BackgroundAnnually 8500 total knee arthroplasty (TKA) are performed in Denmark. About 80% of this population is overweight or obese. The present material is part of a longitudinal randomized study (ClinicalTrial.gov: NCT01469403).ObjectivesTo investigate whether it is feasible and safe to implement an intensive weight loss program in order to reduce preoperative body weight of obese patients before TKA surgery. The primary aim of the Weight Loss Intervention before Total Knee Arthroplasty (WITKA) study is to investigate whether weight loss interventions before total knee arthroplasty (TKA) will improve QoL and physical function 1 year after surgery.MethodsWe conducted a single-blind, randomized study. Eligible patients were scheduled for TKA due to osteoarthritis (OA) of the knee and obesity (BMI ≥30kg/m2). Participants were randomized to either a control group that followed the standard care or a weight loss group that followed a low-energy diet (810 kcal/day) 8 weeks before surgery. Outcomes were assessed before intervention for the weight loss group, and within 1 week preoperatively for both the weight loss group and the control group. The primary outcome in the WITKA study was the Short-Form 36 (SF-36). Secondary outcomes were Knee injury and Osteoarthritis Outcome Score (KOOS), 6 Minutes' Walk Test, and body composition.ResultsIncluded were 77 patients (weight loss group n=38; control group n=39), 71% were females, the mean age was 65 years (range 46-85), and the average BMI was 31. The average weight loss after 8 weeks was 10.7 kg (10% of body weight). According to dual energy X-ray absorptiometry (DXA), the weight loss consisted of a 6.7 kg reduction in fat mass, a 3.0 kg reduction in lean body mass, and lean body mass increased by 2.3%. In addition, cholesterol decreased and systolic blood pressure decreased by 12 mm/Hg. The intensive diets had few and mild adverse effects. Serious cardiac complications were found in two cases in the intervention group and in one case in the control group. All three patients later underwent TKA without complications. No perioperative complications were recorded in any group.ConclusionsOur results suggest that it is feasible and safe to implement an intensive weight loss program shortly before TKA.ReferencesMessier SP, Gutekunst DJ, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum. 2005;52(7):2026–32Bliddal H, Leeds AR, Stigsgaard L, Astrup A, Christensen R. Weight loss as treatment for knee osteoarthritis symptoms in obese patients: 1-year results from a randomised controlled trial.Liljensøe A, Lauersen JO, Søballe K, Mechlenburg I. Overweight preoperatively impairs clinical outcome after knee arthroplasty: a cohort study of 197 patients 3–5 years after surgery. Acta Orthop. 2013;84(4):392–7.AcknowledgementsThe Danish Rheumatism Association; Linak A/S; Fabrikant Mads Clausens foundation Danfoss; Johs. M. Klein and wife foundation; Knud and Edith Eriksens foundation; Peter Ryholts foundati...
Introduction
Patients undergoing major cardiothoracic or abdominal surgery are at increased risk of developing post‐operative pulmonary complications (PPC), but respiratory physiotherapy can prevent PPC. We have previously developed the PPC Risk Prediction Score to allocate physiotherapists' resources and stratify patients into three risk groups. In this study, we performed a temporal external validation of the PPC Risk Prediction Score. Such validation is rare and adds to the originality of this study.
Methods
A cohort of 360 patients, admitted to undergo elective cardiothoracic or abdominal surgery, were included. Performance and clinical usefulness of the PPC Risk Prediction Score were estimated through discrimination, calibration and clinical usefulness, and the score was updated.
Results
The score showed c‐statistics of 0.62. Related to clinical usefulness, a cut point at 8 gave a sensitivity of 0.49 and a specificity of 0.70, whereas a cut point at 12 gave a sensitivity of 0.13 and a specificity of 0.95. Two predictors included in the development sample score, thoraco‐abdominal incision odds ratio (OR) 2.74 (1.12;6.71) and sternotomy OR 2.09 (1.18;3.72), were statistically significantly associated to PPC in the validation sample.
Conclusions
The score was not able to discriminate between patients with and without PPC; neither was the updated score, but the study identified clinically relevant risk factors for developing PPC.
Background and purpose: Dual mobility (DM) articulation total hip arthroplasty (THA) is used increasingly to reduce dislocation risk. We investigated cup fixation, polyethylene (PE) wear, serum chromium and cobalt ions, and their correlation to physical activity in patients with DM cups at 6-year follow-up.Patients and methods: In a patient-blinded RCT, 60 patients with hip osteoarthritis at a median age of 74 years (70–82) were randomly allocated to cemented (n = 30) or cementless hydroxyapatite-coated (n = 30) fixation of Avantage DM THA with a highly-crosslinked vitamin-E PE liner. Cup migration and PE wear were measured with radiostereometric analysis (RSA), chromium and cobalt ions were measured in serum, and physical activity was measured with accelerometers.Results: At 6-year follow-up, proximal cup migration was similar: 0.14 mm (95% CI 0.01–0.28) for cemented cups and 0.21 mm (0.02–0.39) for cementless cups. The PE wear rate from 1- to 6-year follow-up was also similar: 0.06 mm/year (0.04–0.09) for cemented cups and 0.07 mm/year (0.04–0.11) for cementless cups. Serum metal ion levels were undetectable or very low. Physical activity was mainly low intensity and did not correlate to PE wear rate or cup migration.Conclusion: Cemented and cementless DM cups with highly crosslinked vitamin-E infused liners have similar cup migration and PE wear when used for primary THA surgery.
