Search

The goal of postoperative pain protocols in total knee arthroplasty (TKA) is to get pain free patients throughout severe pain period without impairing walking ability. The aim of the study was to investigate if an adductor canal block performed 20 hours after TKA, in patients treated with systemic analgesia and intraoperative local infiltration anesthesia (LIA), improves postoperative pain and functional outcomes.A prospective randomized, double-blinded controlled study was conducted. One hundred eighty-three patients undergoing primary TKA were randomized to receive either a sham block or an adductor canal block with 20 mL of ropivacaine 0.5%. The primary outcome was resting and dynamic pain scores using the Numerical Pain Rating Scale (NPRS). Secondary outcomes included opioid rescue requirements, quadriceps and adductor muscle strength, patient ability for ambulation and complications.Two hours after the block, in adductor canal block group NPRS was significantly lower at rest (1 [0-2] vs. 3 [2-5], P0.001) and with mobilization (5 [3-6] vs. 6 [5-8], P0.001), and quadriceps strength was significantly higher (3.7 [2.7-6] vs. 3 (1.7-4.9), P=0.023). The differences were not maintained beyond 24 hours post-block. In the first 24 hours the percentage of patients with tramadol requirements was lower in the adductor canal block group (36 [38.3] vs. 52 [58.4], P=0.006). Other secondary outcomes were similar between groups. There were no patient falls.An adductor canal block done 20 hours after total knee arthroplasty reduces pain and opioid requirements without increasing the risk of falls. An optimal pain control, especially at movement was not achieved.

BACKGROUND Integrated care (IC) can promote health and social care efficiency through prioritization of preventive patient-centered models and defragmentation of care and collaboration across health tiers, and mobile health (mHealth) can be the cornerstone allowing for the adoption of IC. OBJECTIVE This study aims to assess the acceptability, usability, and satisfaction of an mHealth-enabled IC model for complex chronic patients in both patients and health professionals. METHODS As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, 2-arm, parallel, hybrid effectiveness-implementation trial was conducted from July 2018 to August 2019 in a rural region of Catalonia, Spain. Home-dwelling patients 55 years and older with chronic conditions and a history of hospitalizations for chronic obstructive pulmonary disease or heart failure (use case [UC] 1), or a scheduled major elective hip or knee arthroplasty (UC2) were recruited. During the 3 months, patients experienced an mHealth-enabled IC model, including a self-management app for patients, a set of integrated sensors, and a web-based platform connecting professionals from different settings or usual care. The Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) and the Nijmegen Continuity Questionnaire (NCQ) assessed person-centeredness and continuity of care. Acceptability was assessed for IC arm patients and staff with the Net Promoter Score (NPS) and the System Usability Scale (SUS). RESULTS The analyses included 77 IC patients, 58 controls who completed the follow-up, and 30 health care professionals. The mean age was 78 (SD 9) years in both study arms. Perception of patient-centeredness was similarly high in both arms (usual care: mean P3CEQ score 16.1, SD 3.3; IC: mean P3CEQ score 16.3, SD 2.4). IC patients reported better continuity of care than controls (usual care: mean NCQ score 3.7, SD 0.9; IC: mean NCQ score 4.0, SD 1; P=.04). The scores for patient acceptability (UC1: NPS +67%; UC2: NPS +45%) and usability (UC1: mean SUS score 79, SD 14; UC2: mean SUS score 68, SD 24) were outstanding. Professionals’ acceptability was low (UC1: NPS −25%; UC2: NPS −35%), whereas usability was average (UC1: mean SUS score 63, SD 20; UC2: mean SUS score 62, SD 19). The actual use of technology was high; 77% (58/75) of patients reported physical activity for at least 60 days, and the ratio of times reported over times prescribed for other sensors ranged from 37% for oxygen saturation to 67% for weight. CONCLUSIONS The mHealth-enabled IC model showed outstanding results from the patients’ perspective in 2 different UCs but lacked maturity and integration with legacy systems to be fully accepted by professionals. This paper provides useful lessons learned through the development and assessment process and may be of use to organizations willing to develop or implement mHealth-enabled IC for older adults.

