ABSTRACT
OBJECTIVES: To estimate future utilization scenarios for knee arthroplasty (KA) revision in the Spanish National Health System in the short- and long-term and their impact on primary KA utilization. METHODS: A discrete-event simulation model was built to represent KA utilization for 20 years (2012-2031) in the Spanish National Health System. Data on KA utilization from 1997 to 2011 were obtained from the minimum data set. Three scenarios of future utilization of primary KA (1, fixed number since 2011; 2, fixed age- and sex-adjusted rates since 2011; and 3, projection using a linear regression model) were combined with two prosthesis survival functions (W [worse survival], from a study including primary KA from 1995 to 2000; and B [better survival], from the Catalan Registry of Arthroplasty, including primary KA from 2005 to 2013). The simulation results were analyzed in the short-term (2015) and the long-term (2030). RESULTS: Variations in the number of revisions depended on both the primary utilization rate and the survival function applied, ranging from increases of 8.3% to 31.6% in the short- term and from 38.3% to 176.9% in the long-term, corresponding to scenarios 1-B and 3-W, respectively. The prediction of increases in overall surgeries ranged from 0.1% to 22.3% in the short-term and from 3.7% to 98.2% in the long-term. CONCLUSIONS: Projections of the burden of KA provide a quantitative basis for future policy decisions on the concentration of high-complexity procedures, the number of orthopedic surgeons required to perform these procedures, and the resources needed.
Subject(s)
Arthroplasty, Replacement, Knee/statistics & numerical data , Prosthesis Failure , Reoperation/trends , Aged , Computer Simulation , Female , Forecasting , Health Services/statistics & numerical data , Humans , Linear Models , Male , Middle Aged , Models, Theoretical , Osteoarthritis, Knee/surgery , Registries , SpainABSTRACT
BACKGROUND: Response to N-palmitoylethanolamide (PEA) appear to be influenced by hormonal changes. OBJECTIVE: To evaluate sex differences in the effectiveness of PEA. METHOD: Patients with neuropathic pain resulting from lumbosciatalgia were assigned to conventional treatment plus PEA or conventional treatment. The pain variables were measured using a visual analog scale and quality of life was assessed. RESULTS: One hundred and twelve patients were included. Significant differences were seen in men for all the variables. In women the differences were only significant for pain. A multivariate linear regression analysis showed a positive interaction between men and PEA treatment for the SF-12 mental component. CONCLUSION: Men treated with PEA are more likely to improve their quality of life regarding mental health, compared with women.