Results of total knee replacement with a cruciate-retaining model for severe valgus deformity--a study of 48 patients followed for an average of 9 years.

The objectives of the present study were to find out the results and the factors affecting survival after primary knee arthroplasty with a cruciate-retaining prosthesis in severe valgus deformity. Forty-eight patients (52 knees) participated in the current follow-up study. All patients were followed at least 5 years or to first revision. Mean follow-up time was 9 years (range, 1 to 17 years).The Kaplan-Meier analysis revealed 79% (95% CI 68% to 91%) survival rate with revision for any reason and 81% (95% CI 70% to 93%) survival rate with revision for instability as an endpoint at 10 years. Preoperatively TFA was 23° (range, 15°-51°) in valgus and 7° (range, 21° valgus-4° varus) in valgus postoperatively. Of the 14 re-operated patients, eight were revised because of progressive postoperative medial collateral ligament instability. All re-operations were performed during the first 4 years of the follow-up. The mean TFA was 15.5° valgus postoperatively for those eight and the odds ratio for a revision was 2 (95% CI 1-3, p = 0.025) when compared to the rest of the study population. The residual valgus deformity increases the risk of re-operation and it should be avoided. If proper soft-tissue balance cannot be achieved or there is no functional medial collateral ligament present more constrained implants should be used. In selected cases where both bony correction and ligament balancing have properly been achieved the use of a cruciate-retaining type of prosthesis is justified.

Empowering citizens for well-being and chronic disease management with wellness diary.

Chronic conditions closely related to lifestyles are the major cause of disability and death in the developed world. Behavior change is the key to managing well-being and preventing and managing chronic diseases. Wellness diary (WD) is a mobile application designed to support citizens in learning about their behavior, and both making and maintaining behavior changes. WD has been found acceptable, useful, and suitable for long-term use as a part of an intervention. When used independently, however, it does not seem to have enough engaging and motivating features to support adoption and long-term commitment. The main improvement needs identified based on a review of WD-related studies were: personalization of the application to individual needs, increasing motivation during early use, maintaining motivation, and aiding in relapse recovery in long-term use. We present concepts to improve the personalization of WD as well as improvements to the feedback and interpretation of the self-observation data. We also present usage models on how this type of mobile application could be utilized.

Medial unicompartmental knee arthroplasty with Miller-Galante II prosthesis: mid-term clinical and radiographic results.

AIM: The purpose of our study was to evaluate retrospectively the mid-term results of the Miller-Galante II (Zimmer, Warsaw, USA) unicondylar knee arthoplasty (UKA). METHOD: The study included 46 patients with medial UKAs. Mean follow-up time was 7.0 years (range 2.7-13.1 years). RESULTS: Survival rate of the prosthesis was 86.6% (95% CI 73.7-99.6) at 7 years. The mean clinical and functional Knee Society Scores had increased from 51 and 62 points preoperatively to 76 and 93 points (P < 0.001) postoperatively. Five of the 46 knees were revised because of excessive wear of the polyethylene liner, and three due to progression of the osteoarthritis in the lateral compartment of the knee. CONCLUSION: Survival of this fixed-bearing UKA was not as good as previously reported and polyethylene wear seems to be a more common problem than previously assumed.

Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: a follow-up study of 50,493 knee replacements from the Finnish Arthroplasty Register.

BACKGROUND AND PURPOSE: Both unicondylar arthroplasty (UKA) and total knee arthroplasty (TKA) are commonly used for the treatment of unicompartmental osteoarthritis (OA) of the knee. The long-term survivorship and cost-effectiveness of these two treatments have seldom been compared on a nationwide level, however. We therefore compared the survival of UKA with that of TKA and conducted a cost-benefit analysis comparing UKA with TKA in patients with primary OA. PATIENTS AND METHODS: We analyzed 1,886 primary UKAs (3 designs) and 48,607 primary TKAs that had been performed for primary OA and entered in the Finnish Arthroplasty Register between 1980 and 2003 inclusive. RESULTS: UKAs had a 60% (95% CI: 54-66) survival rate and TKAs an 80% (95% CI: 79-81) survival rate at 15 years with any revision taken as the endpoint. Overall survival of UKAs was worse than that of TKAs (p < 0.001). All 3 UKA designs had poorer overall survival than the corresponding TKA designs. In the theoretical cost-benefit analysis, the cost saved by lower implant prices and shorter hospital stay with UKA did not cover the costs of the extra revisions. INTERPRETATION: At a nationwide level, UKA had significantly poorer long-term survival than TKA. What is more, UKA did not even have a theoretical cost benefit over TKA in our study. Based on these results, we cannot recommend widespread use of UKA in treatment of unicompartmental OA of the knee.

A customizable mobile tool for supporting health behavior interventions.

Recorded self-observations on a regular basis is an important component in many health behavior interventions. Using information and communication technologies (ICT) and especially mobile eHealth applications is a promising way of improving user-friendliness and possibly the overall effectiveness of self-monitoring. Mobility as such brings the added value of continuous availability and timely information access. One additional benefit of ICT based solutions is the possibility for various types of customization, allowing support for a wider set of application requirements than was originally planned, and meeting changing needs and targets of individuals, groups or larger user segments. In this paper, we present a customizable mobile application for recording and managing health related self-observations, Wellness Diary, and the ideas and technical solutions for supporting tailoring of the application. The main idea is to allow end-users to freely change the data model in the application, and customize related data presentations. This work has been done in Nuadu ITEA project, as well as further work where the effectiveness of the mobile tool and other ICT technologies will be investigated in a controlled trial in Finland. We'll also present shortly a counterpart for the mobile application, a web service that should bring some added value for the end user.

Unicondylar knee replacement for primary osteoarthritis: a prospective follow-up study of 1,819 patients from the Finnish Arthroplasty Register.

BACKGROUND: The choice and use of unicondylar knee arthroplasty (UKA) has gone through a nation wide resurgence at the start of the 21st century in Finland. We evaluated the population-based survival of UKA in patients with primary osteoarthritis (OA) in Finland, and the factors affecting their survival. METHOD: The Finnish Arthroplasty Register was established in 1980. During the years 1985-2003, 1,928 primary UKAs were recorded in the register; 1,819 of these were performed for primary OA. Of these 1,819 UKAs, we selected for further analysis implants that had been used in more than 100 operations during the study period. The survival rates of UKAs were analyzed using Kaplan-Meier analysis and the Cox regression model. RESULTS: Analysis of the whole study period showed that UKAs had a 73% (95% CI: 70-76) survival rate at 10 years, with revision for any reason as the end point. Those patients who received the Oxford menisceal bearing unicondylar (n = 1145) had a survival rate of 81% (95% CI: 72-89) at 10 years. The group that received the Miller-Galante II unicondylar (n = 330) had a 79% survival rate (95% CI: 71-87) at 10 years, whereas the Duracon (n = 196) had a survival rate of 78% (95% CI: 72-84) and the PCA (n = 146) had a survival rate of 53% (95% CI: 45-60) at 10 years. The number of UKA operations in Finland has increased markedly in recent years. At the time of operation, the mean age of the patients was 65 (38-91) years. Younger patients (