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1.
Osteoarthritis Cartilage ; 30(9): 1254-1262, 2022 09.
Article in English | MEDLINE | ID: mdl-34890810

ABSTRACT

OBJECTIVES: To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population. METHODS: This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association National Joint Registry and population data from the Australian Bureau of Statistics. The time-trend change in incidence of TKR relating to BMI was assessed between 2015 and 2018. The influence of obesity on the incidence of TKR in different age and gender groups was determined. The population attributable fraction (PAF) was then calculated to estimate the effect of obesity reduction on TKR incidence. RESULTS: The greatest increase in incidence of TKR was seen in patients from obese class III. The incidence rate ratio for having a TKR for obesity class III was 28.683 at those aged 18-54 years but was 2.029 at those aged >75 years. Females in obesity class III were 1.7 times more likely to undergo TKR compared to similarly classified males. The PAFs of TKR associated with overweight or obesity was 35%, estimating 14,287 cases of TKR attributable to obesity in 2018. The proportion of TKRs could be reduced by 20% if overweight and obese population move down one category. CONCLUSIONS: Obesity has resulted in a significant increase in the incidence of TKR in the youngest population in Australia. The impact of obesity is greatest in the young and the female population. Effective strategies to reduce the national obese population could potentially reduce 35% of the TKR, with over 10,000 cases being avoided.


Subject(s)
Arthroplasty, Replacement, Knee , Osteoarthritis, Knee , Australia/epidemiology , Female , Humans , Incidence , Male , Obesity/complications , Obesity/epidemiology , Osteoarthritis, Knee/epidemiology , Osteoarthritis, Knee/etiology , Osteoarthritis, Knee/surgery , Overweight/complications , Overweight/epidemiology
2.
Bone Joint J ; 96-B(7): 853-4, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24986934

ABSTRACT

The Bone & Joint Journal provides the latest evidence to guide the clinical practice of orthopaedic surgeons. The benefits of one intervention compared with another are presented using outcome measures; some may be specific to a limb or joint and some are more general health-related quality of life measures. Readers will be familiar with many of these outcome measures and will be able to judge the relative benefits of different interventions when measured using the same outcome tool; for example, different treatments for pain in the knee measured using a particular knee score. But, how should readers compare outcomes between different clinical areas using different outcome measures? This article explores the use of standardised effect sizes.


Subject(s)
Orthopedics/standards , Outcome Assessment, Health Care , Hip Joint/surgery , Humans , Orthopedic Procedures/standards , Outcome Assessment, Health Care/standards , Quality of Life , Shoulder Joint/surgery
5.
Orthop Traumatol Surg Res ; 97(1): 73-8, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21159567

ABSTRACT

BACKGROUND: Thoracic sarcomas are rare, and resection can leave behind defects that require significant reconstruction by the multidisciplinary surgical team. The aim of this study is to review the experience of our regional referral centre with primary thoracic tumor resection and thoracic reconstruction. METHODS: We have reviewed the treatment of all chest wall tumors resected at Sir Charles Gairdner Hospital in Western Australia over a 5-year period. There were 11 cases in total that involved removal of deep muscle, ribs and/or sternum. RESULTS: In the six cases that required bony resection, the surgical team utilized a Gore-Tex (e-PTFE) mesh prosthesis to allow immediate closure of the defect, whilst five other closures were achievable using primary layered closure alone. Four patients had postoperative complications, including one who required prosthesis removal. Mean length of hospital stay was 5 days. No 30-day or 6-month mortality was recorded. All patients were followed-up for a minimum of 24 months, and all patients were alive and free of disease at their most recent follow-up. CONCLUSIONS: This study concurs with previous literature indicating that thoracic tumor resection and immediate reconstruction often involving use of prosthetic mesh is a safe and effective one stage surgical procedure for a variety of chest wall defects with low postoperative morbidity.