Neck pain is a common reason for seeking medical attention. It affects at least 15% of the labor force and up to 40% of individuals whose occupation is hazardous. On the other hand, primary bone lymphoma is a very rare disease (less than 1% of all malignant bone tumors), and the relationship between the 2 has rarely been mentioned. We report the case of a patient who had a 1-month history of neck pain. The main symptom was pain on palpation of C2-C6 cervical spinous processes and contracture of the trapezius muscle that did not cease with conventional treatment. Imaging studies indicated an abnormality. He underwent surgery and the results of vertebral biopsy were compatible with diffuse large B-cell lymphoma. He was treated with radiotherapy with a good outcome.

Background and aim The Catalonian Arthroplasty Register (RACat) is a public health-based population register used to analyse and evaluate hip and knee replacements in Catalonia. The aim of this study is to present the outcomes after 10 years in operation (January 2005 to December 2014). Methodology Using the information from the RACat and the minimum basic data set at hospital discharge, an analysis was made of the quality and exhaustivity of the data, as well as a descriptive analysis of the patients, prostheses, and care process. Survival was also analysed by calculating the accumulated incidence of revisions (according to the cause of intervention in hip replacements and conservation or sacrifice of the posterior cruciate ligament in knee replacement). The relationship between revision risk and the fixation technique of the prosthesis is also analysed, using competitive risk models adjusted for gender, age, and comorbidities. Results The main reason for the primary hip and knee replacement surgery was arthrosis. The accumulated incidence of revisions at 10 years was 3.9% in hip replacements caused by arthrosis, and 2.3% in those caused by fracture. Conservation of the posterior cruciate ligament was achieved in 4.4% of knee replacements, with sacrifice in 5.1%. Discussion The RACat is consolidated as a tool for the evaluation of joint replacements, with great potential in the analysis of medium and long-term efficacy, the study of the variability in clinical practice, and post-marketing surveillance.

Resumen Antecedentes y objetivo El Registro de Artroplastias de Cataluna (RACat) es un registro poblacional basado en el sistema sanitario publico para analizar y evaluar artroplastias de cadera y rodilla en Cataluna. El objetivo de este estudio es presentar los resultados tras 10 anos de funcionamiento (de enero de 2005 a diciembre de 2014). Metodologia A partir de la informacion del RACat y del conjunto minimo basico de datos al alta hospitalaria, se analizo la calidad y exhaustividad de los datos y se realizaron analisis descriptivos de pacientes, protesis y proceso asistencial. Ademas, se analizo la supervivencia calculando la incidencia acumulada de revision (segun causa de intervencion en artroplastias de cadera y preservacion o sacrificio del ligamento cruzado posterior en artroplastia de rodilla) y la asociacion entre riesgo de revision y tecnica de fijacion de las protesis como modelos de riesgos competitivos ajustados por sexo, edad y comorbilidad. Resultados El principal motivo de intervencion en artroplastias primarias de cadera y rodilla fue la artrosis. La incidencia acumulada de revision a los 10 anos fue del 3,9% en artroplastias de cadera causadas por artrosis y del 2,3% en las causadas por fractura. Las artroplastias de rodilla que conservan el ligamento cruzado posterior son el 4,4% y las que no lo conservan, el 5,1%. Discusion El RACat se consolida como herramienta para la evaluacion de las artroplastias con gran potencial en el analisis de la efectividad a medio y largo plazo, el estudio de la variabilidad de la practica clinica y la vigilancia poscomercializacion.

