Management of the hemophilic pseudotumor of the abdomen: A rare pathological entity.

INTRODUCTION: Hemophilic pseudotumor is a rare complication that occurs in patients with severe hemophilia. Results from multiple episodes of bleeding into the bones and soft tissues. PRESENTATION OF CASE: A 31 years old male patient, with severe hemophilia A. Diagnosed with an abdominal tumor 10 years ago during routine screening, that progressively grew to encompass the entire abdominal area, with symptoms of intestinal obstruction. DISCUSSION: Hemophilic pseudotumor appears as a painless tumor of slow growth that can compress vital organs producing bone destruction, muscle and skin necrosis. The tumor may have fistulas or break spontaneously. CONCLUSION: The abdominal hemophilic pseudotumor is a rare pathological entity, with few reports worldwide, but must be considered in hemophilic patients with a well documented abdominal tumor.

Celecoxib and heterotopic bone formation after total hip arthroplasty.

We assessed the effectiveness of celecoxib in the prevention of heterotopic ossification (HO) following primary total hip replacement (THR). We studied 170 consecutive THRs. Sixty-three patients received celecoxib after surgery (200mg twice/daily) for 28 days and 84 did not. HO was more common in non-celecoxib patients than in the celecoxib-group at 3, 6, and 12 months (P =0.005, 0.004 and 0.01, respectively). At 1 year, fewer celecoxib recipients had Brooker classes II or III. None of the celecoxib patients developed HO Brooker class IV, while 2% in the non-celecoxib group did. No patient discontinued treatment or had revision for aseptic loosening. A short course of celecoxib for pain aids in the prevention of HO after primary THR, and could be a useful and safe option that does not interfere with anticoagulation.

Alcohol use in elective total hip arthroplasty: risk or benefit?

BACKGROUND: Excessive alcohol consumption has been associated with adverse health measures after elective surgery. The effects of low or moderate consumption remain unclear. QUESTION/PURPOSES: We determined differences among patients with different consumption levels in (1) preoperative and postoperative patient-perceived outcomes and hip scores, (2) changes in those scores from preoperatively to postoperatively, (3) demographics and comorbidities, and (4) length of stay (LOS) and hospitalization charges. METHODS: We retrospectively reviewed 191 patients (218 primary hips). Based on a self-administered consumption questionnaire, patients were stratified into three groups: (1) nondrinkers (n = 52), (2) occasional drinkers (n = 56), and (3) moderate drinkers (n = 17). Demographics, BMI, Charlson Comorbidity Index, and American Society of Anesthesiologists grade; preoperative and postoperative Quality of Well-being Scale, SF-36, WOMAC, Harris hip, and Merle d'Aubigné-Postel hip scores; and LOS and hospital charges were obtained and compared among groups adjusting for patient characteristics. Minimum followup was 1 year (mean, 3.5 years; range, 1-6 years). RESULTS: Most abstainers were older, female, and Hispanic. Preoperatively, moderate drinkers had better WOMAC function and total scores and Harris hip scores. There were no differences postoperatively among groups. However, nondrinkers had greater improvement (preoperative to postoperative) in the WOMAC function, pain, and total scores. Compared to nondrinkers, moderate drinkers had a higher contribution margin and net income. CONCLUSIONS: Alcohol consumption is more common among men and non-Hispanics. Moderate consumption was associated with better WOMAC and Harris hip scores. After surgery, abstainers achieved greater improvements in the WOMAC function, pain, and total scores. LEVEL OF EVIDENCE: Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

Arthroplasty knee surgery and alcohol use: risk factor or benefit?

BACKGROUND: Excessive alcohol consumption has been associated with adverse measures of health after elective surgery. However, associations of low/moderate consumption remain uncertain. QUESTION/PURPOSES: We determined differences among patients with three different self-reported consumption levels in (1) preoperative/postoperative patient-perceived outcomes and knee scores, (2) preoperative/postoperative changes in these scores, (3) preoperative demographics and comorbidities, and (4) length of stay (LOS) and inpatient charges. METHODS: We retrospectively studied 430 patients (545 TKAs). Based on a self-administered consumption questionnaire, patients were stratified into groups: (1) nondrinkers, (2) occasional drinkers, and (3) moderate drinkers. We compared the following variables between groups: demographics, BMI, American Society of Anesthesiologists score, Charlson Comorbidity Index, preoperative and postoperative Quality of Well-being Index (QWB-7), SF-36 score, WOMAC score, Knee Society (KS) Score, Hospital for Special Surgery (HSS) knee score, LOS, and hospital charges. QWB-7, SF-36, WOMAC, KS, and HSS scores were compared adjusting for patient characteristics. Minimum followup was 1 year (average, 3.4 years; range, 1-6 years). RESULTS: Preoperatively, compared to self-reported nondrinkers, moderate drinkers had better QWB-7, SF-36, and WOMAC scores. At followup, occasional and moderate drinkers had better KS function and HSS scores. However, nondrinkers had greater SF-36 general health improvement. Most nondrinkers were older, female, and Hispanic and had more comorbidities. Nondrinkers had a longer LOS. CONCLUSIONS: Self-reported alcohol consumption was more common among men and non-Hispanics. Moderate drinkers had better preoperative QWB-7, SF-36, and WOMAC scores and shorter LOS than nondrinkers. However, after surgery, self-reported abstainers achieved greater improvements in the SF-36 general health score.

Do patient expectations about arthroplasty at initial presentation for hip or knee pain differ by sex and ethnicity?

