Outcome evaluations are of primary concern in contemporary medical practice. Questionnaires are being used increasingly to provide input data for such outcomes evaluation. This study comprised 50 ...primary total hip arthroplasties in 36 patients who had undergone the procedure at least 12 months before enrollment. Each patient completed a self-report Harris Hip Score (HHS) 30 days before a formal evaluation by an independent orthopaedic surgeon that included a HHS. Comparison was made between the completed responses to the individual items on the self-report HHS and surgeon-assessed HHS. Concordance of item response and kappa statistic were calculated. Overall the self-report and surgeon-assessed HHS showed excellent concordance. The results of this study support the use of the HHS as a self-report instrument.
To document and examine the concerns patients have prior to undergoing primary total hip or total knee arthroplasty in a tertiary care center or an orthopedic private practice group.
In this ...prospective survey, 136 patients from a tertiary care center and 130 from an orthopedic private practice group completed a questionnaire covering 54 items regarding their concerns prior to undergoing primary total hip or total knee arthroplasty. Patients responded on a visual analog scale, and concern was ranked by mean responses (1, not concerned at all; 2, somewhat concerned; 3, very concerned; or 4, extremely concerned).
Responses to only 6 items averaged scores higher than 1.9: pain immediately after the surgery (2.07), length of recovery (2.07), ability to walk as much as you wish (2.03), ability to return to recreational activities (1.97), ability to go up and down stairs (1.94), and risk of getting acquired immunodeficiency syndrome from a transfusion (1.92). Older patients (> or = 65 years) were less concerned than younger patients (< 65 years) in 34 of the 54 questions asked. Women were more concerned than men in 19 of the 54 questions asked.
These data provide information that will be helpful in preoperative patient discussions and in development of educational materials for patients undergoing total hip or total knee arthroplasty.
Abstract Adverse reaction to metal debris (ARMD) is a known cause of failed metal in hip arthroplasty. Diagnosis of this type of prosthesis failure may be difficult, and the hallmark is an abnormally ...elevated serum cobalt level. Concomitant diagnoses may also be present, such as infection, instability, and loosening, and this may confuse interpretation of abnormal laboratories. We present here, for the first time, 2 patients with ARMD and crystalline arthropathy. In each case, the patient chose surgery for ARMD, with resolution of symptoms and no recurrence of the crystalline arthropathy. We present these cases to alert the orthopaedist that crystalline arthropathy may be present at the same time as ARMD, but is likely not the primary cause of symptoms.
To summarize previously published findings and to present the opinions of a group of reconstructive orthopedic surgeons from a single institution on participation in sports after hip or knee ...arthroplasty.
We reviewed the literature pertaining to participation in sports after hip or knee arthroplasty and surveyed a group of orthopedic surgeons about their recommendations for resumption of various sports activities by patients who had undergone total hip or knee arthroplasty.
A computerized literature search was performed, and salient issues about participation in sports after joint replacement procedures were synthesized. At the Mayo Clinic, 28 orthopedic surgeons (13 consultants and 15 fellows or residents) completed a single-page questionnaire that requested a recommendation (“yes,” “no,” or “depends”) about patients resuming participation in 28 common sports after recovery from total hip or knee arthroplasty. Staff surgeon responses were compared with responses from fellows and residents by using the Mann-Whitney U test. Sports in which 75% of surgeons would not allow participation were identified as “not recommended,” whereas sports in which 75% of surgeons would allow participation were labeled as “recommended.”
Fellows and residents were less likely than staff surgeons to allow return to cross-country skiing after total knee arthroplasty. Otherwise, responses from consultant surgeons and from fellows and residents did not differ significantly. Recommended sports included sailing, swimming laps, scuba diving, cycling, golfing, and bowling after hip and knee replacement procedures and also cross-country skiing after knee arthroplasty. Sports not recommended after hip or knee arthroplasty were running, waterskiing, football, baseball, basketball, hockey, handball, karate, soccer, and racquetball.
