Major Joint Arthroplasty Research Articles

Post-operative cardiovascular complications in major joint arthroplasties

METHODS Patient’s demographic data, cardiovascular co-morbidities, anaesthetic type, type of arthroplasty, and post-operative complications were identified. Statistical analysis was performed by t-test or Chisquare. Regional anaesthesia (RA) was defined as spinal, epidural or combined spinal-epidural. Failed regional technique requiring conversion to general anaesthetic was counted as a general anaesthetic (GA). Bilateral arthroplasties were done sequentially under one anaesthetic. Staged arthroplasties were done within 4 years of one another.

The role of the IPSS (International Prostate Symptoms Score) in predicting acute retention of urine in patients undergoing major joint arthroplasty

Acute urinary retention following major joint arthroplasty is common. It does necessitate instrumentation, puts patients at risk of complications, and causes discomfort and embarrassment. The aim of the study was to find a test to help the surgeon to predict the possibility of acute retention of urine. Male patients admitted for elective major joint arthroplasty filled in an IPSS (International Prostate Symptoms Score) during the pre-operative visit. They were observed post-operatively to document if they passed urine spontaneously or went into acute retention. There was a strong correlation between the IPSS and the likelihood of developing acute retention. Patients with moderate to high IPSS had a 55% to 100% chance of developing acute retention of urine, respectively. The IPSS proved to be a simple and reliable test to help the surgeon in predicting the possibility of developing acute retention. It might be a good addition to the pre-admission clinic investigations in patients undergoing major surgery. It could consolidate the decision to pre-emptive catheterisation in patients at risk.

Self Report Co-Morbidity and Health Related Quality of Life – A Comparison with Record Based Co-Morbidity Measures

The purpose of this projectwas to compare three hospital-based measures ofco-morbidity to patient self-reportco-morbidity and to determine the relativeproportion of outcome predicted by each of theco-morbidity measures in a population ofindividuals receiving major joint arthroplasty. Baseline measures using the SF-36 generalhealth questionnaire and the Western OntarioMcMaster Osteoarthritis Index (WOMAC) wereobtained from 518 persons undergoing total kneeor hip replacement. A second measure wasobtained six months post-surgery. Co-morbiditywas calculated by summing the self-reportedco-morbidity at baseline, using both thechart-based and administrative data version ofCharlson's Co-morbidity Index, and by summingthe number of International Classification ofDiseases – Version 9 (ICD-9) codes appearingin the electronic health record. Linearregression was used to determine how much ofthe variation in outcome was explained by eachof the co-morbidity measurement methods. Self-report co-morbidity explained as muchvariation in outcome as the hospital-basedindices. Self-report co-morbidity did notperform as well as the other methods inexplaining the variance in health systemutilization. It was concluded that self-reportco-morbidity is minimally as useful asrecord-based systems when measuring the impactof co-morbidity on health related quality oflife (HRQL). This is an important finding, asprivacy legislation, the time until data isavailable and cost are all barriers to usingrecord-based co-morbidity measures.

Peri-operative troponin I concentration as a marker of long-term postoperative adverse cardiac outcomes--a study in high-risk surgical patients.

We have previously demonstrated that the peri-operative measurement of increased serum concentrations of the cardiac markers troponins I and T and creatine kinase-MB can be predictors of major cardiovascular outcomes (including cardiac death) at 3 months after surgery. In the present study, we have followed the postoperative course of 157 patients undergoing major vascular surgery or major joint arthroplasty to 1 year using a patient questionnaire, general practitioner follow-up and case-notes review. Increased postoperative marker concentrations were defined as values greater than the upper reference limit. Increases in troponin I and troponin T concentrations, as well as a single elevated creatine kinase-MB and two successively elevated creatine kinase-MB concentrations were measured in 12, 13, 33 and 15 patients respectively. Thirty-nine major adverse cardiac outcomes were recorded (cardiac death, myocardial ischaemia, congestive cardiac failure, unstable angina, cerebrovascular accident and major arrhythmias needing active treatment). There was no association between increases in any of these cardiac markers and cardiac death to 1 year. However, increases in troponin I and both a single elevated creatine kinase-MB and two successively elevated creatine kinase-MB concentrations were associated with an increased incidence of major cardiac outcomes, including cardiac death, to 1 year (odds ratio [95% confidence intervals] = 4.19 [1.16-14.87], 3.97 [1.65-9.44] and 5.19 [1.60-16.22], respectively).

Evaluation of the Hemocue portable hemoglobinometer after major joint arthroplasty

We evaluated the potential use of the Hemocue (Hemocue AB, Sweden) portable hemoglobinometer on the 1st postoperative evening after major joint arthroplasty. We compared hemoglobinometer values with conventional Coulter counter laboratory analysis in a population of 67 patients. The hemoglobinometer proved practical, economical, and accurate in general, although 2 outlying values were severe enough as potentially to influence clinical decision making. Potential causes and solutions are discussed.