Background and aims Total knee arthroplasty (TKA) is a painful procedure. In our hospital the worst pain appears in postoperative day one, which could be related to the use of an effective but short analgesic intraoperative technique: a periarticular local analgesic infiltration associated with NSAIDs and rescue opioids. The aim of this study is to assess if adductor canal block (ACB) performed the day after TKA improves analgesia without motor blockade and impairment of ambulation ability. Methods The trial is registered at http://www.clinicaltrials.gov (NCT03915522) and approved by the Regional Ethics Committee. This is a prospective, double-blinded study that includes patients ASA I-III, aged 18–85 years, admitted for TKA. Exclusion criteria are daily intake of strong opioids, allergy to drugs used and surgery performed under general anesthesia. Patients are transferred the day after the surgery to postoperative resuscitation unit. A sterile dressing of the extremity is performed, and after the adductor canal is identified with ultrasound, a puncture is done with or without doing the ACB. After all patients have a sterile apposite on the puncture site. Outcome measures are postoperative pain score measured with a numerical rating scale, knee extensor and adductor muscle strength measured using a hand-held dynamometer, ability to walk with ten meter walk test, rate of opioid side effects, rate of adductor canal block complications and length of hospital stay. Results The study is in recruiting status. The estimated number of patients enrolled is 140 and the estimated primary completion date September 2019. Conclusions In TKA it is essential to treat pain without motor leg impairment.

The volume of total hip (THA) and knee arthroplasties (TKA) performed in a hospital per year could be an influential factor on the revision of these procedures. The aims of this study were: To obtain comparable cohorts in higher- and lower-volume hospitals, and to assess the association between the hospital volume and the incidence of revision. Data from patients undergoing THA and TKA caused by osteoarthritis and recorded in the Catalan Arthroplasty Register (RACat) between January 2005 and December 2016 were used. The main explanatory variable was hospital volume by year (higher/lower). The cut-off point was fixed, based on previous research, at 50 THA and 125 TKA procedures/year. To obtain comparable populations, a propensity-score matching method (1:1) was used. Patient characteristics prior to and after matching were compared. To assess differences by volume, subhazard ratios (SHRs) from competing risks models were obtained. After matching, 13,772 THA and 36,316 TKA patients remained in the study. Prior to matching, in both joints, significant differences in all confounders were observed between volume groups. After matching, none of them remained significant. Both in THA and TKA, a higher risk of revision in higher-volume hospitals was observed (THA SHR: 1.25, 95%CI: 1.02&ndash, 1.53, and TKA SHR: 1.29, 95%CI: 1.16&ndash, 1.44). Unlike other contexts, currently in Catalonia, higher-volume hospitals have a greater risk of revision than lower-volume hospitals. Further research could be valuable to define context-dependent measures to reduce the incidence of revision.

Background Monitoring results regarding the effectiveness of knee and hip arthroplasties may be useful at the clinical, economic and patient level and help reduce the number of prosthesis revisions. In Spain, and specifically in Catalonia, there is currently no systematic monitoring of the different prosthesis models available on the market. Within this context, the aim of the project presented in this protocol is to evaluate the short- and medium-term effectiveness of knee and hip models implanted in Catalonia and to identify where the results could be better or worse than expected. Methods A prospective observational design will be drawn up based on data from a population-based arthroplasty register for hip and knee replacements that includes data from 53 of the 61 public hospitals in Catalonia. The knee and hip prosthesis models used will be identified and classified according to the type of prosthesis, fixation and, in total hip replacements, the bearing surface. For the data analysis, two methodological approaches will be used sequentially: first, an approach based on a survival analysis, followed by an approach based on standardised revision ratios and funnel plots. Following the analyses, a panel of experts will evaluate the results to identify possible sources of bias. Lastly, those models with results better or worse than expected compared to those from the comparison group will be valued, and strengths and difficulties for routine implementation of this methodology within the Catalan Arthroplasty Register will be identified. Discussion The study presented in this protocol will allow us to identify the hip and knee prosthesis models whose results might be better or worse than expected. This information could have a potential impact at the patient, orthopaedic surgeon, healthcare manager, decision-making and industry levels, both in the short term and in the medium and long term.

