in three hospitals: two in the Netherlands and one in Curacao.Patients will visit the outpatient clinic preoperative, at 6 weeks, 3 months and 1 year postoperative. The data that will be collected includes baseline characteristics, reason for surgery, complications and adverse events, patient reported outcomes (Oxford Shoulder Score, EuroQol-5D and Numeric Rating Scale for pain) and range of motion of the shoulder.All patients will be instructed to use a sling only for 1 day and to follow a progressive physiotherapy schedule for 12 weeks. The primary outcome is the occurrence of complications and adverse events. ETHICS AND DISSEMINATION The Medical Ethics Committee from the VUmc and Curacao reviewed this study protocol and granted exemption from ethical approval (METC VUmc 2019.111, METC Curacao 2019-02). Study results will be presented at (inter)national conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL7656).
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Affiliation(s)
- Tom van Essen
- Orthopaedic Surgery, Dijklander Ziekenhuis, Purmerend, The Netherlands
| | - Anke Kornuijt
- Orthopaedic Surgery, Sint Annaziekenhuis, Geldrop, Noord-Brabant, The Netherlands
| | | | - Remco Stokman
- Orthopaedic Surgery, Sint Elisabeth Hospitaal, Willemstad, Curaçao
| | | | - Rob Bogie
- Orthopaedic Surgery, Sint Annaziekenhuis, Geldrop, Noord-Brabant, The Netherlands
| | - Robert Jan Hillen
- Orthopaedic Surgery, Dijklander Ziekenhuis, Purmerend, The Netherlands
| | - D A van Kampen
- Orthopedic Surgery and Traumatologie, Dijklander Ziekenhuis, Hoorn, The Netherlands
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van der Weegen W, Kornuijt A, Das D, Vos R, Sijbesma T. It is safe to use minimal restrictions following posterior approach total hip arthroplasty: results from a large cohort study. Hip Int 2019; 29:572-577. [PMID: 30630364 DOI: 10.1177/1120700018823504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND To prevent early postoperative dislocation following a total hip arthroplasty (THA) procedure, patients must adhere to restrictions. Restrictive protocols are common if THA surgery is performed using the posterior approach, but scientific evidence form larger studies that supports these restrictions are scarce. In this large cohort study we compare the <90-days dislocation rate between patients receiving posterior approach THA managed with minimal versus extensive restrictions. METHODS Prospective cohort (n = 1049) of consecutive elective primary hip replacement surgery procedures (September 2014-July 2017) managed with minimal postoperative restrictions. Hospital charts were prospectively reviewed for patient demographics, risk factors and any hip dislocation. Control (n = 1102) consecutive primary elective THAs (January 2011-August 2014) managed with a traditional restrictive protocol. A posterior surgical approach was used in all procedures. RESULTS Minimal restrictions group: 17 dislocations <90 days (1.6%); Restricted group: 28 (2.5%), chi-square p = 0.1. Testing the hypothesis of inferiority by a minimum of 1% increase in ⩽90 days dislocation risk: p = 0.14 (test for difference) and p < 0.001 (non-inferiority test), allowing us to discard the null hypothesis (absolute increase in risk of ⩾1% with minimal restrictions). The proportion of surgeries performed with a femoral head size ⩾32 mm was higher in the minimal restrictions group. CONCLUSIONS Patients can be managed safely with minimal restrictions following posterior approach THA if combined with frequent use of larger femoral heads.
