Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study.

BACKGROUND: A subset of patients with total hip arthroplasty (THA) or total knee arthroplasty (TKA) has suboptimal postoperative results in terms of Patient Reported Outcomes (PROs), and psychological factors could contribute to these suboptimal results. OBJECTIVES: To examine the prevalence of anxiety and depressive symptoms in patients undergoing primary THA or TKA preoperatively and postoperatively, and the relationship between preoperative anxiety and depressive symptoms on PROs of THA and TKA. DESIGN: In this prospective study patients were measured preoperatively, and 3 and 12 months postoperatively. Patients filled in the Hospital Anxiety and Depression Scale, Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS) and a satisfaction questionnaire. RESULTS: Data were obtained from 149 hip and 133 knee patients. The prevalence of anxiety symptoms decreased significantly from 27.9% to 10.8% 12 months postoperatively in hip patients, and from 20.3% to 14.8% in knee patients. Depressive symptoms decreased significantly from 33.6% to 12.1% 12 months postoperatively in hip patients, and from 22.7% to 11.7% in knee patients. In hip and knee patients, preoperative depressive symptoms predicted smaller changes in different HOOS or KOOS subscales and patients were less satisfied 12 months postoperatively. CONCLUSIONS: Preoperatively, the prevalence of anxiety and depressive symptoms was high. At 3 and 12 months postoperatively, the prevalence of anxiety and depressive symptoms was decreased in both hip and knee patients. However, patients with preoperative anxiety and depressive symptoms had worse PROs 3 and 12 months after THA and TKA and were less satisfied than patients without anxiety or depressive symptoms.

Physical functioning four years after total hip and knee arthroplasty.

Our previous study showed that 6 months after total hip arthroplasty (THA) or total knee arthroplasty (TKA), patients reported having less difficulty with daily activities, showed better functional capacity, and performed activities in their natural environment faster compared to preoperatively. However, their actual daily activity level was not significantly improved. Six months is a rather short follow-up period and the discrepancy in recovery among different aspects of functioning might be explained by this limited duration of follow-up. The objective of the present study was to examine the recovery of different aspects of physical functioning at a follow-up nearly 4 years after THA/TKA. Special attention was given to the actual daily activity level, and whether it had increased 4 years after THA/TKA compared to 6 months postoperatively. Seventy-seven (35 hip, 42 knee) patients who were measured preoperatively and postoperatively (6 months after surgery) in a previous study were invited to participate; 44 patients (23 hip, 21 knee) agreed to participate. The 4-year follow-up data were compared with the preoperative and 6-month postoperative data. The daily activity level after 4 years was found to be actually lower than at 6 months post-surgery (128 min vs. 138 min activity per 24h; p-value 0.48). However, the patients continued to improve in other aspects of physical functioning. In conclusion, 4-year post-surgery patients continued to improve on perceived physical functioning, capacity, and performance of activities in daily life. However, even in this relatively healthy study population, patients did not adopt a more active lifestyle 4 years after surgery.

Walking and chair rising performed in the daily life situation before and after total hip arthroplasty.

OBJECTIVE: An earlier study showed that 6 months after total hip arthroplasty (THA) patients' overall daily activity level had not increased, despite significant improvement in their perceived physical functioning. This discrepancy might be because postoperative recovery is not expressed by a more overall active lifestyle, but by the fact that patients could perform the individual activities of daily living (ADL) faster and/or for a longer period of time. The aim of this study was to assess whether patients perform ADL faster and/or for a longer period of time 6 months post-THA compared to baseline. Also examined was whether patients perform activities on the level of healthy matched controls. METHOD: Thirty patients were measured at home with an accelerometry-based Activity Monitor, pre-operatively and 6 months post-THA. Patients were matched with healthy controls on gender and age (±2 years). RESULTS: Compared with baseline, 6 months post-THA the stride frequency and body motility during walking of patients had increased [56.1 (54.3, 57.8)strides/min vs 52.1 (50.3, 54.1)strides/min; P-value<0.0001, and 0.265 (0.245, 0.286)g vs 0.219 (0.197, 0.240)g; P-value<0.0001], and they rose faster from a chair [2.6 (2.5, 2.8)s vs 3.0 (2.8, 3.2)s; P-value<0.0001]. Compared with controls, preoperative all patients had lower values for these parameters. Six months post-THA the stride frequency and body motility during walking were similar to that of controls, but patients rose slower from a chair than controls. CONCLUSION: Six months post-THA patients walked faster and rose from a chair faster compared to baseline. Patients walked as fast as healthy controls but took longer rising from a chair.

Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes.

