Haut PDF The wait for total hip replacement by patients with osteoarthritis

The wait for total hip replacement by patients with osteoarthritis

The wait for total hip replacement by patients with osteoarthritis

Research has demonstrated that the burden of pain and disability could be reduced by ordering waiting lists for THR and Total Knee Replacement (TKR) with respect to severity of disease ([r]

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Wait Times to Rheumatology and Rehabilitation Services for Persons with Arthritis in Quebec

Wait Times to Rheumatology and Rehabilitation Services for Persons with Arthritis in Quebec

begin appropriate treatment 87 . However, our study suggests that almost 60% of persons with new onset RA are not being seen by rheumatologists within three months post-referral, which means that their total wait time is much longer than current standards. Moreover, even among those Presumed RA scenarios who did receive an appointment within three months, there is still the time to referral to consider. This is extremely problematic. Nevertheless the wait time to see a rheumatologist may be the most amenable to improvement since rheumatologists strongly advocate for the need to see persons with RA as soon as possible (and according to a Canadian survey, try to see such patients within 2 weeks) 7 . A possible strategy to decrease the wait time may be the establishment of a standardized model of triage or guidelines to ensure that referrals are completed and appointments are obtained in a prompt fashion. This is being piloted in more than one centre in Quebec 103 . Increasing patient and family physician awareness regarding the importance of early access to rheumatology care is vital for persons with RA.
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Knee and hip intra-articular adipose tissues (IAATs) compared with autologous subcutaneous adipose tissue: a specific phenotype for a central player in osteoarthritis

Knee and hip intra-articular adipose tissues (IAATs) compared with autologous subcutaneous adipose tissue: a specific phenotype for a central player in osteoarthritis

(n=5) undergoing surgery for total knee or hip replacement at Henri Mondor Hospital (Créteil, France). Sequential patients from whom informed consent was obtained were included. Surgeons harvested the IFP with the synovial membrane lining its posterior surface and the SPFP during knee replacement or AFP located in the bottom of acetabular fossa during hip replacement. The SCAT

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Total Joint Replacement after Glucosamine Sulphate Treatment in Knee Osteoarthritis: Results of a Mean 8-Year Observation of Patients from Two Previous 3-Year, Randomised, Placebo-Controlled Trials

Total Joint Replacement after Glucosamine Sulphate Treatment in Knee Osteoarthritis: Results of a Mean 8-Year Observation of Patients from Two Previous 3-Year, Randomised, Placebo-Controlled Trials

While it was impossible to estimate how many patients had access to glucosamine or other putative OA-specific medications during the follow-up in the Study 2 cohort, and this is clearly a limitation, retrospective information could be collected for the last year of follow-up in a subset of patients from Study 1. Actually, four patients only had re- ceived any glucosamine preparation in this patient subset and they belonged to the minority of less than 20% patients receiving any so-called chondroprotectives or slow-acting symptomatic agents during the last year of follow-up, with- out differences between groups. Conversely, patients for- merly on glucosamine sulphate had used approximately half analgesics and NSAIDs than those in the original pla- cebo group, which would suggest an overall better control of the disease symptoms in agreement with the results of the primary outcome. This was also in agreement with a lower use of other health resources and a better global pharmacoeconomic performance for patients who had re- ceived glucosamine sulphate. Such pharmacoeconomic data are limited by being obtained only in a subset of pa- tients and referring only to the last year of follow-up. For this latter reason they could not include the costs of TJR, whose incidence was assessed over the entire observation period. However, any cost analysis that included the costs of surgery would produce an even higher favourable effect of the previous treatment with glucosamine sulphate, given the results of the primary outcome of the present study. Such pharmacoeconomic outcome would not change even if the modest cost of this particular formulation of glu- cosamine sulphate (which is a patented prescription drug in Europe) is taken into account for the 3-year average treat- ment duration, the expense for which should be spread over the average 8 years of observation.
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The reliability of the anterior pelvic plane for computer navigated acetabular component placement during total hip arthroplasty: Prospective study with the EOS imaging system

