Essential Oils for Complementary Treatment of Surgical Patients: State of the Art

Aromatherapy is the controlled use of plant essences for therapeutic purposes. Its applications are numerous (i.e., wellbeing, labour, infections, dementia, and anxiety treatment) but often they have not been scientifically validated. The aim of the present study is to review the available literature to determine if there is evidence for effectiveness of aromatherapy in surgical patients to treat anxiety and insomnia, to control pain and nausea, and to dress wound. Efficacy studies of lavender or orange and peppermint essential oils, to treat anxiety and nausea, respectively, have shown positive results. For other aspects, such as pain control, essential oils therapy has shown uncertain results. Finally, there are encouraging data for the treatment of infections, especially for tea tree oil, although current results are still inconclusive. It should also be considered that although they are, allergic reactions and toxicity can occur after oral ingestion. Therefore, while rigorous studies are being carried out, it is important that the therapeutic use of essential oils be performed in compliance with clinical safety standards

Relationship between obesity and early failure of total knee prostheses

<p>Abstract</p> <p>Background</p> <p>Obesity is a risk factor for knee arthritis. Total knee arthroplasty is the definitive surgical treatment of this disease. Therefore, a high percentage of subjects treated are overweight. Since 2000 in the Emilia-Romagna Region the Register of Orthopedic Prosthetic Implantology, RIPO, has recorded data of all the primary and revision operations performed on the knee; height and weight of patients at the time of surgery have also been recorded.</p> <p>Methods</p> <p>To understand how overweight and obesity affect the outcome of knee arthroplasty, a population of subjects treated with cemented total knee arthroplasty between 2000 and 2005 was studied. 9735 knee prostheses were implanted in 8892 patients; 18.9% of the patients were normal weight, 48.2% were overweight (25 < Body Mass Index <= 30), 31.1% were obese (30 < BMI <= 40), and 1.8% were morbidly obese (BMI > 40). Mean and range of follow-up were respectively 3.1 and 1.5–6 yrs. Implant failure was defined as the exchange of at least one component for whatever reason.</p> <p>Results</p> <p>In normal weight patients there were 36 failures out of 1840 implants (1.96%), in overweight patients there were 87 out of 4692 (1.85%), in obese 59 out of 3031 (1.94%), and in morbidly obese there were 4 out of 172 (2.3%). The mean time to failure for each class was 1.57, 1.48, 1.60, 1.77 yrs. Cox regression analyses showed that the risk of implant failure was not influenced by BMI, absolute body weight, or sex. Conversely, an increased failure risk was observed in mobile meniscus prostheses in comparison with those with a fixed meniscus (Rate Ratio 1.88); an increased failure risk was also related to age (Rate Ratio 1.05 per year). These results were also confirmed when considering septic loosening as the end-point. There were no differences in the rate of perioperative complications and death in the 4 classes of BMI.</p> <p>Conclusion</p> <p>In conclusion, cemented knee prostheses, implanted in patients with arthritis do not have significantly different rates of survival or perioperative complications in obese subjects compared with normal weight subjects, at least up to 5 years after surgery. The conclusion also applies to subjects affected by morbid obesity, altough this findings should be regarded with caution due to the small sample examined.</p

Modeling the Cost-Effectiveness for Cement-Less and Hybrid Prosthesis in Total Hip Replacement in Emilia Romagna, Italy

Background. The aim of the present study was to assess the cost-effectiveness of cement-less versus hybrid prostheses in total hip replacement (THR) in patients diagnosed with primary osteoarthritis. Methods. Effectiveness data were obtained from the Emilia-Romagna Regional Registry on Orthopaedic Prosthesis (RIPO), which collects information on all orthopaedic intervention performed in Emilia-Romagna (41,199 total hip replacements performed from 2000 to 2007), and from which we obtained survival curves and transition probabilities for the cement-less and hybrid prostheses, respectively. Conversely, costs were derived from regional databases through a specific procedure, which allowed us to register individual component's costs for both primary and subsequent revision interventions. A specific Markov transition model was constructed in order to consider the 3 types of revisions that an implant could possibly undergo through its life-span: total, cup or stem, head insert or neck. The cost-effectiveness was expressed in terms of cost per "revision-free" life year. Results and conclusions. Considering a 70-y old patient undergoing THR, the cementless strategy resulted more effective but more costly than the hybrid solution, with an incremental cost effectiveness ratio of 2401.63 (sic) per revision-free life year. Following a deterministic sensitivity analysis, hybrid and cementless fixation showed, respectively, a dominance profile for patients older than 83 y and younger than 43 y, whereas for all ages in between, we report a progressive increase in the ICER of cementless prostheses. Our results proved to be robust, as underlined by the probabilistic sensitivity analysis performed using cost distributions. (C) 2011 Elsevier Inc. All rights reserved