Early cell adhesion events differ between osteoporotic and non-osteoporotic osteoblasts

In osteoporosis, the regenerative capacity of bone is compromised, which may involve altered osteoblast (OB) activity. This could be attributed to an inappropriate synthesis and assembly of an extracellular matrix (ECM), altered cell adhesion to the ECM, or be due to inappropriate downstream activation of adhesion-mediated signaling cascades through proteins such as focal adhesion kinase (FAK). The purpose of our study was to compare early adhesion-mediated events using previously described and characterized clinically derived OBs obtained from human patients undergoing major joint arthroplasty for osteoporosis or osteoarthritis. The presence or absence of osteoporosis was established with a radiographic index. Using light microscopy and crystal violet staining, we show that OB cells derived from sites of osteoporosis do not attach and spread as well as non-osteoporotic (OP) OB cells. OP cells initially have a more rounded morphology, and show significantly less ( P<0.001) attachment to serum-coated tissue culture plastic over a 24 h time period. Immunofluorescent labeling after 24 h of attachment showed that OP OB focal adhesions (FAs) and stress fibers were less defined, and that the OP cells were smaller and had a more motile phenotype. When normalized protein lysates were Western blotted for phosphotyrosine (PY) a band corresponding to pp125FAK was identified. FAK tyrosine phosphorylation was evident at 6 h in both the OP and non-OP OBs, but decreased or was absent through 24 h in OP OBs. These results suggest early adhesion-mediated events, such as cell adhesion, attachment, and FAK signaling via PY may be altered in OP OBs.

Change in pain and function while waiting for major joint arthroplasty

The objective of this study was to examine the change in pain and physical function that occurs while waiting for major arthroplasty. Data were collected prospectively from a cohort of 313 patients who were waiting >1 month for total hip arthroplasty or total knee arthroplasty. The WOMAC and the SF-36 health status instruments were administered at the time the patient was placed on the waiting list and again just before surgery. Minimal amounts of change in pain and physical and psychosocial function occurred for hip and knee arthroplasty patients while they waited. Overall, waiting time did not appear to have a negative impact on the amount of pain and dysfunction experienced.

Recovery from hip and knee arthroplasty: Patients' perspective on pain, function, quality of life, and well-being up to 6 months postoperatively

Salmon P, Hall GM, Peerbhoy D, Shenkin A, Parker C. Recovery from hip and knee arthroplasty: patients' perspective on pain, function, quality of life, and well-being up to 6 months postoperatively. Arch Phys Med Rehabil 2001;82:360-6. Objective: To provide a more detailed description from patients' perspectives than is yet available of recovery from hip and knee arthroplasty and to use this information to test 2 assumptions about recovery from these procedures: that recovery from knee arthroplasty, as assessed by patients, routinely reaches the level achieved by hip arthroplasty; and that fatigue is prolonged after major orthopedic surgery. Design: A cohort study. Setting: University teaching hospitals. Participants: Consecutive patients undergoing hip (n = 107) or knee (n = 53) arthroplasty. Interventions: Unilateral hip or knee arthroplasty. Main Outcome Measures: Standardized self-rated measurements of pain, function, quality of life, and well-being from preoperatively to 6 months follow-up. Results: Pain and function improved significantly less after knee arthroplasty than after hip arthroplasty, but the 2 procedures led to similar improvements in life evaluation, mood, and subjective health. Fatigue was only transiently increased. Conclusion: The findings were inconsistent with both assumptions. Nevertheless, despite poorer recovery in pain and function, patients receiving knee arthroplasty felt that life had improved as much as did patients with hip arthroplasty. Detailed information about how major joint arthroplasty in routine practice affects patients' lives can be used to advise patients and clinicians and can invalidate influential, but inaccurate, assumptions.

The impact of health status on waiting time for major joint arthroplasty

This study was conducted to determine the impact of health status on waiting time for major joint arthroplasty in a universal publicly funded health system. Data were collected prospectively from a cohort of 553 patients waiting for total hip or total knee arthroplasty. The WOMAC and SF-36 health status instruments were administered at the time the patient was placed on the waiting list. The outcome measure was length of waiting time. Multivariate analyses found increased body mass index and decreased social function as the only determinants of waiting time. This model explained only 4% of the variance in waiting time. The association between health status and waiting time for arthroplasties appears to be small. These findings suggest that major joint arthroplasty is not prioritized on the basis of burden of illness.

The systematic assessment of short-term functional recovery after major joint arthroplasty.