The reliability of the anterior pelvic plane for computer navigated acetabular component placement during total hip arthroplasty: Prospective study with the EOS imaging system

Two measurements were performed by two independent observers (a surgeon and a radiologist) and two successive measurements were performed at 1-month interval by the same observer for the 10 first patients. The mean differences (d), the standard deviation (SD) and the 95% confidence interval (CI 95%) (equivalent to 2 × SD) were calculated to analyze the data. The correlations between measurements and between observers were evaluated by linear regression for paired samples and the Pearson’s interclass correla- tion coefficient (ICC) between the different series. An ICC of more than 0.8 was considered to be good and confirmed reliability of measurements. Reliability between measurements was evaluated according to the Bland and Altman [11] method by graphically rep- resenting the difference between the 2 measurements (performed by the same observer or 2 independent observers) in relation to the mean measurement.
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Survival at 11 to 21 years for 779 Metasul® metal-on-metal total hip arthroplasties

Survival at 11 to 21 years for 779 Metasul® metal-on-metal total hip arthroplasties

The main objective of this study was to evaluate the survival of the MoM. The main criterion of judgment was the surgical revision. After an analysis of the medical files and the consultation reports, telephone interviews were carried out to contact the patients directly or, failing that, their immediate family (spouse or child) or their attending physician to find out if their patients had revision. In case of revision, the date, reason, and name of the surgeon per- forming the revision were recorded to confirm the cause and the type of procedure performed (cleaning, unipolar, or bipolar revision). These interviews used a standardized questionnaire, and it was performed by three of the authors (RE, GV, and SM). During the interview with the patient and in the absence of revision, the Oxford functional score (Appendix 1) 11,12 was collected. The scores ranged from 60 to 12 points for an asymptomatic hip to a very painful hip with a major functional impairment.
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A prospective randomised multicentre study comparing continuous and intermittent treatment with celecoxib in patients with osteoarthritis of the knee or hip

A prospective randomised multicentre study comparing continuous and intermittent treatment with celecoxib in patients with osteoarthritis of the knee or hip

Secondary end points included the percentage of days with intake of the flare drug, the AUC of the change in the WOMAC total scores between baseline and weeks 2, 6, 12 and 18, and the last assessment divided by the time interval (the last assess- ment was defined as the last observation available for a variable), the WOMAC total scores and subscores between baseline and weeks 2, 6, 12, 18 and 24, and the last assessment, the patient’s and physician’s global assessment of osteoarthritis at weeks 2, 6, 12, 18 and 24, and the last assessment, the number of paracetamol tablets (rescue drug) taken per day, and the number and percentage of patients discontinuing the study drug over time for treatment failure. The incidence of the primary end point in the two treatment arms was further assessed in retrospective analyses according to three stratified groups: previous NSAID use, osteoarthritis of the knee or hip, and the functional capacity class. The percentage of days with intake of the flare drug was defined as the proportion of total days in the treatment period that the patients judged themselves to be in flare and hence took the flare drug (celecoxib 200 mg once daily).
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Factors that impact the sustainability of wait time management strategies for total
joint replacement surgeries in canadian provinces

Factors that impact the sustainability of wait time management strategies for total joint replacement surgeries in canadian provinces

their targets and getting additional funding from the Ministry. Despite these best efforts, this year the program experienced its first deficit in five years. On another note, the available infrastructure was an important element of the strategy in this particular organization. Significant capacity-related issues were mentioned. Although there was a sufficient number of ORs, with 12 OR theatres for seven orthopaedic surgeons, the utilization of OR rooms was not as efficient as it could be, such that certain surgeons would spend half their day sitting in the lounge watching TV when they could have been performing four or five more surgeries that day. One surgeon proposed that all the surgeons could do a “surgical blitz”, either by running double OR rooms exceptionally or by asking the booking clerks to book time for orthopaedic surgeons when other types of surgeons did not need the OR time. However, this was not a sustainable solution because it was too resource-intensive. For one surgeon, the answer was simple: extend arthroplasty days by 25 % to 30 %. The problem with that surgeon’s plan was that other healthcare professionals would also have had to extend their work time by 25 to 30 %.
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Quality of the preoperative medication history for the patients scheduled for total hip replacement or total knee replacement at the CHU of Liege (QAMP-STUDY)

