Patient acceptable symptom states after totalhip or knee replacement at mid-term follow-up: Thresholds of the Oxford hip and knee scores.

OBJECTIVES: To define Patient Acceptable Symptom State (PASS) thresholds for the Oxford hip score (OHS) and Oxford knee score (OKS) at mid-term follow-up. METHODS: In a prospective multicentre cohort study, OHS and OKS were collected at a mean follow-up of three years (1.5 to 6.0), combined with a numeric rating scale (NRS) for satisfaction and an external validation question assessing the patient's willingness to undergo surgery again. A total of 550 patients underwent total hip replacement (THR) and 367 underwent total knee replacement (TKR). RESULTS: Receiver operating characteristic (ROC) curves identified a PASS threshold of 42 for the OHS after THR and 37 for the OKS after TKR. THR patients with an OHS ≥ 42 and TKR patients with an OKS ≥ 37 had a higher NRS for satisfaction and a greater likelihood of being willing to undergo surgery again. CONCLUSIONS: PASS thresholds appear larger at mid-term follow-up than at six months after surgery. With- out external validation, we would advise against using these PASS thresholds as absolute thresholds in defining whether or not a patient has attained an acceptable symptom state after THR or TKR. Cite this article: Bone Joint Res 2014;3:7-13.

Hip and knee replacement patients prefer pen-and-paper questionnaires: Implications for future patient-reported outcome measure studies.

OBJECTIVES: Electronic forms of data collection have gained interest in recent years. In orthopaedics, little is known about patient preference regarding pen-and-paper or electronic questionnaires. We aimed to determine whether patients undergoing total hip (THR) or total knee replacement (TKR) prefer pen-and-paper or electronic questionnaires and to identify variables that predict preference for electronic questionnaires. METHODS: We asked patients who participated in a multi-centre cohort study investigating improvement in health-related quality of life (HRQoL) after THR and TKR using pen-and-paper questionnaires, which mode of questionnaire they preferred. Patient age, gender, highest completed level of schooling, body mass index (BMI), comorbidities, indication for joint replacement and pre-operative HRQoL were compared between the groups preferring different modes of questionnaire. We then performed logistic regression analyses to investigate which variables independently predicted preference of electronic questionnaires. RESULTS: A total of 565 THR patients and 387 TKR patients completed the preference question. Of the THR patients, 81.8% (95% confidence interval (CI) 78.4 to 84.7) preferred pen-and-paper questionnaires to electronic questionnaires, as did 86.8% (95% CI 83.1 to 89.8) of TKR patients. Younger age, male gender, higher completed level of schooling and higher BMI independently predicted preference of electronic questionnaires in THR patients. Younger age and higher completed level of schooling independently predicted preference of electronic questionnaires in TKR patients. CONCLUSIONS: The majority of THR and TKR patients prefer pen-and-paper questionnaires. Patients who preferred electronic questionnaires differed from patients who preferred pen-and-paper questionnaires. Restricting the mode of patient-reported outcome measures to electronic questionnaires might introduce selection bias. Cite this article: Bone Joint Res 2013;2:238-44.

Hepatitis C: the case against routine partner notification.

This review article outlines the salient points relating to the advantages and disadvantages around partner notification for hepatitis C testing.

The Femoral Epicondylar Frame to track femoral rotation in optoelectronic gait analysis.

Relative movement of skin markers to underlying bone limits a valid interpretation of axial femorotibial rotation in noninvasive optoelectronic gait analysis. A distal femoral clamp is a practical solution for thigh marker placement, however, existing devices are still susceptible to measurement errors at increased angles of knee flexion. We developed the Femoral Epicondylar Frame (FEF), which should result in less femoral rotational measurement error due to its anatomic fitting and controlled pressure adjustment. Seven subjects with a total knee replacement in situ, mean age 71 years, mean body mass index 28, were equipped with the frame mounted with a set of tantalum markers. Fluoroscopic data was collected during a step-up motion. A three-dimensional model fitting technique was used to compare the in vivo position and orientation of the frame and the femoral prosthesis component of the prosthesis. The frame rotational measurement error appeared to be linearly dependent on the knee flexion angle. When considering knee flexion angles lower than 40° of flexion, the highest measurement error was 3.3° on average, with an absolute extreme of 6.2°. It is concluded that the accuracy of the FEF is sufficient to evaluate axial knee rotation with optoelectronic gait analysis at group level in clinical studies.