What are the influencing factors on hip and knee arthroplasty survival? Prospective cohort study on 63619 arthroplasties

International audienceBackground: Body mass index is used by the World Health Organization to classify obesity. While obesity influences the onset of arthritis and type-2 diabetes, its effect on implant survival is still open to debate, with conflicting results from clinical and registry studies, as well as meta-analyses. Other known factors such as gender or diabetes status could ponderate or mask the effect of BMI on implant survival.Hypothesis: Our hypothesis was BMI influenced hip and knee arthroplasty survival, when results were made independent of gender and diabetes status.Patient and methods: A registry study was designed on 30733 Total Hip Arthroplasties (THA), 28483 Total Knee Arthroplasties (TKA), 3754 Uni compartmental Knee Arthroplasties (UKA) and 649 Hinged Knee arthroplasties (HK), from 01/01/2003 to 31/12/2015. Mean follow-up was 5.5 years. Diabetes status was added to the model. Each arthroplasty survival was tested for age at implantation, gender, diabetes status, implant characteristics and specifically BMI, taking into account gender and diabetes status.Results: Gender had a strong influence on arthroplasty results. Age also influenced arthroplasty survival, especially aseptic loosening; a young age would lower implant survival. Diabetes had an influence in hip survival, but its influence on septic loosenings in TKA wasn't proven (p=0.065). A mobile liner and/or a cruciate retaining knee were factors increasing the risk of revision. Weight influenced THA survival, especially aseptic loosening, but didn't have a measurable effect in any other arthroplasty. BMI was not found to influence any arthroplasty survival, whatever the endpoint, when diabetes and gender were taken into account.Discussion: Gender, age and diabetes influenced survival of the lower limb arthroplasties, whereas BMI did not. Only weight did influence THA results and should be used instead of BMI.Conclusion: Studies on arthroplasty survival should systematically mention gender and diabetes status and beware of potential group incomparability

Is Cross-Linked Polyethylene an Improvement Over Conventional Ultra-High Molecular Weight Polyethylene in Total Knee Arthroplasty?

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Quels sont les facteurs qui influencent la survie de l’arthroplastie de la hanche et du genou ? Étude prospective de cohorte sur 63 619 arthroplasties

International audienceIntroductionL’indice de masse corporelle (IMC) est utilisé par l’Organisation mondiale de la santé pour classer l’obésité. Bien que l’obésité influence l’apparition de l’arthrose et du diabète de type 2, son effet sur la survie des implants fait encore l’objet de débats, les résultats contradictoires d’études cliniques et d’études de registre, ainsi que de méta-analyses, étant non concluants. D’autres facteurs connus, tels que le sexe ou le statut diabétique pourraient pondérer ou masquer l’effet de l’IMC sur la survie des implants.HypothèseNotre hypothèse était que l’IMC influençait la survie de l’arthroplastie de la hanche et du genou, lorsque les résultats étaient rendus indépendants du sexe et du statut diabétique.MéthodesUne étude de registre a été conçue sur 30 733 prothèses totales de hanche (PTH), 28 483 prothèses totales du genou (PTG), 3754 prothèses uni-compartimentales de genou (PUC) et 649 prothèses charnières de genou (PC), du 01/01/2003 au 31/12/2015. Le suivi moyen était de 5,5 ans. L’état diabétique a été ajouté au modèle. Chaque survie d’implant a été testée en fonction de l’âge au moment de l’implantation, du sexe, de l’état diabétique, des caractéristiques de l’implant et plus particulièrement de l’IMC, en tenant compte du sexe et du statut diabétique.RésultatsLe sexe avait une forte influence sur les résultats de l’arthroplastie. L’âge influençait également la survie de l’arthroplastie, en particulier sur la survie pour descellement aseptique ; un jeune âge diminuerait la survie de l’implant. Le diabète avait une influence sur la survie de la hanche, mais son influence sur le descellement septique des PTG n’a pas été prouvée (p = 0,065). Un plateau rotatoire et/ou une prothèse de genou avec conservation du LCP étaient des facteurs qui augmentaient le risque de révision. Le poids a influencé la survie de la PTH, en particulier vis-à-vis du descellement aseptique, mais n’a pas eu d’effet mesurable dans aucune autre arthroplastie. L’IMC n’a pas eu d’influence sur la survie de l’arthroplastie, quel que soit le critère d’évaluation, lorsque le diabète et le sexe étaient pris en compte.DiscussionLe sexe, l’âge et le diabète influençaient la survie des arthroplasties des membres inférieurs, mais pas l’IMC. Seul le poids a influencé les résultats de la PTH et devrait être utilisé préférentiellement, au lieu de l’IMC.ConclusionLes études sur la survie des arthroplasties devraient systématiquement mentionner le sexe et l’état diabétique et se méfier de l’incomparabilité potentielle des groupes.Niveau de preuveIII, étude de cohorte