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Bidirectional association between disturbed sleep and neuropathic pain symptoms : a prospective cohort study in post total joint replacement participants

Bidirectional association between disturbed sleep and neuropathic pain symptoms : a prospective cohort study in post total joint replacement participants

Methods: A total of 423 individuals who had undergone total joint replacement (TJR) for osteoarthritis were assessed at the mean time of 3.6 years post-surgery and again at 5.9 years post-TJR, using the Medical Outcomes Survey sleep subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and painDETECT questionnaire instruments. Cox hazard ratios (HRs) and 95% confidence intervals (CIs) were computed adjusting for age, body mass index, sex, and use of hypnotic and analgesic medication.

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Length of stay in hospital and all-cause readmission following elective total joint replacement in elderly men

Length of stay in hospital and all-cause readmission following elective total joint replacement in elderly men

of 41,000 men were identified via the Western Australian electoral roll (voting is mandatory in Australia) and random- ized into invited and control groups of equal size. Of the men who were invited, 12,203 attended the baseline screening in 1996–1999. At baseline, the participants provided detailed health information and study nurses recorded their weight and height. During 2001–2004, the surviving men of the 12,203 initial participants were invited to a follow-up study during which they were weighed a second time. Electronic record linkage was used to identify admissions to hospital (hospital morbidity data) for total joint replacement, inhos- pital postoperative complications, and all-cause readmission in the target population.
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Total joint replacement in the past does not relate to a deteriorated functional level and health status in the oldest old.

Total joint replacement in the past does not relate to a deteriorated functional level and health status in the oldest old.

Gait speed is considered to be an important predictor of functional status and adverse health events [18, 19]. It is also related to functional activities, such as crossing the street [19]. A recently published study confirmed our results of lower gait speed in subjects with a total joint replacement [19]. That study showed slower gait speed in middle aged to elderly patients who received a total hip replacement about 2.5 years before [19]. More severe joint pain is associated with lower gait speed in patients with osteoarthritis (OA) [20]. The group with total joint replacement complained more of joint pain; this could have contributed to the lower gait speed. It was not recorded whether the joint pain complaints came from the left, right, or both sides. A reason why oldest old participants with a joint replacement complained more about joint pain can be the presence of OA in the other lower extremity joints. Since total joint replacement is the end-stage treatment of OA, other joints are likely to be affected by OA as well [21, 22].
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Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

Treatment of Chronic Temporomandibular Joint Pain and Sleep Disordered Breathing by Teledontic and Telegnathic Protocol Utilizing Total Joint Replacement

Orthopedic clinicians frequently encounter patients with temporomandibular joint (TMJ) pain and associated sleep disordered breathing (SDB) that coex- ists with the patient’s orthopedic conditions. The systemic effects and asso- ciated comorbidities caused by TMJ and associated SDB are commonly not recognized as potential contributors to the patient’s long-term orthopedic outcome. This article describes a comprehensive and interdisciplinary medical dental treatment, which was able to successfully address patient’s severe chronic TMJ, head, neck and shoulder pain as well as other health concerns including SDB. Moreover, a new teledontic and telegnathic treatment protocol and principles utilizing total joint replacement for care of patients with chronic TMJ pain and SDB will be introduced describing a completed case.
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Consensus on draft OMERACT core domains for clinical trials of Total Joint Replacement outcome by orthopaedic surgeons: a report from the International consensus on outcome measures in TJR trials (I COMiTT) group

Consensus on draft OMERACT core domains for clinical trials of Total Joint Replacement outcome by orthopaedic surgeons: a report from the International consensus on outcome measures in TJR trials (I COMiTT) group

