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Consensus on draft OMERACT core domains for clinical trials of Total Joint Replacement outcome by orthopaedic surgeons: a report from the International consensus on outcome measures in TJR trials (I-COMiTT) groupSingh, Jasvinder A., Dohm, Michael, Choong, Peter F. 26 January 2017 (has links)
Background: There are no core outcome domain or measurement sets for Total Joint Replacement (TJR) clinical trials. Our objective was to achieve an International consensus by orthopaedic surgeons on the OMERACT core domain/area set for TJR clinical trials. Methods: We conducted surveys of two orthopaedic surgeon cohorts, which included (1) the leadership of international orthopaedic societies and surgeons (IOS; cohort 1), and (2) the members of the American Academy of Orthopaedic Surgeons' Outcome Special Interest Group (AAOS-Outcome SIG), and/or the Outcome Research Interest Group of the Orthopaedic Research Society (ORS; cohort 2). Participants rated OMERACT-endorsed preliminary core area set for TJR clinical trials on a 1 to 9 scale, indicating 1-3 as domain of limited importance, 4-6 being important, but not critical, and 7-9 being critical. Results: Eighteen survey participants from the IOS group and 69 participants from the AAOS-Outcome SIG/ORS groups completed the survey questionnaire. The median (interquartile range [IQR]) scores were seven or higher for all six proposed preliminary core areas/domains across both groups, IOS and AAOS-Outcome SIG/ORS, respectively: pain, 8 [8, 9] and 8 [7, 9]; function, 8 [8, 8] and 8 [7, 9]; patient satisfaction, 8 [7, 9] and 8 [7, 8]; revision surgery, 7 [6, 9] and 8 [6, 8]; adverse events, 7 [5, 8] and 7 [6, 9]; and death, 7 [7, 9] and 8 [5, 9]. Respective median scores were lower for two additional optional domains: patient participation, 6.5 [5, 7] and 6 [5, 8]; and cost, 6 [5, 7] and 6 [5, 7]. Conclusions: This study showed that two independent surveys dervied from three groups of orthopaedic surgeons with international representation endorsed a preliminary/draft OMERACT core domain/area set for Joint Replacement clinical trials.
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Anthropometric shape parameters in obese subjects: implications for obese total joint arthroplasty patientsSimoens, Kevin James 01 May 2017 (has links)
Obesity is a severe concern worldwide and its prevalence is expected to continue to increase. Linked to diabetes, kidney disease, heart disease, and high blood pressure among other things, obesity has been identified as the forthcoming, largest preventable cause of mortality. Osteoarthritis, surgical consequences, distribution of subcutaneous adipose tissue, and alteration of joint biomechanics have vast implications in total joint repair (TJR). Previous studies have linked obesity to increased forces through weight-bearing lower extremities, alterations in gait, and risk of implant failure. The objectives of this study were to (1) provide a tool to predict lower extremity dimensions and shape variations of subcutaneous adipose tissue, (2) identify the degree to which obesity influences shape variation of the osseous anatomy of the knee joint, and (3) lay a foundation to compare the knee contact force of obese patients in activities of daily living.
Long-leg EOS films were obtained, retrospectively over 5 years, from 232 patients that were being seen at the Adult Reconstruction Clinic at the University of Iowa. Using custom Matlab algorithms, measurements of soft tissue distribution and lower extremity osseous anatomy were obtained and analyzed. Additionally knee contact force measurements were obtained through motion capture analysis and modeling in Anybody Technology.
Males and females had similar lower extremity shapes, with females having greater knee circumferences than males. The variability of PPT and PTT tended to be greater in females and increased with increasing BMI. Although similar in the anteroposterior direction, males tended to have on average 12mm wider proximal tibias in the mediolateral direction. Clinical observations of increased post-operative complications trend with these findings. The future of research into biomechanics of obesity will rely heavily on anatomic models of the obese lower extremities, which until this work did not exist.
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Evidence-Based Guidelines for Prevention of Inadvertent Hypothermia in Total Joint ArthroplastyMorris, Courtney A. January 2024 (has links)
No description available.
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Osteonecrosis in children, adolescents and young adults treated for cancerNiinimäki, R. (Riitta) 14 January 2014 (has links)
Abstract
Treatment-related late effects have increasingly become important, since the majority of children, adolescents and young adults with cancer become long-term survivors. Osteonecrosis (ON) is recognized as a potential debilitating sequel in patients with cancer.
