ABSTRACT
There is a paucity of information detailing functional outcome following total knee arthroplasty for this length of follow-up. We collected data from 187 knees in 150 surviving patients, beyond 15 years from implantation. Survival of the implant was confirmed and a patient administered questionnaire including WOMAC, SF-36 and patient satisfaction was used, data was scrutinised for differences between primary and revision knee surgery. Seventy knees were revised at a mean of 10.8 years. The mean WOMAC Pain score was 72 indicating predominantly mild pain. The mean WOMAC Function scores were lower at 55 indicating moderate limitation of most activities. No significant differences were found between revised and un-revised patients. Long-term pain and satisfaction scores in this population were good illustrating the benefits of TKA in the long term even in patients who have undergone revision surgery.
Subject(s)
Arthroplasty, Replacement, Knee , Outcome Assessment, Health Care , Activities of Daily Living , Aged , Arthritis, Rheumatoid/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteoarthritis, Knee/surgery , Pain Measurement , Patient Satisfaction , Quality of Life , Reoperation/statistics & numerical data , Surveys and Questionnaires , United KingdomABSTRACT
Ovarian hyperstimulation is a recognized complication of ovulation induction with gonadotrophins. The syndrome is becoming more common as the number of women undergoing in-vitro fertilization increases. It is rarely seen in conjunction with clomiphene citrate usage. This case report is of moderate to severe ovarian hyperstimulation in a patient who was treated with clomiphene citrate because of infertility secondary to anovulation. She presented with amenorrhoea for five weeks, lower abdominal pain and a positive urinary human chorionic gonadotrophin (hCG) test. Pelvic ultrasonography was suggestive of a possible ectopic pregnancy with a differential diagnosis of a ruptured ovarian cyst. Diagnostic laparoscopy was done followed by laparotomy. Oophorectomy was performed because the ovary was thought to be complex with solid areas. However, conservative management with avoidance of laparotomy is the recommendation in confirmed cases of ovarian hyperstimulation but this requires a high level of suspicion in patients who have ovulation induction.
Subject(s)
Adult , Female , Humans , Clomiphene , Fertility Agents, Female , Ovulation Induction/adverse effects , Ovarian Hyperstimulation Syndrome/chemically induced , Ovarian Hyperstimulation Syndrome/diagnosis , Ovarian Hyperstimulation Syndrome/surgeryABSTRACT
Ovarian hyperstimulation is a recognized complication of ovulation induction with gonadotrophins. The syndrome is becoming more common as the number of women undergoing in-vitro fertilization increases. It is rarely seen in conjunction with clomiphene citrate usage. This case report is of moderate to severe ovarian hyperstimulation in a patient who was treated with clomiphene citrate because of infertility secondary to anovulation. She presented with amenorrhoea for five weeks, lower abdominal pain and a positive urinary human chorionic gonadotrophin (hCG) test. Pelvic ultrasonography was suggestive of a possible ectopic pregnancy with a differential diagnosis of a ruptured ovarian cyst. Diagnostic laparoscopy was done followed by laparotomy. Oophorectomy was performed because the ovary was thought to be complex with solid areas. However, conservative management with avoidance of laparotomy is the recommendation in confirmed cases of ovarian hyperstimulation but this requires a high level of suspicion in patients who have ovulation induction.
