Does Consulting an Occupational Medicine Specialist Decrease Time to Return to Work Among Total Knee Arthroplasty Patients? A 12-Month Prospective Multicenter Cohort Study.

PURPOSE: The aim of this study is to investigate whether total knee arthroplasty (TKA) patients who consulted an occupational medicine specialist (OMS) within 3 months after surgery, return to work (RTW) earlier than patients who did not consult an OMS. METHODS: A multi-center prospective cohort study was performed among working TKA patients, aged 18 to 65 years and intending to RTW. Time to RTW was analyzed using Kaplan Meier and Mann Whitney U (MWU), and multiple linear regression analysis was used to adjust for effect modification and confounding. RESULTS: One hundred and eighty-two (182) patients were included with a median age of 59 years [IQR 54-62], including 95 women (52%). Patients who consulted an OMS were less often self-employed but did not differ on other patient and work-related characteristics. TKA patients who consulted an OMS returned to work later than those who did not (median 78 versus 62 days, MWU p < 0.01). The effect of consulting an OMS on time to RTW was modified by patients' expectations in linear regression analysis (p = 0.05). A median decrease in time of 24 days was found in TKA patients with preoperative high expectations not consulting an OMS (p = 0.03), not in patients with low expectations. CONCLUSIONS: Consulting an OMS within 3 months after surgery did not result in a decrease in time to RTW in TKA patients. TKA patients with high expectations did RTW earlier without consulting an OMS. Intervention studies on how OMSs can positively influence a timely RTW, incorporating patients' preoperative expectations, are needed.

Surgical site infection after wound closure with staples versus sutures in elective knee and hip arthroplasty: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to study surgical site infection of wound closure using staples versus sutures in elective knee and hip arthroplasties. METHODS: A systematic literature review was performed to search for randomized controlled trials that compared surgical site infection after wound closure using staples versus sutures in elective knee and hip arthroplasties. The primary outcome was surgical site infection. The risk of bias was assessed with the Cochrane risk of bias assessment tool. The relative risk and 95% confidence interval with a random-effects model were assessed. RESULTS: Eight studies were included in this study, including 2 studies with a low risk of bias, 4 studies having 'some concerns', and 2 studies with high risk of bias. Significant difference was not found in the risk of SSI for patients with staples (n = 557) versus sutures (n = 573) (RR: 1.70, 95% CI: 0.94-3.08, I2 = 16%). The results were similar after excluding the studies with a high risk of bias (RR: 1.67, 95% CI: 0.91-3.07, I2 = 32%). Analysis of studies with low risk of bias revealed a significantly higher risk of surgical site infection in patients with staples (n = 331) compared to sutures (n = 331) (RR: 2.56, 95% CI: 1.20-5.44, I2 = 0%). There was no difference between continuous and interrupted sutures (P > 0.05). In hip arthroplasty, stapling carried a significantly higher risk of surgical site infection than suturing (RR: 2.51, 95% CI: 1.15-5.50, I2 = 0%), but there was no significant difference in knee arthroplasty (RR: 0.87, 95% CI: 0.33-2.25, I2 = 22%; P > 0.05). CONCLUSIONS: Stapling might carry a higher risk of surgical site infection than suturing in elective knee and hip arthroplasties, especially in hip arthroplasty.

Comparison between the Harris- and Oxford Hip Score to evaluate outcomes one-year after total hip arthroplasty.

Harris Hip Score (HHS) is a surgeon administered measurement for assessing hip function before and after total hip arthroplasties (THA). Patient reported outcome measurements (PROMs) such as the Oxford Hip Score (OHS) are increasingly used. HHS was compaired to the OHS assessing whether the HHS can be replaced by the OHS for clinical evaluation of THAs. All 155 patients (167 THAs) were asked to complete an OHS before and one-year after surgery. The surgeon independently scored the HHS at the same time points. We examined and compared the clinimetric properties of both instruments. Internal consistency reliability of the OHS was notably higher than that of the HHS at all occasions. HHS had a higher effect size (4.1) than the OHS (2.1). Ceiling effect at follow up was 55.6% (HHS) and 36.4% (OHS). Spearman's rank correlation between HHS and OHS was 0.57 at baseline and 0.65 and after one year. The correlation between the change scores was 0.50. The Oxford Hip Score is of good use in quality assessment after THA.

The Zweymller cementless total hip prosthesis in patients aged 50 years and younger.

Sixty-eight young patients (74 prostheses), mean age 43 years (standard deviation 7.7) at the time of the index operation, with a Zweymller cementless total hip prosthesis were evaluated with a mean follow-up time of 75 months (sd 15.7). At follow-up, the mean Harris Hip Score was 94 (sd 8.1). Six stem prostheses had vertical sub-sidence and nine cups showed signs indicating possible loosening. The Oxford Hip Score averaged 19 points (sd 8.7). Revision surgery was performed for septic loosening (n=3 stem and cup prostheses), for aseptic loosening of the cup (n=2), and for a traumatic periprosthetic fracture (n=1 stem). Worst case survival analysis for aseptic loosening of the cup showed a probability for revision of 3% (CI95 0 7.2%) with a cumulative survival of 96% (CI95 100 90.3%) after 84 months. For the stem prostheses the probability for revision was 1% (CI95 0 4.3%) after 114 months with a cumulative survival of 99% (CI95 100 95.8%) after 72 months. Worst case cumulative survival for any reason of revision was 94.5% (CI95 99.9 89.2%) after 81 months. Promising results of the Zweymller cementless hip prosthesis for the younger patient were obtained, although longer follow-up will be necessary. (Hip International 2005; 15: 1-11).

Micturition symptoms and urinary incontinence after non-radical hysterectomy.

The effects of 554 non-radical vaginal and abdominal hysterectomies on micturition symptoms and urinary incontinence were studied. From the urological point of view, two groups of women may be distinguished prior to hysterectomy: one without urological symptoms and the second with urological complaints (present in no less than 57% of all women and differing significantly from the distribution of urological symptoms in the normal population). In the first group, frequency developed significantly more often than nocturia, dysuria, stress incontinence and nocturnal and diurnal urge incontinence. The type of hysterectomy was not related to this development, except that urgency more often followed vaginal hysterectomy. In the second group, highly significant improvement and disappearance of symptoms was observed. Age, parity, menopausal status, the presence of myomas, height, weight and body mass index had no influence.