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Affiliation(s)
| | - Anke Kornuijt
- Department of Physical Therapy, St. Anna Hospital, Geldrop, The Netherlands
| | - Dirk Das
- Department of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Thea Sijbesma
- Department of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
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18
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Timmers T, Janssen L, van der Weegen W, Das D, Marijnissen WJ, Hannink G, van der Zwaard BC, Plat A, Thomassen B, Swen JW, Kool RB, Lambers Heerspink FO. The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e15323. [PMID: 31638594 PMCID: PMC6914303 DOI: 10.2196/15323] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/24/2019] [Accepted: 09/23/2019] [Indexed: 12/31/2022] Open
Abstract
Background Patients who undergo primary Total Knee Replacement surgery (TKR) are often discharged within 1-3 days after surgery. With this relatively short length of hospital stay, a patient’s self-management is a crucial factor in optimizing the outcome of their treatment. In the case of TKR, self-management primarily involves adequate pain management, followed by physiotherapy exercises and daily self-care activities. Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity, complexity, and the passive mode of communication used to convey it. Objective This study primarily aims to determine whether actively educating TKR patients with timely, day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive standard information about their recovery through the app. In addition, physical functioning, quality of life, ability to perform physiotherapy exercises and daily self-care activities, satisfaction with information, perceived involvement by the hospital, and health care consumption were also assessed. Methods A multicenter randomized controlled trial was performed in five Dutch hospitals. In total, 213 patients who had undergone elective, primary, unilateral TKR participated. All patients had access to an app for their smartphone and tablet to guide them after discharge. The intervention group could unlock day-to-day information by entering a personal code. The control group only received weekly, basic information. Primary (level of pain) and secondary outcomes (physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption) were measured using self-reported online questionnaires. All outcomes were measured weekly in the four weeks after discharge, except for physical functioning and quality of life, which were measured at baseline and at four weeks after discharge. Data was analyzed using Student t tests, chi-square tests, and linear mixed models for repeated measures. Results In total, 114 patients were enrolled in the intervention group (IG) and 99 in the control group (CG). Four weeks after discharge, patients in the IG performed significantly better than patients in the CG on all dimensions of pain: pain at rest (mean 3.45 vs mean 4.59; P=.001), pain during activity (mean 3.99 vs mean 5.08; P<.001) and pain at night (mean 4.18 vs mean 5.21; P=.003). Additionally, significant differences were demonstrated in favor of the intervention group for all secondary outcomes. Conclusions In the four weeks following TKR, the active and day-to-day education of patients via the app significantly decreased their level of pain and improved their physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption compared to standard patient education. Given the rising number of TKR patients and the increased emphasis on self-management, we suggest using an app with timely postoperative care education as a standard part of care. Trial Registration Netherlands Trial Register NTR7182; https://www.trialregister.nl/trial/6992
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Affiliation(s)
- Thomas Timmers
- Interactive Studios, Rosmalen, Netherlands.,Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, Netherlands
| | | | | | - Dirk Das
- Sint Anna Hospital, Geldrop, Netherlands
| | | | - Gerjon Hannink
- Radboud university medical center, Nijmegen, Netherlands
| | | | - Adriaan Plat
- Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | | | | | - Rudolf B Kool
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, Netherlands
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van Zaanen Y, van Geenen RCI, Pahlplatz TMJ, Kievit AJ, Hoozemans MJM, Bakker EWP, Blankevoort L, Schafroth MU, Haverkamp D, Vervest TMJS, Das DHPW, van der Weegen W, Scholtes VA, Frings-Dresen MHW, Kuijer PPFM. Three Out of Ten Working Patients Expect No Clinical Improvement of Their Ability to Perform Work-Related Knee-Demanding Activities After Total Knee Arthroplasty: A Multicenter Study. J Occup Rehabil 2019; 29:585-594. [PMID: 30539374 PMCID: PMC6675779 DOI: 10.1007/s10926-018-9823-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Purpose Three out of ten patients do not return to work after total knee arthroplasty (TKA). Patient expectations are suggested to play a key role. What are patients' expectations regarding the ability to perform work-related knee-demanding activities 6 months after TKA compared to their preoperative status? Methods A multi-center cross-sectional study was performed among 292 working patients listed for TKA. The Work Osteoarthritis or joint-Replacement Questionnaire (WORQ, range 0-100, minimal important difference 13) was used to assess the preoperatively experienced and expected ability to perform work-related knee-demanding activities 6 months postoperatively. Differences between the preoperative and expected WORQ scores were tested and the most difficult knee-demanding work-related activities were described. Results Two hundred thirty-six working patients (81%) completed the questionnaire. Patients' expected WORQ score (Median = 75, IQR 60-86) was significantly (p < 0.01) higher than their preoperative WORQ score (Median = 44, IQR 35-56). A clinical improvement in ability to perform work-related knee-demanding activities was expected by 72% of the patients, while 28% of the patients expected no clinical improvement or even worse ability to perform work-related knee-demanding activities 6 months after TKA. Of the patients, 34% expected severe difficulty in kneeling, 30% in crouching and 17% in clambering 6 months after TKA. Conclusions Most patients have high expectations, especially regarding activities involving deep knee flexion. Remarkably, three out of ten patients expect no clinical improvement or even a worse ability to perform work-related knee-demanding activities 6 months postoperatively compared to their preoperative status. Therefore, addressing patients expectations seems useful in order to assure realistic expectations regarding work activities.
