Marital Relationship and Quality of Life in Couples Following Hip Replacement Surgery.

For the majority of patients with osteoarthritis, total hip (THA) arthroplasty results in a significant reduction in pain, emotional distress, and disability and a significant improvement in their quality of life. Little is known about how these recovery-related changes impact the spouse or the marital relationship. METHODS: Twenty-nine couples whose spouse underwent a THA (29 THA) participated in a semi-structured retrospective interview designed for this study. They were each asked to recall the level of pain before and after surgery and to provide a numerical rating score for questions pertaining to the level of disability in seven different activities of daily living. Couples were also asked to list in order of importance the five ways in which the surgery affected their overall quality of life. RESULTS: The spouses estimated their partner's pain, both pre- and postoperatively, to be significantly higher level than the patient's perception. The spouses perceived a greater improvement in family/home responsibilities, recreation and social activities, and in their occupation than that noted by the partner. After the arthroplasty, the spouses indicated that their lives had improved with respect to doing more activities/leisure (72%), because their partner had less suffering (59%), they had more independence/less caregiving (55%), it improved their marital relationship (52%), they had a better social/family life (28%), and they were able to travel (28%). CONCLUSIONS: This study indicates that THA result in a significant improvement in quality of life not only for the patients, but also for their spouses.

Challenges to Implementing Total Joint Replacement Programs in Developing Countries.

In this review article, the authors present the many challenges that orthopedic surgeons in developing countries face when implementing arthroplasty programs. The issues of cost, sterility, and patient demographics are specifically addressed. Despite the many challenges, developing countries are beginning to offer hip and knee reconstructive surgery to respond to the increasing demand for such elective operations as the prevalence of osteoarthritis continues to increase. The authors shed light on these nascent arthroplasty programs.

Capsular closure outweighs head size in preventing dislocation following revision total hip arthroplasty.

INTRODUCTION: The high dislocation rate following revision total hip arthroplasty (THA) has been shown to be significantly reduced by closing the posterior capsule and by the use of large diameter femoral heads. The relative importance of each of these strategies on the rate of dislocation remains unknown. We undertook a study to determine if increasing femoral head diameter, in addition to posterior capsular closure would influence the dislocation rate following revision THA. METHODS: We retrospectively reviewed 144 patients who underwent a revision THA. We included all patients who underwent revision THA with closure of the posterior capsule and who had at least a 2-year minimum follow-up. 48 patients had a 28-mm femoral head, 47 had a 32-mm head and 49 patients had a 36-mm femoral head. RESULTS: At a minimum follow-up of 2 years, there were 3 dislocations. There were no dislocations in the 28-mm group (0%), 2 in the 32-mm group (4%) and 1 in the 36-mm group (2%). Head size alone was not found to significantly decrease the risk of dislocation (28-mm versus 32-mm p = 0.12; 28-mm versus 36-mm p = 0.27; 32-mm versus 36-mm p = 0.40). CONCLUSION: Both large diameter heads and careful attention to surgical technique with posterior capsular closure can decrease the historically high dislocation rate after revision THA when utilising the posterolateral approach. Capsular closure outweighs the effect of femoral head diameter in preventing dislocation following revision THA through a posterolateral approach.

Evaluating the Accuracy of Tibial Tunnel Placement After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Anatomic anterior cruciate ligament (ACL) reconstruction improves knee kinematics and joint stability in symptomatic patients who have ACL deficiency. Despite a concerted effort to place the graft within the ACL's native attachment sites, the accuracy of tunnel placement using contemporary techniques is not well established. PURPOSE: To use 3-dimensional magnetic resonance imaging (3D MRI) to prospectively evaluate the accuracy of tibial tunnel placement after anatomic ACL reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Forty patients with symptomatic, ACL-deficient knees were prospectively enrolled in the study and underwent 3D MRI of both their injured and uninjured knees before and after surgery through use of a validated imaging protocol. The root ligament of the anterior horn of the lateral meniscus was used as a radiographic reference, and the center of the reconstructed graft was compared with that of the contralateral normal knee. The tunnel angles and intra-articular graft angles were also measured, as was the percentage overlap between the native tibial footprint and tibial tunnel. RESULTS: The reconstructed tibial footprint was placed at a mean ± SD of 2.14 ± 2.45 mm (P < .001) medial and 5.11 ± 3.57 mm (P < .001) posterior to the native ACL footprint. The mean distance between the center of the native and reconstructed ACL at the tibial attachment site was 6.24 mm. Of the 40 patients, 18 patients had a tibial tunnel that overlapped more than 50% of the native footprint, and 10 patients had maximal (100%) overlap. Further, 22 of the 40 patients had less than 50% overlap with the native footprint, and in 12 patients the footprint was missing completely. CONCLUSION: Despite the use of contemporary surgical techniques to perform anatomic ACL reconstruction, a significant positioning error in tibial tunnel placement remains.

Evaluation of the contribution of the three breast cancer susceptibility genes CHEK2, STK11, and PALB2 in non-BRCA1/2 French Canadian families with high risk of breast cancer.

Inactivating mutations of the CHEK2 and STK11 genes are responsible for Li-Fraumeni and Peutz-Jeghers syndrome, respectively, both autosomal dominant syndromes associated with an increased risk of breast cancer. The PALB2/FANCN gene encodes a nuclear partner of BRCA2 and acts as a linker between BRCA1 and BRCA2. Monoallelic PALB2 truncating mutations were shown to confer higher risk of breast cancer. To evaluate the proportion of French Canadian non-BRCA1/BRCA2 families with high risk of breast cancer potentially harboring alterations in these three breast cancer susceptibility genes, the whole coding and flanking intronic sequences were analyzed in a series of 96 high-risk breast cancer individuals. Despite no PALB2 deleterious truncating mutations being identified, the c.1100delC breast-cancer-associated CHEK2 mutation and a STK11 mutation reported to be the causative mutation in a Peutz-Jeghers family were identified. This extensive analysis also led to the identification of several variants in these genes. Ascertainment of allele frequency of these variants in a cohort of 96 healthy unrelated women suggests a difference in allele frequency for two STK11 intronic variants. In addition, large genomic rearrangements in both STK11 and PALB2 were also examined. Our analysis led to the conclusion that CHEK2, STK11, and PALB2 mutations or large genomic rearrangements of either STK11 or PALB2 are rare, and do not contribute to a substantial fraction of breast cancer susceptibility in high-risk French Canadian breast cancer families.