Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment.

BACKGROUND: Between 7% and 15% of patients are dissatisfied after total hip arthroplasty (THA). To assess predictors and postoperative determinants of satisfaction and expectation fulfilment one year after (THA). METHODS: Before THA surgery, 132 patients from three tertiary care centres and their surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (THR survey). One year after surgery, patients (n = 123) were contacted by phone to complete a questionnaire on expectation fulfilment (THR survey), satisfaction, functional outcome (Womac), and health-related quality of life (SF 12). Univariate and multivariate analyses were performed. RESULTS: Preoperative predictors of satisfaction were a good mental wellbeing (adjusted OR 1.09 [1.02; 1.16], p = 0.01) and optimistic surgeons expectations (1.07 [1.01; 1.14], p = 0.02). The main postoperative determinant of satisfaction was the fulfilment of patient's expectations (1.08 [1.04; 1.12], p < 0.001). Expectation fulfilment could be predicted before surgery by young age (regression coefficient -0.55 [-0.88; -0.21], p = 0.002), good physical function (-0.96 [-1.82; -0.10], p = 0.03) and good mental wellbeing (0.56 [0.14; 0.99], p = 0.01). Postoperative determinants of expectation fulfilment were functional outcome (-2.10 [-2.79; -1.42], p <0.001) and pain relief (-14.83 [-22.38; -7.29], p < 0.001). CONCLUSION: To improve patient satisfaction after THA, patients' expectations and their fulfilment need to be carefully addressed. Patients with low mental wellbeing or physical function should be identified and specifically informed on expected surgical outcome. Surgeons' expectations are predictive of satisfaction and information should aim to lower discrepancy between surgeons' and patients' expectations.

Fractures of ceramic bearings: history and present status.

During a period of 25 years (1977 to 2001), 13 fractures of an alumina component were recorded retrospectively. During the same period, approximately 5500 alumina components were implanted (3300 with all-alumina bearings and 1200 with alumina-on-polyethylene). These events occurred in seven women and six men, with a mean age of 59 years and a mean weight of 71 kg. There were eight fractures of the femoral head and five fractures of the socket component. Three fractures clearly were related to trauma (two fractures of the socket and one fracture of the head) and two were related to an abnormal design (one 22-mm head and one extra-long neck). Five fractures occurred without any rational explanation, but two fractures that occurred in the early phase could have been caused by a weaker alumina material. Finally three recent fractures of the liner were related to a change in the design of the material. This has been corrected and no additional fractures were observed. Although this dramatic event is of concern, it is infrequent and easy to solve by a limited revision procedure if done emergently. This rare complication should be balanced with the other complications of THR, including mechanical failures and osteolysis, often described with metal-on-polyethylene prostheses.

Preparation of isolated human muscle fibers: a technical report.

The aim of this study was to develop a technique to culture satellite cells from isolated intact fast or slow human muscle fibers. Previous studies have been carried out on small rodent muscles where the fibers run from tendon to tendon, but this is the first description of the modification of this technique for much larger human muscles. We have demonstrated that the human muscle fibers are in fact segmental, and we have also shown that it is possible to obtain very pure satellite cell cultures. We discuss the importance of this technique as a source of highly purified muscle cell cultures, which can be used for further studies on satellite cell behavior.

Percutaneous Biopsy of the Synovial Membrane.

Techniques of percutaneous synovial biopsy under fluoroscopic control of large joints of the limbs (other than the knee) may be useful in arthritis of undetermined etiology especially when infection is considered. Main technical refinements include adequate selection of an optimal approach and biopsy site using new imaging methods, use of a Tru-Cut(R) needle, and placement of the cutting window tangential to the joint surface, and selection of an optimal approach and biopsy site. Detailed technique of the synovial biopsy of hip, ankle, shoulder, and elbow joints is discussed.

Steroid Injection of the Appendicular Skeleton and Sacroiliac Joints.

Steroid joint injections may be effective in painful joints due to degenerative disease and posttraumatic changes, as well as rheumatoid arthritis and seronegative spondylarthropathy. Fluoroscopic guidance may be necessary for deep (sacroiliac, hip, and shoulder) or small (wrist, hand, and foot) joints. Detailed technique of the steroid injection is given, especially for the sacroiliac joint.

Percutaneous Resection of Osteoid Osteomas.

Osteoid osteomas in almost all locations may be treated by percutaneous resection under CT scan guidance. The authors give their own experience with a series of 30 cases. The different techniques of percutaneous resection reported in the literature are reviewed. Advantages of the percutaneous resection are compared to those of classical surgery and other percutaneous techniques such as lesion destruction with thermocoagulation, photocoagulation, and intralesional injection of alcohol.

Aspiration of Tendinous Calcific Deposits.

Needle aspiration of tendinous calcific deposits under fluoroscopic control may be a valuable tool in selected cases of painful shoulders with chronic and debilitating pain resistant to medical treatment. This article reviews the technique and results of this treatment. The aims of this procedure are (1) to evacuate a maximum amount of calcium; (2) to fragment the residual calcific deposits to facilitate its resorption during the following weeks; (3) to reduce the inflammation secondary to the presence and migration of residual calcific deposits by in situ injection of corticosteroids. Good results are obtained in 61Ð74% of cases. Surgical treatment should be restricted to failures of needle aspiration.