Outcome Of Joint Replacement Surgery Research Articles

Joint replacement surgery for elbow tumours: a systematic review of outcomes

Tumour resection followed by joint reconstruction is a surgical option in the appropriate patient. The evidence for such reconstructive surgery of the elbow joint is limited. The aim of this study is to review the literature to evaluate the outcomes of joint replacement surgery in tumours of the elbow. A systematic review of PUBMED and EMBASE databases was conducted. Case series and comparative studies reporting results after total elbow arthroplasty, modular endo-prosthetic replacement and custom prosthesis were eligible for inclusion. Eleven eligible studies were identified (n = 134). At mean follow-up of 44 months, the overall revision rate was 14% and complication rate was 28%. The mean Mayo Elbow Performance Score was 75, with 56% of patients reporting good or excellent outcomes. The mean post-operative range of motion was 97°. Elbow prosthesis reconstruction after tumour resection can provide good functional outcomes at mid-term follow-up. The complication and revision rates are comparable to other indications for elbow replacement surgery. Further prospective studies are required to compare outcomes between different elbow arthroplasty options after tumour resection.

Gait adaptation differences in severe knee osteoarthritis patients versus asymptomatic contols

Purpose: Gait adaptability is crucial in the performance of activities of daily living and the capacity to adapt to a new joint may be a predicting factor in the outcome of joint replacement surgery. Among older adults, knee osteoarthritis (KOA) is highly prevalent. It is expected that the symptoms of KOA reduce gait adaptability, but this effect varies between individuals. When patients with severe KOA undergo knee replacement surgery, a limited capacity for gait adaptation is thought to obstruct a full restoration of their gait pattern.

Iranian Joint Registry (Iranian National Hip and Knee Arthroplasty Registry).

Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran's Ministry of Health and Education.

Is hospital volume associated with length of stay, re-admissions and reoperations for total hip replacement? A population-based register analysis of 78 hospitals and 54,505 replacements

Hospital volume has been suggested to be a significant determinant of the outcome of joint replacement surgery. We updated previously published data on the effect of hospital volume on length of stay, re-admissions, and reoperations for total hip replacement (THR) at the population level in Finland. A total of 54,505 THRs for primary osteoarthritis performed between 1998 and 2010 were identified from the Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified into four groups according to the number of primary and revision total hip and knee arthroplasties performed on an annual basis over the whole study period: 1–199 (group 1), 200–499 (group 2), 500–899 (group 3), and >900 (group 4). We analyzed the association between hospital procedure volume and length of stay (LOS), length of uninterrupted institutional care (LUIC), re-admissions and reoperations. The larger the volume group, the shorter were LOS and LUIC (p < 0.01). According to the adjusted data, risk for re-admission in 42 days was greater in group 1 than in group 4 (OR = 1.14; 95 % CI: 1.05–1.23). There was no difference in the risk for reoperation. LOS and LUIC ought to be shortened in lower volume hospitals.

FRI0428 Do biologic drugs affect the need for and outcome of joint replacements in patients with rheumatoid arthritis? A register-based study

BackgroundThere is little information on the effect of biological treatment on the incidence and outcomes of joint replacement surgery. The results from a single centre in Brazil show a reduction...

Influence of socioeconomic status on outcome of joint replacement surgery

Total joint arthroplasty is one of the most successful and cost-effective treatments for end-stage arthritis. Understanding the disparity of outcomes associated with total knee and hip arthroplasty is crucial in the treatment of arthritis. Disparity in health care occurs in a variety of demographics and is on the front lines of health care policy. An individual's socioeconomic status, typically based on income and educational level, has been shown to have an effect on the outcomes of total joint arthroplasty. Acknowledging the differences in outcomes and discovering ways to reduce the disparity will not only be beneficial to individuals undergoing total joint arthroplasty but will also provide a better foundation for future orthopaedic surgeons and health care workers. Identifying individuals' differences in socioeconomic status and making appropriate adjustments should improve outcomes after total joint arthroplasty and prevent further disparities of care.