BACKGROUND: Many studies show gender and ethnic differences in healthcare utilization and outcomes. Patients' presurgical cognitions regarding surgical outcomes also may vary by gender and ethnicity and play a role in explaining utilization and outcome differences. However, it is unclear whether and to what extent gender and ethnicity play a role in patients' presurgical cognitions. QUESTIONS/PURPOSES: Do gender and ethnicity influence outcome expectations? Is arthroplasty-related knowledge affected by gender and ethnicity? Do gender and ethnicity influence willingness to pay for surgery? METHODS: In a prospective, multicenter study we gave 765 patients an anonymous questionnaire on expectations, arthroplasty knowledge, and preferences before their consultation for hip and/or knee pain, from March 2005 to July 2007. RESULTS: Six hundred seventy-two of the 765 patients (88%) completed questionnaires. Non-Hispanics and men were more likely to indicate they would be able to engage in more activities. Non-Hispanics and men had greater arthroplasty knowledge. Hispanics and women were more likely to report they would not pay for a total joint arthroplasty (TJA) relative to non-Hispanics and men. CONCLUSIONS: Sex and ethnic differences in patients presenting for their initial visit to the orthopaedists for hip or knee pain influence expectations, knowledge, and preferences concerning TJAs. Longitudinal study of relationships between patients' perceptions and utilization or outcomes regarding TJA is warranted.

Access to arthroplasty in South Florida.

Our objective was to compare the availability of hip and knee arthroplasty to an adult insured by Medicaid and by private insurance. All orthopedic surgeons' offices in a South Florida county were contacted by telephone and presented with a hypothetical patient that needed either a hip or a knee arthroplasty for end stage arthritis. Two scenarios were presented. The hypothetical patient was presented as either having private insurance or Medicaid. 14.3% of all offices contacted offered an appointment to patients with Medicaid coverage for hip and knee arthroplasty, respectively. All offices offered an appointment to patients with private insurance. The mean time until appointment was longer for patients with Medicaid when compared with private insurance. Adults insured with Medicaid currently have limited access to total joint arthroplasty within the studied community.

Ethnic and racial factors influencing well-being, perceived pain, and physical function after primary total joint arthroplasty.

BACKGROUND: Studies suggest, even when controlling for disease severity, socioeconomic status, education, and access to care, racial and ethnic minorities receive lower-quality health care and have worse perceived pain and function before and after total joint arthroplasty. QUESTION/PURPOSES: We evaluated the influence of race and ethnicity on well-being, pain, and function after total joint arthroplasty and determined whether race, ethnicity, sex, and joint involvement influenced perceived function and pain after total joint arthroplasty. PATIENTS AND METHODS: We retrospectively reviewed the records of 1749 patients receiving total joint arthroplasty (739 hips and 1010 knees). Sixty-eight percent were women, with a mean age of 65 years at followup. We assessed patients preoperatively and at a minimum of 2 years (mean, 5.1 years; range, 2-16 years) on perceived well-being, function, and pain, as well as clinical assessment tools. Also, we assessed the behavior of dependent measures between groups over time. RESULTS: Preoperatively, in both TKA and THA candidates, African American patients presented with worse scores. Postoperatively, all patients had substantial improvement, yet African Americans who had TKA or THA continued to have worse scores on some measures. In both TKA and THA, women had worse scores. CONCLUSIONS: Racial and ethnic minorities undergoing hip and knee arthroplasty appear to have worse patient-perceived outcomes (well-being, pain, and function) when compared to whites. This discrepancy is most pronounced for African Americans. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Patient perceived outcomes after primary hip arthroplasty: does gender matter?

BACKGROUND: Total hip arthroplasty (THA) provides high functional scores and long-term survivorship. However, differences in function and disability between men and women before and after arthroplasty are not well understood. QUESTIONS/PURPOSES: We determined if there was a gender difference in patient-perceived functional measures and range of motion in primary THA. METHODS: We retrospectively studied 532 patients (658 hips) undergoing primary THA. A total of 59% were women and 41% were men. Patients were assessed preoperatively and at minimum 2 years using Quality of Well-being, SF-36, WOMAC, and Harris hip score. We determined if differences existed between genders before and at followup for all dependent measures. Independent t-tests were also used to determine differences between genders concerning the change (Δ) scores and hip range of motion. The time course of perceived functional recovery was also documented. RESULTS: Males were on average 5 years (58) younger than females (63). Before surgery, females scored worse than males on the Harris hip score, WOMAC function, WOMAC pain, and WOMAC total scores. All scores improved at followup in both groups. Regardless of time, females had lower scores than males. However, females had greater improvement over males for WOMAC function (39 versus 35), WOMAC pain (11 versus 10), and WOMAC total (53 versus 48). CONCLUSIONS: Substantial gender functional differences exist before treatment. However, women reported greater improvement as a result of the intervention when compared with men. LEVEL OF EVIDENCE: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

All-Patient Refined Diagnosis-Related Groups in primary arthroplasty.

Our objective was to determine if the All-Patient Refined Diagnosis-Related Groups (APR-DRGs) and other comorbidity scores correlate with pain level, functional abilities, and hospital cost after primary total joint arthroplasty (TJA). Three hundred three patients having TJA were evaluated with average follow-up of 21 months. Western Ontario and McMaster Universities osteoarthritis index, Short-Form 36, and Quality of Well-Being index were administered before and after surgery. The APR-DRG subclassification including severity of illness (SOI) subclass scores and risk of mortality (ROM), Charlson index, American Society of Anesthesiologist (ASA), Charnley score, length of stay, and hospital costs were reported. Patients in a higher SOI and ROM subclasses had a statistically significant decrease in functional outcomes scores, longer length of stay, and greater hospitals costs than those in lower subclasses. However, correlations of comorbidity categories with outcome scores were poor. The APR-DRG classification helps identify those individuals with worse function and is specially suited in identifying those patients who incur a higher hospital cost.