No description available.

No description available.

No description available.

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.

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.

No description available.

No description available.

6 Abstract Title: Comparison of Movement Activity and Sport between Patients after Resurfacing and Total Hip Replacement Surgery Objectives: To summarize the available information about after-surgery regime and self- sufficiency after total hip replacement. To accent the differences between resurfacing and total hip replacement. To obtain the information about sport behavior and movement activity of patients after resurfacing and total hip surgery using questionnaire survey. To find out if they are able to return back to sport sctivity and how much do the total hip replacement limits them, to find out how the pain influences their movement activity. To compare the movement activity of patients after resurfacing with patients after total hip surgery. Methods: Thesis is worked out using quality assessment of information obtained by empiric way - using questionnaire survey. Results are processed using MS Excel into charts and graphs. Results: The objective of clear justification of advantages of hip resurfacing as a surgery method providing early return to movement activity has not been met. However the results cannot be simply generalized because of limited amount of respondents. Keywords: hip, total joint replacement, movement activity, sport

Ultra-high molecular weight polyethylene (UHMWPE) is used worldwide as a bearing material in total joint replacement prostheses. Despite its excellent biocompatibility and high wear resistance, wear of UHMWPE components continues to be a major problem limiting the clinical lifespan of UHMWPE-containing orthopaedic implant devices. Multi-directional motion or cross-path motion is known to affect wear rates of UHMWPE in total knee and hip replacement prostheses. The purpose of this study was to quantify the effect of counterface roughness on the cross-path wear of UHMWPE and to determine if the previously established unified theory of wear model could accurately predict wear rates in an abrasive wear environment. UHMWPE pins were articulated against both smooth (centerline roughness, Ra, of 0.015 µm) and rough (Ra = 0.450µm) cobalt-chromium counterfaces in a series of six rectangular wear paths (width = A, length = B) with systematically increasing aspect ratios (B/A) and linear tracking (A = 0), all with identical path lengths (20mm) per cycle. Gravimetric weight loss was converted into volumetric wear rates and wear factors, k. The results showed that for both smooth and rough-counterface tests, wear reached a maximum when a 3mmx7mm wear path was employed. The unified theory of wear was generally accurate in predicting wear rates; however, for rough-counterface tests there was a larger increase in the wear factor for higher aspect ratio rectangular wear paths. The ratio [k rough/ k smooth] decreased monotonically as a function of increasing width of rectangles, normalized by total path length, or A/(A +B). This study showed that wear of UHMWPE articulating in a rectangular motion path likely occurs via a two-step mechanism beginning with molecular orientation followed by material fracture from the UHMWPE surface. The models inability to accurately predict UHMWPE wear for rectangular paths with lower aspect ratios suggests that there may be other operative wear mechanisms including significant re-orientation in the perpendicular sliding direction. In conclusion, it is possible to predict the wear behavior of UHMWPE using mathematical models. A robust model would have an important role in characterizing and predicting performance of currently used and potential future orthopaedic implant materials.

Managing postoperative pain continues to be a challenging public health problem. The organization under study was experiencing a prolonged length of hospital stay (LOS) in the post-total knee and hip replacement surgery population that was causing system-wide patient flow issues. The purpose of this quality improvement project was to educate patients through an established education class on pain expectations, strategies on managing pain, discharge planning, and physical therapy expectations with a goal of reducing pain and LOS. The health belief model was used as a guide to incorporate new content into the educational program that addressed patient knowledge on pain, concerns, fears, and misconceptions related to surgery. New content was added to the class on strategies to improve postoperative pain to help the organizational need to meet 2- to 3-day LOS. The project compared differences in pain levels and LOS in participants who completed the preoperative education and those who did not. The project methodology was a retrospective nonexperimental pretest and posttest design, and a quantitative analysis was used to compare pain levels measured by visual analog scale in documented charts during hospital stay. LOS was measured from data collected from chart review. The findings revealed lower pain levels during the hospital stay of those who completed the educational program. The patients who did not attend the class had an average mean LOS of 5 days as compared to 3 days LOS for those who attended the preoperative class. The project impacts social change on an organizational level by demonstrating that patients undergoing joint replacement surgery benefit from the revised educational plan, which results in early mobility, better pain control, and decreased LOS.