Subject(s)
Plastic Surgery Procedures/methods , Sarcoma/surgery , Surgical Mesh , Thoracic Neoplasms/surgery , Thoracic Wall/surgery , Adult , Aged , Aged, 80 and over , Biopsy, Needle , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Length of Stay , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Sarcoma/diagnosis , Sarcoma/mortality , Survival Rate/trends , Thoracic Neoplasms/diagnosis , Thoracic Neoplasms/mortality , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Western Australia/epidemiology , Young Adult
6.
Knee ; 15(1): 15-9, 2008 Jan.
Article in English | MEDLINE | ID: mdl-17997100

ABSTRACT

Previous published research has shown promising results with flexion splinting post total knee arthroplasty. Before instituting this practice, we conducted a randomised controlled trial to confirm any benefits over splinting in extension. Five patients were recruited into the trial. 5 were excluded. The flexion group consisted of 49 patients who had their knee placed in 70 degrees of flexion over an inactive CPM machine for 24 h post operation. The extension group consisted of 46 patients who were splinted in full extension for the first 24 h post operation. We assessed post-operative day 1 drain volume, haemoglobin and haematocrit, blood transfusions, duration of inpatient stay, range of motion and complications within 6 weeks of surgery. There was no significant difference between the two groups among any of the outcomes measured. As such, we have been unable to demonstrate any benefit with splintage in flexion post total knee arthroplasty and have not adopted it as part of our post-operative management.


Subject(s)
Arthroplasty, Replacement, Knee , Postoperative Care , Splints , Aged , Aged, 80 and over , Bandages , Blood Transfusion , Female , Hematocrit , Hemoglobins/analysis , Humans , Knee Joint/physiopathology , Male , Middle Aged , Postoperative Hemorrhage/blood , Postoperative Hemorrhage/therapy , Range of Motion, Articular
7.
Cochrane Database Syst Rev ; (4): CD005320, 2006 Oct 18.
Article in English | MEDLINE | ID: mdl-17054252

ABSTRACT

BACKGROUND: Dislocation following hip replacement is associated with significant morbidity and functional cost. The cause is usually multifactorial. A variety of treatment options are available which can broadly be classified into operative and non-operative. OBJECTIVES: To determine the best methods of treatment of recurrent dislocation following total hip replacement. SEARCH STRATEGY: The following databases were searched until August 2006: MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Health Technology Assessment database (HTA), Database of Abstracts of Reviews of Effectiveness (DARE), International Standard Randomised Controlled Trial Number Register (ISRCTN), and MetaRegister of Controlled Trials (mRCT). SELECTION CRITERIA: Randomised and quasi-randomised trials comparing operative and non-operative treatments for recurrent dislocation following total hip replacement. DATA COLLECTION AND ANALYSIS: Two independent reviewers applied the inclusion criteria to identified studies. MAIN RESULTS: Searches identified 269 studies. None fulfilled the inclusion criteria. AUTHORS' CONCLUSIONS: The authors invite researchers to perform RCTs comparing different treatment options for recurrent dislocation of the hip. The heterogeneity of the population and variety of underlying causes would favour a multi-centre study to achieve an adequate sample size.


Subject(s)
Arthroplasty, Replacement, Hip , Hip Dislocation/therapy , Hip Dislocation/surgery , Humans , Recurrence
8.
Int Orthop ; 30(5): 409-11, 2006 Oct.
Article in English | MEDLINE | ID: mdl-16642345

ABSTRACT

There has been a debate amongst orthopaedic surgeons about which plain radiographs are required in common knee conditions and this is a 5-year review assessing the influence of recent publications on the use of radiographs. A postal survey of all members of the British Orthopaedic Association was performed. The response rate was 60% (990/1,650). There was a broad agreement on the use of anteroposterior and lateral radiographs. The use of the posteroanterior (PA) weight-bearing radiograph has increased from 82 to 86%. The use of skyline view for suspected arthritis and after knee replacement has increased from 23 to 41%. There is still disparity amongst orthopaedic surgeons regarding the knee flexion angle for skyline and weight-bearing views. After review of the literature we recommend that a single skyline view in 30 degrees flexion is adequate and should be a standard investigation in knee disorders. We also stress the importance of weight-bearing PA radiograph in 30 degrees knee flexion for adequate assessment in all patients with suspected arthritis.


Subject(s)
Arthrography/statistics & numerical data , Knee Joint/diagnostic imaging , Evidence-Based Medicine , Health Care Surveys , Humans , Orthopedics , Physicians , Societies, Medical , Surveys and Questionnaires , United Kingdom
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