Despite extensive information about long-term recovery from major joint arthroplasty, little attention has been given to the measurement of functional recovery in the immediate postoperative period. Therefore assumptions about the importance of physical therapy during this period remain untested. We devised a way of recording functional recovery before discharge, based primarily on the achievement of objective milestones. This was incorporated into routine physiotherapy practice and applied to sequential patients undergoing elective hip (n = 163) or knee (n = 66) replacement. Six months later, we followed up 160 patients, of whom 145 completed questionnaires to assess subjective physical and emotional state and functional recovery. The method was sensitive to known influences on pace of recovery, including type of arthroplasty (hip vs knee) and surgeons' differing requirements for mobilization. In addition, we were able to confirm and quantify sources of variation in functional recovery which previously were suspected but unconfirmed: in particular, the timing of early mobilization. Outcome at 6 months was unrelated to objective functional recovery in hospital, although fatigue and wellbeing at this time were predicted by physiotherapists' subjective assessment of patients' motivation before discharge. The findings can be used to inform patients and as a source of comparison data for the assessment of functional recovery in other centres. More importantly, the procedure reported may be applied to quantify functional recovery in routine practice and thereby expose variability in recovery to scientific scrutiny.

Delayed Neurological Deficit After Total Hip Arthroplasty

Delayed Neurological Deficit After Total Hip Arthroplasty

Early Rehabilitation After Major Joint Arthroplasty is Safe and Cost Effective.

Rehabilitation after elective hip and knee arthroplasty often begins a week or more after surgery. This randomized controlled trial compared the impact

Fatigue after major joint arthroplasty: Relationship to preoperative fatigue and postoperative emotional state

Fatigue has been widely assumed to increase after major surgery, and possible physical explanations have been intensively investigated. Nevertheless, existing data are almost exclusively from abdominal surgery and are based on the use of a single visual analogue scale. Moreover, no physical basis has been found. The present study used a more homogeneous surgical model than has been employed hitherto in order to find whether fatigue was related to emotional state. We measured fatigue before and 1 and 7 weeks after major joint arthroplasty in 63 patients, using a questionnaire that separates mental and physical fatigue. Physical function and subjective emotional and somatic state were measured at the same times; optimism was measured preoperatively. Neither mental nor physical fatigue increased after this form of surgery. Mental and physical fatigue each correlated with low positive mood throughout. The best predictor of physical fatigue postoperatively and at follow-up was preoperative physical fatigue. Preoperative mental fatigue and negative mood were independent predictors of mental fatigue postoperatively and at follow-up. Preoperative fatigue also predicted worse subjective emotional and physical state after surgery. These results suggest that fatigue should be regarded as an aspect of emotional distress perioperatively and that complaints of fatigue postoperatively may reflect the tendency to complain of fatigue or negative mood preoperatively rather than being attributable to surgical trauma.

SHORT-TERM RECOVERY FROM HIP AND KNEE ARTHROPLASTY

There are many studies of long-term recovery from major point arthroplasty, but little is known about the first days and weeks after operation. We measured function, emotional state and life evaluation before arthroplasty and at seven and 50 days after in a consecutive series of 40 hip and 23 knee replacements. Pain was relieved significantly at seven days after hip arthroplasty and even more at 50 days. In knee patients, pain relief was modest and was not apparent until 50 days. Functional ability was much improved by 50 days in hip patients, but hardly changed in knee patients. Positive mood and life satisfaction did not improve in either group. Our findings will help with more accurate information for patients before operation and also in judging the rate of recovery.

Total blood loss in major joint arthroplasty: A comparison of cemented and noncemented hip and knee operations

Blood loss is an important aspect of any major surgery. With increased experience and increasing use of noncemented prostheses, there are indications that the total blood loss is higher in noncemented than in similar cemented arthroplasties. This report is a retrospective study of blood loss comparing cemented and non-cemented cases. In a total of 30 total hip and 37 total knee arthroplasties that were reviewed in detail, the difference in blood loss between the two groups was statistically significant. The authors give suggestions on how to reduce blood loss in noncemented knee procedures.

Long-term results of total joint arthroplasty in nonambulatory patients

The authors conducted a long-term follow-up study of 27 patients, all confined to a bed or wheelchair for at least 6 months, who had total joint arthroplasty to relieve rest pain, correct deformity, and enable independent ambulation. The average duration of nonambulatory status before operation was 3 years (mean, 1 1/2 years), with the longest being 15 years. The patients required an average 3-month hospital stay and an average of three major total joint arthroplasties in the lower extremities. All of the patients were ambulatory at the time of discharge but required some sort of aid. After 1 year, 20 patients (74%) were able to launch independently; 9 (33%) could ambulate without aids; and 14 (52%) could ambulate with aids. At follow-up evaluation 3–12.8 years (average, 6.5 years) after operation, nine patients (33%) ambulated without aids, five (19%) required a single crutch or cane, and nine (33%) required bilateral crutches or a walker, for a total success rate of 85%, which did not deteriorate with time.