The aims of this work were to define the incidence of and clinical risk factors for ON identified with end-of-therapy magnetic resonance imaging (MRI) screening among patients with childhood cancer and to investigate the incidence of and risk factors for ON requiring total joint arthroplasty (TJA) in patients treated for cancer in childhood, adolescence or young adulthood in a register-based study.
MRI of the lower extremities revealed ON in 23 (24%) of the 97 patients with acute lymphoblastic leukemia (ALL) at the end of treatment. High body mass index, female gender, older age at diagnosis, and higher cumulative dexamethasone dose were independent risk factors for ON. Six of the 32 patients (19%) treated for lymphoma or solid tumor had ON in MRI scans at the end of the treatment. All of these patients with ON had non-Hodgkin lymphoma or Hodgkin lymphoma.
In a register-based study, patients diagnosed with cancer before 31 years of age were identified from the Finnish and Danish Cancer registries. These data were combined with data from the National Hospital Discharge and the Finnish Arthroplasty registers. The cohort consisted of 6,358 patients diagnosed with hematologic malignancy and 18,542 patients diagnosed with solid tumor from 1975 to 2000 in Finland and from 1975 to 2006 in Denmark. The estimated cumulative incidence of TJA was 4.5% at 20 years for patients treated for chronic myeloid leukemia, followed by 2.1% for patients treated for acute myeloid leukemia and 0.4% for patients treated for ALL. Allogeneic stem cell transplantation increased the risk of TJA.
In conclusion, ON as determined with MRI is a common complication in children after treatment for ALL. High BMI was identified as a new significant risk factor for ON in patients with pediatric ALL. The incidence of ON requiring TJA was highest among children, adolescents and young adults treated for myeloid leukemias. / Tiivistelmä
Syöpähoitojen aiheuttamien myöhäisvaikutusten merkitys on viime vuosina kasvanut, koska suuri osa lapsena tai nuorena aikuisena syöpään sairastuneista paranee. Syöpähoitojen seurauksena voi syntyä luukuolioita, jotka heikentävät merkittävästi elämänlaatua ja liikuntakykyä.
Tämän väitöskirjatyön tarkoituksena oli selvittää magneettitutkimuksella luukuolioiden ilmaantuvuus ja riskitekijät syöpähoitojen lopetusvaiheessa lapsuusiän syövän sairastaneilla sekä selvittää rekisteritutkimuksella tekonivelleikkausta vaativan luukuolion ilmaantuvuus ja riskitekijät lapsena tai nuorena aikuisena hoidetuilla syöpäpotilailla.
Akuutin lymfaattisen leukemian (ALL) sairastaneista 23/97:lla (24 %) todettiin alaraajojen magneettitutkimuksessa luukuolioita. Korkea painoindeksi, naissukupuoli, vanhempi ikä diagnoosihetkellä ja suurempi kumulatiivinen deksametasoniannos lisäsivät luukuolion todennäköisyyttä. Lymfooman tai kiinteän kasvaimen sairastaneista 6/32:lla (19 %) todettiin luukuolioita.
Tutkimme tekonivelleikkausta vaativan luukuolion ilmaantuvuutta Suomen ja Tanskan väestöpohjaisten rekistereiden avulla. Tutkimuskohorttimme muodostui 6 358 leukemiaan ja lymfooman sekä 18 542 kiinteään kasvaimeen Suomessa ja Tanskassa alle 31-vuotiaana sairastuneesta potilaasta. Tekonivelleikkausta vaativan luukuolion kumulatiivinen ilmaantuvuus 20 vuoden seurannan aikana oli kroonisen myelooisen leukemian sairastaneilla 4,5 %, akuutin myelooisen leukemian sairastaneilla 2,1 % ja ALL:n sairastaneilla 0,4 %. Allogeeninen kantasolujen siirto lisäsi luukuolioiden todennäköisyyttä.
Tässä väitöskirjatyössä osoitettiin, että ALL:n sairastaneilla lapsilla magneettitutkimuksella todetut luukuoliot ovat yleinen haittavaikutus. Korkea painoindeksi on luukuolioiden uusi merkittävä riskitekijä. Tutkimus antoi myös uutta tietoa tekonivelleikkausta vaativan luukuolion ilmaantuvuudesta ja riskitekijöistä lapsuusiällä tai nuorella aikuisiällä syövän sairastaneilla.