Knee rotation during a weightbearing activity: influence of turning.

Kinematic studies, in which mobile- and fixed-bearing total knee arthroplasty (TKA) were compared, showed controversial results with respect to axial femorotibial rotation. However, all studies focused only on straight ahead tasks, which may underestimate possible differences in freedom of rotation. The purpose of this study was to investigate the influence of turning on normal axial knee rotation. If large differences across tasks were to be found, this would support the use of this task in the evaluation of in-vivo TKA kinematics. In 15 healthy persons, crossover and sidestep turns were added to a standardized chair rise. Three-dimensional knee angles were recorded using an optoelectronic motion analysis system, and a noninvasive epicondylar frame was developed to track the femur. Compared to knee rotation during the straight ahead task, average peak tibial internal rotation increased during a crossover turn (p<0.001), as did peak external tibia rotation during a sidestep turn (p<0.001). The combined range of axial rotation for both turning tasks together was 20.9 degrees , versus 13.5 degrees for the straight ahead task (p<0.001). The turning maneuvers in this study induced a large range of axial knee rotation, so they could be important in studies comparing freedom of rotation in mobile- and fixed-bearing TKA.

[Diagnostic image (282). A woman with invalidating hip complaints]. / Diagnose in beeld (282). Een vrouw met invaliderende heupklachten.

A 40-year-old woman with a five-year history of rheumatoid arthritis experienced progressive pain of the left hip due to protrusio acetabuli.

[A missed unstable cervical vertebra fracture in a patient with ankylosing spondylitis]. / Een niet-herkende instabiele cervicale wervelfractuur bij een patient met de ziekte van Bechterew.

A 53-year-old man with a 13-year history ofankylosing spondylitis presented to the emergency clinic of another hospital because of neck pain after a fall from a low stepladder. The patient was put at ease and discharged after physical examination and X-ray of the cervical spine revealed nothing out of the ordinary. Because his neck pain persisted, the patient contacted his rheumatologist. New cervical X-rays revealed fractures of the body and articular process of CVI and CVII. The patient was referred to our hospital for orthopaedic treatment. The fractures healed during 2.5 months' treatment with halotraction and a halovest. All patients with ankylosing spondylitis with neck pain after trauma have an unstable cervical fracture until proven otherwise. Cervical fractures should be excluded in all cases and other diagnostic tools (CT-scan or MRI) must be used whenever necessary.

[Thrombosis prevention in orthopaedic surgery: clinical practice in the Netherlands in 2002]. / Tromboseprofylaxe in de orthopedische chirurgie: de klinische praktijk in Nederland anno 2002.

OBJECTIVE: Establish the use of thromboprophylaxis in orthopaedic surgery both during and after the hospital admission. DESIGN: Cross-sectional study. METHOD: In April 2002, a letter was sent to all orthopaedic surgeons in the Netherlands announcing that at every hospital with a Department of Orthopaedic Surgery, an orthopaedic surgeon would be approached for a telephone survey. They were phoned in the months April-June 2002. This study included hospitals where major orthopaedic surgery (e.g. the insertion of hip or knee prostheses and hip fracture surgery) took place (n = 124) as well as clinics that only performed day treatments (n = 5). RESULTS: For major orthopaedic operations, 91% of the hospitals used low molecular weight heparin (LMWH) during the admission period: 36% as monotherapy and 55% in combination with coumarin derivates. In 85% of cases the use of LMWH was started preoperatively. Coumarin derivates were used as a monotherapy in 9% of the hospitals. In 37% of the hospitals the use of NSAIDs was continued, particularly in patients with rheumatoid arthritis. In 94% of the hospitals, the use of acetylsalicylic acid was always stopped. In 97% of the hospitals prophylaxis was given after discharge in the form of LMWH (37% of the cases) or coumarin derivates (63% of the cases). The use of thromboprophylaxis with respect to arthroscopies and plaster immobilisation was variable.

