The Impact of Depression, Personality, and Mental Health on Outcomes of Total Knee Arthroplasty

Background@#Precise assessment of preoperative mental health and psychological determinants may be useful in identifying patients at risk for poor postoperative outcomes of total knee arthroplasty (TKA). The aim of this study was to investigate the influence of psychological status and physical and mental health on the outcome of patients undergoing TKA. @*Methods@#Fifty-two patients undergoing unilateral TKA were assessed preoperatively with Oxford Happiness Inventory, Eysenck Personality Inventory, 12-item short form health survey (SF-12), and Knee Injury and Osteoarthritis Outcome Score (KOOS) for evaluating depression, personality traits, physical and mental health, and function, respectively. At 1 year after surgery, health-related quality of life (HRQL) and function were assessed using the SF-12 and KOOS. @*Results@#HRQL and function of all personality traits increased significantly after TKA, without significant difference among them. Extroversion and neuroticism did not have significant correlation with subjective well-being, HRQL, and function before and after surgery. Subjective well-being and the baseline physical and mental health scores were correlated strongly and directly with postoperative physical component summary, mental component summary, and KOOS scores and their improvement. Among many factors that significantly affected the outcomes of TKA, the only independent predictor of physical, mental, and functional outcome was depression. @*Conclusions@#Outcomes of surgery were not significantly different among diverse personality traits. Patients with less depressive symptoms and higher baseline mental and physical scores had significantly greater improvement in HRQL after surgery. The only independent factor affecting the physical, mental, and functional outcome was depression.

Results of surgically treated talar fractures / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Talar fractures present a great challenge to surgeons due to poor treatment outcome and high incidence of sequelae. The purpose of this study was to report the surgical treatment outcome of displaced talar fractures treated by internal fixation.</p><p><b>METHODS</b>A total of 30 patients with a mean age of 38 years presenting with talar body or neck fractures were studied retrospectively to assess postoperative outcome based on American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale.</p><p><b>RESULTS</b>Postoperatively, malunion was found in 18 cases, infection in 5 cases and avascular necrosis in 12 cases. There were 12 cases with subtalar arthritis and 18 cases with both subtalar and malleolar arthritis. The average score of questionnaire was 64+/-12. Functional score was 53+/-15 and pain score was 65+/-13. Range of motion failure was detected as 15+/-4.</p><p><b>CONCLUSION</b>Talar injuries can compromise motion of the foot and ankle and result in poor prognosis on long-term evaluation. Late complications subsequent to surgically treated talar body fractures are inevitable, and patients are supposed to be counseled about the adverse outcome.</p>

Comparison of the efficacy of local corticosteroid injection and physical therapy on pain severity, joint range of motion and muscle strength in patients with shoulder impingement syndrome referred to Rasool-e-Akram Medical Center from April 2008 to September 2009

Subacromial impingement is a common cause of shoulder pain and many patients with this condition recover with conservative management. The most commonly used modalities of non-operative treatment include activity modification, anti-inflammatory medication and subacromial injection of steroid and ultrasound and physical therapy programs. This study assessed the value of physiotherapy versus subacromial corticosteroid injection in patients with shoulder impingement syndrome [SIS]. Seventy three patients with SIS enrolled in the study and treated through physiotherapy [n=37] and subacromial corticosteroid injection [n=36]. Two follow-up sessions accomplished at the end of 4[th] week and 3[rd] month of treatment respectively. Corticosteroid injection caused dramatic improvement in the painful state [p<0.0001] and sleep dysfunction score [p=0.039] in the first follow-up. However, physiotherapy showed significantly better results regarding patients' pain score [p=0.016] and their shoulder join range of motions [p=0.017 and p=0.029 for the abduction and extension, respectively] in their second follow-up. Our study results showed that subacromial corticosteroid injection primarily resulted in more improvement in the impingement symptoms. However, with the long-term follow-up the results were better for the physiotherapy. These results suggest that patients should not undergo surgery before having conservative treatment