Total Joint Replacement (TJR) is one of the most common elective procedures performed in the US and worldwide. The rate of utilization of this highly cost effective and clinically successful procedure has, in part, been attributed to the increasing prevalence of osteoarthritis, obesity, and an aging population [1–3]. Despite the recognition that the measurement of pain and function after TJR is very important and the common practice is to assess these outcomes in clinical practice, there is no consensus as to which domains or outcome measures should be included in every TJR trial. Consistency in measurement is essential for enabling valid comparisons between TJR clinical trials and head-to-head studies, which currently is hampered by the heterogeneity of outcome measures [4], and the inabil- ity to pool data for meta-analysis. A TJR outcome Work- ing Group (WG) first met at the OMERACT-9 meeting in 2008 where this critical issue was discussed in detail [5]. Based on the strategy outlined, we have continued the work in this area within our WG for the last 8 years.
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Clinical predictors of elective total joint replacement in persons with end stage knee osteoarthritis

Clinical predictors of elective total joint replacement in persons with end stage knee osteoarthritis

[8]. Surgeons are less likely to prescribe total joint replacement in the presence of cardiovascular or psycho- logical co-morbidities and are more likely to perform total joint replacements on individuals with severe pain, those with radiographic evidence of end-stage cartilage degeneration and for men [4,8-11]. These surveys provide important insight into the rationale of prescribing sur- gery, but they do not reflect the motivations of the patient's decision to undergo TKA. Previous studies that have included a longitudinal assessment of predictive fac- tors from a patient's perspective have utilized a question- naire-based format, which only permits self-perceived assessment of functional ability [12,13]. Self-perceived performance often substantially differs from an individ- ual's actual functional capabilities [14,15].
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Total joint replacement in sub Saharan Africa: a systematic review

Total joint replacement in sub Saharan Africa: a systematic review

There are many patients in sub-Saharan Africa (SSA) suffering from conditions that may benefit from total joint replacement (TJR). However, these countries com- monly do not have adequate resources to offer this ser- vice to all eligible patients. 1 TJR of the hip and knee is performed frequently in high-income countries and evi- dence supports that these procedures are cost-effective. 2 Little is known about the outcomes or the number of TJRs performed in SSA. The age of patients and their indications for TJR differ considerably from those in the developed world and include a larger proportion of patients living with HIV. 3,4 Facilities, resources and training of surgeons and allied health professionals are substantially different from those of a high- income country. 5 It cannot be assumed that outcomes as seen on TJR registries, such as the UK National Joint Registry, will directly transpose to SSA. 4
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The effect of co-morbidities on health-related quality of life in patients placed on the waiting list for total joint replacement

The effect of co-morbidities on health-related quality of life in patients placed on the waiting list for total joint replacement

In Finland, total joint replacements (TJR) are surgical pro- cedures with high volume and long waiting times. In 2003, primary hip and knee replacements were carried out for almost 15500 patients [4]. For patients with primary total joint replacement of hip the median waiting time was 155 days, and for patients with primary total joint replacement of knee, 205 days [4]. One reason for these long waiting times is that OA is not itself life threatening. However, some previous studies have reported that those awaiting hip or knee replacement have a significantly poorer quality of life and that arthritis becomes a chronic and heavy burden to the patients [5,6]. Also few studies having examined waiting time effects on health status in OA patients have not been able to show that patients hav- ing to wait longer would suffer from pain and functional
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Telerehabilitation Feasibility in Total Joint Replacement

Telerehabilitation Feasibility in Total Joint Replacement

Despite documented benefits, many Total Joint Replacement (TJR) patients find it difficult to access rehabilitation following discharge from hospital. One solution to improve access for TJR patients is telerehabilitation. This study aimed to assess the feasibility of introducing a telerehabilitation program for TJR patients. TJR patients at QEII Jubilee Hospital were invited to complete a questionnaire regarding their access, feelings towards and preferences in using technology. Seventy-five patients were recruited. Most patients had computer access (72%) and internet (69%) at home. Sixty-five percent of participants were willing to participate in telerehabilitation. A significant difference was found between older and younger patients. Watching videos on an electronic device was the preferred method for a technology-based home exercise program and phone call the preferred method of communication. Results indicate telerehabilitation in the TJR population is feasible from the perspective of access to, feelings toward, and preferences for technology.
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Clinical relevance of heparin PF4 complex antibody in DVT after total joint replacement

