1: Arthritis Rheum 2002 Oct;47(5):484-93
Locomotor deficits before and two months after knee arthroplasty.
Ouellet D, Moffet H.
Laval University and CIRRIS, Quebec Rehabilitation Institute, Quebec City,
Canada.
OBJECTIVES: To quantify the locomotor deficits before and 2 months after a total
knee arthroplasty (TKA) in patients with osteoarthritis of the knee, and to
compare pre- and postoperative performance. METHODS: Locomotor capacity of
patients was evaluated using laboratory gait and stair-ascent evaluations
(kinematic and kinetic variables, electromyographic activity of 4 muscles of
both lower limbs, and spatiotemporal parameters), the timed Up & Go (TUG), and
the 6-minute walk (6MW) test. RESULTS: Large locomotor deficits (increased hip
flexion, decreased excursions of the knee and ankle, smaller extensor and flexor
moments of force at the 3 joints, and muscle activation levels lower in all
muscles tested) are still present in patients, particularly in the single-limb
support subphase before and 2 months after TKA. These deficits explain the
slower walk and stair-ascent speeds and a reduced performance at the TUG and 6MW
tests. CONCLUSIONS: These results emphasize the need for more careful followup
and intensive rehabilitation programs in the first months following TKA.
PMID: 12382296 [PubMed - in process]
2: Acta Orthop Scand 2002 Aug;73(4):425-31
Intensive geriatric rehabilitation of hip fracture patients: a randomized,
controlled trial.
Huusko TM, Karppi P, Avikainen V, Kautiainen H, Sulkava R.
Department of Public Health and General Practice, University of Kuopio, Finland.
tiina.huusko@hus.fi
We determined the effect of geriatric rehabilitation of hip fracture patients on
mortality, length of hospital stay, and functional recovery. In a randomized,
controlled intervention study, 243 community dwelling hip fracture patients over
64 years of age were randomly assigned to 2 rehabilitation groups. The
intervention group (n = 120) was referred to a geriatric ward for team
rehabilitation, and the controls (n = 123) to local hospital wards for standard
care. The median length of total hospital stay after a hip fracture operation
was 34 (95% CI 28-38) days in the intervention group and 42 (95% CI 35-48) days
in the control group (p = 0.05). The intervention group recovered instrumental
activities of daily living faster (p = 0.05). Direct costs of medical care
during the first year did not differ remarkably.
Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12358116 [PubMed - indexed for MEDLINE]
3: Clin Biomech (Bristol, Avon) 2002 Oct;17(8):580
Bilateral lower limb strategies used during a step-up task in individuals who
have undergone unilateral total knee arthroplasty.
Byrne J, Gage W, Prentice S.
Gait and Posture Laboratory, University of Waterloo, 200 University Avenue West,
N2L 3G1, Waterloo, ON, Canada
Objective. The purpose of this study was to determine how bilateral lower limb
joint function is altered by the combined effects of osteoarthritis and its
treatment by total knee arthroplasty.Design. Lower limb joint work of
age-matched healthy, control participants was compared to surgical and
non-surgical limb work in individuals who had undergone total knee
arthroplasty.Background. Research investigating outcomes following total knee
arthroplasty has focussed primarily on the surgical knee, identifying deficits
in surgical knee function. The existence of additional lower limb deficits and
adjustments made by unaffected joints to complement these deficits, has yet to
be examined.Methods. Joint moments, power and work were calculated using
bilateral lower limb force and kinematic data collected during a step-up to
heights of 11.25 and 20 cm.Results. Fifty percent of patients were unable to
step onto the 20 cm step. At both step heights, when the surgical limb led the
step-up, surgical knee work was less than controls. When the non-surgical limb
led, deficits in non-surgical lead knee work were observed. In both cases, lead
hip work increased.Conclusions. Work done by both surgical and non-surgical
knees in a step-up task was lower than that done by healthy controls. This
deficit was balanced by increased lead hip extensor work.RelevanceThese findings
highlight the importance of including exercises that optimize bilateral knee and
hip function in rehabilitation programs used following knee replacement.
Clinicians working with this population can use this information to assist in
the design of evidenced based treatment programs.
PMID: 12243717 [PubMed - in process]
4: Aust J Physiother 2002;48(3):234; discussion 234-5
Comment on:
Aust J Physiother. 2002;48(2):73-81.
Bed exercises result in decreased pain with functional activities following hip
arthroplasty. (Comment on Jesudason C and Stiller K, Australian Journal of
Physiotherapy 48: 73-81.).
McEllister C.
Comment
Letter
PMID: 12217074 [PubMed - indexed for MEDLINE]
5: J Clin Nurs 2002 Sep;11(5):634-9
Patients' learning needs after hip arthroplasty.
Johansson K, Hupli M, Salantera S.
Department of Nursing, University of Turku, FIN-20014 Turku, Finland.
kirsi.johansson@utu.fi
The purpose of this study was to describe patients' learning needs after hip
arthroplasty and compare them prior to and 2 weeks after hospital discharge.
