The aim of the study was to examine the relationship between comorbidities and pain, physical function and health-related quality of life (HRQoL) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). A cross-sectional retrospective survey was conducted including 19 specific comorbidities, administered in patients who underwent THA or TKA in the previous 7–22 months in one of 4 hospitals. Outcome measures included pain, physical functioning, and HRQoL. Of the 521 patients (281 THA and 240 TKA) included, 449 (86 %) had ≥1 comorbidities. The most frequently reported comorbidities (>15 %) were severe back pain; neck/shoulder pain; elbow, wrist or hand pain; hypertension; incontinence of urine; hearing impairment; vision impairment; and cancer. Only the prevalence of cancer was significantly different between THA (n = 38; 14 %) and TKA (n = 52; 22 %) (p = 0.01). The associations between a higher number of comorbidities and worse outcomes were stronger in THA than in TKA. In multivariate analyses including all comorbidities with a prevalence of >5 %, in THA dizziness in combination with falling and severe back pain, and in TKA dizziness in combination with falling, vision impairments, and elbow, wrist or hand pain was associated with worse outcomes in most of the analyses. A broad range of specific comorbidities needs to be taken into account with the interpretation of patients’ health status after THA and TKA. More research including the ascertainment of comorbidities preoperatively is needed, but it is conceivable that in particular, the presence of dizziness with falling, pain in other joints, and vision impairments should be assessed and treated in order to decrease the chance of an unfavorable outcome.

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Between 1990 and 2001, 292 patients with acute Achilles tendon rupture were admitted to our institution. Depending on the day of admission patients were allocated either to the Department of Trauma Surgery or to the Department of Orthopaedics. Two hundred and twelve patients (mean age 37±9.4 years) were treated with surgical suture followed by plaster for 6 weeks. Eighty patients were treated non-surgically with splinting for 12 weeks. For both groups mean follow-up was 6±3 years. There were 14 re-ruptures, ten after surgical repair and four after non-surgical treatment. In the surgical group there were seven major wound problems, 11 minor wound complications and six patients with complaints from the sural nerve. In the non-surgical group one patient suffered a pulmonary embolism after a re-rupture, 3 months after the initial rupture. There was no difference in mean ankle score and patient-satisfaction score between groups. Only 52% regained their original sports activity level, slightly better in the surgically treated group. With a nonsignificant difference in re-rupture rate but relatively more complications after surgical repair, non-surgical treatment is preferred. With a slightly better recovery of sports activity after surgical repair, this might be used as an argument for surgical treatment in young athletes.Résumé Entre 1990 et 2001, 292 malades avec une rupture du tendon d'Achille ont été admis dans notre institution. Selon le jour de l'admission les malades ont été alloués au Département de Traumatologie ou au Départe-ment d'Orthopédie. 212 malades (âge moyen 37±9,4 ans) ont été traité par suture chirurgicale suivie d'un plâtre pour 6 semaines et 80 malades ont été traités conservativement avec attelle pour 12 semaines. Pour les deux groupes la moyenne de suivi était de 6±3 années. Il y avait 14 ruptures itératives, 10 après réparation chirurgicale et quatre après traitement non chirurgical. Dans le groupe chirurgical il y avait sept problèmes majeurs de paroi, 11 complications mineures de paroi et six malades avec souffrance du nerf sural. Dans le groupe non chirurgical un malade a eu une embolie pulmonaire après une rupture itérative, trois mois après la rupture initiale. Il n'y avait aucune différence dans le score moyen de la cheville et le score de satisfaction des malades entre les deux groupes. Seulement 52% ont regagné leur niveau d'activité sportive original, légèrement mieux dans le groupe traité chirurgicalement. Avec une différence non significative dans le taux des ruptures itératives mais relativement plus de complications après réparation chirurgicale, le traitement non -chirurgical est préféré. La récupération sportive légèrement meilleure après réparation chirurgicale est un élément de discussion pour le traitement chirurgical chez les jeunes athlètes.

BackgroundIn the light of both the importance and large numbers of case series and cohort studies (observational studies) in orthopaedic literature, it is remarkable that there is currently no validated measurement tool to appraise their quality. A Delphi approach was used to develop a checklist for reporting quality, methodological quality and generalizability of case series and cohorts in total hip and total knee arthroplasty with a focus on aseptic loosening.MethodsA web-based Delphi was conducted consisting of two internal rounds and three external rounds in order to achieve expert consensus on items considered relevant for reporting quality, methodological quality and generalizability.ResultsThe internal rounds were used to construct a master list. The first external round was completed by 44 experts, 35 of them completed the second external round and 33 of them completed the third external round. Consensus was reached on an 8-item reporting quality checklist, a 6-item methodological checklist and a 22-item generalizability checklist.ConclusionsChecklist for reporting quality, methodological quality and generalizability for case series and cohorts in total hip and total knee arthroplasty were successfully created through this Delphi. These checklists should improve the accuracy, completeness and quality of case series and cohorts regarding total hip and total knee arthroplasty.

Rotational malalignment is recognized as one of the major reasons for knee pain after total knee arthroplasty (TKA). Although Computer Assisted Orthopaedic Surgery (CAOS) systems have been developed to enable more accurate and consistent alignment of implants, it is still unknown whether they significantly improve the accuracy of femoral rotational alignment as compared to conventional techniques. We evaluated the accuracy of the intraoperatively determined transepicondylar axis (TEA) with that obtained from postoperative CT-based measurement in 20 navigated TKA procedures. The intraoperatively determined axis was marked with tantalum (RSA) markers. Two observers measured the posterior condylar angle (PCA) on postoperative CT scans. The PCA measured using the intraoperatively determined axis showed an inter-observer correlation of 0.93. The intra-observer correlation, 0.96, was slightly better than when using the CT-based angle. The PCA had a range of -6 degrees (internal rotation) to 8 degrees (external rotation) with a mean of 3.6 degrees for observer 1 (SD = 4.02 degrees ) and 2.8 degrees for observer 2 (SD = 3.42 degrees ). The maximum difference between the two observers was 4 degrees . All knees had a patellar component inserted with good patellar tracking and no anterior knee pain. The mean postoperative flexion was 113 degrees (SD = 12.9 degrees ). The mean difference between the two epicondylar line angles was 3.1 degrees (SD = 5.37 degrees ), with the CT-based PCA being larger. During CT-free navigation in TKA, a systematic error of 3 degrees arose when determining the TEA. It is emphasized that the intraoperative epicondylar axis is different from the actual CT-based epicondylar axis.