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The aim of this study was to evaluate work ability, activity limitations and physical activity in adults that had gone through major bone sarcoma resection and reconstruction surgery in hip and knee. Twenty patients, of 72 enrolled, and 20 controls were included in this cross-sectional study. Work Ability Index scores (general [0–10 points], physical and mental [1–5 points]), the Patient Specific Functional Scale (0–10 points), step counts and the International Physical Activity Questionnaire (IPAQ) were assessed. Adjusted and unadjusted general linear models were applied. The patients had a mean age of 43 (range, 20–71) years and were assessed 7 years (range, 2–12) after surgery (proximal femoral n = 9, distal femoral n = 7, proximal tibia n = 4). Compared with controls, patients had lower general work ability (mean difference [95%CI], −1.3 points [−2.1, −0.5]) and work ability in relation to physical demands at work (−1.4 points [−2.0, −0.8]). The patients reported higher severities of activity limitation (−6.7 points [−7.9, −5.4]). There were no between-group differences in step counts or IPAQ-scores. Despite similar levels of physical activity, patients showed poorer work ability and severe activity limitation. Post-operative rehabilitation in patients of the working-age population should include assessments of work ability and activities important to the individual. Adults that have gone through resection and reconstruction surgery following bone sarcoma in lower extremity show clinically relevant reductions in work ability and self-selected activities To tailor post-operative rehabilitation at short and long term, initial assessment and monitoring should include work ability and activities important to the individual patient. [ABSTRACT FROM AUTHOR]

OBJECTIVES Patients undergoing hip fracture surgery have a 10 times increased risk of stroke compared with the general population. We aimed to evaluate the association between the CHA2DS2‐VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke/TIA [transient ischemic attack]/systemic embolism (2 points), vascular disease, age 65‐74 years, and female sex) score and the risk of stroke, thromboembolism, and all‐cause mortality in patients with hip fracture with or without atrial fibrillation (AF). DESIGN Nationwide prospective cohort study. SETTING Danish hospitals. PARTICIPANTS Subjects were all incident hip fracture patients in Denmark age 65 years and older with surgical repair procedures between 2004 and 2016 (n = 78,096). Participants were identified using the Danish Multidisciplinary Hip Fracture Registry. MEASUREMENTS We calculated incidence rates, cumulative incidences, and hazard ratios (HRs) with 95% confidence intervals (CIs) by CHA2DS2‐VASc score, stratified on AF history. RESULTS: The cumulative incidence of ischemic stroke 1 year after hip fracture increased with ascending CHA2DS2‐VASc score, and it was 1.9% for patients with a score of 1 and 8.6% for patients with a score above 5 in the AF group. Corresponding incidences in the non‐AF group were 1.6% and 7.6%. Compared with a CHA2DS2‐VASc score of 1, adjusted HRs were 5.53 (95% CI = 1.37‐22.24) among AF patients and 4.91 (95% CI = 3.40‐7.10) among non‐AF patients with a score above 5. A dose‐response–like association was observed for all cardiovascular outcomes. All‐cause mortality risks and HRs were substantially higher for all CHA2DS2‐VASc scores above 1 in both the AF group and the non‐AF group. CONCLUSION: Among patients with hip fracture, a higher CHA2DS2‐VASc score was associated with increased risk of stroke, thromboembolism, and death. This finding applied both to patients with and without AF. Patients with high CHA2DS2‐VASc scores had almost similar absolute risks for cardiovascular outcomes, irrespective of AF. J Am Geriatr Soc 68:1698‐1705, 2020. [ABSTRACT FROM AUTHOR]

