Presurgery osteoarthritis severity over 10 years in 2 Ontario prospective total knee replacement cohorts: a cohort study.

BACKGROUND: It has been suggested that total knee replacement is being performed in people with less-severe osteoarthritis. We aimed to determine whether there were differences in the presurgery profile, symptoms and disability of 2 cohorts who underwent total knee replacement over a 10-year period. METHODS: Patients aged 18-85 years undergoing primary total knee replacement for osteoarthritis at 1 of 4 sites in Toronto and Strathroy, Ontario, were recruited in a cohort study during 2006-2008 (cohort 1) and 2012-2015 (cohort 2). Patients undergoing unicompartmental or revision arthroplasty were excluded. Demographic and health (body mass index [BMI], comorbidity) variables and osteoarthritis severity, as assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the disability component of the Late-Life Function and Disability Instrument (LLFDI-D), were collected before surgery. We calculated proportions, means and standard deviations with 95% confidence intervals (CIs) for all data. We constructed density plots by tertile score for the WOMAC pain and physical function subscales and the LLFDI-D limitation scale. RESULTS: There were 494 patients in cohort 1 and 251 patients in cohort 2. There were no differences in age, sex, education, living status, BMI, comorbidity, pain severity or disability between the cohorts based on overlapping 95% CIs and the density plots. More patients in cohort 1 than in cohort 2 were single (176 [35.6%], 95% CI 32.5%-41.1% v. 63 [25.1%], 95% CI 20.3%-31.0%). Patients in cohort 2 reported less limitation in higher-demand activities than did those in cohort 1 (mean score on LLFDI-D 62.3 [95% CI 60.7-63.9] v. 59.2 [95% CI 58.2-60.2]). INTERPRETATION: The patient profile and reported osteoarthritis severity were similar in 2 cohorts that had total knee replacement over a 10-year period. This suggests that increasing total knee replacement volumes over this period likely were not driven by these factors.

A cohort study of one-year functional and radiographic outcomes following intra-articular distal radius fractures.

BACKGROUND: The purpose of this study was to describe the outcomes of a series of patients followed prospectively after intra-articular distal radius fractures. METHODS: One hundred forty-eight patients with intra-articular fractures (mean age, 47 years; age range, 44-54 years; gender distribution, 60 males and 88 females) were treated with cast only, arthroscopy/closed reduction plus pins, arthroscopy/closed reduction with external fixation, open reduction and internal fixation (ORIF) alone, and ORIF with external fixation according to surgeon preference and fracture characteristics. The 1-year outcomes across the groups were measured radiographically (n = 148) and functionally (n = 113; 1-year Wrist Outcome Measure score, Grip Strength, SF-36, and PRWE scores). RESULTS: Radiographically, the groups had statistically significant differences in radial inclination, volar tilt, intra-articular step-off, and radial shortening in the pre-treatment X-rays. However, following treatment, treatment groups demonstrated no difference statistically in their follow-up radiographic measures. One-year PRWE scores were found to be statistically different across groups. Across groups, the ORIF-alone treatment group had the highest PRWE score reflecting greatest amount of pain and disability. One-year wrist outcome measure scores and grip strength scores were also found to be significantly different across treatment groups. The general health status as measured by the SF-36 was not found to be different across treatment groups. CONCLUSIONS: These findings are consistent with treatment by indication; suboptimal ORIF outcomes may reflect older practice patterns with dorsal plating. A randomized control trial that compares treatments controlling for fracture severity and studies that develop formal clinical prediction rules for treatment assignment are needed.

Ten-year results of an inset biconvex patella prosthesis in primary knee arthroplasty.

UNLABELLED: The inset biconvex patella component is an alternative form of patella resurfacing in knee arthroplasty. We retrospectively reviewed 433 patients in whom 521 patella prostheses were implanted before April 1997 to determine survivorship, factors associated with failure of the implant, incidence of anterior knee pain, and factors that may be associated with the latter. We had clinical results for 204 surviving patients (242 knees) without failure of their implants with a minimum 10-year followup (mean, 11.4 years; range, 10-17 years). For the remaining 229 patients we used chart or radiographic review to determine if failure of their implant or other complications had occurred. At latest followup, 14 patella components had been revised for aseptic reasons or were radiographically loose. The 10-year Kaplan-Meier survivorship for the entire cohort for aseptic failure was 97.0%. Aseptic failure of the patella component was associated with the presence of osteonecrosis and the absence of a superior rim of bone radiographically. The incidence of anterior knee pain in surviving patients without failure of their implants was 7.8%. No factor examined was associated with anterior knee pain. Survivorship and clinical and radiographic results are equivalent, but not clearly superior, to those reported for other forms of patella resurfacing. LEVEL OF EVIDENCE: Level IV, therapeutic study.

The impact of morbid obesity on patient outcomes after total knee arthroplasty.

Five hundred fifty patients who underwent primary total knee arthroplasty between 1987 and 2004 with a primary diagnosis of osteoarthritis and 1-year outcome data (Western Ontario and McMaster Osteoarthritis Index [WOMAC]) were evaluated. Patients were stratified into body mass index categories based on the World Health Organization classification of obesity. Patients were dichotomized into a class III morbidly obese group and a non-morbidly obese group. Independent t test and multivariable linear regression were used to determine if a difference existed in the 1-year WOMAC outcome between morbidly obese patients and all other patients. Although 1-year outcomes were worse for morbidly obese patients (P < .05), they showed greater improvement in function compared with non-morbidly obese patients. Morbid obesity does not affect 1-year outcomes in patients who have had a total knee arthroplasty.