OBJECTIVE: To compare long term outcome of highly active patients with anterior cruciate ligament ruptures treated operatively versus non-operatively. DESIGN: We reviewed high level athletes with an anterior cruciate ligament rupture on either MRI or arthroscopic evaluation more than 10 years previously, who were treated conservatively. They were pair-matched with patients who had had an anterior cruciate ligament reconstruction with bone-patella-tendon-bone, with respect to age, gender and Tegner activity score before injury. PARTICIPANTS: In total 50 patients were pair-matched. RESULTS: We found no statistical difference between the patients treated conservatively or operatively with respect to osteoarthritis or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination. CONCLUSION: We conclude that the instability repair using a bone-patella-tendon-bone anterior cruciate ligament reconstruction is a good knee stabilising operation. Both treatment options however show similar patient outcome at 10 year follow up.

Short communication: Quantification of the transmission of microorganisms to milk via dirt attached to the exterior of teats.

Pathogens and spoilage microorganisms can be transmitted to milk via dirt (e.g., feces, bedding material, soil, or a combination of these) attached to the exterior of the cows' teats. To determine the relevance of this pathway and to perform quantitative microbial risk analysis of the microbial contamination of farm tank milk (FTM), it is important to know the amount of dirt transmitted to milk via the exterior of teats. In this study at 11 randomly selected Dutch farms the amount of dirt transmitted to milk via the exterior of teats is determined using spores of mesophilic aerobic bacteria as a marker for transmitted dirt. The amount of transmitted dirt to milk varied among farms from approximately 3 to 300 mg/L, with an average of 59 mg/L. The usefulness of the data for microbial risk analyses is briefly illustrated using the contamination of FTM with spores of butyric acid bacteria as a case study. In a similar way the data can be used to identify measures to control the contamination of FTM with other microorganisms or chemical residues.

Minimizing the level of butyric acid bacteria spores in farm tank milk.

A year-long survey of 24 dairy farms was conducted to determine the effects of farm management on the concentrations of butyric acid bacteria (BAB) spores in farm tank milk (FTM). The results were used to validate a control strategy derived from model simulations. The BAB spore concentrations were measured in samples of FTM, feces, bedding material, mixed corn and grass silage fed to cows in the barn, and soil. In addition, a questionnaire was used to gather farm management information such as bedding material used and teat cleaning method applied. The average BAB spore concentration in FTM was 2.7 log10 spores/L, and 33% of the FTM samples exceeded a concentration of 3 log10 spores/L. Control of the average spore concentration in mixed silage fed was the only aspect of farm management that was significantly related to the concentration of BAB spores in FTM. Farms that fed mixed silage with the lowest average BAB spore concentrations (3.4 log10 spores/g) produced FTM with the lowest average concentration (2.1 log10 spores/L). The efficiency of farm management in controlling the BAB spore concentration in FTM depended to a large extent on the ability of farmers to prevent incidents with elevated BAB spore concentrations in mixed silage (>5 log10 spores/g) and not on the average BAB spore concentration in mixed silage across the year. The survey showed that farmers should aim for a concentration in mixed silage of less than 3 log10 spores/g and should prevent the concentration from exceeding 5 log10 spores/g to ensure a concentration in FTM of less than 3 log10 spores/L. These results correspond with the previously reported model simulations.

Minimizing the level of Bacillus cereus spores in farm tank milk.

In a year-long survey on 24 Dutch farms, Bacillus cereus spore concentrations were measured in farm tank milk (FTM), feces, bedding material, mixed grass and corn silage, and soil from the pasture. The aim of this study was to determine, in practice, factors affecting the concentration of B. cereus spores in FTM throughout the year. In addition, the results of the survey were used in combination with a previously published modeling study to determine requirements for a strategy to control B. cereus spore concentrations in FTM below the MSL of 3 log10 spores/L. The B. cereus spore concentration in FTM was 1.2 +/- 0.05 log10 spores/L and in none of samples was the concentration above the MSL. The spore concentration in soil (4.9 +/- 0.04 log10 spores/g) was more than 100-fold higher than the concentration in feces (2.2 +/- 0.05 log10 spores/g), bedding material (2.8 +/- 0.07 log10 spores/g), and mixed silage (2.4 +/- 0.07 log10 spores/g). The spore concentration in FTM increased between July and September compared with the rest of the year (0.5 +/- 0.02 log10 spores/L difference). In this period, comparable increases of the concentrations in feces (0.4 +/- 0.03 log10 spores/g), bedding material (0.5 +/- 0.05 log10 spores/g), and mixed silage (0.4 +/- 0.05 log10 spores/g) were found. The increased B. cereus spore concentration in FTM was not related to the grazing of cows. Significant correlations were found between the spore concentrations in FTM and feces (r = 0.51) and in feces and mixed silage (r = 0.43) when the cows grazed. The increased concentrations during summer could be explained by an increased growth of B. cereus due to the higher temperatures. We concluded that year-round B. cereus spores were predominantly transmitted from feeds, via feces, to FTM. Farmers should take measures that minimize the transmission of spores via this route by ensuring low initial contamination levels in the feeds (<3 log10 spores/g) and by preventing growth of B. cereus in the farm environment. In addition, because of the extremely high B. cereus spore concentrations in soil, the contamination of teats with soil needs to be prevented.