Background Integrated care (IC) can promote health and social care efficiency through prioritization of preventive patient-centered models and defragmentation of care and collaboration across health tiers, and mobile health (mHealth) can be the cornerstone allowing for the adoption of IC. Objective This study aims to assess the acceptability, usability, and satisfaction of an mHealth-enabled IC model for complex chronic patients in both patients and health professionals. Methods As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, 2-arm, parallel, hybrid effectiveness-implementation trial was conducted from July 2018 to August 2019 in a rural region of Catalonia, Spain. Home-dwelling patients 55 years and older with chronic conditions and a history of hospitalizations for chronic obstructive pulmonary disease or heart failure (use case [UC] 1), or a scheduled major elective hip or knee arthroplasty (UC2) were recruited. During the 3 months, patients experienced an mHealth-enabled IC model, including a self-management app for patients, a set of integrated sensors, and a web-based platform connecting professionals from different settings or usual care. The Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) and the Nijmegen Continuity Questionnaire (NCQ) assessed person-centeredness and continuity of care. Acceptability was assessed for IC arm patients and staff with the Net Promoter Score (NPS) and the System Usability Scale (SUS). Results The analyses included 77 IC patients, 58 controls who completed the follow-up, and 30 health care professionals. The mean age was 78 (SD 9) years in both study arms. Perception of patient-centeredness was similarly high in both arms (usual care: mean P3CEQ score 16.1, SD 3.3; IC: mean P3CEQ score 16.3, SD 2.4). IC patients reported better continuity of care than controls (usual care: mean NCQ score 3.7, SD 0.9; IC: mean NCQ score 4.0, SD 1; P=.04). The scores for patient acceptability (UC1: NPS +67%; UC2: NPS +45%) and usability (UC1: mean SUS score 79, SD 14; UC2: mean SUS score 68, SD 24) were outstanding. Professionals’ acceptability was low (UC1: NPS −25%; UC2: NPS −35%), whereas usability was average (UC1: mean SUS score 63, SD 20; UC2: mean SUS score 62, SD 19). The actual use of technology was high; 77% (58/75) of patients reported physical activity for at least 60 days, and the ratio of times reported over times prescribed for other sensors ranged from 37% for oxygen saturation to 67% for weight. Conclusions The mHealth-enabled IC model showed outstanding results from the patients’ perspective in 2 different UCs but lacked maturity and integration with legacy systems to be fully accepted by professionals. This paper provides useful lessons learned through the development and assessment process and may be of use to organizations willing to develop or implement mHealth-enabled IC for older adults.

Neck pain is a common reason for seeking medical attention. It affects at least 15% of the labor force and up to 40% of individuals whose occupation is hazardous. On the other hand, primary bone lymphoma is a very rare disease (less than 1% of all malignant bone tumors), and the relationship between the 2 has rarely been mentioned. We report the case of a patient who had a 1-month history of neck pain. The main symptom was pain on palpation of C2-C6 cervical spinous processes and contracture of the trapezius muscle that did not cease with conventional treatment. Imaging studies indicated an abnormality. He underwent surgery and the results of vertebral biopsy were compatible with diffuse large B-cell lymphoma. He was treated with radiotherapy with a good outcome.

