Lymphedema Predictor Factors after Breast Cancer Surgery: A Survival Analysis.

BACKGROUND: Factors associated with lymphedema development after breast cancer surgery are not well established. The purpose is to assess the value of patient, disease and treatment-related factors predicting lymphedema development. METHODS AND RESULTS: This study included 371 women with primary invasive breast cancer treated surgically between 2005 and 2009 with follow-up until December 2011. At each follow-up visit, both upper limb circumferences were measured at seven points to calculate the upper limb volume. Kaplan-Meier and Cox regression models for survival were applied. By the end of the follow-up period, 33.4% of women (n=124) had developed lymphedema. According to volume, lymphedema at diagnosis was mild in 78.5%, moderate in 19.0%, and severe in 2.5% of them. A 77.4% of lymphedema had enough clinical relevance to be treated. The probability of developing lymphedema within 12, 24, and 36 months post-surgery was 28.7% (95%CI 24.1-34.0%), 34.6% (95%CI 29.5-40.2%), and 38.3% (95%CI 32.8-44.3%), respectively. High stages, axillary lymph node dissection, chemotherapy, radiotherapy, and postoperative seroma were predictors of lymphedema in the bivariate survival analysis. Only axillary lymph node dissection and radiotherapy maintained their significance in the multivariate model. When the analysis was restricted to patients who underwent axillary lymph node dissection, the number of nodes excised did not influence the occurrence of lymphedema. CONCLUSIONS: Axillary lymph node dissection and radiotherapy affected lymphedema development. This study provides support that breast cancer patients with such characteristics should be closely monitored, especially during the first year after surgery.

Correlation of dorsiflexion angle and plantar pressure following arthrodesis of the first metatarsophalangeal joint.

BACKGROUND: The correlation between angle of fusion of the first metatarsophalangeal (1MTTP) joint and pressures under metatarsal heads and hallux has not been well characterized. The main purpose was to investigate the correlation between fusion dorsiflexion angle of the 1MTTP joint and plantar pressures under the first metatarsal head and hallux during gait. METHODS: Patients who underwent arthrodesis of the 1MTTP joint from 2005 to 2010 were seen for a follow-up examination. Of 27 patients, 15 (22 feet) with a mean follow-up of 26.2 months were evaluated in the study. Main outcomes included the fusion clinical and radiological dorsiflexion angles and the mean and maximum dynamic plantar pressures under all 5 metatarsal heads and under the hallux. Plantar pressures were measured through an in-shoe system while patients walked normally along a corridor. RESULTS: The dorsiflexion angle was positively correlated with mean dynamic plantar pressures under the first metatarsal head: P = .02 (r = 0.5) for clinical angle, and P = .01 (r = 0.58) for radiological angle. Patients with 15 degrees or more of clinical dorsiflexion angle demonstrated higher mean dynamic plantar pressure under the first metatarsal head (P = .05) and higher maximum dynamic plantar pressure under the second metatarsal head (P = .04) compared with patients with less than 15 degrees. In contrast, the latter patients demonstrated higher mean dynamic plantar pressure beneath the hallux (P = .04). Patients with 30 degrees or more of radiological dorsiflexion angle demonstrated significantly higher mean dynamic plantar pressure under the first metatarsal head (P = .04) compared with patients with less than 30 degrees. CONCLUSION: Higher dorsiflexion angles correlate with higher plantar pressures under the first metatarsal head. Lower dorsiflexion angles increase plantar pressures beneath the hallux during gait. CLINICAL RELEVANCE: Significant increase in plantar pressure under the first metatarsal head may be avoided by performing the arthrodesis of the 1MTTP joint below 30° and 15° for the radiological and clinical dorsiflexion angles, respectively.

Balance 1 year after TKA: correlation with clinical variables.

Knee osteoarthritis results in changes that affect balance. It has been reported that osteoarthritis worsens proprioception and increases the risk of falling. The objective of this study was to assess changes in balance among patients with knee osteoarthritis at 1 year after total knee arthroplasty (TKA) surgery and its relationship with clinical variables. This prospective, observational study evaluated 44 patients before and 1 year after TKA. Variables analyzed included age, body mass index, pain, range of motion for both knees, bilateral quadriceps and hamstrings muscle strength, gait velocity, and Knee Society score. Balance and posture control were assessed using the following computerized posturography tests: the weight bearing test, modified Clinical Test of Sensory Interaction on Balance (mCTSIB) test, and sit-to-stand test. Pre- and postoperative differences were analyzed using Wilcoxon and chi-square tests, and effect size was measured using standardized response mean. Correlations were assessed by the Spearman test. One year after TKA, some improvement in balance tests was observed. Significant differences were observed in the mCTSIB test: foam surface with open eyes (P≤.001), foam surface with closed eyes (P≤.001), and composite value (P≤.001). Effect size was moderate to high. Age showed significant correlation with mCTSIB composite value changes (-0.369; P=.037). No significant correlations were found between posturographic tests and other analyzed variables. Balance measured by computerized posturography improved 1 year after TKA. Significant changes were observed between open and closed eyes using a foam surface for the mCTSIB test. A mild negative correlation was found between age and posturographic changes.