Efficacy of a Physician Assistant Student-Developed Behavior Change Program at a Local Free Clinic.

PURPOSE: A quality assurance and quality improvement assessment was conducted to evaluate the efficacy of a behavior change program developed by physician assistant (PA) students at a local free clinic. METHODS: Physician assistant students developed and implemented a program using motivational interviewing and healthy lifestyle behavioral counseling at a local free clinic. Twenty-eight patients participated in the program over 5 cohorts. A retrospective chart review was used to collect data. RESULTS: Weight and body mass index (BMI) data were gathered retrospectively from patients' charts corresponding to the 6 months before the program, at the start of the program, at the end of the 12-week program, and at 3 and 6 months after the program. Significant differences were found between the start and end of the program for weight (P < .001) and BMI scores (P < .001). The mean weight decreased from 111.98 (standard deviation [SD] = 33.47) to 109.00 kg (SD = 33.93). The weight loss ranged from 0.45 to 9.53 kg, and 75% of participants lost weight. The mean BMI decreased from 41.21 (SD = 10.64) to 40.13 (SD = 10.98). Differences were maintained at 3- and 6-month follow-ups. However, only half the sample's data were available at follow-ups because some patients did not return to the free clinic during that time period. CONCLUSIONS: A program facilitated by PA students and designed to help patients make healthy diet and exercise changes can be a valuable resource for free clinics and patients and an excellent clinical opportunity for PA students. To strengthen the program's commitment to maintenance of weight loss, program components of continued follow-up and engagement of patients should be explored and developed.

Minimum ten-year results of primary bipolar hip arthroplasty for degenerative arthritis of the hip.

BACKGROUND: Bipolar hip arthroplasty has been advocated by some as an alternative to total hip arthroplasty for the treatment of degenerative arthritis of the hip. We sought to assess the results of this procedure at our institution after a minimum duration of follow-up of ten years. METHODS: We retrospectively reviewed a consecutive series of 152 patients (173 hips) who underwent primary bipolar hemiarthroplasty for the treatment of symptomatic degenerative arthritis of the hip with a cementless femoral component between 1983 and 1987. Of the original cohort of 152 patients, ninety-two patients (104 hips) were available for clinical and radiographic review at a mean of 12.2 years postoperatively. At the time of the latest follow-up, self-administered Harris hip questionnaires were used to assess pain, mobility, activity level, and overall satisfaction with the procedure. Biplanar hip radiographs were made to evaluate bipolar shell migration, osteolysis, and femoral stem fixation. RESULTS: At the time of the latest follow-up, nineteen patients (nineteen hips) had undergone revision to total hip arthroplasty because of mechanical failure, and three patients (three hips) were awaiting revision because of symptomatic radiographic mechanical failure. Twelve acetabular revisions were performed or scheduled for the treatment of pelvic osteolysis or protrusio acetabuli secondary to component migration. Acetabular reconstruction required bone-grafting, an oversized shell, and/or a pelvic reconstruction ring. The overall rate of mechanical failure was 21.2% (twenty-two of 104 hips), with 91% (twenty) of the twenty-two failures involving the acetabular component. Reaming of the acetabulum at the time of the index arthroplasty was associated with a 6.4-fold greater risk of revision. The rate of implant survival, with revision because of mechanical failure as the end point, was 94.2% for femoral components and 80.8% for acetabular components at a mean of 12.2 years. Of the remaining sixty-nine patients (eighty-one hips) in whom the original prosthesis was retained, seventeen patients (24.6%) rated the pain as moderate to severe. Nearly 30% of patients with an intact prosthesis required analgesics on a regular basis. Radiographs were available for fifty-eight hips (including all of the hips with moderate to severe pain) after a minimum duration of follow-up of ten years; twenty-eight of these fifty-eight hips had radiographic evidence of acetabular component migration. CONCLUSIONS: This bipolar cup, when used for hemiarthroplasty in patients with symptomatic arthritis of the hip, was associated with unacceptably high rates of pain, migration, osteolysis, and the need for revision to total hip arthroplasty, especially when the acetabulum had been reamed. To the extent that these findings can be generalized to similar implant designs with conventional polyethylene, we do not recommend bipolar hemiarthroplasty as the primary operative treatment for degenerative arthritis of the hip.