Knee Arthroplasty: Disabilities in Comparison to the General Population and to Hip Arthroplasty Using a French National Longitudinal Survey

International audienceBACKGROUND: Knee arthroplasty is increasing exponentially due to the aging of the population and to the broadening of indications. We aimed to compare physical disability and its evolution over two years in people with knee arthroplasty to that in the general population. A secondary objective was to compare the level of disabilities of people with knee to people with hip arthroplasty. METHODOLOGY/PRINCIPAL FINDINGS: 16,945 people representative of the French population were selected in 1999 from the French census and interviewed about their level of disability. This sample included 815 people with lower limb arthroplasty. In 2001, 608 of them were re-interviewed, among whom 134 had knee arthroplasty. Among the other participants re-interviewed, we identified 68 who had undergone knee arthroplasty and 145 hip arthroplasty within the last two years (recent arthroplasty). People with knee arthroplasty reported significantly greater difficulties than the general population with bending forward (odds ratio [OR] = 4.7; 95% confidence interval [CI]: 1.7, 12.6), walking more than 500 meters (OR = 6.0; 95% CI: 1.5, 24.7) and carrying 5 kg kilograms for 10 meters (OR = 4.6; 95% CI: 1.3, 16.4). However, the two years evolution in disability was similar to that in the general population for most activities. The level of mobility was similar between people with recent knee arthroplasty and those with recent hip arthroplasty. Nevertheless, people with recent knee arthroplasty reported a lower level of disability than the other group for washing and bending forward (OR = 0.3; 95% CI: 0.1, 0.6 and OR = 0.4; 95% CI: 0.1, 0.9, respectively). CONCLUSIONS/SIGNIFICANCE: People with knee arthroplasty reported a higher risk of disability than the general population for common activities of daily living but a similar evolution. There was no relevant difference between recent knee and hip arthroplasties for mobility

REPRISE DES PROTHESES TOTALES DE HANCHE ALUMINE-ALUMINE (MODALITES ET RESULTATS AU RECUL MOYEN DE 6 ANS)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Third-generation pure alumina and alumina matrix composites in total hip arthroplasty: What is the evidence?

Wear, corrosion and periprosthetic osteolysis are important causes of failure in joint arthroplasty, especially in young patients.Ceramic bearings, developed 40 years ago, are an increasingly popular choice in hip arthroplasty. New manufacturing procedures have increased the strength and reliability of ceramic materials and reduced the risk of complications.In recent decades, ceramics made of pure alumina have continuously improved, resulting in a surgical-grade material that fulfills clinical requirements.Despite the track record of safety and long-term results, third-generation pure alumina ceramics are being replaced in clinical practice by alumina matrix composites, which are composed of alumina and zirconium.In this review, the characteristics of both materials are discussed, and the long-term results with third-generation alumina-on-alumina bearings and the associated complications are compared with those of other available ceramics. Cite this article: EFORT Open Rev 2018;3:7-14. DOI: 10.1302/2058-5241.3.170034

Evolution of disability in adults with hip arthroplasty: a national longitudinal study.

OBJECTIVE: To describe disability in individuals with hip arthroplasty and its evolution over 2 years compared with that in the general population, and to compare the degree of disability between subjects with recent and older hip arthroplasty. METHODS: We selected a national representative sample of 16,945 subjects from the 1999 French population census. This sample, interviewed in 1999 and 2001 about their level of disability, included 527 subjects with hip arthroplasty (i.e., representing 424,000 individuals in the French noninstitutionalized population): 145 who underwent the procedure between 1999 and 2001 (recent hip arthroplasty) and 382 with an older hip arthroplasty. RESULTS: Subjects with hip arthroplasty reported more difficulty in bending forward (odds ratio [OR] 4.5, 95% confidence interval [95% CI] 3.1-6.6), climbing stairs (OR 2.2, 95% CI 1.5-3.1), walking >300 meters (OR 1.6, 95% CI 1.03-2.6), dressing (OR 2.9, 95% CI 2.1-4.2), and getting in and out of a chair (OR 2.5, 95% CI 1.7-3.6) than the general population. However, the evolution in disability was similar to that of the general population. Compared with subjects with older hip arthroplasty, those with recent hip arthroplasty reported more difficulty walking >300 meters (OR 2.7, 95% CI 1.3-5.6), washing (OR 2.9, 95% CI 1.6-5.4), dressing (OR 2.2, 95% CI 1.2-4.2), and getting in and out of a chair (OR 2.1, 95% CI 1.1-3.9). CONCLUSION: This study describes the potential future disability in the more elderly population, with implications for health-related planning

Osteonecrosis after Allogeneic Bone Marrow Transplantation

Osteonecrosis after bone marrow transplantation is usually severe. Most patients develop acute and chronic graft-versus-host disease requiring a high dose of steroids for a long period of time. Generally ineffective nonoperative treatment in the past has resulted in treatment primarily with total hip arthroplasty (THA). We asked whether THA (1) reliably improved functional status, (2) led to more complications, and (3) THA after bone marrow transplantation was as durable as THA for idiopathic ON. We retrospectively reviewed 77 patients (123 hips) with osteonecrosis. The mean age at surgery was 33 years (range, 15.7–56 years). We performed all arthroplasties with an alumina ceramic bearing coupled with an alumina head 32 mm in diameter. The minimum followup was 2 years (mean, 9.2 years; range, 2–26 years). We documented seven revisions: three for late septic loosening, four for late aseptic loosening. Considering loosening of any component as the end point, the survivorship was 74.8% (range, 58.7%–90.9%) at 10 years. In this difficult situation, we believe the results acceptable. Septic loosening affecting this specific population has to be considered a serious event

Evolution of disability for people with recent (less than 2 years) knee arthroplasty (68 subjects) and for those with recent hip arthroplasty (145 subjects).

<p>Percentages and 95% confidence interval [CI].</p

Disability according to domains of disability, for all subjects with knee arthroplasty (202 subjects) compared to the other participants (11,510 subjects) in 2001, after adjustment for age, sex, education, number of chronic conditions and probability of nonresponse. Adjusted Odds ratio [Adj-OR] and 95% confidence interval [CI].

*<p>Adj-OR, adjusted OR.</p><p>Significant ORs are in bold.</p><p>The dependent variable is «reporting at least some difficulties for each activity of daily living».</p

Disability and evolution (i.e., worsening) over two years according to domains of disability, for subjects with recent knee arthroplasty (68 subjects) compared to those with recent hip arthroplasty (145 subjects) adjusted for age, sex, education, chronic conditions and probability of nonresponse.

<p>Adjusted Odds ratio [Adj-OR] and 95% confidence interval [CI].</p>$<p>The dependent variable is «reporting at least some difficulties» for each activity of daily living.</p>*<p>The term worsening was used to assess overall worsening of walking-distance limitation.</p><p>Significant ORs are in bold.</p