Clinical relevance of heparin PF4 complex antibody in DVT after total joint replacement

laxis after TKA, the prevalence of DVT has been 41% to 85% [4]. In this study, we attempted to lower the inci- dence of DVT by combining a fixed dose of UFH with the intermittent pneumatic compression device. We found the incidence of symptomatic DVT after total joint replacement to be 15.4% overall (16/104) with distal (calf) thrombosis in all cases. The diagnosis of DVT is dif- ficult in the absence of symptoms and consequently it is often under-diagnosed. Venography is the gold standard diagnostic method for DVT [12], but it is difficult to justify its use as a screening tool in all at-risk patients due to its
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Patients and surgeons provide endorsement of core domains for total joint replacement clinical trials

Patients and surgeons provide endorsement of core domains for total joint replacement clinical trials

Using a multistep, data-driven process detailed in pre- vious publications [16–20] that mandated the input and consensus of a number of experts and key stakeholders (including patients), as well as the coleadership of ortho- pedic surgeons, methodologists, and trialists, the OMER- ACT Total Joint Replacement Working Group proposed six core domains that would help to standardize the reporting of TJR clinical trials. Once the core domain set is widely accepted, a validated measure (or more mea- sures) of each core domain can be identified to create a standardized core measurement set using a data-driven, multistakeholder process similar to the process used earlier for core domains. These six domains, collectively labeled the TJR core domain set, include pain, function, patient satisfaction, revision surgery, adverse events, and death [16, 17]. The core domain set is meant to be re- ported in every hip/knee TJR clinical trial. The scope of TJR was limited to THR and TKR for this exercise, but it included all end-stage hip and knee arthritis refractory to medical treatment, including OA and rheumatoid arthritis (RA) [17].
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MOBILE and the provision of total joint replacement

MOBILE and the provision of total joint replacement

Coverage of the ‘political’ aspects of TJR, referred to above, sometimes implies that there is a bottomless pit of need, and that services could never cope with the numbers of people who might benefit from such inter- ventions. This is obviously nonsense, but there had been almost no empirical work done on population- based needs for these procedures in the UK, and those who are responsible for delivering services need such information. We used the Somerset and Avon Survey of Health data-set (SASH) to investigate this. 16,17 The SASH cohort is a cross-sectional survey of a stratified (according to the UK population) random sample of 28,080 individuals aged 35 years and over; from the data obtained in this cohort we esti- mated the requirement for joint replacement on the basis of levels of pain and activity ability (based on the New Zealand priority scoring system – NZ score 7 ), adjusting for evidence of co-morbidity and treatment preferences. We chose the NZ score not because it was well validated as a priority scoring instrument, but because it was the only one available.
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Participation in physical activity in patients 1–4 years post total joint replacement in the Dominican Republic

Participation in physical activity in patients 1–4 years post total joint replacement in the Dominican Republic

Each patient enrolled in the program between 2009–2012 was asked to complete a baseline survey in Spanish that consisted of several reliable and validated measures of health related quality of life, as well as items on demo- graphic features and patient expectations of surgery [29]. Specifically, we used the Pain and Functional Status Scales of the Western Ontario and MacMaster Universities Arthritis Index (WOMAC), re-scaled from 0–100 with 100 being the worst, and the Physical Activity Scale of the Short Form (36-item) Health Survey (SF-36). Patients who underwent bilateral surgery were not asked about each joint individually. Each of these scales has been shown to be reliable, particularly in elderly populations and in persons with OA [30,31]. Crohnbach’s alpha coeffi- cients were previously reported to equal or exceed 0.75 in the Dominican cohort for the WOMAC and SF-36 subscales included in our surveys [10,32]. Regarding expectations, we asked patients to indicate the likeli- hood of pain relief following surgery and the likelihood of a serious complication. Each of these items had five ordinal responses.
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One  and two stage surgical revision of infected elbow prostheses following total joint replacement: a systematic review