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Affiliation(s)
- Yvonne van Zaanen
- Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Thijs M J Pahlplatz
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur J Kievit
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marco J M Hoozemans
- CORAL - Center for Orthopaedic Research Alkmaar, Department of Orthopaedics, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Eric W P Bakker
- Master Evidence Based Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias U Schafroth
- Orthopaedic Research Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Slotervaart Center of Orthopedic Research and Education (SCORE), MC Slotervaart, Amsterdam, The Netherlands
| | - Ton M J S Vervest
- Department of Orthopaedic Surgery, Tergooi Hospital, Hilversum, The Netherlands
| | - Dirk H P W Das
- Department and Research Center of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | - Walter van der Weegen
- Department and Research Center of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | | | - Monique H W Frings-Dresen
- Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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20
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Pronk Y, Pilot P, Brinkman JM, van Heerwaarden RJ, van der Weegen W. Response rate and costs for automated patient-reported outcomes collection alone compared to combined automated and manual collection. J Patient Rep Outcomes 2019; 3:31. [PMID: 31155689 PMCID: PMC6545294 DOI: 10.1186/s41687-019-0121-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/05/2019] [Indexed: 12/30/2022] Open
Abstract
Background The response rate on patient-reported outcome measurements (PROMs) necessary to adequately evaluate a treatment and improve patient care is unknown. Hospitals generally aim for the highest possible response rate without insight into the increase in costs involved. This study aimed to investigate which PROMs response rate is achievable in relation to the costs in an orthopaedic practice. Methods In an observational study, patients planned for orthopaedic surgery were asked to participate per surgical procedure (5769 surgical procedures at 5300 patients). Patient-reported outcomes (PROs) collection with a digital online automated PROMs collection system (minimal effort) was compared to a combined automated system and manual collection (maximal effort). Response rate was calculated preoperative and at two postoperative time points separately, and on all three time points together. Costs were calculated for the study period, per year and per surgical procedure. Calculations were executed for all surgical procedures and for three subgroups: knee arthroplasty, hip arthroplasty and anterior cruciate ligament reconstruction (ACLR). Results Using maximal effort the response rate increased for all surgical procedures compared to minimal effort; the preoperative response rate from 86% to 100% and the postoperative response rates from 55% to 83% (3 or 6 months) and 53% to 83% (12 months). Concerning the response at all three time points for all surgical procedures, minimal effort resulted in 44% response rate and increased to 76% with maximal effort. Lowest postoperative response rates were found in the ACLR group for both maximal and minimal effort. A costs difference of €5.55–€5.98 per surgical procedure between maximal and minimal effort was found. Conclusions A two times higher PROMs response rate for patients responding at all three time points (44% versus 76%) is achievable with maximal effort compared to the use of an automated PROMs collection system only. Manual collection adds a cost of €5.5–€6 per surgical procedure to automated PROMs collection alone. It is debatable if these additional costs are justifiable from a value-based health care perspective as the response rate for adequate evaluation of a treatment is still unknown.
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Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, The Netherlands.
| | - Peter Pilot
- Zimmer Biomet NL, Dordrecht, The Netherlands
| | - Justus M Brinkman
- Department of orthopaedic surgery, Kliniek ViaSana, Mill, The Netherlands
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21
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Timmers T, Janssen L, Pronk Y, van der Zwaard BC, Koëter S, van Oostveen D, de Boer S, Kremers K, Rutten S, Das D, van Geenen RC, Koenraadt KL, Kusters R, van der Weegen W. Assessing the Efficacy of an Educational Smartphone or Tablet App With Subdivided and Interactive Content to Increase Patients' Medical Knowledge: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e10742. [PMID: 30578185 PMCID: PMC6320423 DOI: 10.2196/10742] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023] Open
Abstract
Background Modern health care focuses on shared decision making (SDM) because of its positive effects on patient satisfaction, therapy compliance, and outcomes. Patients’ knowledge about their illness and available treatment options, gained through medical education, is one of the key drivers for SDM. Current patient education relies heavily on medical consultation and is known to be ineffective. Objective This study aimed to determine whether providing patients with information in a subdivided, categorized, and interactive manner via an educational app for smartphone or tablet might increase the knowledge of their illness. Methods A surgeon-blinded randomized controlled trial was conducted with 213 patients who were referred to 1 of the 6 Dutch hospitals by their general practitioner owing to knee complaints that were indicative of knee osteoarthritis. An interactive app that, in addition to standard care, actively sends informative and pertinent content to patients about their illness on a daily basis by means of push notifications in the week before their consultation. The primary outcome was the level of perceived and actual knowledge that patients had about their knee complaints and the relevant treatment options after the intervention. Results In total, 122 patients were enrolled in the control group and 91 in the intervention group. After the intervention, the level of actual knowledge (measured on a 0-36 scale) was 52% higher in the app group (26.4 vs 17.4, P<.001). Moreover, within the app group, the level of perceived knowledge (measured on a 0-25 scale) increased by 22% during the week within the app group (from 13.5 to 16.5, P<.001), compared with no gain in the control group. Conclusions Actively offering patients information in a subdivided (per day), categorized (per theme), and interactive (video and quiz questions) manner significantly increases the level of perceived knowledge and demonstrates a higher level of actual knowledge, compared with standard care educational practices. Trial Registration International Standard Randomized Controlled Trial Number ISRCTN98629372; http://www.isrctn.com/ISRCTN98629372 (Archived by WebCite at http://www.webcitation.org/73F5trZbb)
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Affiliation(s)
- Thomas Timmers
- Interactive Studios, Rosmalen, Netherlands.,Radboud University Medical Center, IQ Healthcare, Nijmegen, Netherlands
| | | | | | | | | | | | | | | | | | - Dirk Das
- Sint Anna Ziekenhuis, Geldrop, Netherlands
| | | | | | - Rob Kusters
- Open University of The Netherlands, Heerlen, Netherlands
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van der Weegen W, Verduin CM, Graumans M, Hoekstra HJ. Successful Debridement of a Knee Joint Prosthesis Infected with Listeria Monocytogenes. Case Report and Review of Current Literature. J Bone Jt Infect 2018; 3:203-206. [PMID: 30416944 PMCID: PMC6215986 DOI: 10.7150/jbji.28146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/27/2018] [Indexed: 12/03/2022] Open
Abstract
According to the relevant literature, prosthetic joint infections caused by Listeria monocytogenes require two stage revision surgery or prosthesis removal for a successful outcome. We present the case of a patient who suffered such an infection after Total Knee Replacement surgery and was successfully treated with antibiotics, joint lavage, debridement and retention of the prosthesis.
