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Background: Up to 40% of patients are receiving opioids at the time of total knee arthroplasty (TKA) in the United States despite evidence suggesting opioids are ineffective for pain associated with arthritis and have substantial risks. Our primary objective was to determine whether preoperative opioid users had worse knee pain and physical function outcomes 12 months after TKA than patients who were opioidnaive preoperatively; our secondary objective was to determine the prevalence of opioid use before and after TKA in Alberta, Canada. Methods: In this retrospective analysis of population-based data, we identified adult patients who underwent TKA between 2013 and 2015 in Alberta. We used multivariable linear regression to examine the association between preoperative opioid use and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function scores 12 months after TKA, adjusting for potentially confounding variables. Results: Of the 1907 patients, 592 (31.0%) had at least 1 opioid dispensed before TKA, and 124 (6.5%) were classified as long-term opioid users. Long-term opioid users had worse adjusted WOMAC pain and physical function scores 12 months after TKA than patients who were opioid-naive preoperatively (pain score (3 = 7.7, 95% confidence interval [CI] 4.0 to 11.6; physical function score (3 = 7.8, 95% CI 4.0 to 11.6; p < 0.001 for both). The majority (89 ([71.8%]) of patients who were long-term opioid users preoperatively were dispensed opioids 180-360 days after TKA, compared to 158 (12.0%) patients who were opioid-naive preoperatively. Conclusion: A substantial number of patients were dispensed opioids before and after TKA, and patients who received opioids preoperatively had worse adjusted pain and functional outcome scores 12 months after TKA than patients who were opioidnaive preoperatively. These results suggest that patients prescribed opioids preoperatively should be counselled judiciously regarding expected outcomes after TKA. Contexte : Jusqu'a 40 % des patients se font prescrire des opioides lors d'une chirurgie pour prothese totale du genou (PTG) aux Etats-Unis, et ce, malgre des donnees selon lesquelles les opioides sont inefficaces pour la douleur associee a l'arthrite et comportent des risques substantiels. Notre objectif principal etait de determiner si les patients qui utilisaient deja des opioides en periode preoperatoire obtenaient des resultats plus negatifs aux plans de la douleur et du fonctionnement 12 mois apres leur PTG, comparativement aux patients qui ne prenaient pas d'opioides avant leur intervention; notre objectif secondaire etait de mesurer la prevalence du recours aux opioides avant et apres la PTG en Alberta, au Canada. Methodes : Dans cette analyse retrospective menee sur des donnees de population, nous avons identifie les patients adultes soumis a une PTG entre 2013 et 2015 en Alberta. Nous avons utilise un modele de regression lineaire multivarie pour examiner le lien entre l'utilisation d'opioides en periode preoperatoire et les scores de douleur et de fonctionnement a l'echelle WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) 12 mois apres la PTG, en tenant compte de potentielles variables de confusion. Resultats : Sur les 1907 patients, 592 (31,0 %) ont recu au moins 1 opioide avant leur PTG, et 124 (6,5 %) en etaient consideres des utilisateurs de longue date. Les utilisateurs d'opioides de longue date presentaient de moins bons scores WOMAC ajustes pour les domaines de douleur et de fonctionnement 12 mois apres la PTG, comparativement aux patients qui n'en prenaient pas avant l'intervention (score de douleur (3 = 7,7, intervalle de confiance [IC] de 95 % 4,0 a 11,6; score de fonctionnement (3 = 7,8, IC de 95 % 4,0 a 11,6; p < 0,001 pour les 2 domaines). La majorite (89 [71,8 %]) des patients utilisateurs d'opioides de longue date avant l'intervention se sont fait servir des opioides 180-360 jours apres la PTG, comparativement a 158 patients (12,0 %) qui n'en prenaient pas avant l'intervention. Conclusion : Un nombre substantiel de patients ont recu des opioides avant et apres la PTG, et ceux qui en prenaient avant l'intervention presentaient des scores de douleur et de fonctionnement ajustes plus defavorables 12 mois apres la PTG, comparativement aux patients qui n'en prenaient pas avant l'intervention. Selon ces resultats, il faut adresser des conseils judicieux aux patients qui sont deja sous opioides en periode preoperatoire et les informer des resultats possibles de la PTG., Over the past 20 years, the number of opioids prescribed to manage arthritis has increased dramatically in North America despite emerging evidence suggesting that opioids provide no benefit compared to [...]

