Survival of 11,390 Continuum cups in primary total hip arthroplasty based on data from the Finnish Arthroplasty Register

Background and purpose - The use of trabecular metal (TM) cups for primary total hip arthroplasty (THA) is increasing. Some recent data suggest that the use of TM in primary THA might be associated with an increased risk of revision. We compared implant survival of Continuum acetabular cups with other commonly used uncemented cups. Patients and methods - Data on 11,390 primary THAs with the Continuum cup and 30,372 THAs with other uncemented cups (reference group) were collected from the Finnish Arthroplasty Register. Kaplan-Meier survival estimates were calculated; the endpoint was revision for any reason, for infection, or for dislocation. Revision risks were assessed with adjusted Cox multiple regression models. A subgroup analysis on the use of neutral or elevated liners in the Continuum group was made. Results - The 7-year survivorship of the Continuum group was 94.6% (95% CI 94.0-95.2) versus 95.6% (CI 95.3-95.8) in the reference group for revision for any reason. The risk for revision was higher in the Continuum group than in the reference group both for revision for any reason (HR 1.3 [CI 1.2-1.5)]) and for revision for dislocation (HR 1.9 [CI 1.5-2.3]). There was no difference in the rates of revision because of infection (HR 0.99 [CI 0.78-1.3]). Use of a neutral liner increased the risk for revision due to dislocation in comparison with the use of an elevated rim liner in the Continuum group (HR 1.7 [CI 1.2-2.5]). Interpretation - THA with Continuum cups is associated with an increased risk of revision compared with other uncemented cups, mainly due to revisions because of dislocation. Our results support the use of an elevated liner when Continuum cups are used for primary THA

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Healthcare professionals’ proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey:a qualitative interview study

Abstract Aims and objectives: This study examined the lived experience of healthcare professionals providing care for patients with total hip and knee arthroplasty. The aim of this study is to understand healthcare professionals’ proposed eHealth needs in elective primary fast‐track hip and knee arthroplasty journey. Background: There is little evidence in nursing literature to indicate how to develop new eHealth services to support surgical care journeys. Evidence is particularly lacking regarding the development of eHealth solutions. Design: This was a qualitative interview study. Methods: Semi‐structured interviews were conducted with four surgeons, two anaesthesiologists, ten nurses, and four physiotherapists in a single joint replacement centre during autumn 2018. The data were analysed using an inductive content analysis method. NVivo qualitative data analysis software was used. The COREQ checklist for qualitative studies was followed. Results: Our research addressed the gap in evidence by focusing on the four main parts of the patient journey in the selected context. Analysis of the data revealed nine main categories for the proposed eHealth needs: eligibility criteria, referrals, meeting the Health Care Guarantee, patient flow, post‐discharge care, patient counselling, communication, transparency of the journey, and receiving feedback. In addition, the requirements and further development needs for eHealth solutions were generally identified. Conclusions: From the point of view of healthcare professionals, eHealth solutions have huge potential in supporting the elective primary fast‐track hip and knee arthroplasty journey. However, it is important to acknowledge that these needs may be very different depending on the technological and organisational environment in question. Relevance to clinical practice: More effective use of information and communication technologies is needed for organisational optimisation resulting in a streamlined pathway, better access to healthcare services, improved outcomes, and an improved patient experience. These results can be used in the development of new eHealth solutions to support surgical care journeys and patient education

Healthcare professionals’ perceived problems in fast-track hip and knee arthroplasty:results of a qualitative interview study

Abstract Background: Fast-track and outpatient arthroplasty methodologies combine evidence-based clinical features with organizational optimization resulting in a streamlined pathway from admission to discharge and beyond. This qualitative study explored perceived problems of healthcare professionals during fast-track hip and knee arthroplasty. Methods: Semi-structured interviews were conducted with four surgeons, two anesthesiologists, ten nurses, and four physiotherapists. An inductive content analysis was used to analyze the data. NVivo qualitative data analysis software was used. Results: Analysis of the data revealed eight main categories of problems: patient selection, referrals, meeting the Health Care Guarantee, patient flow, homecare, patient counseling, transparency of the journey, and receiving feedback. In addition, problems related to information flows and communication, responsibilities between different stakeholders, and existing information systems were identified. Conclusions: The study revealed that healthcare professionals perceived several problems during the fast-track journey that reduce its effectiveness and make it more difficult to meet the Health Care Guarantee. Problems could be alleviated by changing internal and external organizational practices, as well as by developing new information and communication technologies that would provide up-to-date communication channels for healthcare professionals and patients. In addition, new collaboration mechanisms should be developed in order to solve the problems that occur across different organizations

Patients’ satisfaction and experiences during elective primary fast‐track total hip and knee arthroplasty journey:a qualitative study

Abstract Aims and objectives: To explore how satisfied patients are with the process of treatment and care, and to identify the experiences that patients perceive during elective primary fast‐track total hip and knee arthroplasty journey. Background: Greater satisfaction with care has predicted better quality of recovery, and patient experience has been positively associated with patient safety and clinical effectiveness. However, little is still known about how patients experience their treatment and care. Design: A qualitative interview study. Methods: The study was conducted among 20 patients in a single joint replacement centre during 2018. Patient satisfaction was measured using a numerical rating scale. Patients’ experiences were identified through qualitative semi‐structured interviews which were analysed using an inductive content analysis method. The COREQ checklist was used (Supplementary File 1). Results: The mean numerical rating scale score for overall satisfaction was 9.0 (SD 1.1) on a scale from 0 to 10. The patients’ experiences were grouped under eight main categories that were derived from the qualitative data in the analysis: 1) patient selection, 2) meeting the Health Care Guarantee, 3) patient flow, 4) post‐discharge care, 5) patient counselling, 6) transparency of the journey, 7) communication and 8) feedback. Conclusions: The findings suggest that patients are highly satisfied after an elective primary fast‐track total hip and knee arthroplasty. However, closer analysis of the patients’ experiences reveals challenges and suggestions on how they could be solved, often involving digital technologies. Relevance to clinical practice: As the number of total joint arthroplasties grows, patients and their families need to take ever greater responsibility, for their own care from advance preparation to rehabilitation. The findings of the study can be used to organise work, improving patient‐clinical communication, fostering engagement, and improving patient centredness. In addition, the results pinpoint the issues on how the patient experience could be improved