The effectiveness and safety of shoulder arthroplasties in the general context of a Spanish patient population remains unclear. The aim of this study was to ascertain both the effectiveness and safety of primary shoulder arthroplasties and the prosthesis types used in Spain. A systematic review of all the available literature evaluating the effectiveness and safety of primary shoulder arthroplasties in Spain was performed. A narrative synthesis was performed, and evidence tables were created in four dimensions: study design, arthroplasty characteristics, safety, and effectiveness. Orthopaedic Data Evaluation Panel (ODEP) scores were used to evaluate prosthesis types. Twenty-one studies were selected that included a total of 1293 arthroplasties. The most common indication was fractures, while the prosthesis most frequently used was the Delta Xtend (ODEP 10A). The most common complication was scapular notching. Prosthesis revision rate was approximately 6% for follow-ups between 12 and 79 months. In addition, significant improvements were observed in the Constant–Murley test score after the intervention. Currently in Spain, shoulder arthroplasty can be considered a safe and effective procedure with functional recovery and pain reduction for eligible patients with humeral fracture, rotator cuff arthropathy, fracture sequelae and malunion of the proximal humerus, and degenerative disease. Future longitudinal research and population-based studies could serve to confirm these results and identify points of improvement.

La osteonecrosis vertebral se caracteriza por presentar el fenomeno de vacio intravertebral. Es un proceso poco frecuente y aunque puede ser debido a diferentes afecciones, la causa mas frecuente es la postraumatica. La explicacion de que aparezca gas intravertebral no es del todo conocida. Presentamos el caso de una paciente de 74 anos que despues de sufrir un traumatismo vertebral inicio clinica de dolor dorsolumbar intenso. El estudio radiologico simple, la tomografia computarizada y la resonancia magnetica confirmaron el fenomeno del vacio intravertebral. Hemos hecho una revision de este signo radiologico y comentamos la evolucion despues de vertebroplastia percutanea.

Vertebral osteonecrosis is characterized by the presence of the intravertebral vacuum phenomenon. It is a relatively uncommon disease and although it may be caused by different pathologies, the most frequent cause is posttraumatic. The explanation for the presence of intravertebral gas is not known completely. We present the case of a 74-year-old patient who after suffering a vertebral traumatism, to complain of intense vertebral pain. A simple radiological study, CT scan, and magnetic resonance confirmed the presence of intravertebral vacuum phenomenon. We studied this radiological sign and then commented on its evolution after percutaneous vertebroplasty.

Resumen Introduccion Son muchos los estudios publicados sobre patologia raquidea en personas con sindrome de Down (SD), pero la mayoria se centran en las anomalias atloaxoideas de columna cervical. En cambio, no hay mucha informacion referente a otras malformaciones como la escoliosis, la cifosis o la lordosis, tal vez porque parece una patologia poco frecuente y de poca repercusion fisica o vital. El objetivo de nuestro estudio era determinar la prevalencia de estas malformaciones raquideas en un grupo de personas con SD y buscar los factores predictivos que puedan orientar sobre su desarrollo. Pacientes y metodos Se estudio a un total de 60 personas con SD, 26 mujeres (43,33%) y 34 hombres (56,67%), con una media de edad de 39,8 ± 10,19 anos, una media de peso de 65,4 ± 13,55 kg y una media de altura de 1,51 ± 0,4 m. En todas ellas estudiamos las distintas alteraciones de la estatica raquidea siguiendo un protocolo establecido de estudio en los tres planos del espacio. Estudiamos sus datos antropometricos y tambien valoramos la presencia de otras alteraciones que, por su frecuencia, creiamos que podrian guardar relacion con las malformaciones raquideas estudiadas: patologias tiroidea, cardiaca y visual y otros tipos de alteraciones del aparato locomotor, como inestabilidad atloaxoidea, hiperlaxitud ligamentosa y deformidad de extremidades inferiores. Resultados Un total de 49 personas (81,67%) tenian alguna malformacion raquidea, 21 (35%) tenian escoliosis, 19 (31,67%), cifosis y 30 (50%), hiperlordosis lumbar. Quince personas (25%) tenian a la vez dos o mas de estas malformaciones. Entre los factores predictivos no se hallo ninguna relacion con el sexo y la talla, pero si con la edad: la prevalencia de lordosis lumbar era mayor en las personas de menos edad (p Conclusiones La prevalencia de malformaciones raquideas en el grupo de personas con SD estudiado es muy alta. Con la edad van cambiando las curvaturas: entre los mas jovenes predomina la hiperlordosis lumbar y entre los mayores, la cifosis dorsal. Los que tienen trastornos visuales y otras malformaciones esqueleticas corren mas riesgo de sufrir escoliosis. Es opinion de los autores que en este grupo de la poblacion es muy importante prevenir o reducir la aparicion de desviaciones raquideas.