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Recommending an ERAS Guideline for Patients Undergoing Total Joint ArthroplastyKnapke, Kahl January 2024 (has links)
No description available.
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Identification of patients at risk of poor outcomes following hip or knee arthroplastyLungu, Eugen 12 1900 (has links)
Les arthroplasties totales de la hanche (ATH) et du genou (ATG) sont souvent offertes aux patients atteints de dégénérescence articulaire sévère. Bien qu’efficace chez la majorité des patients, ces interventions mènent à des résultats sous-optimaux dans de nombreux cas. Il demeure difficile d’identifier les patients à risque de résultats sous-optimaux à l’heure actuelle. L’identification de ces patients avant la chirurgie pourrait permettre d’optimiser la gamme de soins et de services offerts et de possiblement améliorer les résultats de leur chirurgie. Ce mémoire a comme objectifs : 1) de réaliser une revue systématique des déterminants associés à la douleur et aux incapacités fonctionnelles rapportées par les patients à moyen-terme suivant ces deux types d’arthroplastie et 2) de développer des modèles de prédiction clinique permettant l’identification des patients à risque de mauvais résultats en terme de douleur et d’incapacités fonctionnelles suivant l’ATH et l’ATG.
Une revue systématique de la littérature identifiant les déterminants de la douleur et de la fonction suivant l’ATH et l’ATG a été réalisée dans quatre bases de données jusqu’en avril 2015 et octobre 2014, respectivement. Afin de développer un algorithme de prédiction pouvant identifier les patients à risque de résultats sous-optimaux, nous avons aussi utilisé des données rétrospectives provenant de 265 patients ayant subi une ATH à l’Hôpital Maisonneuve-Rosemont (HMR) de 2004 à 2010. Finalement, des données prospectives sur 141 patients recrutés au moment de leur inclusion sur une liste d’attente pour une ATG dans trois hôpitaux universitaires à Québec, Canada et suivis jusqu’à six mois après la chirurgie ont permis l’élaboration d’une règle de prédiction clinique permettant l’identification des patients à risque de mauvais résultats en terme de douleur et d’incapacités fonctionnelles.
Vingt-deux (22) études d’une qualité méthodologique moyenne à excellente ont été incluses dans la revue. Les principaux déterminants de douleur et d’incapacités fonctionnelles après l’ATH incluaient: le niveau préopératoire de douleur et de fonction, un indice de la masse corporelle plus élevé, des comorbidités médicales plus importantes, un état de santé générale diminué, une scolarité plus faible, une arthrose radiographique moins sévère et la présence d’arthrose à la hanche controlatérale. Trente-quatre (34) études évaluant les déterminants de douleur et d’incapacités fonctionnelles après l’ATG avec une qualité méthodologique moyenne à excellente ont été évaluées et les déterminants suivant ont été identifiés: le niveau préopératoire de douleur et de fonction, des comorbidités médicales plus importantes, un état de santé générale diminué, un plus grands niveau d’anxiété et/ou de symptômes dépressifs, la présence de douleur au dos, plus de pensées catastrophiques ou un faible niveau socioéconomique.
Pour la création d’une règle de prédiction clinique, un algorithme préliminaire composé de l’âge, du sexe, de l’indice de masse corporelle ainsi que de trois questions du WOMAC préopératoire a permis l’identification des patients à risque de résultats chirurgicaux sous-optimaux (pire quartile du WOMAC postopératoire et percevant leur hanche opérée comme artificielle avec des limitations fonctionnelles mineures ou majeures) à une durée moyenne ±écart type de 446±171 jours après une ATH avec une sensibilité de 75.0% (95% IC: 59.8 – 85.8), une spécificité de 77.8% (95% IC: 71.9 – 82.7) et un rapport de vraisemblance positif de 3.38 (98% IC: 2.49 – 4.57).
Une règle de prédiction clinique formée de cinq items du questionnaire WOMAC préopratoire a permis l’identification des patients en attente d’une ATG à risque de mauvais résultats (pire quintile du WOMAC postopératoire) six mois après l’ATG avec une sensibilité de 82.1 % (95% IC: 66.7 – 95.8), une spécificité de 71.7% (95% IC: 62.8 – 79.8) et un rapport de vraisemblance positif de 2.9 (95% IC: 1.8 – 4.7).