Quality of the preoperative medication history for the patients scheduled for total hip replacement or total knee replacement at the CHU of Liege (QAMP-STUDY)

© Acta Anæsthesiologica Belgica, 2014, 65, n° 3 P.132 ported by the patient to the pharmacist was 5.5 ± 3.8, in- creasing to 8.7 ± 4.5 by using specific questions or by contacting the patient’s community pharmacist. Informa- tion in the medical chart was incomplete for 486 drugs (53.5%). The discrepancies were : drug omission 61.9%, treatment schedule omission 13.8%, dose omission 10.3%, treatment schedule and dose omission 15.0%. Omitted drugs were mainly complementary and alterna- tive medicine products, analgesics and osteoporosis treatments, drugs for obstructive airway diseases, drugs for acids-related disorders, and cardiovascular system drugs (Table 1).
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Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years

Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years

Most studies published in recent years have established a positive impact of HA and KA on HRQOL [ 19 , 20 ]. Disease- specific measures are more accurate for assessing immediate effects, whereas generic measures reveal the long-term effects of an intervention in overall function. All health domains on the SF-36 were superior or similar to those at baseline over a follow-up of 5 years. As one might expect, the physical do- mains (PF, RP, BP, and GH) reveal the largest benefits. In addition, benefit has also been observed in the psychosocial domains (VT, RE, MH, and SF) after HA and KA, even though this may not be the primary goal of surgery. The sta- bilization phase observed from 12 months to 5 years after surgery can be attributed to aging (e.g., an increasing number of comorbidities and multiple sites of OA). However, HRQOL remains above the preoperative level. Logically,
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Unintended Consequences of Strategies Implemented in Canadian Healthcare Organizations to Reduce Wait Times for Elective Hip and Knee Surgeries

Unintended Consequences of Strategies Implemented in Canadian Healthcare Organizations to Reduce Wait Times for Elective Hip and Knee Surgeries

For example, project management uses strategic, tactical and operational planning to achieve a project’s objectives (Goulet, Albert, & Touré, 1996). It also follows specific steps using a variety of governance, management, and administrative activities (Beaudouin, 1984). In project management, control and evaluation activities are used as instruments for adjusting the process or intervention to improve outcomes. However, project management does not include analysis of a project’s potential effects. In healthcare, planning management deals with forces such as healthcare providers, patients’ interest groups, and a variety of other organizations and agencies involved in the healthcare system (Green, 1992). “Priority setting of health interventions is one of the most challenging and difficult issues faced by health policy decision makers around the world” (Youngkong, Kapiriri, & Baltussen, 2009, p. 930). The healthcare planning management process includes implementation, control and evaluation activities (Goulet et al., 1996). Control and evaluation activities are used to analyze the effects of a program or project. The control process compares an intervention’s outcomes with its objectives and with established standards, both of which are used to make changes to improve outcomes (Bergeron, 1986). Evaluation has been studied from different perspectives. However, there is not a single agreed-upon definition, since there are different models of evaluation (Patton, 1982). Moreover, the concept has evolved based on historical and philosophical changes (Guba & Lincoln, 1989).
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Characterization of synovial angiogenesis in osteoarthritis patients and its modulation by chondroitin sulfate

Characterization of synovial angiogenesis in osteoarthritis patients and its modulation by chondroitin sulfate