Background There are many studies of spine pathology in people with Down Syndrome (DS), the majority of these focusing on atlantoaxial anomalies of the cervical column. There is, in contrast, much less information about other malformations such as scoliosis, kyphosis and lordosis, perhaps due to the fact that they are much less frequent pathologies with few physical and life-threatening repercussions. The aim of our study was to determine the prevalence of these spine-related malformations in a group of patients with DS and to look for factors that might predict the course of their development. Patients and methods We studied a total of 60 people with DS, 26 women (43.33) and 34 men (56.67%) with an average age of 39.8 ± 10.19 years, weight average of 65.4 ± 13.55 kg, and height average of 1.51 ± 0.4 metres. In all cases, we studied the different alterations of the spine following a well-established three-dimensional study protocol. We studied anthropometric data for these patients and also evaluated the other alterations which, due to their frequency, were thought to be potentially related to other spineinduced malformations: thyroidal pathologies, heart- and sight-related problems and alterations affecting the locomotive apparatus such as atlantoaxial instability, hyperlaxitude of the ligaments and deformation of the lower limbs. Results Forty-nine (81.67%) of the patients had some spine-related malformation, 21 (35%) had malformations related with scoliosis, 19 (31.67%) with kyphosis, 30 (50%) with lumbar hyperlordosis, and 15 (25%) suffered from 2 or more of these malformations. Sex and height did not seem to be predictive factors, but age seemed related to lumbar lordosis, with this condition being more prevalent in younger patients (p Conclusions The number of patients with spine-related malformations was very high in the DS study group. With time, the curvatures change: in young people bone curvature predominantly affects the lumbar hyperlordosis, while in older patients it affects the dorsal kyphosis. Patients with visual disorders and other malformations of the skeleton have a greater risk of suffering scoliosis. We think that in this population group it is very important to prevent or to reduce the column deviations.

The results of randomized controlled trials and systematic reviews have suggested reduced radiographic wear in highly cross-linked polyethylene compared with conventional polyethylene in primary total hip arthroplasty. However, longer-term clinical results have not been thoroughly examined, to our knowledge. The purpose of this study was to compare the risk of revision for metal-on-conventional and metal-on-highly cross-linked total hip arthroplasty bearing surfaces with use of a distributed data network of six national and regional registries (Kaiser Permanente, HealthEast, the Emilia-Romagna region in Italy, the Catalan region in Spain, Norway, and Australia). Inclusion criteria were osteoarthritis as the primary diagnosis, cementless implant fixation, and a patient age of forty-five to sixty-four years. These criteria resulted in a sample of 16,571 primary total hip arthroplasties. Multivariate meta-analysis was performed with use of linear mixed models, with survival probability as the unit of analysis. The results of a fixed-effects model suggested that there was insufficient evidence of a difference in risk of revision between bearing surfaces (hazard ratio, 1.20 [95% confidence interval, 0.80 to 1.79]; p = 0.384). Highly cross-linked polyethylene does not appear to have a reduced risk of revision in this subgroup of total hip arthroplasty patients. Arthroplasties involving highly cross-linked polyethylene do not appear to have an increased risk of revision in this subgroup of total hip arthroplasty patients.

We present the case of a 35-year-old patient with long-standing polyarthritis and Down syndrome. Both of these conditions share a clinical and radiological sign in common, namely, atlantoaxial subluxation, though probably due to different causes. We discuss this rare combination of both conditions as well as challenges for treatment.