The Morscher Press-Fit Acetabular Component: An Independent Long-Term Review at 18-22 Years.

BACKGROUND: There are relatively few 20-year results of uncemented acetabular components, and most of these are modular designs. This study reports the 20-year results of a monoblock press-fit acetabular component. METHODS: A total of 122 total hip arthroplasties (111 patients) using the Morscher cup were reviewed at a mean of 19.7 years. The average age at implantation was 57.3 years (range, 36-74 years), and 81 (66%) were men. RESULTS: Twenty-two patients (25 hips) had died. Seven hips were revised, including 5 acetabular revisions. Six patients (6 hips) declined to participate but were known not to have been revised. The mean Oxford hip score was 41.1 (range, 22-48), and the mean reduced Western Ontario and McMaster Universities Osteoarthritis Index score was 5.7/48 (range, 0-24). Eccentric wear was seen in 13 (15.7%) and major osteolysis in 14 (17%) of 82 surviving hips with radiographs. The all-cause revision rate was 0.32 per 100 observed component years (95% confidence interval [CI], 0.13-0.66). The 20-year Kaplan-Meier survival was 93.4% (CI, 86.6-96.8) for all-cause revisions, 95.5% (CI, 89.4-98.1) for any acetabular revision, and 97.1% (CI, 91.2-99.1) for acetabular aseptic loosening, wear, or osteolysis. CONCLUSION: The Morscher acetabular component has continued to perform well at 20 years despite using conventional polyethylene with results that match or surpass other cementless acetabulae.

Rationing for Total Hip and Knee Arthroplasty Using the New Zealand Orthopaedic Association Score: Effectiveness and Comparison With Patient-Reported Scores.

BACKGROUND: There is increasing interest in scoring systems to prioritize patients for hip and knee arthroplasty. The purpose of this study was to determine the effectiveness of the New Zealand Orthopaedic Association (NZOA) score and compare it with patient-reported scores of patients listed for hip and knee arthroplasty. METHODS: Over a 1-year period, all patients listed for primary hip and knee arthroplasty were scored by a prioritization nurse. The NZOA score, outcome, preoperative Oxford hip or knee score (OHKS) and reduced Western Ontario McMaster osteoarthritis index (WOMAC) score (RWS) were collected. RESULTS: Overall, 608 patients were listed for hip (319) or knee (289) arthroplasty. The mean scores for knees were all better than hips (P < .001). On initial scoring, 324 patients (53%) were given certainty (mean NZOA, 80.5; OHKS, 10.0; RWS, 35.1), 90 (15%) given clinical over-ride (NZOA, 69.6; OHKS, 12.0; RWS, 33.2), and 194 (32%) returned to general practitioner (NZOA, 64; OHKS, 14.2; RWS, 30.8). Knees (38%) were more likely to be returned than hips (26%; P = .002). Fifty (26%) were re-referred during the study period (mean, 5 months) and given certainty or over-ride. The difference at final outcome between patients with certainty and clinical over-ride was NZOA, 10.3 points; Oxford, 1.6 points; and RWS, 1.4 points. The difference between clinical over-ride and returned to general practitioner was NZOA, 7.2; Oxford, 4.4; RWS, 5.3. CONCLUSION: The NZOA score is an effective tool for rationing for joint arthroplasty. Patients around the threshold score of 70 may not have a clinically important difference compared with those above threshold.

Employment among schoolchildren and its associations with adult substance use, psychological well-being, and academic achievement.

PURPOSE: To examine the association between paid part-time employment among schoolchildren, and adult substance use, psychological well-being, and academic achievement. METHODS: Longitudinal data from the Dunedin Multidisciplinary Health and Development Study were used to evaluate the association between employment at each of 11, 13, and 15 years and adult smoking, regular alcohol binge drinking, regular cannabis use, sense of coherence, social participation, positive coping style, prosociality, no formal qualifications, and university degree. Associations were initially assessed using unadjusted regression analyses and then adjusted for the potential childhood confounders intelligence quotient, reading development, Student's Perception of Ability Scale, socioeconomic disadvantage, family climate, harsh parent-child interaction, parental opinion of their child's attitude to school, and child's personal attitude to school. RESULTS: Employment at 11 years of age was associated with a lower odds of adult smoking; the odds of subsequent regular alcohol binge drinking were greater for those who were employed at age 13; and higher adult rates of social participation and prosociality were identified for adolescents who were employed at 15 years of age. When the potential confounders were controlled, employment at age 13 was predictive of both adult smoking and regular binge drinking, and working at 15 years of age was protective against regular cannabis use and associated with greater social participation. CONCLUSIONS: There is no consistent evidence that exposing schoolchildren to part-time employment compromised subsequent health, well-being, and education in a developed country.