One and two stage surgical revision of infected elbow prostheses following total joint replacement: a systematic review

Given the sparse evidence on the topic, our review represents the first attempt at bringing all the evi- dence together using a systematic approach. The search strategy was comprehensive and involved mul- tiple databases, with manual reference scanning and no language restrictions; which made it unlikely that we had missed any relevant study conducted on the topic. Though the data was limited and sparse on outcome measures, harmonisation to consistent com- parisons enabled interpretation of the findings. We took into account the low event rates reported by the majority of the studies. Finally, we conducted a de- tailed assessment of the methodological quality of the included studies based on a well validated tool. There were important limitations to this review and these were all related to the included studies. The included studies recruited participants between 1978 to 2016; hence given that some of these studies were con- ducted several decades ago, inclusion of these data may not reflect current standards of practice, as TER implant designs have changed over time [32]. Pros- thetic designs and surgical techniques have improved as well as the introduction of newer and more effect- ive antimicrobial therapies, therefore including these older studies could have biased the outcomes. There was a small possibility that two of the two-stage revi- sion studies had overlapping patients [13, 24] and at- tempts to get the original authors to confirm or refute this proved futile. Whereas some studies did not report the definition of PJI, those reported by other studies varied and these could have biased the findings; however, the majority of studies diagnosed PJI using similar criteria. A robust comparison of all outcomes of interest could not be made between the two revision strategies because of the limited number of published studies and outcome data reported. The sample sizes were small and had very low event rates. These limitations precluded detailed analyses and ef- fective comparisons. The findings therefore need to be interpreted with caution. However, the current findings are timely and relevant because they provide substantial insight on the huge gaps in the existing literature. In the absence of case series to compare the effectiveness of the two revision strategies, there is a potential that data from national joint registries may be useful in answering these questions.
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Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences

Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences

Resources. If the performance data on wait times sub- mitted by the HCO to the health region does not show improvement, the health region can choose to withdraw funding. The HCO team had to argue with the health re- gion that funding to increase surgical volumes initially had the opposite effect of increasing waiting times, as they had to clear their backlog. Significant capacity-related issues were reported. Although there was a sufficient number of ORs (12 OR theatres for seven orthopedic surgeons), OR utilization was not as efficient as it could have been. Solutions such as “double joint days” (where a surgeon has two sets of staff, so that one can set up while the sur- geon operates in the other room) were not sustainable due to insufficient staffing – of nurses, in particular – and to the upcoming retirement of a few anesthesiologists. There were additional difficulties around efficient bed management and utilization. Few of the 10 beds located on the surgical unit were reserved for orthopedic patients.
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Impact of variation in physical activity after total joint replacement

Impact of variation in physical activity after total joint replacement

Purpose: Patients who undergo total knee arthroplasty (TKA) or total hip arthroplasty (THA) often develop postoperative pain. Exercise approaches are recommended postoperatively; how- ever, the impact of excessive variation in physical activity is unclear. The purpose of the present preliminary study was to investigate the impact of excessive variation in physical activity using the accelerometer in the early period after TKA or THA.

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Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study

Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study

between the groups [4]. However, the analyses were not adjusted for other possibly important covariates such as age, gender, or comorbidity. In contrast, another study that examined the risk of implant revision in 1301 THA patients found no association between smoking and revi- sion risk in ceramic-on-polyethylene bearing primary THA [5]. A systematic review of the effect of smoking on outcomes after total joint replacement showed that current smoking increased the risk of overall post- operative complications and death but that there were scarce data for smoking and surgical outcomes of arthroplasty [6]. To our knowledge, well-designed stud- ies that have examined the risk of post-arthroplasty implant-related complications due to tobacco use are lacking. A recent meta-analysis of studies assessing the effect of smoking on THA outcomes acknowledged the lack of a consistent definition of “current smoker,” ad- justment for important covariates, and heterogeneity among studies as key limitations [7].
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A comprehensive joint replacement program for total knee arthroplasty: a descriptive study

