Does forced or compensated turnout lead to musculoskeletal injuries in dancers? A systematic review on the complexity of causes

Injury prevalence in dancers is high, and misaligned turnout (TO) is claimed to bear injury risk. This systematic review aimed to investigate if compensating or forcing TO leads to musculoskeletal injuries.A systematic literature review was conducted according to the PRISMA Guidelines using the databases of PubMed, Embase, Emcare, Web of Science, Cochrane Library, Academic Search Premier, and ScienceDirect. Studies investigating the relationship between compensated or forced TO and injuries in all genders, all ages, and levels of dancers were included. Details on misaligned TO measurements and injuries had to be provided. Screening was performed by two researchers, data extraction and methodological quality assessment executed by one researcher and checked by another.7 studies with 1293 dancers were included. Methodological quality was low due to study designs and a general lack of standardised definition of pathology and methods of assessment of misaligned TO. The studies investigating the lower extremities showed a hip-focus only. Non-hip contributors as well as their natural anatomical variations were not accounted for, limiting the understanding of injury mechanisms underlying misaligned TO. As such no definite conclusions on the effect of compensating or forcing TO on musculoskeletal injuries could be made.Total TO is dependent on complex motion cycles rather than generalised (hip) joint dominance only. Objective dual assessment of maximum passive joint range of motion through 3D kinematic analysis in combination with physical examination is needed to account for anatomical variations, locate sites prone to (overuse)injury, and investigate underlying injury mechanisms. (C) 2020 Elsevier Ltd. All rights reserved.Clinical epidemiolog

Challenges in developing national orthopedic health research agendas in the Netherlands: process overview and recommendations

- Growing demand for clinical research to improve evidence-based medicine in daily medical practice led to healthcare evaluation, which assesses the effectiveness of the existing care. The first step is identifying and priori-tizing the most important evidence uncertainties. A health research agenda (HRA) can be valuable and helps determine funding and resource allocation, aiding researchers and poli-cymakers to design successful research programs and imple-ment the results in daily medical practice. We provide an overview of the development process of the first 2 HRAs within orthopedic surgery in the Netherlands and the follow-ing research process. In addition, we developed a checklist with recommendations for the future development of an HRA. This perspective guides the development of high -quality and widely supported nationwide HRAs, including preparatory actions. This improves the uptake of evidence uncertainties in a successful research program and dissemi-nates evidence-based literature in daily medical practice to improve patient care.Clinical epidemiolog

Data linkage of two national databases: lessons learned from linking the Dutch Arthroplasty Register with the Dutch Foundation for Pharmaceutical Statistics

Background: To provide guidance on data linkage in case of non-unique identifiers, we present a case study linking the Dutch Foundation for Pharmaceutical Statistics and Dutch Arthroplasty Register to investigate opioid prescriptions before/after arthroplasty. Methods: Deterministic data linkage was used. Records were linked on: sex, birthyear, postcode, surgery date, or thromboprophylaxis initiation as a proxy for the surgery date. Different postcodes were used, depending on availability: patient postcode (available from 2013 onwards), hospital postcode with codes for physicians/hospitals, and hospital postcode with catchment area. Linkage was assessed in several groups: linked arthroplasties, linked on patient postcode, linked on patient postcode, and low-molecular-weight heparin(LWMH). Linkage quality was assessed by checking prescriptions after death, antibiotics after revision for infection, and presence of multiple prostheses. Representativeness was assessed by comparing the patient-postcode-LMWH group with the remaining arthroplasties. External validation was performed by comparing our opioid prescription rates with those derived from datasets from Statistics Netherlands. Results: We linked 317,899 arthroplasties on patient postcode/hospital postcode(48%). Linkage on the hospital postcode appeared insufficient. Linkage uncertainty ranged from roughly 30% in all arthroplasties to 10-21% in the patient-postcode-LMWH-group. This subset resulted in 166.357(42%) linked arthroplasties after 2013 with somewhat younger age, fewer females, and more often osteoarthritis than other indications compared to the other arthroplasties. External validation showed similar increases in opioid prescription rates. Conclusions: After identifier selection, checking data availability and internal validity, assessing representativeness, and externally validating our results we found sufficient linkage quality in the patient-postcode-LMWH-group, which consisted of around 42% of the arthroplasties performed after 2013.Orthopaedics, Trauma Surgery and Rehabilitatio