Les résultats de ce mémoire ont permis d’identifier, à partir de la littérature, une liste de déterminants de douleur et d’incapacités fonctionnelles après l’ATH et l’ATG avec le plus haut niveau d’évidence à ce jour. De plus, deux modèles de prédiction avec de très bonnes capacités prédictives ont été développés afin d’identifier les patients à risque de mauvais résultats chirurgicaux après l’ATH et l’ATG. L’identification de ces patients avant la chirurgie pourrait permettre d’optimiser leur prise en charge et de possiblement améliorer les résultats de leur chirurgie. / Total joint arthroplasties (TJA) are commonly performed procedures for patients afflicted with hip and knee osteoarthritis (OA), and although successful, these surgeries can yield suboptimal results in a non-negligible proportion of patients. In order to improve surgical outcomes, patients at risk of poor results could be targeted with focused interventions. However, the evidence regarding the ability to identify which patients are at risk of poor outcomes is scarce. The objectives of this memoir were 1) to systematically review the literature of preoperative determinants of medium-term patient-reported pain and physical function after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and 2) to develop clinical prediction models allowing the individual identification of patients at risk of poor outcomes following THA and TKA.
Systematic literature searches targeting studies evaluating all studied determinants of pain and function following THA and TKA were performed in four important databases until April 2015 and October 2014 respectively. Moreover, retrospective data from 265 patients having undergone THA at the Hôpital Maisonneuve-Rosemont from 2004 to 2010 was used to develop a preliminary prediction algorithm (PA) to identify patients at risk of poor surgical results. Finally, prospective data from 141 patients recruited at their inclusion on a preoperative waitlist for TKA in three hospitals in Québec City, Canada and followed 6 months postoperatively was used to develop a clinical prediction rule (CPR) to identify patients at risk of poor outcomes
Twenty-two (22) studies evaluating determinants of poor pain and function after THA with moderate-to-excellent methodological quality found that preoperative levels of pain and function, higher body mass index (BMI), greater medical comorbidities, worse general health, lower education level, lower OA radiographic severity and contralateral hip OA were consistently associated with poor THA outcomes. Thirty-four (34) studies evaluating determinants of poor pain and function after TKA with moderate-to-excellent methodological quality identified preoperative levels of pain and function, greater medical comorbidity, lower general health, greater levels of depression and/or anxiety, presence of back pain, greater pain catastrophizing and greater socioeconomic deprivation as consistently associated with worse outcomes.
A preliminary PA consisting of age, gender, BMI and three items of the preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was able to identify patients at risk of suboptimal outcomes (worst quartile of the postoperative WOMAC score and perceiving their operated hip as artificial with minor or major limitations) on an average±standard deviation (SD) of 446±171 days after THA with a sensitivity of 75.0% (95% CI: 59.8 – 85.8), a specificity of 77.8% (95% CI: 71.9 – 82.7) and a positive likelihood ratio of 3.38 (98% CI: 2.49 – 4.57). A CPR consisting of five items of the preoperative WOMAC was able to predict the identity of patients awaiting TKA at the highest risk of poor outcomes (worst quintile of the postoperative WOMAC score) six months postoperatively with a sensitivity of 82.1 % (95% CI: 66.7 – 95.8), a specificity of 71.7% (95% CI: 62.8 – 79.8) and a positive likelihood ratio of 2.9 (95% CI: 1.8 – 4.7).
This memoir led to the identification of a list of determinants of pain and disability following TKA and THA with the highest level of evidence to date. Moreover, two clinical prediction models with good predictive capabilities were developed in order to allow the identification of patients at risk of poor outcomes following TKA and THA. These findings could help target the patients most likely to benefit from interventions aimed at diminishing their risk profile and improving surgical outcomes of hip or knee arthroplasties. External validation of these rules is warranted before clinical implementation.
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SYSTEMATIC REVIEW OF OUTCOMES OF TOTAL JOINT REPLACEMENT CLASS PARTICIPATIONFisher, Emily Kay 09 May 2013 (has links)
No description available.
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Final Scholarly Project: A Systematic Record Review of a Local Quality Improvement Impacts on Anesthesia Provider Knowledge and Attitudes Following a Presentation of Current Evidence-Based Practices Involving Intrathecal Mepivacaine Use in Total Joint Arthroplasty Surgical PatientsMcClellan, Kevin 02 May 2023 (has links)
No description available.
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