A comprehensive joint replacement program for total knee arthroplasty: a descriptive study

The costs associated with TKAs (e.g. hospitalization, reha- bilitation, etc.) are high. For example, Medicare reim- burses over $2 billion each year for primary TKAs.[6,7] Medicare reimbursement rates are often much lower than those billed by hospitals. In the 2006 fiscal year, the national average charge for TKAs (and total hip arthro- plasties) was $38,447, yet the national average reimburse- ment was $11,916.[8] Because of this discrepancy, some hospitals are electing to eliminate total joint replacement surgeries from their list of provided services. For others, the need to efficiently utilize healthcare resources while optimizing patient outcomes when caring for patients after TKAs is obvious.[4] To accomplish this, an emphasis is placed on reducing lengths of hospital stays and mini- mizing peri-operative complications (e.g. hypoxia, infec- tion, pneumonia, thrombosis, etc.) as means of managing the costs associated with TKAs. [9-11] Each of the follow- ing has a potential to minimize length of stay and/or post- operative complications in some manner: pre-operative education, [12-14] peri- and post-operative pain manage- ment, [15-17] clinical pathways, [18-20] early and aggres- sive rehabilitation including physical therapy (PT),[10,21-24] and proactive discharge planning.[13,25] To our knowledge, there is no literature showing the effect(s) of a comprehensive program which incorporates all of these components. Hence, we developed an evi- dence-based, comprehensive program for the manage- ment of TKA and implemented it at a regional medical center. The purpose of this prospective study was to describe the joint replacement program (JRP) for TKA's and report post-surgical outcomes over 6 months of fol- low-up.
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Association between occupation and knee and hip replacement due to osteoarthritis: a case control study

Association between occupation and knee and hip replacement due to osteoarthritis: a case control study

ment as definition. OA varies in its severity and radiolog- ical findings have poor correlation to the clinical presentation [18,19]. Total joint replacement is generally done for patients with severe OA symptoms not managed satisfactorily by other interventions. In contrast to, for example, a definition based on radiographs only, a case definition based on joint replacement represents a signif- icant disease burden. A limitation of this case definition is, however, the multiple influences beyond symptoms on the patient and health professional decision of joint replacement [35]. A further limitation with our choice of case definition was that we surely had some false nega- tives in our control group, that is, some of the controls might after the end of the study develop OA that requires joint replacement. This would lead to a bias towards the null. To try to minimise this we chose to include only individuals that were 60 years of age or older at study entry. Because we used joint replacement as a definition for our cases, persons that were deemed too ill to have joint replacement are also classified as controls, even though their disease severity motivates that they should be classified as cases. This healthy patient selection bias is also towards the null.
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Feasibility, Effectiveness, Costs and Patient Satisfaction Associated with a Web-based Follow-up Assessment Following Total Joint Arthroplasty

Feasibility, Effectiveness, Costs and Patient Satisfaction Associated with a Web-based Follow-up Assessment Following Total Joint Arthroplasty

Arthritis is one of the most common chronic conditions, and is a leading cause of pain, physical disability and use of health care services 1-6 . Total joint replacement surgery is an effective procedure to alleviate pain and improve function for patients with advanced osteoarthritis. The incidence of major medical complications and death following total joint arthroplasty is low, with the majority of complications occurring in the first year post-operative 7 . Complications can occur both early (thromboembolic events, infection, stiffness, instability) and late (infection, wear, implant loosening and failure). It is generally common practice to monitor patient outcomes and the performance of the implant through an annual follow-up visit. Because of the low rate of post-operative complications, the majority of follow-up visits are uneventful with no change in clinical management.
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