After hip or knee arthroplasty, participation in no-impact or low-impact sports can be encouraged, but participation in high-impact sports should be prohibited.
We reviewed the records of 143 patients, two months to fifteen years old, who were seen at the Mayo Clinic between 1950 and 1991 because of an injury to the cervical spine. There was a clear ...demarcation between the characteristics of the injury of two age-groups. Children who were less than eleven years old had fewer injuries as a group, were most often injured in falls, tended to have a predominance of ligamentous injuries of the cephalic portion of the cervical spine, and had a high rate of mortality as a consequence of injury to the spinal cord. Children who were eleven through fifteen years old had more injuries as a group, were most often injured during sports and recreational activities, had a higher male-to-female ratio, were more frequently injured in the caudal portion of the cervical spine, and had a pattern of injury similar to that of adults. The age and sex-adjusted incidence was 7.41 per 100,000 population per year.
Purpose The purpose of this study was to evaluate the clinical feasibility of a new method to orient 3-dimensional (3D) computed tomography models to the natural head position (NHP). This method uses ...a small and inexpensive digital orientation device to record NHP in 3 dimensions. This device consists of a digital orientation sensor attached to the patient via a facebow and an individualized bite jig. The study was designed to answer 2 questions: 1 ) whether the weight of the new device can negatively influence the NHP and 2 ) whether the new method is as accurate as the gold standard. Patients and Methods Fifteen patients with craniomaxillofacial deformities were included in the study. Each patient's NHP is recorded 3 times. The first NHP was recorded with a laser scanning method without the presence of the digital orientation device. The second NHP was recorded with the digital orientation device. Simultaneously, the third NHP was also recorded with the laser scanning method. Each recorded NHP measurement was then transferred to the patient's 3D computed tomography facial model, resulting in 3 different orientations for each patient: the orientation generated via the laser scanning method without the presence of the digital orientation sensor and facebow (orientation 1), the orientation generated by use of the laser scanning method with the presence of the digital orientation sensor and facebow (orientation 2), and the orientation generated with the digital orientation device (orientation 3). Comparisons are then made between orientations 1 and 2 and between orientations 2 and 3, respectively. Statistical analyses are performed. Results The results show that in each pair, the difference (Δ) between the 2 measurements is not statistically significantly different from 0°. In addition, in the first pair, the Bland-Altman lower and upper limits of the Δ between the 2 measurements are within 1.5° in pitch and within a subdegree in roll and yaw. In the second pair, the limits of the Δ in all 3 dimensions are within 0.5°. Conclusion Our technique can accurately record NHP in 3 dimensions and precisely transfer it to a 3D model. In addition, the extra weight of the digital orientation sensor and facebow has minimal influence on the self-balanced NHP establishment.
Errors, omissions, false understanding, and contradictory answers can compromise the use of questionnaires to generate follow-up data. To assess the utility of and effort involved in adding routinely ...a telephone interview to clarify the questionnaire, a study of total hip arthroplasty patients was carried out. Thirty-six patients with 37 primary and 13 revision total hip arthroplasties filled out a standardized questionnaire (which asks a number of demographic questions as well as questions that allow calculation of the Medical Outcome Studies MOS 36-Item Short-form Health Survey SF-36, Western Ontario MacMaster Arthritis Center WOMAC osteoarthritis index, and Harris hip score) prior to returning for routine follow-up evaluation a minimum of 1 year after surgery. Two hundred thirty-two of a possible 4,350 responses (5.3%) were missing, contradictory, or answered with two or more answers on the questionnaire. Only eight such defects occurred following the telephone interview by a skilled orthopaedic surgeon, representing a significant reduction in these defects (
P < .005). The average time of the telephone call was 2.8 minutes (range, 1–12 minutes), and the average number of attempts to contact the patient was 1.4 (range, 1–6). All questionnaire data and questionnaire data plus telephone data were compared with data obtained from a subsequent face-to-face interview by a different skilled orthopaedic surgeon who was blinded to the data from both the questionnaire and the telephone interview. It is demonstrated that a telephone call to follow up a standardized, self-administered questionnaire is a very effective way to augment the quality and quantity of questionnaire responses.
