Since 1996, an experimental program in New York City has tried to show that by engaging and helping the families of drug users, the criminal justice system can overcome the limitations of its present focus on punishment and treatment of users alone. The program, La Bodega de la Familia, engages both substance abusers and their family members in family case management and other services as a supplement to probation, parole, or pre-trial supervision. By providing support to the families of drug users in the criminal justice system, Bodega aims to increase the success of drug treatment, reduce the use of incarceration to punish relapse, and reduce the harms addiction causes within families. To evaluate Bodega's impact, researchers at the Vera Institute of Justice compared outcomes for a sample of Bodega participants with outcomes for a comparison group of drug users and their family members. Researchers used standardized interview instruments that measure physical and mental health, family functioning, and social support, when study members entered the research and again six months later. The researchers obtained official arrest and conviction data on each drug user in the study and conducted more detailed, ethnographic interviews with a sub-sample of both the Bodega participants and the comparison group. The research sheds new light on the family dynamics that accompany drug abuse in poor, drug-filled neighborhoods. The average age at which study group members first used a drug other than marijuana was 15. Drug use and dealing were frequently taught by one generation to the next, and often put family members in physical danger. Arrest and incarceration had become so routine among users in the study that almost two-thirds considered their present legal problems to be "not at all important." Even in these conditions, the researchers found that Bodega's family case management made a difference. Family members participating in the program obtained medical and social services they said they needed at significantly higher rates than those in the comparison group, and they showed a significantly stronger sense of being supported emotionally and materially in their social relationships. At the same time, the percentage of Bodega substance abusers using any illegal drug declined from 80 percent to 42 percent, significantly more than in the comparison group. Arrests and convictions were also lower among drug users participating in Bodega over six months. The reduction in drug use was not produced, as originally anticipated, by greater use of drug treatment among Bodega participants, but instead appears to be a direct result of pressure and support from Bodega case managers and family members themselves. The results of the research suggest that Bodega's family case management can be an effective supplement to more traditional criminal justice responses to drug addiction.

INTRODUCTION The aim of this study was to compare the functional outcome between the first and second knee replacement in patients undergoing staged bilateral total knee arthroplasty. METHODS We identified 64 patients who had bilateral knee replacements and had at least one year of postoperative outcome studies. Data on pain scores, walking ability, use of walking aids, range of movement, instability, muscle strength, WOMAC ® (Western Ontario and McMaster Universities) scores, SF-12 (Short Form 12) scores, American Knee Society radiological scores and length of hospital stay (LOS) were recorded. The difference in data between the first and second knee was assessed. RESULTS Groups remained statistically comparable between the first and second operation. Four outcomes showed a significant difference between the second and first knee. The mean score for postoperative walking ability was 4.83 (second knee) vs 4.51 (first knee) (p=0.03). The mean score for postoperative walking aid requirement was 5.73 (second knee) vs 5.46 (first knee) (p=0.01). The mean postoperative SF-12 score was 54.26 (second knee) vs 52.45 (first knee) (p=0.04). The mean LOS was 4.73 days (second knee) vs 6.16 days (first knee) (p=0.05). All other data comparisons were statistically insignificant. CONCLUSIONS Patients have a reduced LOS and continue to improve after the second procedure with regards to walking ability, use of walking aids and psychological wellbeing.

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The Journey-I total knee replacement was designed to improve knee kinematics but had several complications including early dislocation. The Journey-II modification was introduced to reduce these while maintaining high function. To assess whether the modified Journey-II prosthesis has succeeded in its designers aims, we undertook an observational study of prospectively recorded data to analyze and compare the two knees. A total of 217 Journey-I and 129 Journey-II knees were identified from the department's prospectively collated registry and were assessed at 1 year by a comparative statistical analysis using numerous factors including pain, functional activity, physical assessment, Short Form-12 (SF-12), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Oxford scores. The statistical tests included Chi-square, Wilcoxon's rank and Mann–Whitney U-tests with the level of significance set at p < 0.05. There was a variation in primary patella resurfacing between the two groups with 14.3% in the Journey-I cohort and 66.7% in the Journey-II cohort. Both replacements demonstrated excellent postoperative function, but the Journey II performed significantly better than Journey I with fewer complications (37 vs. 10) and better improvement in almost all clinical scores including pain (p < 0.01), mobility outcomes (p = 0.018), Oxford (p = 0.004), and WOMAC (p = 0.039) scores but not with flexion improvement and SF-12 score. There was significant improvement in patellofemoral pain postoperatively in both the Journey I (p = 0.011) and Journey II (p = 0.042) arthroplasty; however the primarily resurfaced patella in a Journey-II implant had better postoperative scores. The main complication of dislocation in the Journey I was not seen in the modified Journey-II implant with stiffness requiring intervention reduced in Journey II. These results suggest that the Journey II has improved short-term clinical outcomes compared with Journey I with reduction of dislocation and other complications.

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