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Affiliation(s)
- Walter van der Weegen
- Department of orthopedic surgery, St. Anna hospital, Bogardeind 2, 5664 EH, Geldrop, the Netherlands
| | - Cees M Verduin
- Department of medical microbiology, Laboratory for Pathology and Medical Microbiology (Stichting PAMM), De Run 6250, 5504 DL, Veldhoven, the Netherlands
| | - Miriam Graumans
- Department of Infection control, St. Anna hospital, Bogardeind 2, 5664 EH, Geldrop, the Netherlands
| | - Henk J Hoekstra
- Department of orthopedic surgery, St. Anna hospital, Bogardeind 2, 5664 EH, Geldrop, the Netherlands
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23
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Löwik CAM, Wagenaar FC, van der Weegen W, Poolman RW, Nelissen RGHH, Bulstra SK, Pronk Y, Vermeulen KM, Wouthuyzen-Bakker M, van den Akker-Scheek I, Stevens M, Jutte PC. LEAK study: design of a nationwide randomised controlled trial to find the best way to treat wound leakage after primary hip and knee arthroplasty. BMJ Open 2017; 7:e018673. [PMID: 29288184 PMCID: PMC5770823 DOI: 10.1136/bmjopen-2017-018673] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly successful treatment modalities for advanced osteoarthritis. However, prolonged wound leakage after arthroplasty is linked to prosthetic joint infection (PJI), which is a potentially devastating complication. On the one hand, wound leakage is reported as a risk factor for PJI with a leaking wound acting as a porte d'entrée for micro-organisms. On the other hand, prolonged wound leakage can be a symptom of PJI. Literature addressing prolonged wound leakage is scarce, contradictory and of poor methodological quality. Hence, treatment of prolonged wound leakage varies considerably with both non-surgical and surgical treatment modalities. There is a definite need for evidence concerning the best way to treat prolonged wound leakage after joint arthroplasty. METHODS AND ANALYSIS A prospective nationwide randomised controlled trial will be conducted in 35 hospitals in the Netherlands. The goal is to include 388 patients with persistent wound leakage 9-10 days after THA or TKA. These patients will be randomly allocated to non-surgical treatment (pressure bandages, (bed) rest and wound care) or surgical treatment (debridement, antibiotics and implant retention (DAIR)). DAIR will also be performed on all non-surgically treated patients with persistent wound leakage at day 16-17 after index surgery, regardless of amount of wound leakage, other clinical parameters or C reactive protein. Clinical data are entered into a web-based database. Patients are asked to fill in questionnaires about disease-specific outcomes, quality of life and cost effectiveness at 3, 6 and 12 months after surgery. Primary outcome is the number of revision surgeries due to infection within a year of arthroplasty. ETHICS AND DISSEMINATION The Review Board of each participating hospital has approved the local feasibility. The results will be published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NTR5960;Pre-results.