Concentrations of butyric acid bacteria spores in silage and relationships with aerobic deterioration.

Germination and growth of spores of butyric acid bacteria (BAB) may cause severe defects in semihard cheeses. Silage is the main source of BAB spores in cheese milk. The objectives of the study were to determine the significance of grass silages and corn silages as sources of BAB spores and to investigate the relationships between high concentrations of BAB spores in corn silage and aerobic deterioration. In the first survey, samples were taken from various locations in silos containing grass and corn silages and from mixed silages in the ration offered to the cows on 21 farms. We demonstrated that the quantity of BAB spores consumed by cows was determined by a small fraction of silage with a high concentration of spores (above 5 log10 BAB/g). High concentrations were most often found in corn silage within areas with visible molds (69% of the samples). Areas with visible molds in grass silage and surface layers of corn silage contained, respectively, 21 and 19% of the cases of concentrations above 5 log10 BAB spores/g. Based on these results, we concluded that currently in the Netherlands, corn silage is a more important source of BAB than is grass silage. In a second survey, 8 corn silages were divided into 16 sections and each section was studied in detail. High concentrations of BAB spores were found in only the top 50 cm of these 8 silages. Elevated concentrations of BAB spores were associated with different signs of aerobic deterioration. In 13% of the sections in corn silage with more than 5 log10 yeasts and molds/g, more than 5 log10 BAB spores/g were found. Sections with a temperature of more than 5 degrees C above ambient temperature contained, in 21% of the cases, more than 5 log10 BAB spores/g. Concentrations above 5 log10 BAB spores/g were measured in 50% of the sections with a pH above 4.4. All sections with a pH above 4.4 also showed a temperature that was more than 5 degrees C above ambient temperature and a concentration of yeasts and molds above 5 log10 cfu/g. Based on these results, we postulated that high concentrations of BAB spores in corn silage are the result of oxygen penetration into the silage, resulting in aerobic deterioration and the formation of anaerobic niches with an increased pH just below the surface. Growth of BAB in these anaerobic niches with an increased pH caused the locally high concentrations of BAB in corn silage.

Predictive modeling of Bacillus cereus spores in farm tank milk during grazing and housing periods.

The shelf life of pasteurized dairy products depends partly on the concentration of Bacillus cereus spores in raw milk. Based on a translation of contamination pathways into chains of unit-operations, 2 simulation models were developed to quantitatively identify factors that have the greatest effect on the spore concentration in milk. In addition, the models can be used to determine the reduction in concentration that could be achieved via measures at the farm level. One model predicts the concentration when soil is the source of spores, most relevant during grazing of cows. The other model predicts the concentration when feed is the main source of spores, most relevant during housing of cows. It was estimated that when teats are contaminated with soil, 33% of the farm tank milk (FTM) contains more than 3 log(10) spores/L of milk. When feed is the main source, this is only 2%. Based on the predicted spore concentrations in FTM, we calculated that the average spore concentration in raw milk stored at the dairy processor during the grazing period is 3.5 log(10) spores/L of milk and during the housing period is 2.1 log(10) spores/L. It was estimated that during the grazing period a 99% reduction could be achieved if all farms minimize the soil contamination of teats and teat cleaning is optimized. During housing, reduction of the concentration by 60% should be feasible by ensuring spore concentrations in feed below 3 log(10) spores/g and a pH of the ration offered to the cows below 5. Implementation of these measures at the farm level ensures that the concentration of B. cereus spores in raw milk never exceeds 3 log(10) spores/L.

Improving farm management by modeling the contamination of farm tank milk with butyric acid bacteria.

Control of contamination of farm tank milk (FTM) with the spore-forming butyric acid bacteria (BAB) is important to prevent the late-blowing defect in semi-hard cheeses. The risk of late blowing can be decreased via control of the contamination level of FTM with BAB. A modeling approach was applied to identify an effective control strategy at the farm level. The simulation model developed was based on a translation of the contamination pathway into a chain of unit operations. Using various simulations, the effects of factors related to feed quality, feed management, cattlehouse hygiene, and milking practices on the contamination level of FTM were evaluated. Contamination level of silage was found to be the most important factor. When silage contains on average less than 3 log10 BAB/g, a basic pretreatment of udder teats before milking (approximately 75% removal of attached spores) is sufficient to assure an FTM contamination level below 1 BAB/mL. When silage contains more than 5 log10 BAB/g, it should not be fed, because it then becomes almost impossible to assure an FTM contamination level below 1 BAB/mL. Measures aimed at improving cattlehouse hygiene, the contamination via soil, and the contamination level of other feeds contribute only marginally to the control of the contamination of FTM with BAB. Application of the modeling methodology could be beneficial for the control of the contamination of FTM with other microorganisms such as Bacillus cereus.