[Realization of a measurement module for determining pH value in perfusion cultures]. / Realisierung eines Messmoduls für die pH-Wert-Bestimmung in Perfusionskulturen.

For cultivating animal cells in bioreactors the maintenance of a fixed pH-value is of elementary importance. In a perfused cell culture system the pH-value is measured by electrochemical flow rate sensors. For the acceptance of a technical solution the integration in complex workplaces is necessary, thereby small size and low costs are the main features. For that a special measurement module was developed, consisting of measuring amplifier and microcontroller component with CAN-Bus-interface.

[Development of a CAN (controller area network) bus for modules of a perfused cell culture system]. / Entwicklung einer CAN-Bus-Kopplung für Module eines perfundierten Zellkultursystems.

For computer-aided data acquisition and automated running of experiments in cell cultivation reactors networking of all sensoric and actoric devices is required. A low cost and high performance solution to this demand can be found by using the widely established CAN (Controller Area Network) bus. If standard PCs running MS Windows are used to control this network special measures have to be taken to prevent loss of data caused by differences in the computing power of the PC on one hand and microcontroller-based devices on the other.

[Recording and control of culture parameters in perfused cell culture systems]. / Erfassung und Steuerung von Versorgungsparametern in perfundierten Zellkultursystemen.

For the cultivation of animal cells perfused cell culture systems are advantageous. The measurement of the process parameters for the check of the culture is difficult through the small volumes and dimensions. A developed measuring system allows the measuring of the parameters temperature, pH-value and dissolved oxygen.

The prevalence of Chlamydia trachomatis infection in male undergraduates: a postal survey.

OBJECTIVES: To determine the prevalence of Chlamydia trachomatis infection in male undergraduates and to investigate whether prevalence increases with time spent at university. To investigate the feasibility of screening men for C trachomatis by self sampling and posting of urine specimens. METHODS: The study design was a postal survey undertaken by the Department of Genito-Urinary Medicine (GUM) and Student University Health Service (SUHS) in SHEFFIELD: 2607 male undergraduates from the SUHS patient list were invited to participate in the study by providing a first void urine specimen and posting it to the laboratory. The main outcome measure was the detection of C trachomatis infection. RESULTS: 758 students participated in the study, a response rate of 29.1%. Nine students (1.2%) tested positive for C trachomatis. The prevalence of infection in the first, second, and third year of study was 0.7%, 1.5%, and 1.6% of participants respectively. There was no statistically significant difference in prevalence of infection between first and third year students (chi(2) test, p = 0.32). However, students with chlamydia had a higher median age (Mann-Whitney U test, p < or = 0.05). Contact tracing identified four further cases of C trachomatis infection. CONCLUSION: Screening for C trachomatis infection by postal survey is feasible. However, the response rate in this study was poor and the estimated sample size was not reached. Therefore, it has not been possible to determine the true prevalence of infection in this population or to accurately assess changes in prevalence with time spent at university.

Effects of glufosinate-ammonium on off crop vegetation--interim results.