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Affiliation(s)
- Claudia A M Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvette Pronk
- Research Department, Kliniek Viasana, Mill, The Netherlands
| | - Karin M Vermeulen
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Wagenaar FC, Löwik CA, Stevens M, Bulstra SK, Pronk Y, van den Akker-Scheek I, Wouthuyzen-Bakker M, Nelissen RG, Poolman RW, van der Weegen W, Jutte PC. Managing persistent wound leakage after total knee and hip arthroplasty. Results of a nationwide survey among Dutch orthopaedic surgeons. J Bone Jt Infect 2017; 2:202-207. [PMID: 29188171 PMCID: PMC5704001 DOI: 10.7150/jbji.22327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background: Persistent wound leakage after joint arthroplasty is a scantily investigated topic, despite the claimed relation with a higher risk of periprosthetic joint infection. This results in a lack of evidence-based clinical guidelines for the diagnosis and treatment of persistent wound leakage after joint arthroplasty. Without such guideline, clinical practice in orthopaedic hospitals varies widely. In preparation of a nationwide multicenter randomized controlled trial on the optimal treatment of persistent wound leakage, we evaluated current Dutch orthopaedic care for persistent wound leakage after joint arthroplasty. Methods: We conducted a questionnaire-based online survey among all 700 members of the Netherlands Orthopaedic Association, consisting of 23 questions on the definition, classification, diagnosis and treatment of persistent wound leakage after joint arthroplasty. Results: The questionnaire was completed by 127 respondents, representing 68% of the Dutch hospitals that perform orthopaedic surgery. The results showed wide variation in the classification, definition, diagnosis and treatment of persistent wound leakage among Dutch orthopaedic surgeons. 56.7% of the respondents used a protocol for diagnosis and treatment of persistent wound leakage, but only 26.8% utilized the protocol in every patient. Most respondents (59.1%) reported a maximum period of persistent wound leakage before starting non-surgical treatment of 3 to 7 days after index surgery and 44.1% of respondents reported a maximum period of wound leakage of 10 days before converting to surgical treatment. Conclusions: The wide variety in clinical practice underscores the importance of developing an evidence-based clinical guideline for the diagnosis and treatment of persistent wound leakage after joint arthroplasty. To this end, a nationwide multicenter randomized controlled trial will be conducted in the Netherlands, which may provide evidence on this important and poorly understood topic.
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Affiliation(s)
| | - Claudia A.M. Löwik
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvette Pronk
- Research Department, Kliniek Viasana, Mill, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob G.H.H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rudolf W. Poolman
- Department of Orthopaedics, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Paul C. Jutte
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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Halim W, van der Weegen W, Lim T, Wullems JA, Vissers KC. Percutaneous Cervical Nucleoplasty vs. Pulsed Radio Frequency of the Dorsal Root Ganglion in Patients with Contained Cervical Disk Herniation; A Prospective, Randomized Controlled Trial. Pain Pract 2016; 17:729-737. [PMID: 27611826 DOI: 10.1111/papr.12517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/01/2016] [Accepted: 07/27/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cervical neck pain is often caused by cervical disk pathology and may cause severe symptoms and disability. Surgeons and patients are increasingly aware of postsurgery-related complications. This stimulated the clinical usage of minimally invasive treatments such as percutaneous nucleoplasty (PCN) and pulsed radio frequency (PRF). However, scientific evidence on both treatments is limited. OBJECTIVE Our objective was to evaluate the efficacy of PCN compared to PRF in patients with contained cervical disk herniation. METHODS A prospective randomized clinical trial was conducted including 34 patients with radicular pain due to a single contained cervical disk herniation who were treated with either PCN or PRF. Demographic data were collected, and the Medical Outcomes Study 12-Item Short Form (SF-12) Health Survey, visual analog scale (VAS), and the Neck Disability Index (NDI) were completed 1, 2, and 3 months after treatment. Treatment satisfaction and complications were recorded. RESULTS In the PCN group (n = 17, mean age 52.4 years, 10 female/7 male), patients were treated at C5 to C6 (8 cases) or C6 to C7 (9 cases). In the PRF group (n = 17, mean age 49.5 years, 8 female/9 male), patients were treated at C3 to C4 (1 case), C5 to C6 (10 cases), or C6 to C7 (6 cases). At 3 months, mean pain VAS improved significantly from baseline in the PCN group (mean improvement: 43.4 points) and in the PRF group (34.0 points). However, improvement in 1 group was not superior compared to the other group (P = 0.48). No serious complications were reported. CONCLUSION Within 3 months, both PCN and PRF show significant pain improvement in patients with contained cervical disk herniation, but none is superior to the other. Both treatment options appear to be effective and safe in regular clinical practice.
