The Latest News in Rheumatology
11/22/2002
Late Dislocation After Total Hip Arthroplasty
Effect of Baseline Functional Status and Pain on
Outcomes of Total Hip Arthroplasty
The Value of Knee Arthroscopy in Patients With Severe
Radiological Osteoarthritis
Study Concludes No Difference Between Ionized Bracelet
and Placebo for Musculoskeletal Pain Relief
European Survey Suggests Doctors Should Listen to
Patients More Closely and Use More Aggressive Treatments in AS
Little is known about risk factors and outcomes associated with dislocation
many years after a total hip arthroplasty. This study sought to determine the
prevalence of late dislocation after total hip arthroplasty, to characterize
factors associated with late dislocations, and to report late dislocation
outcomes. Marius von Knoch, MD, and colleagues from the Mayo Clinic in
Rochester, Minnesota published the study in a recent issue of The Journal of
Bone and Joint Surgery.
Results: 15,964 people between the years of 1969 and 1995 at the Mayo
Clinic in Rochester had a total of 19,680 total hip arthroplasty surgeries. The
patients were followed at regular intervals to see whether the hip had
dislocated. First dislocations that occurred five years or more after the
operation were defined as late dislocations.
2.6% (513 hips) of the 19,680 hips dislocated. Out of the 513, 32% of those
hips were considered late dislocations. The average occurrence of the late
dislocations occurred 11.3 years after the operation. Late dislocation was more frequent
than early dislocation in women, and late dislocation was associated with a
younger age at the time of the primary total hip arthroplasty than was early
dislocation.
The researchers conclude that late dislocation is more common than was
previously thought, and several processes can lead to late dislocation. Late
dislocation can occur from a long-standing problem with the prosthesis that
manifests late (like incorrect position of the implant), it can occur in
association with a new problem (such as an episode of trauma), or it can occur
in combination with any of these factors. The likelihood of the first late
dislocation recurring is high.
It is unknown whether there is an optimal time for surgery, meaning whether a
patient should wait until greater disability results before undergoing surgery. This study examined the effect of baseline status on the outcome of total
hip arthroplasty. Jeremy Holtzman, MD, MS, and colleagues at the University of
Minnesota, Minneapolis, MN published their findings in the recent issue of The
Journal of Bone and Joint Surgery.
Results: 1640 Medicare patients undergoing total hip arthroplasty for
osteoarthritis in twelve states took part. They were surveyed within two months
after surgery, and at twelve months after surgery. The baseline survey
(completed by 1120 patients) included items regarding the patient's level of
activity, presence and severity of pain while walking, the need for assistance
for walking, the distance the patient could walk, and whether the patient could
perform Instrumental Activities of Daily Living (IADLs).
- Patients with pain during walking at baseline were more likely to have
pain after one year than those without pain at baseline (21% compared with
9%).
- Patients needing assistance with walking at baseline were more likely to
need assistance at one year than those who did not need assistance at
baseline (38% compared with 15%).
- Similar results seen for assistance with housework (39% compared with
18%), grocery shopping (37% compared with 14%), and to participation in
moderate activity (17% compared with 10%).
- The worse a patient's preoperative status, the more he/she gained in all
four measures.
The researchers conclude that the worse a patient's preoperative status, the
more he/she will benefit from total hip arthroplasty. Their findings also
suggest that patients who have a worse preoperative status may not have as good
an outcome as those who have a better preoperative status. Patients and
physicians should consider this when discussing the timing of total hip
arthroplasty.
Researchers sought to access the value of knee arthroscopy in patients with
radiological signs of severe osteoarthritis.
Results: 104 patients (50 men, 54 women, average age 60 years) with
radiological knee osteoarthritis were followed up after knee arthroscopy between
1989 and 1996. The average follow-up time was 5.4 years after surgery.
- 81% reported an increase in their activities of daily living
- 43% were still without any complaints
- 65% rated their total outcome was "very good" or
"good"
- Only 20% required further surgery before the assessment
They conclude that knee arthroscopy is valuable treatment for patients with
pain, swelling, and radiological signs of severe osteoarthritis because it
improves the patients' daily activities, and helps to postpone further surgery.
Jacksonville, FL--Researchers from the Mayo Clinic in Jacksonville, FL
found that wearing ionized bracelets for treatment of muscle and joint pain was
no more effective than wearing placebo bracelets. The results were published in
the November 2002 issue of Mayo Clinic Proceedings.
Dr. Robert Bratton from the Department of Family Medicine, said he and
colleagues find this study particularly important because many patients are interested
in alternative medicines. He believes there should be objective, controlled
studies to show whether or not these treatments are beneficial.
Results: Participants included a total of 610 men and women who had self-reported musculoskeletal pain
at the beginning of the study. Half were randomly assigned to wear
the ionized bracelets, and half wore a placebo bracelet--no one knew which they
received to help ensure study accuracy.
Both groups self-reported significant improvement in pain. Researchers did
not find a difference in the amount of self-reported pain relief between the
people wearing the ionized bracelets and the group wearing the placebo
bracelets.
The researchers conclude that the equivalent, subjective improvement in
patient pain "calls into question the true benefit of using an ionized
bracelet."
New Orleans, LA-- A survey involving more than 6,000 patients (89.4%
with rheumatoid arthritis, 10.6% with AS) in eleven European countries show that
most patients in Europe are being treated with only one disease modifying agent
against rheumatic disease (DMARD) and continue to have active disease. Many of
the participants rated their current health status lower than did their
physicians, and reported being more severely affected by the disease than their
physicians perceived them to be.
Results: 6124 patients and their physicians participated. Of the 10.6%
of patients with AS, 42% had AS for ten years or more, and nearly half (47.1%)
were unemployed due to their disease.
Among both the rheumatoid arthritis and AS groups, patients' perception of
general health was 5.0, compared with their physicians' perception of 3.8.
While an estimated 15% to 20% of patients in North America use a biologic (Enbrel®
or Remicade®), only 10% of the study's patients from Europe were using a
biologic agent. 90% of the European patients in the study were taking 1 DMARD.
Many of the patients taking the DMARDs are still becoming disabled by their
disease.
Dr. Christian Antoni (University of Erlangen, Germany) suggests that the
European doctors should listen to their patients more closely and treat them
more aggressively.