Population-based 10-year cumulative revision risks after hip and knee arthroplasty for osteoarthritis to inform patients in clinical practice: a competing risk analysis from the Dutch Arthroplasty Register

Background and purpose - A lifetime perspective on revision risks is needed for optimal timing of arthroplasty in osteoarthritis (OA) patients, weighing the benefit of total hip arthroplasty/total knee arthroplasty (THA/TKA) against the risk of revision, after which outcomes are less favorable. Therefore, we provide population-based 10-year cumulative revision risks stratified by joint, sex, fixation type, and age.Patients and methods - Data from the Dutch Arthroplasty Register (LROI) was used. Primary THAs and TKAs for OA between 2007 and 2018 were included, except metal-on-metal prostheses or hybrid/reversed hybrid fixation. Revision surgery was defined as any change of 1 or more prosthesis components. The 10-year cumulative revision risks were calculated stratified by joint, age, sex, at primary arthroplasty, and fixation type (cemented/uncemented), taking into account mortality as a competing risk. We estimated the percentage of potentially avoidable revisions assuming all OA patients aged < 75 received primary THA/TKA 5 years later while keeping age-specific 10-year revision risks constant.Results - 214,638 primary THAs and 211,099 TKAs were included, of which 31% of THAs and 95% of TKAs were cemented. The 10-year cumulative revision risk varied between 1.6% and 13%, with higher risks in younger age categories. Delaying prosthesis placement by 5 years could potentially avoid 23 (3%) THA and 162 (17%) TKA revisions.Interpretation - Cumulative 10- year revision risk varied considerably by age in both fixation groups, which may be communicated to patients and used to guide timing of surgery.Clinical epidemiolog

Studien uber heterogenetische Antigene der Hornmasse des Pferdes

Von den drei Hornmassenarten (Huf, Kastanie und Sporn), welche an der Oberhaut des Pferdes vorhanden sind, prufte ich das Vorkommen heterogenetischer Antigene und untersuchte zugleich das durch diese Antigene hervorgerufene Verwandtschaftsverhaltnis der Hornmassen zueinander. Die Kaninchen wurden entweder mit einem Extrakte immunisiert, das aus dem zu untersuchenden Material mit physiologischer Kochsalzlosung als Medium hergestellt war (Emulsion), oder mittels eines unter Erwarmung bereiteten alkoholischen Auszugs (Lipoide). Auf diese Weise wurde versucht, die Antigene in vivo festzustellen. Dann wurden die Antigene noch in vitro einer Untersuchung unterzogen. Die Ergebnisse dieser Studien sind kurz folgende: 1. Der Hornstoff des Hufes enthalt heterogenetisches Antigen. Besonderes Interesse beansprucht jedoch dabei die Beobachtung, dass selbst bei ein und demselben Huf je nach der Stelle der Antigen-Titer des Hornstoffes in weiten Grenzen schwankt. 2. Der Kastanienhornstoff hat heterogenetisches Antigen. 3. Auch beim Spornhornstoff findet sich heterogenetisches Antigen. 4. Wenn man die aus diesen drei Hornmassen gewonnenen heterogenetischen Antigene mit dem bekannten Antigen, welches den Organen des Meerschweinchens und den Erythrozyten des Schafes gemeinsam ist, vergleicht, so erkennt man, dass alle diese Antigene quantitativ wesentlich verschieden sind. Die ersten drei stehen namlich im allgemeinen dem letzteren nach, wahrend sie aber qualitativ miteinander in Einklang stehen. Uber die Verteilung des heterogenetischen Antigens in den Hornmassen soll folgende Tabelle nach dem Immunisierungsindex Aufschluss geben. 5. Das heterogenetische Antigen ist im Lipoid enthalten und stellt das sogenannte Hapten dar. Dieses Lipoid entfaltet im lebenden Korper als Schlepper erst durch Zusatz von Eiweissbestandteilen Vollantigenitat. 6. Alle Reaktionen mit heterogenetischen Antikorpern ergaben kein so zuverlassiges Resultat, aus dem man auf einen Verwandtschaftsgrad zwischen den Hornmassen hatte schliessen konnen. Kastan

Adherence to the Dutch recommendation for physical activity: prior to and after primary total hip and knee arthroplasty