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Affiliation(s)
| | | | - Toine Lim
- Anna Hospital, Geldrop, The Netherlands
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26
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van Drumpt RAM, van der Weegen W, King W, Toler K, Macenski MM. Safety and Treatment Effectiveness of a Single Autologous Protein Solution Injection in Patients with Knee Osteoarthritis. Biores Open Access 2016; 5:261-8. [PMID: 27668131 PMCID: PMC5031090 DOI: 10.1089/biores.2016.0014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Osteoarthritis (OA) is a common degenerative condition characterized by pain and loss of function. A pathological biochemical environment with excess inflammatory and catabolic proteins is a major contributor to OA. nSTRIDE(®) Autologous Protein Solution (APS) is a new therapy under development for the treatment of OA. This therapy is formed from a patient's blood and contains high concentrations of anti-inflammatory and anabolic proteins. This study assessed the safety and treatment effects of APS. Eleven subjects with early to moderate OA were injected with APS. Subjects were closely monitored for adverse events (AE) following the injection. Treatment outcome measures were obtained before injection. AE and clinical outcomes were assessed at 1 and 2 weeks postinjection and 1, 3, and 6 months postinjection. There were no serious AE or AE that were reported by the investigator as greater than mild in severity. There were no AE that were related to the device. There were minor AE related to the injection procedure, including injection site discomfort (1/11), injection site joint pain (1/11), and procedural nausea (1/11), which resolved quickly and did not require treatment. Mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) composite scores and pain, stiffness, and function subscale scores all showed significant improvement compared to baseline by 2 weeks postinjection. The data presented here suggest that the treatment is safe and show a complication profile that is mild and consistent with similar treatments. A single injection of APS for treatment of early to moderate knee OA led to symptom improvement over the study course. Based on these results, an adequately powered, well-controlled, randomized multicenter study to establish clinical efficacy is warranted.
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van der Weegen W, Kornuijt A, Das D. Do lifestyle restrictions and precautions prevent dislocation after total hip arthroplasty? A systematic review and meta-analysis of the literature. Clin Rehabil 2016; 30:329-339. [DOI: 10.1177/0269215515579421] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objective: A systematic literature review and meta-analysis on the effectiveness of lifestyle restrictions and precautions to prevent dislocation after total hip arthroplasty. Data sources: MEDLINE and the Cochrane Library were searched in February 2015, with additional hand searching of systematic reviews and reference lists. Review methods: This review was conducted in accordance with the PRISMA statement for reporting systematic reviews and meta-analysis. PubMed and the Cochrane Library were searched from their start date through to February 2015. Randomized controlled trials and comparative case series in English, Dutch or German language were included. Only primary total hip arthroplasty procedures managed with different postoperative restrictions and precautions protocols were included. Primary outcome was the total hip arthroplasty dislocation rate, secondary outcomes were patient functioning, return to activities of daily living and patient satisfaction. Results: A total of 119 eligible articles were identified, six were included: three randomized controlled trials, one retrospective matched cohort study, one retrospective and one prospective cohort study, describing 1122 procedures (restrictions group: n = 528; no restrictions group: n = 594). Both the standard posterior and anterolateral surgical approaches were included. There were eight dislocations (1.5%) in the restricted group, vs. six dislocations (1.0%) in the unrestricted group. Patients in the unrestricted group resumed activities significantly faster and were more satisfied with their pace of recovery. Conclusion: A more liberal lifestyle restrictions and precautions protocol will not lead to worse dislocation rates after total hip arthroplasty, but will lead to earlier and better resumption of activities and higher patient satisfaction. These results appear to hold up for various surgical approaches.
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Affiliation(s)
| | - Anke Kornuijt
- Department of Physiotherapy, St. Anna Hospital, Geldrop, The Netherlands
| | - Dirk Das
- Department of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
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van der Weegen W, Wullems JA, Bos E, Noten H, van Drumpt RAM. No difference between intra-articular injection of hyaluronic acid and placebo for mild to moderate knee osteoarthritis: a randomized, controlled, double-blind trial. J Arthroplasty 2015; 30:754-7. [PMID: 25548079 DOI: 10.1016/j.arth.2014.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/11/2014] [Accepted: 12/09/2014] [Indexed: 02/01/2023] Open
Abstract
The main goal of our study was to examine the effectiveness and safety of Fermathron plus, a specific brand of hyaluronic acid (HA), in patients with mild to moderate knee osteoarthritis. In a randomized, controlled, double-blind trial, 196 patients with symptomatic knee osteoarthritis (mean age ± SD, 59.4 ± 9.9 years, Kellgren-Lawrence grade 1-3) were given either 3 weekly intra-articular injections of HA or saline (placebo). Although pain and functional scores (WOMAC scale) improved significantly from baseline up to 6 months, HA was not superior to placebo at any follow-up (VAS pain 50 m walking from 56.4 to 38.1, P < .001, and 58.2 to 39.6, P < .001, respectively). No subgroup analysis resulted in superior outcomes. No serious adverse events were noticed.