Background: The prevalence of constipation in the general population is 2–28%. Patients with constipation report symptoms of abdominal pain, bloating, nausea, straining to defecate and general discomfort. Strategies for preventing constipation include laxatives, exercise and increased fluid and fibre intake, but life style adjustments, such as exercise, eating more fibres and drinking more fluids, were not considered a solution by older patients. Previous studies have shown that actively involving patients through individualised care and support increases patients’ outcome. Aim: To test the efficacy of a nursing intervention based on active patient involvement including individualised nursing care plans and daily dialogues for patients with hip fractures in preventing constipation after surgery. Methods: A quasi‐experimental design was applied. Inclusion criteria hip fracture needing surgery, understand Danish. Exclusion criteria dementia, gastrointestinal disease. A total of 186 patients were included and 155 completed. An admission interview including Constipation Risk Assessment Scale was undertaken. On that basis an individualised nursing care plan was made. At admission, discharge and 30 days after surgery constipation, intake of fibres and fluid were measured. The Bristol Stool Scale and Rasmussen's scale were used to measure constipation. Patients in the control group received standard care of the ward. Results: After 30 days constipation rates for patients in the intervention group were significantly lower than for patients in the control group (p = 0.042). The fibre intakes and fluid intakes were significantly higher in the intervention group (p ≤ 0.001). The effect of liquid intake was statistically significant (OR = 1.1, 95% CI: 1.0–1.2). Likewise, the effect of fibre intake was statistically significant; the odds of constipation decreased with increasing fibre intake (OR = 0.4, 95% CI: 0.2–0.8). Conclusion: Patients with hip fractures that were actively involved in their own care in preventing constipation were significantly less constipated 30 days after surgery than control patients. Increases in fluid and fibre intakes had significant effects on reducing the risk of developing constipation. [ABSTRACT FROM AUTHOR]

Background Trabecular metal has shown promising results in experimental studies of bone ingrowth. Several clinical studies support these results. However, until now, no randomized clinical radiostereometric analysis (RSA) studies have been published. In this randomized RSA trial, we compared a new acetabular cup with a surface made of tantalum trabecular metal and a cup with a titanium fiber-mesh surface. Patients and methods Between 2004 and 2006, we operated 60 patients with noninflammatory hip arthritis. The patients were randomized to receive either an uncemented cup with a titanium fiber-mesh surface (Trilogy cup) or a cup with a trabecular tantalum surface (Monoblock cup). After 2 years, 50 patients had completed the study. The primary endpoint was cup migration within the first 2 years after surgery; the secondary endpoints were change in bone mineral density and Harris hip score at 3 months. Results Both cup types showed excellent fixation. RSA revealed minimal translation and rotation at 2 years. There was no statistically significant difference between the cup types with regard to translation. However, less rotation along the transverse axis was seen in the trabecular metal cups than in the fiber mesh cups: mean --0.01ºº (95% CI: --0.11 to 0.12) for trabecular metal cups and --0.60ºº (--0.72 to --0.48) for fiber-mesh cups (p == 0.04). The degree of periprosthetic bone loss was similar between the cup types in any of the regions of interest at 2 years of follow-up. 3 months postoperatively, we found a similar increase in Harris hip score in both groups: from around 50 to over 90. Interpretation We found promising early results concerning fixation of trabecular metal components to the acetabular host bone. However, we recommend a longer observation period to evaluate the outcome of this new cup design. [ABSTRACT FROM AUTHOR]

Background and purpose The reported outcomes of hip resurfacing arthroplasty (HRA) vary. The frequency of this procedure in Denmark, Norway, and Sweden is low. We therefore determined the outcome of HRA in the NARA database, which is common to all 3 countries, and compared it to the outcome of conventional total hip arthroplasty (THA). Methods The risk of non-septic revision within 2 years was analyzed in 1,638 HRAs and compared to that for 172,554 conventional total hip arthroplasties (THAs), using Cox regression models. We calculated relative risk (RR) of revision and 95% confidence interval. Results HRA had an almost 3-fold increased revision risk compared to THA (RR = 2.7, 95% CI: 1.9-3.7). The difference was even greater when HRA was compared to the THA subgroup of cemented THAs (RR = 3.8, CI: 2.7-5.3). For men below 50 years of age, this difference was less pronounced (HRA vs. THA: RR = 1.9, CI: 1.0-3.9; HRA vs. cemented THA: RR = 2.4, CI: 1.1-5.3), but it was even more pronounced in women of the same age group (HRA vs. THA: RR = 4.7, CI: 2.6-8.5; HRA vs. cemented THA: RR = 7.4, CI: 3.7-15). Within the HRA group, risk of non-septic revision was reduced in hospitals performing ≥ 70 HRAs annually (RR = 0.3, CI: 0.1-0.7) and with use of Birmingham hip resurfacing (BHR) rather than the other designs as a group (RR = 0.3, CI: 0.1-0.7). Risk of early revision was also reduced in males (RR = 0.5, CI: 0.2-0.9). The femoral head diameter alone had no statistically significant influence on the early revision rate, but it eliminated the significance of male sex in a combined analysis. Interpretation In general, our results do not support continued use of hip resurfacing arthroplasty. Men had a lower early revision rate, which was still higher than observed for all-cemented hips. Further follow-up is necessary to determine whether HRA might be useful as an alternative in males. [ABSTRACT FROM AUTHOR]