PurposeTo determine the course of adherence to physical activity (PA) recommendation in hip/knee osteoarthritis patients before and after hip/knee arthroplasty (THA/TKA). Moreover, we explored predictors for non-adherence 12 months postoperatively.Materials and methodsPrimary THA/TKA were included in a multicenter observational study. Preoperatively and 6/12 months postoperatively, patients reported engagement in moderate-intensity PA in days/week in the past 6 months (PA-recommendation (& GE;30 min of moderate-intensity & GE;5 days/week)). We included predictors stratified by preoperative adherence: sex, age, BMI, comorbidities, smoking, living/working status, season, mental health, HOOS/KOOS subscales before and 6 months postoperatively, and 6-month adherence.Results(1005 THA/972 TKA) Preoperatively, 50% of the population adhered. Adherence increased to 59% at 6 and 12 months. After 12 months, most patients remained at their preoperative PA level, 11% of the preoperative adherers decreased, while 20% of the preoperative non-adherers increased their PA level. In all different groups, adherence to the PA recommendation at 6 months was identified as a predictor (OR-range: 0.16-0.29). In addition, BMI was identified as predictor in the THA adherent (OR = 1.07; 95%CI [1.02-1.15]) and TKA non-adherent groups (OR = 1.08; 95%CI [1.03-1.12]). THA non-adherent group not having paid work (OR = 0.53; 95%CI [0.33-0.85]), and in the TKA adherent group, lower KOOS subscale symptoms (OR = 1.03; 95%CI [1.01-1.05]) were associated with non-adherence.ConclusionsMajority of patients remained at their preoperative PA level. Non-adherence at 6 months was highly predictive for 12-month non-adherence

Three out of four working-age patients have fulfilled expectations towards paid employment six months after total hip or knee arthroplasty: a multicentre cohort study

To investigate factors associated with fulfilment of expectations towards paid employment after total hip/knee arthroplasty (THA/TKA). Cohort study including preoperatively employed patients aged 18-64 scheduled for THA/TKA. Expectations were collected preoperatively, and 6 and 12 months postoperatively with the paid employment item of the Hospitalfor-Special-Surgery Expectations Surveys (back-to-normal = 1; large improvement = 2; moderate improvement = 3; slight improvement = 4; not applicable = 5). Patients scoring not applicable were excluded. Fulfilment was calculated by subtracting preoperative from postoperative scores (< 0: unfulfilled; = 0: fulfilled). Multivariable logistic regression analyses were conducted separately for THA/TKA at 6 and 12 months postoperatively. Six months postoperatively, 75% of THA patients (n = 237/ n = 316) and 72% of TKA patients (n = 211/n = 294) had fulfilled expectations. Older age (TKA:OR 1.08, 95% CI 1.01-1.15) and better postoperative physical functioning (THA:OR 1.10, 95% CI 1.06-1.14; TKA:OR 1.03, 95% CI 1.01-1.06) increased the likelihood of fulfilment. Physical work tasks (THA:OR 0.12, 95% CI 0.03-0.44), preoperative sick leave (TKA:OR 0.33, 95% CI 0.17-0.65), and difficulties at work (THA:OR 0.10, 95% CI 0.03- 0.35; TKA:OR 0.41, 95% CI 0.17-0.98) decreased the likelihood of fulfilment. Twelve months postoperatively similar risk factors were found. Three out of four working-age THA/TKA patients had fulfilled expectations towards paid employment at 6 months postoperatively. Preoperative factors associated with fulfilment were older age, mental work tasks, no sick leave, postoperative factors were better physical functioning, and no perceived difficulties at work.Orthopaedics, Trauma Surgery and Rehabilitatio

Acute pain after total hip and knee arthroplasty does not affect chronic pain during the first postoperative year: observational cohort study of 389 patients

Chronic pain is frequently reported after total hip and knee arthroplasties (THA/TKA) in osteoarthritis (OA) patients. We investigated if severity of acute postoperative pain following THA/TKA in OA patients was associated with pain during the first postoperative year. From an observational study, OA patients scheduled for primary THA/TKA (June 2012-December 2017) were included from two hospitals in the Netherlands. Acute postoperative pain scores were collected within 72 h postoperatively and categorized as no/mild (NRS 4). Pain was assessed preoperatively, 3, 6 and 12 months postoperatively using the HOOS/KOOS subscale pain. With Multilevel Mixed-effects-analyses, we estimated associations between acute and chronic pain until one year postoperative, adjusted for confounders and including an interaction term (Time*Acute pain). 193 THA and 196 TKA patients were included, 29% of THA and 51% of TKA patients reported moderate/severe pain acutely after surgery. In the THA group, the difference in pain at 3 months between the no/mild and moderate/severe groups, was approximately six points, in favor of the no/mild group (95% CI [-12.4 to 0.9]) this difference became smaller over time. In the TKA group we found similar differences, with approximately four points (95% CI [-9.6 to 1.3]) difference between the no/mild and moderate/severe group at 6 months, this difference attenuated at 12 months. No association between severity of acute postoperative pain and pain during the first postoperative year was found. These findings suggest that measures to limit acute postoperative pain will likely not impact development of chronic pain.Orthopaedics, Trauma Surgery and Rehabilitatio