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Affiliation(s)
| | - Jorgen A Wullems
- Department of Orthopedic Surgery, St. Anna hospital, Geldrop, The Netherlands
| | - Ellis Bos
- Department of Orthopedic Surgery, St. Anna hospital, Geldrop, The Netherlands
| | - Hub Noten
- Department of Orthopedic Surgery, Elkerliek hospital, Helmond, The Netherlands
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van der Weegen W, Sijbesma T, Hoekstra HJ, Brakel K, Pilot P, Nelissen RGHH. Treatment of pseudotumors after metal-on-metal hip resurfacing based on magnetic resonance imaging, metal ion levels and symptoms. J Arthroplasty 2014; 29:416-21. [PMID: 23871706 DOI: 10.1016/j.arth.2013.06.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 02/01/2023] Open
Abstract
Peri-prosthetic pseudotumor formation can be a severe complication following Metal-on-Metal hip resurfacing arthroplasty (MoMHRA), with limited data on the optimal management of this complication. The aims of this study were (1) to evaluate the prevalence and severity of pseudotumors in a consecutive cohort of 248 MoMHRA (214 patients, mean follow-up 4.6 years, range: 1 - 8.2), and (2) to present a clinical guideline for their treatment based on severity grading with Metal Artefact Reduction Sequence Magnetic Resonance Imaging, metal ion levels and symptoms. Pseudotumor prevalence was 36.3%: 61 mild, 25 moderate and four were graded severe. Five revisions followed, all in symptomatic patients with elevated metal ion levels. Pseudotumor severity grading allowed us to be conservative with revision surgery for mild and moderate MoM disease.
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Affiliation(s)
| | - Thea Sijbesma
- Department of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | - Henk J Hoekstra
- Department of Orthopaedic Surgery, St. Anna Hospital, Geldrop, The Netherlands
| | - Koen Brakel
- Radiology Department, St. Anna Hospital, Geldrop, The Netherlands
| | - Peter Pilot
- Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Wullems JA, Halim W, van der Weegen W. Current Evidence of Percutaneous Nucleoplasty for the Cervical Herniated Disk: A Systematic Review. Pain Pract 2013; 14:559-69. [DOI: 10.1111/papr.12122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jorgen A. Wullems
- Department of Orthopedic Surgery; St. Anna Hospital; Geldrop The Netherlands
| | - Willy Halim
- Department of Anesthesia and Pain Management; St. Anna Hospital; Geldrop The Netherlands
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Austen S, van der Weegen W, Verduin CM, van der Valk M, Hoekstra HJ. Coccidioidomycosis infection of a total knee arthroplasty in a nonendemic region. J Arthroplasty 2013; 28:375.e13-5. [PMID: 22810005 DOI: 10.1016/j.arth.2012.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 05/06/2012] [Indexed: 02/01/2023] Open
Abstract
Fungal prosthetic joint infections are rare and difficult to treat. There is an ongoing discussion about the type and duration of antifungal treatment and the necessity of prosthesis removal. We report the first European case of an infected total knee arthroplasty with Coccidioides immitis. Treatment consisted of lifelong treatment with oral fluconazole at a dose of 400 mg/d, without total knee arthroplasty removal. After 6 months, the initial complaints of pain and swelling were completely resolved. This case report clearly states that a travel history and culturing for fungi are helpful in patients with persisting complaints after joint arthroplasty.
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Affiliation(s)
- Shennah Austen
- Department of Orthopaedic Surgery, St. Anna Hospital, P.O. Box 90, 5664 EH Geldrop, The Netherlands
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van der Weegen W, Hoekstra HJ, Sijbesma T, Austen S, Poolman RW. Hip resurfacing in a district general hospital: 6-year clinical results using the ReCap hip resurfacing system. BMC Musculoskelet Disord 2012; 13:247. [PMID: 23234268 PMCID: PMC3529103 DOI: 10.1186/1471-2474-13-247] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 12/07/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of our study was to prospectively report the clinical results of 280 consecutive hips (240 patients) who received a ReCap Hip Resurfacing System implant (Biomet Inc., Warsaw, USA) in a single district general hospital. Literature reports a large variation in clinical results between different resurfacing designs and published results using this particular design are scarce. METHODS Mean follow up was 3.3 years (1.0 to 6.3) and four patients were lost to follow-up. All patients were diagnosed with end-stage hip osteoarthritis, their mean age was 54 years and 76.4% of all patients were male. RESULTS There were 16 revisions and four patients reported a Harris Hip Score <70 points at their latest follow up. There were no pending revisions. Kaplan-Meier implant survival probability, with revision for any reason as endpoint, was 93.5% at six years follow-up (95%-CI: 88.8-95.3). There were no revisions for Adverse Reactions to Metal Debris (ARMD) and no indications of ARMD in symptomatic non-revised patients, although diagnostics were limited to ultrasound scans. CONCLUSIONS This independent series confirms that hip resurfacing is a demanding procedure, and that implant survival of the ReCap hip resurfacing system is on a critical level in our series. In non-revised patients, reported outcomes are generally excellent. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00603395.