In 2000 a field study was conducted at four different locations concerning the effects of low dosages of glufosinate-ammonium, a leaf acting herbicide, on off crop vegetation. Therefore species rich road verges and ditch banks not adapted to a history of herbicide use were sprayed twice with different dosages of glufosinate-ammonium, simulating drift (0, 2, 4, 16, 32 and 64% of the maximum field dose: 800 g a.i./ha). The parameters studied were short term phytotoxic effects and the effects on biomass, species cover and number of species in autumn (Braun-Blanquêt relevés). The results show significant phytotoxic effects at all dosages of glufosinate-ammonium on the non-target vegetation. The low concentrations (2 and 4%) had most impact when applied early in the season (9% average at the 2% dosage and 22% at 4% dosage, after the first spraying. At high dosages (32 and 64%) a decrease of the biomass of the vegetation was found in August. A comparison between treatments in August shows a small decrease in species number and cover in the 64% compared to the control. In the comparison between the spring and August relevés, the decrease in the mean number of species was significantly stronger in the treated plots than in the untreated ones of 4% and higher. For monocotyledons in all treatments except 16%, a significantly stronger decrease in species number was found compared to the untreated. For dicotyledons only the 64% dosage differed from the untreated. Only at the 64% treatment the total cover of species decreased more than in the untreated plots. Since drift percentages of 2-4% can be expected at 1-2 m from a treated plot it can be concluded that the use of glufosinate-ammonium could result in visible short term phytotoxic effects (max 22%) on off-crop vegetation such as ditch banks and verges. There are also indications that effects on the number and cover of species in autumn can occur. Because in future glufosinate-ammonium could be used on a large scale in herbicide resistant crops like maize, which will be cultivated on the same field for many years, this study will be continued in 2001 in order to investigate if there are--whether or not--sustainable effects on the off crop vegetation.

Posterolateral dislocation of the elbow joint. Relationship to medial instability.

BACKGROUND: Dislocation of the elbow joint is the second most common dislocation in the upper extremity, dislocation of the shoulder being the most common. It has been reported that uncomplicated dislocation of the elbow joint may be associated with a decreased range of motion, degenerative changes in the elbow joint, ectopic calcification, or neurological deficits. As the medial collateral ligament complex can be completely disrupted during dislocation, we evaluated the association between the long-term results of treatment of simple posterolateral dislocation of the elbow and the presence of persistent medial or valgus elbow instability. METHODS: Fifty patients who had a mean age of thirty-three years (range, eighteen to fifty-eight years) had closed reduction of a posterolateral dislocation of the elbow without associated fractures. The extremity was immobilized in an above-the-elbow plaster cast for three weeks. After a mean duration of follow-up of nine years (range, six to thirteen years), forty-one patients were evaluated with an interview, a physical examination, and radiographs made while a valgus load was applied to the elbow. RESULTS: The average score according to the system of The Hospital for Special Surgery was 91 points (range, 49 to 100 points), and thirty-one patients described their elbow function as good or excellent. Twenty-four patients had evidence of medial instability on radiographs made while a valgus load was applied to the elbow. Twenty-one patients had signs of degeneration of the joint, and twenty-five patients had ectopic ossification. Magnetic resonance imaging combined with arthrography was performed for the first twenty patients; eight had evidence of rupture of the medial collateral ligament, seven had generalized degenerative changes of the cartilage, and four had a chondral defect of the capitellum. (The study could not be completed for the remaining patient.) Medial instability on radiographs was correlated with signs of degeneration (p = 0.001), ectopic ossification (p = 0.01), a worse score according to the system of The Hospital for Special Surgery (p = 0.002), and persistent pain (p = 0.04). CONCLUSIONS: Posterolateral dislocation of the elbow joint can lead to persistent valgus instability that is associated with a worse overall clinical and radiographic result.

The natural course of Gaucher disease in The Netherlands: implications for monitoring of disease manifestations.

This retrospective study in 20 untreated type I Gaucher disease patients shows that in Dutch patients clinical manifestations of Gaucher disease type I are progressive in the majority of patients, children as well as adults. This is in contrast with studies among Jewish patients. Our results emphasize the need for a regular follow-up to enable timely initiation of enzyme therapy.