Reduced psychosocial functioning in subacromial pain syndrome is associated with persistence of complaints after 4 years

Background: Patients with subacromial pain syndrome (SAPS) frequently present with coexisting psychosocial problems; however, whether this also associates with long-term outcome is currently unknown. We assessed whether psychosocial functioning in patients with SAPS is associated with persistence of complaints after 4 years of routine care.Methods: In a longitudinal study, 34 patients with SAPS were selected after clinical and radiologic evaluation and assessed at baseline and after 4 years. For the assessment of psychosocial functioning, the RAND-36 questionnaire domains of social functioning, role limitations due to emotional problems, mental health, vitality, and general health were evaluated. Complaint persistence at follow-up was assessed by (1) an anchor question (reduced, persistent, or increased symptoms), (2) change in pain (change in visual analog scale score), and (3) change in quality of life (change in Western Ontario Rotator Cuff index score).Results: Lower baseline mental health (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.85-0.98; P = .013), vitality (OR, 0.90; 95% CI, 0.83-0.98; P = .011), and general health (OR, 0.93; 95% CI, 0.88-0.98; P = .009) were associated with persistent complaints as reported by the anchor question, change in visual analog scale score, and change in Western Ontario Rotator Cuff index score.Conclusions: Evaluating psychosocial functioning parallel to physical complaints is currently not standard procedure in the treatment of SAPS. In this study, we showed that factors related to psychosocial functioning are associated with long-term persistence of complaints in SAPS. Future studies may investigate whether a multimodal treatment with assessment of psychosocial functioning may facilitate pain relief and recovery in SAPS. (c) 2020 The Author(s). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Clinical epidemiolog

Time to return to work by occupational class after total hip or knee arthroplasty

Aims For the increasing number of working -age patients undergoing total hip or total knee arthroplasty (THA/TKA), return to work (RTW) after surgery is crucial. We investigated the association between occupational class and time to RTW after THA or TKA. Methods Data from the prospective multicentre Longitudinal Leiden Orthopaedics Outcomes of Osteoarthritis Study were used. Questionnaires were completed preoperatively and six and 12 months postoperatively. Time to RTW was defined as days from surgery until RTW (full or partial). Occupational class was preoperatively assessed and categorized into four categories according to the International Standard Classification of Occupations 2008 (blue -/white-collar, high -/low-skilled). Cox regression analyses were conducted separately for THA and TKA patients. Low-skilled blue-collar work was used as the reference category. Results A total of 360 THA and 276 TKA patients, preoperatively employed, were included. Patients were mainly high-skilled (THA 57%; TKA 41%) or low-skilled (THA 24%; TKA 38%) white =collar workers. Six months post- THA, RTW rates were 78% of low-skilled blue-collar workers compared to 83% to 86% within other occupational classes, increasing after 12 months to 87% to 90% in all occupational classes. Six months post- TKA, RTW rates were 58% of low-skilled and 64% of high-skilled blue-collar workers compared to 80% to 89% of white-collar workers, and after 12 months 79% of low-skilled blue-collar workers compared to 87% to 92% within other occupational classes. High-skilled white-collar workers (THA: haz ard ratio (HR) 2.12 (95% confidence interval (CI) 1.32 to 3.40); TKA: HR 2.31 (95% CI 1.34 to 4.00)) and low-skilled white-collar workers (TKA: HR 1.82 (95% CI 1.04 to 3.18)) had a higher hazard to RTW within six months postoperatively. Conclusion Clear differences existed in time to RTW among both THA and TKA patients in each of the groups studied. These findings may help guide tailored patient-specific information during preoperative consultation and advice postoperatively, as well as to create awareness among workers and their employers.Clinical epidemiolog