Background and purpose: Hip precautions are routinely prescribed to patients with osteoarthritis to decrease dislocation rates after total hip arthroplasty (THA) using a posterior approach. However, recommendations have been based on very low certainty of evidence. We updated the evidence on the influence of hip precautions on early recovery following THA by this systematic review.Materials and methods: We performed systematic searches for randomized controlled trials (RCT) and non-randomized (NRS) studies in MEDLINE, Embase, PEDro, and CINAHL published from 2016 to July 2022. 2 reviewers independently included studies comparing postoperative precautions with minimal or no precautions, extracted data, and assessed the risk of bias. Random effects meta-analyses were used to synthesize the results. The certainty of the evidence was rated by the Grading of Recommendations Assessment and Evaluation approach. The critical outcome was the risk of hip dislocations within 3 months of surgery. Other outcomes were long-term risk of dislocation and reoperation, self-reported and performance-based assessment of function, quality of life, pain, and time to return to work.Results: 4 RCTs and 5 NRSs, including 8,835 participants, were included. There may be no or negligible difference in early hip dislocations (RCTs: risk ratio [RR] 1.8, 95% confidence interval [CI] 0.6–5.2; NRS: RR 0.9, CI 0.3–2.5). Certainty in the evidence was low for RCTs and very low for NRSs. Finally, precautions may reduce the performance-based assessment of function slightly, but the evidence was very uncertain. For all other outcomes, no differences were found (moderate to very low certainty evidence).Conclusion: The current evidence does not support routinely prescribing hip precautions post-surgically for patients undergoing THA to prevent hip dislocations. However, the results might change with high-quality studies.
Developmental dysplasia of the hip (DDH) is a common condition involving instability of the hip with multifactorial etiology. Early diagnosis and treatment are critical as undetected DDH is an important cause of long-term hip complications. Better diagnostics may be achieved through genetic methods, especially for patients with positive family history. Several candidate genes have been reported but the exact molecular etiology of the disease is yet unknown. In the present study, we performed whole exome sequencing of DDH patients from 28 families with at least two affected first-degree relatives. Four genes previously not associated with DDH (METTL21B, DIS3L2, PPP6R2, and TM4SF19) were identified with the same variants shared among affected family members, in more than two families. Among known association genes, we found damaging variants in DACH1, MYH10, NOTCH2, TBX4, EVC2, OTOG, and SHC3. Mutational burden analysis across the families identified 322 candidate genes, and enriched pathways include the extracellular matrix, cytoskeleton, ion-binding, and detection of mechanical stimulus. Taken altogether, our data suggest a polygenic mode of inheritance for DDH, and we propose that an impaired transduction of the mechanical stimulus is involved in the etiopathological mechanism. Our findings refine our current understanding of candidate causal genes in DDH, and provide a foundation for downstream functional studies.
(1) Background: Metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) was presumed to provide superior functional outcomes compared to metal-on-polyethylene (MoP) THA. (2) Methods: We compared muscle mass, power, step test asymmetry, and patient-reported outcomes between MoM THA/HRA and MoP THA. A total of 51 MoM THA/HRAs and 23 MoP THAs participated in the cross-sectional study at a mean of 6.5 (2.4–12.5) years postoperatively. Muscle mass was measured by Dual energy X-ray Absorption (DXA) scans and muscle power in a Leg Extensor Power Rig. Step test asymmetry was obtained with an Inertial Measurement Unit (IMU). The patients completed the Harris Hip Score (HHS) and the Copenhagen Hip and Groin Outcome Score (HAGOS). (3) Results: The MoM THA/HRA group had a greater inter-limb difference in hip muscle mass compared to the MoP THA group (p = 0.02). Other inter-limb differences in muscle mass and power were similar (p > 0.05). Muscle mass of the thigh and calf area and muscle power in both legs were higher in MoM THA/HRA compared to MoP THA (p < 0.009). Step test time asymmetry when ascending was lower in MoM THA/HRA compared to MoP THA (p = 0.03). HHS and HAGOS scores were similar between groups (p > 0.05). (4) Conclusion: Overall, we could not verify the hypothesis that MoM THA/HRA contributes to superior functional outcomes compared to MoP THA.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.