Data were collected in two phases from 22 surgical wards in 17 hospitals in
Finland using a Canadian Patient Learning Needs Scale (Galloway et al., 1996).
The first questionnaire (n=212, 81%) was completed before hospital discharge and
the second (n=144, 55%) was completed at home after hospital discharge. Results
indicated that patients' learning needs diminished significantly after hospital
discharge. In both questionnaires patients felt that the most important
information was about complications and symptoms. Information about medication
was ranked the second most important. Demographic variables such as age, gender,
education and working life were clearly related to learning needs. Women over 60
years old, and less educated and retired respondents had many learning needs.
PMID: 12201890 [PubMed - indexed for MEDLINE]
6: Curr Opin Rheumatol 2002 Sep;14(5):536-41
Hip disease in juvenile rheumatoid arthritis.
Spencer CH, Bernstein BH.
In contrast to adult rheumatoid arthritis, hips are commonly affected joints in
severe, destructive, juvenile rheumatoid arthritis (JRA). Hip disease develops
in 30 to 50% of children with JRA. Because of the importance of the hip joint in
weight bearing the advent of hip disease in a child with JRA warns of future
disability [ 1, 2]. The challenges for the clinician are to prevent significant
hip involvement, to halt further damage when hip disease is noted, and in the
event that conservative treatment fails, to guide the child and family through
hip arthroplasty and rehabilitation. Recent trends suggest that today's more
aggressive treatment approach and more effective drugs are resulting in fewer
children with JRA developing into severe hip disease requiring hip surgery.
Similarly, with improvements in orthopedic surgery, the results of hip
arthroplasty have improved.
PMID: 12192251 [PubMed - in process]
7: Klin Med (Mosk) 2002;80(6):39-41
[Proximal hip fractures and their medico-social sequelae]
[Article in Russian]
Men'shikova LV.
The aim of the trial was to study basic osteoporotic fractures in the proximal
femoral bone in persons over 50 in the population of Irkutsk in 1997 as well as
to evaluate short- and long-term outcomes of hip fractures and relevant social
consequences. The mean incidence rate of femoral fractures was 167.1 per 100.000
(male 127.7, female 190.1 per 100,000). Male/female ratio was 1:1.5. Prevalence
of femoral fractures increased in persons over 70 years of age and older, being
maximum at the age over 80. Six months after the fracture 22 of 172 patients
died, the mortality being for males and females 12.8%. To the end of the year
the mortality increased to 23.3%, to the end of the second year--to 32.6% (30.5%
for males and 33.6% for females). Surgical treatment was conducted in 72.7%,
skeletal extension in 37.8%, osteosynthesis in 33.7%, arthroplasty in only 1.2%.
The patients displayed low functional abilities, daily activity and
self-attendance. 6, 12 and 24 months after the treatment 90.7, 74.2 and 60.3%
patients, respectively, required outsider's service. A program must be designed
of osteoporosis prevention and medico-social rehabilitation for patients with
osteoporotic fractures.
PMID: 12138800 [PubMed - indexed for MEDLINE]
8: Health Technol Assess 2002;6(15):1-109
A systematic review of the effectiveness and cost-effectiveness of
metal-on-metal hip resurfacing arthroplasty for treatment of hip disease.
Vale L, Wyness L, McCormack K, McKenzie L, Brazzelli M, Stearns SC.
Health Services Research Unit, Institute of Applied Health Sciences, University
of Aberdeen, UK.
Review
Review, Academic
PMID: 12137721 [PubMed - indexed for MEDLINE]
9: J South Orthop Assoc 1999 Spring;8(1):14-9
Simple, hybrid deep venous thrombosis/pulmonary embolus prophylaxis after total
hip arthroplasty.
Ward WG, Olin MD.
Department of Orthopaedic Surgery, Wake Forest University, Baptist Medical
Center, Winston-Salem, NC 27157-1070, USA.
A 7.1% deep venous thrombosis rate followed total hip arthroplasty in 56
patients using a hybrid prophylactic regimen against deep venous thrombosis and
pulmonary embolus. There were no bleeding complications, no symptomatic
pulmonary emboli, and no unexplained deaths. The regimen consisted of an initial
loading dose of warfarin, usually 10 mg, the night of surgery followed by 2.5
mg/day for 3 weeks, with dosage adjustments only in cases of
over-anticoagulation. This regimen was combined with elevated sling suspension
of the operative leg, bilateral pedal intermittent pneumatic compression
devices, and early mobilization. This prophylactic regimen is simple,
inexpensive, efficacious, and compatible with an early hospital discharge.
PMID: 12132847 [PubMed - indexed for MEDLINE]
10: J South Orthop Assoc 2001 Fall;10(3):140-6
Patient self-testing of prothrombin time after hip arthroplasty.
Engh CA Jr, Culpepper WJ 2nd, Charette PA, Brown R.
Anderson Orthopaedic Research Institute, Alexandra, VA 22307, USA.