Forty-two patients who had had an arthrodesis for instability of the cervical spine resulting from trauma were followed clinically for a minimum of seven years (median, seventeen years and six ...months). The ages of the patients at the time of the injury ranged from one year and eleven months to fifteen years and eleven months. On the basis of a new post-traumatic neck score, which includes an assessment of pain, mobility, neurological status, and function, thirty-two patients (76 per cent) had an excellent result, six (14 per cent) had a good result, and four (10 per cent) had a fair result. No patient had a poor result. There was no notable deterioration of the clinical result with an increased duration of follow-up. Current radiographs of the cervical spine in flexion and extension were available for thirty-one (74 per cent) of the forty-two patients. There was no change in stability, deformity, or the fusion mass after healing or with an increased duration of follow-up, but there was a significant increase in osteoarthrotic changes in the unfused segments of the cervical spine after an increased duration of follow-up (p = 0.0001). Complications included spontaneous extension of the fusion mass in sixteen patients (38 per cent), mild pain or dysesthesias at the iliac-crest donor site in six patients (14 per cent), superficial infection at a bone-graft donor site in one patient (2 per cent), an incorrect level of arthrodesis in one patient (2 per cent). One patient had instability secondary to juvenile rheumatoid arthritis, which developed after treatment of the original injury, and she needed a reoperation. We concluded that spinal arthrodesis for fractures and dislocations of the cervical spine in children and adolescents can be accomplished safely, with an acceptable clinical outcome, a low rate of complications, and minimum morbidity after long-term follow-up. Pain, neurological status, and function do not change markedly, but mobility may decrease with an increased duration of follow-up. Our patients had a decrease in mobility, associated with an increase in osteoarthrotic changes, as seen on radiographs (p = 0.05).
Abstract Background Mechanically assisted crevice corrosion (MACC) in metal-on-polyethylene total hip arthroplasty (THA) is of concern, but its prevalence, etiology, and natural history are ...incompletely understood. Methods From January 2003 to December 2012, 1352 consecutive THA surgeries using a titanium stem, cobalt-chromium alloy femoral head, and highly cross-linked polyethylene liner from a single manufacturer were performed. Patients were followed at 1-year and 5-year intervals for surveillance, but also seen earlier if they had symptoms. Any patient with osteolysis >1 cm (n = 3) or unexplained pain (n = 85) underwent examination, radiographs, complete blood count, erythrocyte sedimentation rate, and C-reactive protein, as well as tests for serum cobalt and chromium levels. Results Symptomatic MACC was present in 43 of 1352 patients (3.2%). Prevalence of MACC by year of implant ranged from 0% (0 of 61, 2003; 0 of 138, 2005) to 10.5% (17 of 162; 2009). The M/L Taper stem had a greater prevalence (4.9%) of MACC than all other Zimmer (Zimmer, Inc, Warsaw, IN) 12/14 trunnion stem types combined (1.2%; P < .001). Twenty-seven of 43 (62.8%) patients have undergone revision surgery, and 16 of 43 (37.2%) patients have opted for ongoing surveillance. Comparing symptomatic THA patients with and without MACC, no demographic, clinical, or radiographic differences were found. MACC was significantly more common in 0 length femoral heads (compared with both −3.5 mm and +3.5 mm heads). Conclusion The prevalence of MACC in metal-on-polyethylene hips is higher in this cross-sectional study than previously reported. A significantly higher prevalence was found in patients with M/L Taper style stem and THA performed both in 2009 and also between 2009 and 2012 with this manufacturer.
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