Total hip arthroplasty in Belgium: the contribution of a social health insurer to the debate.

This study describes current clinical practice and outcomes of Total Hip Arthroplasty in Belgian hospitals. Orthopaedic registries concentrate on implant related analyses and sometimes on patient reported outcomes. Our aim was to describe the extent and to generate hypotheses about the determinants of the variability of health care practices and of prosthesis survival in Belgium. Only unilateral elective primary Total Hip Arthroplasties were included. Length of stay, costs, transfusion rates and other care activities were analysed over 2008 and 2009 together. Prosthesis survival was studied using Kaplan-Meier and Cox regression hazard ratio computations over the period 2000-2009. 36798 elective Total Hip Arthroplasties have been included in a study of all members of the Belgian Christian Sickness Fund. The non-standardised ten year Total Hip Arthroplasty survival rate is 93% (Kaplan-Meier). Quality has progressed notably compared with 10 years earlier. Important variations still persist though between hospitals, for all studied indicators.

Podiatric care for diabetic patients with foot problems: an observational study.

The aims of this study were to describe podiatric care for diabetic patients with foot problems and to explore the changes in knowledge, self-care behaviour and physical functioning after podiatric care. The treatment characteristics of 26 diabetic patients referred to podiatry were assessed. Prior to the first podiatric visit (T1) and 20 weeks later (T2) these patients filled in a structured questionnaire and performed a six-minute walking test. In half the number of patients preventive goals were set and strived for by general education about the diabetic foot and advice on footwear and self-care behaviour. With regard to treatment, reduction of pain was the most frequently selected goal. To achieve this reduction, a variety of interventions was applied. After podiatric care, patients reported having less severe foot pain and some improvements in functional ability and self-care behaviour were found. This study offers clues to start controlled clinical trials on the effectiveness of podiatry for diabetic patients. Trials should not only be directed to (the role of podiatry in) ulcer healing; it may be even more significant to study its effectiveness for the purpose of prevention and treatment of early-stage diabetic foot symptoms.

Clinical and functional correlates of foot pain in diabetic patients.

PURPOSE: Patients with diabetes mellitus frequently suffer from foot pain. This pain seems to be a neglected area in studies on the diabetic foot. The purpose of this study was to identify clinical variables associated with foot pain in diabetic patients. In addition, the relationships between foot pain and several functional impairments and disabilities were explored. METHOD: The research group consisted of 29 diabetic patients with any symptoms possibly associated with a diabetic foot, who were referred to podiatry. The relationships between several clinical measures and foot pain were analysed by means of Mann-Whitney U-tests. In addition, Spearman rank correlations coefficients were computed to assess the relationships between foot pain and measures of functional health. RESULTS: Diabetic patients suffering from sensory neuropathy experience more severe foot pain. Furthermore, patients with more severe foot pain experience more fatigue, more disabilities in walking and a lower level of affective well-being. CONCLUSION: Based on these findings this paper concludes that foot pain in diabetic patients is an important impairment which deserves further scientific attention.

Anti-CD40 plus interleukin-4-activated human naive B cell lines express unmutated immunoglobulin genes with intraclonal heavy chain isotype variability.

Combination of anti-CD40 antibody and interleukin-4 (IL-4) induces B cell clonal expansion reminiscent of the T-dependent proliferation following antigenic challenge in vivo. We have analyzed the usage of CH genes and the presence or absence of somatic mutations within the progeny of a single human naive B cell activated with anti-CD40 + IL-4. To address this issue, single-cell cultures of naive (sIgD+) tonsillar B lymphocytes expressing the VH1-restricted G8 idiotype were set up. After culture and RNA extraction, VH1+ Ig mRNA were reverse-transcribed, amplified by polymerase chain reaction and sequenced. A single sIgD+ B cell could generate clones expressing mu, gamma 1, gamma 3, or epsilon, illustrating that the progeny of a single cell can express different isotypes in response to the same stimulus in vitro. The rate of somatic mutations affecting the immunoglobulin variable heavy chain gene was indistinguishable from the background of errors introduced by Taq polymerase.

[A specialized outpatient foot clinic for diabetic patients decreases the number of amputations and is cost saving]. / Een gespecialiseerde voetenpolikliniek voor diabetespatiënten vermindert het aantal amputaties en is kostenbesparend.