The effects and safety of telerehabilitation in patients with lower-limb joint replacement:a systematic review and narrative synthesis

Abstract Introduction: As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement. Methods: A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes. Results: Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence. Discussion: Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation

Single dose epidural hydromorphone in labour pain:maternal pharmacokinetics and neonatal exposure

Abstract Introduction: Epidural hydromorphone could be useful in obstetric analgesia as there is a need for a more water-soluble opioid than sufentanil or fentanyl with prolonged analgesic effect. To our knowledge, the pharmacokinetics of epidural hydromorphone has not been evaluated in parturients. Materials and methods: In this pilot study, seven healthy parturients were given a single epidural dose of hydromorphone for labour pain. One parturient received 1.5 mg, two 0.75 mg and four 0.5 mg of hydromorphone hydrochloride. Dose was decreased due to nausea and pruritus. Hydromorphone’s effect, adverse effects and plasma concentrations were evaluated. Neonatal drug exposure was evaluated by umbilical vein and artery opioid concentration at birth. Neonatal outcomes were assessed using Apgar and the Neurologic Adaptive Capacity Score (NACS). Results: All patients received additional levobupivacaine doses on parturients’ requests. The first dose was requested at a median of 163 min (range 19–303 min) after hydromorphone administration. A total of 12 opioid related expected adverse events were reported by seven parturients. All newborn outcomes were uneventful. Hydromorphone’s distribution and elimination after single epidural dose seem similar to that reported for non-pregnant subjects after intravenous hydromorphone administration, but further research is required to confirm this observation. Conclusions: The optimal dose of hydromorphone in labour pain warrants further evaluation

Robotic versus laparoscopic surgery for severe deep endometriosis:protocol for a randomised controlled trial (ROBEndo trial)

Abstract Introduction: Endometriosis is a common gynaecological disease affecting around 10% of fertile-aged women, causing severe pain symptoms. Deep endometriosis is defined as endometriotic implants that infiltrate the underlying organs more than 5 mm in depth. Surgery for deep endometriosis requires advanced multidisciplinary surgical technique, often in very difficult surgical conditions, with increased risks of complications. Robotic surgery offers a high-definition three-dimensional view and articulating instruments that may allow more precise dissection than conventional laparoscopy in the pelvic area. The superiority of robotic surgery has not, however, been provedin randomised controlled studies, and there is a lack of long-term outcome data. Advanced endometriosis surgery offers an excellent platform to study the feasibility and long-term outcomes of robotic surgery compared with conventional laparoscopy. Methods and analysis: ROBEndo is a prospective, randomised, controlled clinical trial in a single-centre setting. Patients with deep endometriosis verified by MRI needing surgery at Oulu University Hospital (Oulu, Finland) will be considered eligible. 70 patients will be allocated 1:1 to receive either robotic-assisted or conventional laparoscopic surgery in two strata: radical surgery (with the removal of the uterus and adnexae) and gynaecological organ-sparing surgery. The primary outcome will be the surgical outcome as regards to pain symptoms measured on numeric rating scale (NRS) questionnaires at 24 hours and 6, 12 and 24 months postoperatively. As secondary outcomes, intraoperative measures, enhanced recovery after surgery factors, complications, cost and long-term quality of life measured with Endometriosis Health Profile-30 (EHP-30), Female Sexual Function Index (FSFI) and 15-dimensional (15D) questionnaires will be compared. Ethics and dissemination: This study has been approved by the Northern Ostrobothnian Hospital District Ethical Committee at Oulu University Hospital (212/2021). Informed consent will be obtained during the preoperative check-up by the operating gynaecologist. The results will be published in peer-reviewed international journals. Trial registration number: NCT05179109

Short-term effects of a digital patient journey solution on patient-reported outcomes and health care utilization in arthroplasty:a pragmatic randomized controlled trial

Abstract Mobile health solutions for patient support have been proposed as promising and safe alternatives to usual care in adults undergoing primary total hip and knee arthroplasty. Studies of such applications, however, have produced conflicting results and only moderate- to low-quality evidence. This study aims to evaluate the short-term effects of a digital patient journey solution on patient-reported outcomes and health care utilization in patients undergoing total hip and knee arthroplasty using a pragmatic randomized controlled trial design. Randomly allocated patients in the control arm (n = 35, 64 ± 9 years) received usual care, while patients in the intervention arm (n = 34, 62 ± 11 years) received the digital patient journey solution in addition to usual care. The primary outcome was health-related quality of life as measured by the EuroQol EQ-5D-5L scale. Secondary outcomes included functional recovery, pain, self-efficacy, patient experience, adherence to fast-track protocol, and health care utilization. Participants were followed from a preoperative surgical visit until a postoperative follow-up visit at 6–12 weeks. The health-related quality of life, functional recovery, pain, patient experience, adherence to the fast-track protocol, and health care utilization did not differ between the arms. During the study, however, the self-efficacy to use digital health services (p=0.027) increased in the intervention arm. The use of the digital patient journey solution was not superior to usual care in terms of patient-reported outcomes and health care utilization. However, the solution improved the self-efficacy of patients to use digital health services, which may lead to greater demand for similar digital offerings as patient become more familiar with mobile health solutions