We have shown a difference of production of pro- inflammatory cytokines (IL-6 and IL-8), pro-angiogenic factor (VEGF) and anti-angiogenic factor (TSP-1) between N/R and I primary SC. These results suggested a shift in the balance of angiogenic factors in favor of the development of neovascularization. IL-6 and IL-8 are the most abundant cytokines found in the synovial fluid of patients with OA and they are considered to play a central role in synovial inflammation [28]. In OA patients, IL-6 production in synovial fluid is correlated with plasma C-reactive protein and with synovial inflam- matory cells infiltration [31]. VEGF is considered as a dominant pro-angiogenic factor which acts early in angiogenesis inducing an increase in blood vessel per- meability and proliferation and migration of endothelial
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BMI-related microstructural changes in the tibial subchondral trabecular bone of patients with knee osteoarthritis

BMI-related microstructural changes in the tibial subchondral trabecular bone of patients with knee osteoarthritis

predisposing factors shows that physiological aging processes contribute to cartilage degeneration. The higher occurrence of knee osteoarthritis in overweight and obese individuals, or those with lower limb misalignment, shows that associated mechanical phe- nomena are important. The role of the subchondral bone in the initiation and progression of osteo- arthritis has already been demonstrated. 2,17,27 Burr and Gallant 2 believe that subchondral bone densifica- tion is not the initiating factor for cartilage degrada- tion and that it does not act in isolation to allow disease progression. The correlation between SCTB microarchitectural changes and weight and the demon- strated temporal relationship, in which SCTB densifica- tion precedes cartilage degeneration, may explain the higher frequency of knee osteoarthritis in younger, overweight patients.
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Tribological behavior of Ti-6Al-4V and Ti-6Al-7Nb Alloys for Total Hip Prosthesis

Tribological behavior of Ti-6Al-4V and Ti-6Al-7Nb Alloys for Total Hip Prosthesis

3.1.1. Microstructure. The samples are mechanically pol- ished and chemically etched with a solution of 3 mL HF, 6 mL HNO 3 , and 100 mL H 2 O for 10 s to reduce the influ- ence of surface hardening. The microstructure of titanium alloy is shown in Figures 3 (a) and 3 (b), respectively. Alloys microstructure consists of globular and acicular 𝛼 grains (white grains) within a matrix containing equiaxial grains 𝛽 (dark grains). The acicular shape of the 𝛼 phase is present in Figure 3 in an arrangement known as basket-weave which characterizes the Widmanst¨atten structure. The microstruc- ture of the Ti-6Al-4V alloy consists of alpha grains (white in the optical micrograph; ( Figure 3 (b)) and lamellar alpha plus beta grains (black in Figure 3 (b)).
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BMI-related microstructural changes in the tibial subchondral trabecular bone of patients with knee osteoarthritis

BMI-related microstructural changes in the tibial subchondral trabecular bone of patients with knee osteoarthritis

movement and changes in the micro-CT parameters due to drying during the scanning process. Each plug was scanned continuously in 7.4 mm thick slices. The voxel size was 7.4 & 7.4 & 7.4 mm. Boundaries and cartilage zones were care- fully excluded to avoid artifacts. The regions of interest (ROI, 8,5 mm in diameter and 5 mm in height) were located in the center of the SCTB of the specimen under the tibial plateau’s subchondral plate, which was excluded from the analysis. The same procedure was used to select all the ROIs in all plugs. The following three-dimensional parameters were used to describe the SCTB structure: bone volume fraction (BV/TV); specific bone surface (BS/BV); trabecular number (Tb.N); trabecular thickness (Tb.Th); trabecular separation (Tb.Sp); trabecular pattern factor (Tb.Pf); degree of architec- tural anisotropy (DA), and structure model index (SMI). Statistical Analysis
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BMI-related microstructural changes in the tibial subchondral trabecular bone of patients with knee osteoarthritis