Greater Perceived Helplessness in Osteoarthritis Predicts Outcome of Joint Replacement Surgery

To determine if there is a difference between male and female patients in their perceived control of osteoarthritis (OA) symptoms at the time of joint replacement surgery, as measured by the Arthritis Helplessness Index (AHI), and how this helplessness affects surgical outcomes at 1 year. From a joint replacement registry, 70 male and 70 female patients were randomly selected and matched for age, body mass index, comorbidity, procedure, and education. Patients completed the AHI prior to surgery. Functional status was assessed at baseline and 1-year followup with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Linear regression modeling was used to determine the effect of sex on predicting AHI scores. A second model was constructed to examine the effect of AHI on the 1-year WOMAC change score. There were no statistically significant differences in demographic data or clinically significant differences in AHI scores between sexes. Linear regression modeling showed that female sex was a significant predictor of a greater AHI score prior to surgery (p < 0.05). Moreover, a greater AHI score was an independent predictor of a lower WOMAC change score at 1 year (p = 0.01). Interventions to improve control over arthritis symptoms should be studied with the goal of improving surgical outcomes.

The safety and outcome of joint replacement surgery in liver transplant recipients

A small group of patients may require total hip arthroplasty, total knee arthroplasty, or other joint replacement surgery after OLT for osteoporotic fractures, osteonecrosis, and osteoarthritis. Although arthroplasty is safe in the general population, its safety in liver transplant recipients is unclear. The aim of the study was to determine the safety and outcome of joint replacement surgery in our liver transplant recipients. A retrospective analysis was performed on all liver transplant recipients who had total joint arthroplasty at a single teaching institution between 1986 and 2002. Data regarding major intraoperative and postoperative complications was obtained from the medical charts and a hospital-based computer system. Of over 1,200 liver transplant recipients, we identified 7 patients who underwent 12 total arthroplasties (8 knee, 3 hip, 1 ankle). Joint replacements were performed electively for osteonecrosis (5 of 12) and osteoarthritis (5 of 12), whereas two hip arthroplasties were performed emergently for fractures. All patients with osteonecrosis or hip fracture had been treated with prolonged corticosteroids. There were no deaths or major complications in the intraoperative and postoperative periods. On long-term follow-up, no patients have had pain, dislocation, or infection in the postsurgical joint. No joint revision surgery has been required. In conclusion, a small number of stable liver transplant recipients at our institution underwent joint replacement surgery without major short-term or long-term complications. Our study suggests that joint replacement surgery may be safely and successfully performed in this population, although larger, randomized, prospective trials are needed to confirm our findings. (Liver Transpl 2003;9:373-376.)

A small punch test technique for characterizing the elastic modulus and fracture behavior of PMMA bone cement used in total joint replacement

Polymethylmethacrylate (PMMA) bone cement is used in total joint replacements to anchor implants to the underlying bone. Establishing and maintaining the integrity of bone cement is thus of critical importance to the long-term outcome of joint replacement surgery. The goal of the present study was to evaluate the suitability of a novel testing technique, the small punch or miniaturized disk bend test, to characterize the elastic modulus and fracture behavior of PMMA. We investigated the hypothesis that the crack initiation behavior of PMMA during the small punch test was sensitive to the test temperature. Miniature disk-shaped specimens, 0.5 mm thick and 6.4 mm in diameter, were prepared from PMMA and Simplex-P bone cement according to manufacturers’ instructions. Testing was conducted at ambient and body temperatures, and the effect of test temperature on the elastic modulus and fracture behavior was statistically evaluated using analysis of variance. For both PMMA materials, the test temperature had a significant effect on elastic modulus and crack initiation behavior. At body temperature, the specimens exhibited “ductile” crack initiation, whereas at room temperature “brittle” crack initiation was observed. The small punch test was found to be a sensitive and repeatable test method for evaluating the mechanical behavior of PMMA. In light of the results of this study, future small punch testing should be conducted at body temperature.