Despite new technologies for total knee arthroplasty (TKA), approximately 20% of patients are dissatisfied. A major reason for dissatisfaction and revision surgery after TKA is persistent pain. The radiological grade of osteoarthritis (OA) preoperatively has been investigated as a predictor of the outcome after TKA, with conflicting results. The aim of this study was to determine if there is a difference in the intensity of pain 12 months after TKA in relation to the preoperative radiological grade of OA alone, and the combination of the intensity of preoperative pain and radiological grade of OA. The preoperative data of 300 patients who underwent primary TKA were collected, including clinical information (age, sex, preoperative pain), psychological variables (depression, anxiety, pain catastrophizing, anticipated pain), and quantitative sensory testing (temporal summation, pressure pain thresholds, conditioned pain modulation). The preoperative radiological severity of OA was graded according to the Kellgren-Lawrence (KL) classification. Persistent pain in the knee was recorded 12 months postoperatively. Generalized linear models explored differences in postoperative pain according to the KL grade, and combined preoperative pain and KL grade. Relative risk models explored which preoperative variables were associated with the high preoperative pain/low KL grade group.Aims
Methods
While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years’ follow-up. Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS.Aims
Methods
Aims. Amputation in intractable cases of complex regional pain syndrome
(CRPS) remains controversial. . The likelihood of recurrent Complex Regional Pain Syndrome (CRPS),
residual and phantom limb pain and persistent disability after amputation
is poorly described in the literature. The aims of this study were
to compare pain, function, depression and quality of life between
patients with intractable CRPS who underwent amputation and those
in whom amputation was considered but not performed. Patients and Methods. There were 19 patients in each group, with comparable demographic
details. The amputated group included 14 men and five women with
a mean age of 31 years (. sd. 12) at the time of CRPS diagnosis.
The non-amputated group consisted of 12 men and seven women and
their mean age of 36.8 years (. sd. 8) at CRPS diagnosis.
The mean time from CRPS diagnosis to (first) amputation was 5.2
years (. sd 4. 3) and the mean time from amputation to data collection
was 6.6 years (. sd. 5.8). . All participants completed the following questionnaires: Short-Form
(SF) 36, Short Form McGill Pain questionnaire (SF-MPQ), Pain Disability
Index (PDI), the
Randomised controlled trials (RCTs) that assessed
the efficacy of bracing for adolescent idiopathic scoliosis have suffered
from small sample sizes, low compliance and lack of willingness
to participate. The aim of this study was to assess the feasibility
of a comprehensive cohort study for evaluating both the efficacy
and the effectiveness of bracing in patients with adolescent idiopathic
scoliosis. Patients with curves at greater risk of progression were invited
to join a randomised controlled trial. Those who declined were given
the option to remain in the study and to choose whether they wished
to be braced or observed. Of 87 eligible patients (5 boys and 63
girls) identified over one year, 68 (78%) with mean age of 12.5
years (10 to 15) consented to participate, with a mean follow-up
of 168 weeks (0 to 290). Of these, 19 (28%) accepted randomisation.
Of those who declined randomisation, 18 (37%) chose a brace. Patients
who were more satisfied with their image were more likely to choose
bracing (Odds Ratio 4.1; 95% confidence interval 1.1 to 15.0; p = 0.035).
This comprehensive cohort study design facilitates the assessment
of both efficacy and effectiveness of bracing in patients with adolescent
idiopathic scoliosis, which is not feasible in a conventional randomised
controlled trial. Cite this article:
We have reviewed 22 patients at a mean of 30 years (28 to 31) after a whiplash injury. A complete recovery had been made in ten (45.5%) while one continued to describe severe symptoms. Persistent disability was associated with psychological distress but both improved in the period between 15 and 30 years after injury. After 30 years, ten patients (45.5%) were more disabled by knee than by neck pain.