BMI-related microstructural changes in the tibial subchondral trabecular bone of patients with knee osteoarthritis

predisposing factors shows that physiological aging processes contribute to cartilage degeneration. The higher occurrence of knee osteoarthritis in overweight and obese individuals, or those with lower limb misalignment, shows that associated mechanical phe- nomena are important. The role of the subchondral bone in the initiation and progression of osteo- arthritis has already been demonstrated. 2,17,27 Burr and Gallant 2 believe that subchondral bone densifica- tion is not the initiating factor for cartilage degrada- tion and that it does not act in isolation to allow disease progression. The correlation between SCTB microarchitectural changes and weight and the demon- strated temporal relationship, in which SCTB densifica- tion precedes cartilage degeneration, may explain the higher frequency of knee osteoarthritis in younger, overweight patients.
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Ten-year survival and complications of total knee arthroplasty for osteoarthritis secondary to trauma or surgery: A French multicentre study of 263 patients

Ten-year survival and complications of total knee arthroplasty for osteoarthritis secondary to trauma or surgery: A French multicentre study of 263 patients

number (%) and quantitative variables as mean ± SD and as median (interquartile range, IQR). Quantitative variables were assessed for distribution normality by applying the Shapiro-Wilk test and a graphical method. Flexion and extension ranges at baseline and last follow-up were compared using the Wilcoxon test for paired data. Survival was evaluated by plotting Kaplan-Meier curves and computing the 95% confidence intervals (95% CIs). Between-group comparisons of estimated survival were with the log-rank test. Survival was assessed to the date of revision surgery for implant exchange or last follow-up.
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Use of a biomimetic material stem reduces stress shielding in surface replacement arthroplasty of the hip

Use of a biomimetic material stem reduces stress shielding in surface replacement arthroplasty of the hip

NRC Publications Archive Archives des publications du CNRC This publication could be one of several versions: author’s original, accepted manuscript or the publisher’s version. / La version de cette publication peut être l’une des suivantes : la version prépublication de l’auteur, la version acceptée du manuscrit ou la version de l’éditeur.

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The Sequence of Cyclophosphamide and Myeloablative Total Body Irradiation in Hematopoietic Cell Transplantation for Patients with Acute Leukemia

The Sequence of Cyclophosphamide and Myeloablative Total Body Irradiation in Hematopoietic Cell Transplantation for Patients with Acute Leukemia

A study by McDonald et al. linked circulating cyclophos- phamide metabolites to liver dysfunction during TBI-based transplantation [15] . The metabolism of Cy was found to be highly variable, and increased levels of 1 of the metabolites, carboxyethyl ephosphoramide mustard, was correlated with higher rates of SOS and nonrelapse mortality [15] . Subse- quently, a phase II trial investigated the effect of a person- alized dosing scheme for each patient according to Cy pharmacokinetics [16] . The trial concluded that a personal- ized dosing system led to lower peak bilirubin levels and acute kidney injury; however, nonrelapse and OS rates were similar to controls [16] . These studies demonstrate a vari- ability of Cy exposure using a standard regimen and a com- mon protocol. Altering the sequence of speci fic agents may increase the variability of Cy metabolism and deserves to be speci fically tested.
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Update Consistency for Wait-free Concurrent Objects

Update Consistency for Wait-free Concurrent Objects

The limitations of eventual consistency led to the study of stronger criteria such as strong eventual con- sistency [9]. Indeed, eventual consistency requires the convergence towards a common state without specifying which states are legal. In order to prove the correctness of a program, it is necessary to fully specify which behaviors are accepted for an object. The meaning of an operation often depends on the context in which it is executed. The notion of intention is widely used to specify collaborative editing [10], [11]. The intention of an operation not only depends on the operation and the state on which it is done, but also on the intentions of the concurrent operations. In another solution [12], it is claimed that, it is sufficient to specify what the concurrent execution of all pairs of non-commutative operations should give (e.g. an error state). This result, acceptable for the shared set, cannot be extended to other more complicated objects. In this case, any partial order of updates can lead to a different result. This approach was formalized in [13], where the concurrent specification of an object is defined as a function of partially ordered sets of updates to a consistent state leading to specifications as complicated as the implementations themselves. Moreover, a concurrent specification of an object uses the notion of concurrent
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