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Affiliation(s)
- Walter van der Weegen
- Department of Orthopaedic Surgery, St. Anna Hospital, Bogardeind 2, Geldrop, EH, 5664, Netherlands
| | - Henk J Hoekstra
- Department of Orthopaedic Surgery, St. Anna Hospital, Bogardeind 2, Geldrop, EH, 5664, Netherlands
| | - Thea Sijbesma
- Department of Orthopaedic Surgery, St. Anna Hospital, Bogardeind 2, Geldrop, EH, 5664, Netherlands
| | - Shennah Austen
- Department of Orthopaedic Surgery, St. Anna Hospital, Bogardeind 2, Geldrop, EH, 5664, Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Halim W, Wullems JA, Lim T, Aukes HA, van der Weegen W, Vissers KC, Gültuna I, Chua NHL. The Long-term Efficacy and Safety of Percutaneous Cervical Nucleoplasty in Patients with a Contained Herniated Disk. Pain Pract 2012; 13:364-71. [DOI: 10.1111/papr.12003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/04/2012] [Indexed: 01/22/2023]
Affiliation(s)
- Willy Halim
- Department of Anesthesia and Pain Management; St. Anna Hospital; Geldrop; The Netherlands
| | - Jorgen A. Wullems
- Department of Orthopedic Surgery; St. Anna Hospital; Geldrop; The Netherlands
| | - Toine Lim
- Department of Anesthesia and Pain Management; St. Anna Hospital; Geldrop; The Netherlands
| | - Hans A. Aukes
- Department of Anesthesia and Pain Management; Albert Schweitzer Hospital; Sliedrecht; The Netherlands
| | | | - Kris C. Vissers
- Department of Anesthesiology, Pain Therapy and Palliative Care; UMC St. Radboud; Nijmegen; The Netherlands
| | - Ismail Gültuna
- Department of Anesthesia and Pain Management; Albert Schweitzer Hospital; Sliedrecht; The Netherlands
| | - Nicholas H. L. Chua
- Department of Anesthesia, Surgical Intensive Care and Pain Management; Tan Tock Seng Hospital; Singapore; Singapore
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van der Weegen W, Barten T, van Kuyk H. Different Linear Relationships Between Maximal Oxygen Uptake and Maximal Power Resulting from Different Cycle Ergometry Exercise Testing Protocols. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200611001-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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van Loon LJC, Koopman R, Manders R, van der Weegen W, van Kranenburg GP, Keizer HA. Intramyocellular lipid content in type 2 diabetes patients compared with overweight sedentary men and highly trained endurance athletes. Am J Physiol Endocrinol Metab 2004; 287:E558-65. [PMID: 15165998 DOI: 10.1152/ajpendo.00464.2003] [Citation(s) in RCA: 163] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent evidence suggests that intramyocellular lipid (IMCL) accretion is associated with obesity and the development of insulin resistance and/or type 2 diabetes. However, trained endurance athletes are markedly insulin sensitive, despite an elevated mixed muscle lipid content. In an effort to explain this metabolic paradox, we compared muscle fiber type-specific IMCL storage between populations known to have elevated IMCL deposits. Immunofluorescence microscopy was performed on muscle biopsies obtained from eight highly trained endurance athletes, eight type 2 diabetes patients, and eight overweight, sedentary men after an overnight fast. Mixed muscle lipid content was substantially greater in the endurance athletes (4.0 +/- 0.4% area lipid stained) compared with the diabetes patients and the overweight men (2.3 +/- 0.4 and 2.2 +/- 0.5%, respectively). More than 40% of the greater mixed muscle lipid content was attributed to a higher proportion type I muscle fibers (62 +/- 8 vs. 38 +/- 3 and 33 +/- 7%, respectively), which contained 2.8 +/- 0.3-fold more lipid than the type II fibers. The remaining difference was explained by a significantly greater IMCL content in the type I muscle fibers of the trained athletes. Differences in IMCL content between groups or fiber types were accounted for by differences in lipid droplet density, not lipid droplet size. IMCL distribution showed an exponential increase in lipid content from the central region toward the sarcolemma, which was similar between groups and fiber types. In conclusion, IMCL contents can be substantially greater in trained endurance athletes compared with overweight and/or type 2 diabetes patients. Because structural characteristics and intramyocellular distribution of lipid aggregates seem to be similar between groups, we conclude that elevated IMCL deposits are unlikely to be directly responsible for inducing insulin resistance.
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Affiliation(s)
- Luc J C van Loon
- Department of Movement Sciences, Nutrition Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands.
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