OBJECTIVE: Evaluation of the effectiveness of a foot clinic for diabetes patients. DESIGN: Retrospective study and cost-effect analysis. SETTING: Spaarne Hospital, Heemstede. METHOD: The effectiveness of 5 years's activity (1987-1991) of a foot clinic was measured by comparing its patient population, the presenting ulcers and amputations, the average stay in hospital and the cost reduction with 1983-1986. RESULTS: From 1987 to 1991 4323 diabetic check-ups were done in the clinic, of which 810 were first referrals. Of these first referrals 112 presented with a leg ulcer. Compared with the period before the establishment of the clinic in 1987, hospital admission for diabetic foot problems decreased from 48 to 29 days and 30 admissions could be prevented. The number of amputations decreased by 43%. The reduction in costs was calculated to be about Dfl. 325,000.--annually. CONCLUSION: A specialised foot clinic reduces morbidity and cost in diabetes foot care. Central figures in this clinic are a chiropodist and a nurse, supported by a surgeon and specialists in internal diseases, rehabilitation and footwear.

Locking graft in the treatment of tibial pseudarthrosis.

Despite modern treatments of tibial fractures, we still have nonunions. In case of failure we used a method of treatment which has become less popular over the last decades. A rectangular inlay graft is harvested from the anteromedial tibial surface. The graft, measuring about 12 to 15 cm long, is placed over the nonunion with 2/3 of its length on one side and the remaining third on the other side. The graft is turned 180 degrees and fixed with four lag screws in the original donor site. Postoperatively, we place a nonweight-bearing cast for 3 months. The results are quite satisfactory for both nonunions and difficult multi-operated nonunions.

Internal fixation of tibial plateau fractures using the AO instrumentation.

Between January 1970 and December 1985, 76 patients (76 fractures) underwent internal fixation for tibial-plateau fractures as recommended by the AO-group (14). Fifty patients were available for follow-up. The long term results of this retrospective study are reported. Subjective results were satisfying. Forty-four percent of the patients were painfree and only 8% had severe postoperative pain, which was clearly related to osteoarthritis. Eight-eight percent of patients had no instability at follow-up. Clinical and radiographic results were evaluated for mobility, laxity and osteoarthritis. Thirty-five patients had a loss of flexion averaging 16.6 degrees. In 12 patients the average decrease in extension amounted to 7.5 degrees. Valgus increase averaged 9.7 degrees in 17 patients, and the average varus increase was 7.5 degrees in 4 patients. Seventy-four percent of patients showed no laxity at follow-up. The finding of osteoarthritis on X-ray was well correlated with the postoperative incongruence of the articular surface. It was also found to develop earlier in patients who underwent (partial) meniscectomy. Some general considerations about tibial condyles fractures are presented, and the technique used by the authors is discussed at length. The indications for internal fixation are also evaluated. The importance of adequate reduction, stable internal fixation and vigorous postoperative rehabilitation is stressed.

[Long-term results of the Krogius-Roux operation]. / Les résultats à longue échéance de l'opération Krogius-Roux.

The authors have reviewed patients treated with the operation of Krogius-Roux with a long follow-up, especially on the indication of recurrent dislocation of the patella. Thirty-nine patients out of 76 operations have been evaluated.

Acetabular bone stock reconstruction with frozen femoral head allografts and the use of a cementless screw cup in total hip revision surgery. A 5 years' clinical, radiologic and scintigraphic follow-up.

This prospective study reviews the behaviour of a cementless conical screw cup in total hip revision surgery with or without the use of bone grafts to reconstruct acetabular bone stock. Clinical and radiologic results are given. For proper radiographic interpretation a new classification system is suggested, based on histologic features, the principles of which are explained. The results of auto- or allografts for the treatment of the same pathological condition are compared. The difference between both grafts successively in bone incorporation, biochemical behaviour, morbidity and mortality rate is discussed. The difference between a cancellous and a cortical bone transplant in the mechanism of repair is discussed. This study also analyzes acetabular bone graft activity using serial technetium-99m bone scans. Some guidelines for rehabilitation programs can be deduced from these observations. Finally, a correlation between graft incorporation and the acetabular deficiency to be reconstructed can be postulated.

A reinvestigation of the Geman-Miller respiratory oscillator model.

The model of Geman-Miller of the respiratory oscillator is reinvestigated for its interpretation of the parameters: W and T. It was found that the interpretation of Geman-Miller, that the parameters T and W represent the chemosensitive feedback, is incorrect. The extension to the model made by Engeman and Swanson is not necessary to produce afterdischarge. It is demonstrated that the afterdischarge can be predicted in the original Geman-Miller model from the Jacobian Matrix.