We determined whether total hip arthroplasty (THA) patients could test their own
prothrombin time reliably over 6 weeks of anticoagulation prophylaxis with a
portable device that measures prothrombin time and whether self-testing would
improve or maintain the quality of care at a lower cost than our standard
procedure. Forty-six THA patients participated in the study and were compared
with a matched group managed with our standard protocol using a home health-care
nurse. Seven patients (15%) could not be trained to obtain the blood sample, and
others required multiple finger sticks to obtain valid results. However, the
results from the 29 patients completing the study showed high reliability when
compared with results obtained through standard protocol. Self-testing saved
about $260 per patient over the cost of venipuncture. Patient self-testing of
prothrombin time using the device in this study is reliable and cost-effective
for monitoring the anticoagulation status after THA in a select group of elderly
patients.
PMID: 12132825 [PubMed - indexed for MEDLINE]
11: Am J Phys Med Rehabil 2002 Jul;81(7):471-7
Prediction of follow-up living setting in patients with lower limb joint
replacement.
Ottenbacher KJ, Smith PM, Illig SB, Fiedler RC, Gonzales VA, Granger CV.
University of Texas Medical Branch, Galveston, Texas, Galveston, 77555-1028,
USA.
OBJECTIVE: The living setting to which older adults are discharged from medical
rehabilitation has important social and economic implications. This study was
undertaken to develop statistical models to predict living setting after medical
rehabilitation in persons with lower limb joint replacement. DESIGN: Information
submitted from 1994 through 1998 to the Uniform Data System for Medical
Rehabilitation was examined. Hip replacement was experienced by 42% of the
patients, 51% experienced a knee replacement, and 7% received some combination
or other lower limb procedure. RESULTS: Persons with hip replacements were
slightly older than persons with knee replacements and had a longer length of
stay. Logistic regression was used to develop a predictive model based on 60% of
the cases. The model included five statistically significant predictor
variables. CONCLUSION: Cognitive and basic motor function associated with
activities of daily living, age, length of stay, and marital status were
important variables in predicting if older adults would be living at home 80-180
days after rehabilitation for lower limb joint replacement.
PMID: 12131171 [PubMed - indexed for MEDLINE]
12: J Orthop Sports Phys Ther 2002 Jun;32(6):260-7
Outcomes of total hip arthroplasty: a study of patients one year postsurgery.
Trudelle-Jackson E, Emerson R, Smith S.
School of Physical Therapy, Texas Woman's University, Dallas, USA.
ejackson@twu.edu
STUDY DESIGN: Ex post facto research using prospective analysis of differences
between the involved hip and uninvolved hip. OBJECTIVES: To assess outcomes of
total hip arthroplasty (THA) by comparing range of motion (ROM), muscle
strength, and postural stability in the surgical hip to those of the uninvolved
hip 1 year postsurgery. An additional objective was to assess degree of
relationship among ROM, strength, and postural stability impairments to a
measure of self-assessed function. BACKGROUND: Most patients who have THA
receive physical therapy that consists mainly of self-care instructions and an
exercise protocol that emphasizes mobility during the acute phase of recovery.
But, outcomes of THA 1 year postsurgery indicate that current physical therapy
programs used during the acute phase of recovery do not effectively restore
physical and functional performance. METHODS AND MEASURES: Subjects consisted of
11 women and 4 men (mean age +/- standard deviation = 62 +/- 8 years) with
unilateral THA performed 1 year prior to data collection. Assessment variables
consisted of self-assessment of function and measures of postural stability,
muscle strength, and hip ROM. The 12-Item Hip Questionnaire was used for
self-assessment of function. Three separate repeated measures MANOVA were used
to compare the involved side to the uninvolved side in measures of postural
stability, strength, and ROM. The Spearman's rho was used to assess degree of
association between the subjects' score of self-assessed function and
impairments in strength and postural stability. RESULTS: Measures of postural
stability were significantly lower (P < or = 0.01) on the side of the replaced
hip. Differences in strength values between the involved and uninvolved sides
were not statistically significant. Correlations between scores of self-assessed
function and hip abductor and knee extensor strength were statistically
significant (r = 0.56, P < or = 0.03). Self-assessed function was not
significantly correlated to postural stability impairments. CONCLUSION: The
brief postsurgical rehabilitation program received by patients with THA may not
be sufficient. A second phase of rehabilitation implemented 4 months or more
after surgery that emphasizes weight bearing and postural stability may be
advisable.
PMID: 12061707 [PubMed - in process]
13: Acta Orthop Belg 2002 Apr;68(2):128-34
Prevention of thromboembolic disease after non-cemented hip arthroplasty. A
multimodal approach.
Leali A, Fetto J, Moroz A.
Department of Orthopaedic Surgery, New York University Medical Center-Hospital
for Joint Diseases, USA. alex.leali@med.nyu.edu
Thromboembolism following total hip arthroplasty is a common complication that
may result in significant morbidity and mortality. Despite this, optimal
prophylactic regimen is controversial. We investigated the efficacy of a
comprehensive approach encompassing the use of aspirin, intermittent compression
devices ('foot pumps'), and early mobilization in a cohort of 200 consecutive
patients after non-cemented total hip replacements. The surgical procedures were
carried out under epidural anesthesia in most cases (91%). All patients were
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Jacek-Paulina