The Latest News in Rheumatology
10/17/2002
Dislocation After Revision Total Hip Arthroplasty
Comparison of Patient and Doctor Responses to a Total
Hip Arthroplasty Clinical Evaluation Questionnaire
How Should You Ease Your Child's Medical Fears?
Acupuncture for Kids: Study Shows Treatment Success
Disclocation is a leading and highly underestimated cause of failure in
revision total hip arthroplasty. Gregory M. Alberton, MD and colleagues sought
to evaluate risk factors leading to problems after the second hip surgery and
the expected outcome of various treatment strategies. The results were
published in a recent issue of The Journal of Bone and Joint Surgery.
They obtained data from 1548 revision arthroplasties in 1405 patients who
were followed anywhere from two years to over 16 years until dislocation
occurred.
Results: A dislocation occurred after 115 (7.4%) of the 1548 revision
surgeries. The initial treatment for 12 of the 115 dislocations were managed
nonoperatively, and 6 of the 12 hips had no further problems.
Of the 103 postoperative dislocations initially managed nonoperatively, a
mere 36 did not redislocate.
38 of the 67 hips that had an additional dislocation after treatment repeated
surgery. Only 11 of the 38 hips were stable at one year after surgery.
In summary, at the time of researcher assessment, 65 (57%) of the 115
dislocated hips were stable, 41 (36%) remained unstable, and the statues of 9
was unknown.
The researchers conclude that risk factors for instability after total hip
arthroplasty revision are not the same as those
after a primary procedure.
As with any procedure, surgeons typically evaluate patients prior to
undergoing total hip arthroplasty in order to determine possible surgery
outcomes. Among other things, this "doctor-derived" data is
questionable because of the potential for different perceptions between doctor
and patient. Few studies have focused on whether data obtained from the doctor
and patient differ.
Margaret A. McGee, BSc, MPH and colleagues from the Royal Adelaide Hospital
in South Australia studied 2,900 evaluation questionnaires (containing 16
questions) completed by both doctor and patient. The article was published in a
recent issue of The Journal of Bone and Joint Surgery.
Results: For twelve of the sixteen items, patient responses for the
most part agreed with doctor responses. If the patient had other joint or health
problems, had a revision total hip arthroplasty, or reported mild or moderate
pain, there was a greater chance of reduced agreement on the pain items. Younger
patients demonstrated better agreement with doctors than did older patients.
The researchers concluded that patients' perceptions of symptoms and outcomes
after total hip arthroplasty were relatively similar to those of their
doctor. From the results of the this study, it was concluded that only
a minimal risk of misinterpreting surgery outcome data by replacing
doctor-completed questionnaires with patient-completed ones.
For patients with other joint or health problems, and for those reporting a
lot of pain, direct doctor involvement in the evaluation of pain was
recommended.
They believe that the use of patient-completed questionnaires has the
potential to greatly reduce the cost of the evaluation process by minimizing
doctor input and time.
If your child has a chronic medical condition, like juvenile ankylosing
spondylitis, or needs to undergo any type of medical procedure, your first
instinct may be to protect your child from any memory of the procedure. However,
a recent study shows that children may fare better in the long run if they are
able to recall details from even the most distressing medical procedures.
As published in the Journal of Developmental and Behavioral Pediatrics
October issue, Karen Salmon, PhD (University of New South Wales in Sydney,
Australia) and colleagues interviewed 32 kids, aged 2-7, who underwent a
"highly distressing" procedure in which x-rays were taken of the
kidneys to investigate urinary problems by inserting a tube into the bladder,
infusing dye into the bladder, and asking the child to urinate on the table or
in a pan while the x-rays were taken.
Results: Children whose parents talked to them about the procedure
remembered the experience more clearly and were less likely to confuse it
with other experiences down the road (such as routine check-ups).
The researchers found that even if a child is distracted during the
procedure, they will still remember what happened, just not as well. They
postulated that a sketchy recall could result in tantrums and hysteria
at later doctor visits, even for minor ailments.
However, Salmon does not discourage distracting your child during a
particularly stressful or painful stage of a procedure as long as you also have
discussed the procedure with the child beforehand.
Salmon and colleagues noticed that children as young as 2 remembered the
procedure six months later, although not as well as older children. This
challenges previous thoughts that young children do not remember medical events.
New research shows that acupuncture offers children significant relief from
chronic headaches, stomachaches, back pain, and other body ills without side
effects. And while more than one-third of U.S. pain treatment centers provide
acupuncture as a therapy, there is less research conducted on children's'
experience with the procedure for pain relief.
Traditional Chinese medicine believes that acupuncture opens energy channels
that run in patterns throughout the body, corrects imbalances and increases
energy. Many modern researchers believe that acupuncture stimulates the nervous
system to release chemicals and hormones that help relieve pain and influence
the body's own internal regulating system.
Researcher Yuan-Chi Lin, MD, Harvard Medical School and Children's Hospital
in Chicago, studied 243 patients aged 6 months to 18 years old who received
acupuncture treatments for one year for a variety of complaints (including lower
back, hip, and lower extremity pain, abdominal pain, and headaches).
Results: Prior to treatment, the children rated their pain an 8 on a
scale of 1-10 where 10 was the most painful. After receiving acupuncture
treatments for a year, the average score was a 3. No one reported side effects
or complications due to the treatments.
Dr. Lin says that the patients reported missing less school, better sleeping
patterns, and being able to participate in more extracurricular activities.
What if a child has a fear of needles? Based on the study's findings, Lin
found that even children who initially feared needles felt less fear and
tolerated treatments "very well" once the researchers carefully
explained the procedure and showed a demonstration.
According to Dr. Lin, some patients feel a slight
discomfort when the needles are inserted, but once in place, the needles do not
cause pain, and that the pain relief typically makes up for any discomfort
in her experience.