A review of the New Zealand National Joint Registry to compare the outcomes of Coonrad-Morrey and Latitude total elbow arthroplasty.

BACKGROUND: Total elbow arthroplasty has traditionally been used in the treatment of inflammatory arthropathy patients. More and more, however, its use is expanding to include acute trauma and sequelae of trauma. In New Zealand, the most commonly used prosthesis is the Coonrad-Morrey prosthesis, but the Latitude prosthesis has gained in popularity, with a 3-fold increase in implantation over the past 5 years. METHODS: Prospectively collected national joint registry data were used to compare the survival rates of these prostheses. Underlying diagnoses, reasons for revision, and patient-reported outcome measures, as well as patient age and exact implants used, were all recorded. Statistical analysis involved survival analysis using Kaplan-Meier curves and the paired Student t test. RESULTS: Over the 18-year study interval, the Coonrad-Morrey prosthesis has shown consistently lower revision rates than the Latitude prosthesis. This was true for both the linked and unlinked Latitude prostheses and was not affected by radial head replacement or underlying diagnosis. In all cases, the risk of revision for the Coonrad-Morrey prosthesis was reduced by at least 65% compared with the Latitude prosthesis. CONCLUSION: This study using New Zealand Joint Registry data shows a lower failure rate of the Coonrad-Morrey elbow prosthesis compared with the Latitude prosthesis. The hazard ratio for a revision procedure for the Coonrad-Morrey prosthesis compared with the Latitude prosthesis was 0.28 (95% confidence interval, 0.14-0.55). This lower rate was evident irrespective of linkage and radial head replacement. The reason for the lower rate of revision with the Coonrad-Morrey prosthesis is likely multifactorial, but perhaps when used by lower-volume surgeons, the Coonrad-Morrey prosthesis may confer better implant longevity.

Hearing Loss Asymmetry due to Chronic Occupational Noise Exposure.

OBJECTIVE: To determine whether occupational noise exposure causes symmetrical or asymmetrical hearing loss. STUDY DESIGN: Retrospective Case Series. SETTING: Otorhinolaryngology Specialist Centre. PATIENTS: Seven hundred forty-four reports for occupational noise-induced hearing loss (NIHL) compensation were analyzed. Subjects with at least 40% of their total hearing loss due to occupational NIHL were included. Claimants with any confounding factor that could cause asymmetric hearing loss such as history of shooting, head, or ear trauma were excluded. With the strict inclusion criteria, 83 subjects were included in the study. Claimants with ≥40%, ≥60%, and ≥80% occupational NIHL of their total hearing loss were compared. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The left ear hearing threshold compared with the right ear hearing threshold (dB) at the frequencies 0.5 to 8 kHz. RESULTS: In the total group, the left ear hearing threshold was statistically significantly higher compared with the right ear at 3 kHz (2.41 dB). In the subgroups ≥60% and ≥80% occupational NIHL of total hearing loss, the left ear hearing threshold was statistically significant higher compared with the right ear at 3 kHz, respectively, 3.81 dB and 5.53 dB and 4 kHz, respectively, 2.86 dB and 5.53 dB. An asymmetry of more than 10 dB at 3 and 4 kHz was observed in 39% and 30% of the subjects respectively. In these cases, the vast majority had more pronounced hearing loss in the left ear. CONCLUSION: Findings of this study further indicate that the left ear is more susceptible to noise exposure compared with the right ear.

Predictors of poor outcome in patients w ith autoimmune hepatitis: a population-based study.

UNLABELLED: Autoimmune hepatitis (AIH) can lead to cirrhosis, hepatic failure, and death. We aimed to identify predictors of advanced liver fibrosis at presentation, predictors of incomplete response to initial immunosuppression, and predictors of poor liver-related outcomes in the population-based AIH cohort from Canterbury, New Zealand. Cases diagnosed after 1980 that fulfilled standard diagnostic criteria were included. Cases were censored at death or liver transplantation and had a median follow-up of 9 years. Analyses were performed with Cox proportional hazards regression and logistic binary regression. The times to event outcomes were summarized using Kaplan-Meier curves. A total of 133 AIH patients were included. Predictors for advanced liver fibrosis at diagnosis were age at presentation of ≤20 years or >60 years (P = 0.02), serum albumin <36 g/L (P < 0.01), platelet <150 U/L (P < 0.01), and International Normalized Ratio (INR) >1.2 (P < 0.01). The only independent predictor for incomplete normalization of alanine aminotransferase (ALT) at 6 months was age at presentation ≤20 years. Independent predictors of poor liver-related outcomes were incomplete normalization of ALT at 6 months (P < 0.01), serum albumin <36 g/L (P < 0.01), and age at presentation of ≤20 years or >60 years (P = 0.01). Kaplan-Meier estimates showed that 10-year adverse liver event-free survival was 80% for age at presentation ≤20 years and >60 years, and 93% and 100% for age at presentation between 21-40 years and 41-60 years, respectively. CONCLUSION: Incomplete normalization of ALT at 6 months, low serum albumin concentration at diagnosis, and age at presentation of ≤20 years or >60 years were significant independent predictors of liver-related death or requirement for liver transplantation. Histological cirrhosis at diagnosis was not associated with poor prognosis and did not influence the response to initial immunosuppressive treatment. (HEPATOLOGY 2013;57:2399-2406).

Mortality and the risk of malignancy in autoimmune liver diseases: a population-based study in Canterbury, New Zealand.

UNLABELLED: Population-based quantitative data on the mortality and cancer incidence of autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC) are scarce. Our aim was to systematically investigate the survival and risk of malignancy on population-based cohorts of AIH, PBC, and PSC in Canterbury, New Zealand. Multiple case-finding methods were employed, including searches of all public and private, adult and pediatric outpatient clinics, hospital notes, laboratory, radiology, and pathology reports. Cases that fulfilled standardized diagnostic criteria were included. Kaplan-Meier survival estimates, standardized mortality ratios (SMR), and standard incidence ratios (SIR) for malignancy were calculated. A total of 130 AIH, 70 PBC, and 81 PSC patients were included contributing to 1,156, 625, and 613 person-years at risk, respectively. For AIH, PBC, and PSC cohorts, SMRs for all-cause mortality were 2.1 (95% confidence interval [CI] 1.4-3.1), 2.7 (95% CI 1.7-4.0), and 4.1 (95% CI 2.6-6.3), SMRs for hepatobiliary mortality were 42.3 (95% CI 20.3-77.9), 71.2 (95% CI 30.7-140.3), and 116.9 (95% CI 66.8-189.8), SIRs for all cancers were 3.0 (95% CI 2.0-4.3), 1.6 (95% CI 0.8-2.9), and 5.2 (95% CI 3.3-7.8), and SIRs for extrahepatic malignancy were 2.7 (95% CI 1.8-3.9), 1.6 (95% CI 0.8-2.9), and 3.0 (95% CI 1.6-5.1), respectively. CONCLUSION: This is the first population-based study to examine and compare the survival and cancer incidence in AIH, PBC, and PSC in the same population. The mortality for all three cohorts was significantly increased due to liver-related death, demonstrating the inadequacy of current management strategies. The risk of hepatic and extrahepatic malignancy was significantly increased in AIH and PSC patients.