Background: Evidence-based guidelines on the use of immobilization in the management of common acute soft-tissue knee injuries do not exist. Our objective was to explore the practice patterns of emergency physicians (EPs), sports medicine physicians (SMPs) and orthopedic surgeons (OS) regarding the use of early immobilization in the management of these injuries. Methods: We developed a web-based survey and sent it to all EPs, SMPs and OS in a Canadian urban centre. The survey was designed to assess the likelihood of prescribing immobilization and to evaluate factors associated with physicians from these 3 disciplines making this decision. Results: The overall response rate was 44 of 112 (39%): 17 of 58 (29%) EPs, 7 of 15 (47%) SMPs and 20 of 39 (51%) OS. In cases of suspected meniscus injuries, 9 (50%) EPs indicated they would prescribe immobilization, whereas no SMPs and 1 (5%) OS would immobilize (p = 0.002). For suspected anterior cruciate ligament injuries, 13 (77%) EPs, 2 (29%) SMPs and 5 (25%) OS said they would immobilize (p = 0.005). For lateral collateral ligament injuries, 9 (53%) EPs, no SMPs and 6 (32%) OS would immobilize (p = 0.04). All respondents would prescribe immobilization for a grossly unstable knee. Conclusion: We found that EPs were are more likely to prescribe immobilization for certain acute soft-tissue knee injuries than SMPs and OS. The development of an evidenced-based guideline for the use of knee immobilization after acute soft-tissue injury may reduce practice variability. Contexte: Il n'existe pas de lignes directrices factuelles sur le recours a l'immobilisation pour la prise en charge des traumatismes aigus communs qui affectent les tissus mous du genou. Notre objectif etait d'explorer les habitudes de pratique des urgentologues, des medecins du sport et des chirurgiens orthopedistes quant au recours a l'immobilisation pour la prise en charge initiale de ces blessures. Methodes: Nous avons concu un sondage Web et l'avons fait parvenir a tous les urgentologues, medecins du sport et chirurgiens orthopedistes d'un centre urbain canadien. Le sondage visait a evaluer la probabilite que l'immobilisation soit prescrite et a degager les facteurs associes a ce type de decision chez les praticiens de ces 3 disciplines. Resultats: Le taux de reponse global a ete de 44 sur 112 (39 %): 17 urgentologues sur 58 (29 %), 7 medecins du sport sur 15 (47 %) et 20 chirurgiens orthopedistes sur 39 (51 %). Dans les cas oU l'on soupconnait une blessure du menisque, 9 urgentologues (50 %) ont indique qu'ils prescriraient l'immobilisation, contre aucun medecin du sport et 1 (5 %) chirurgien orthopediste (p = 0,002). Dans les cas oU l'on soupconnait une blessure du ligament croise anterieur, 13 urgentologues (77 %), 2 medecins du sport (29 %) et 5 chirurgiens orthopedistes (25 %) ont affirme qu'ils immobiliseraient (p = 0,005). Dans les cas de blessure au ligament collateral lateral, 9 urgentologues (53 %), aucun medecin du sport et 6 chirurgiens orthopedistes (32 %) immobiliseraient (p = 0,04). Tous les repondants ont dit prescrire l'immobilisation pour un genou manifestement instable. Conclusion: Nous avons constate que les urgentologues etaient plus susceptibles de prescrire l'immobilisation pour certains traumatismes aigus affectant les tissus mous du genou comparativement aux medecins du sport et aux chirurgiens orthopedistes. La formulation de lignes directrices factuelles sur le recours a l'immobilisation du genou apres un traumatisme aigu des tissus mous pourrait reduire la variabilite des pratiques., Injury to the knee is a common cause of disability after sports-related injuries, yet they are often managed in a single visit with a physician. (1) Accurate recognition and appropriate [...]

Background: Radiographic evaluation has a prominent place in the follow-up of long-term results of uncemented total hip arthroplasty (THA). The most prominent scale reported in studies is the Engh Grading Scale, but there is a lack of literature on the reliability of the scale. Methods: We evaluated intra- and interrater reliability of the Engh Grading System for uncemented THA using 26 follow-up radiographs of patients who had primary uncemented THAs. Four evaluators with different skill levels and specialties participated: 2 arthroplasty surgeons, an orthopedic resident and a radiologist. Reliability was measured using a weighted k coefficient for paired comparisons among the evaluators. Results: Intrarater reliability was dependent on the skill and specialty of the evaluator, with the highest values achieved for the arthroplasty surgeons ([kappa] = 0.52 and [kappa] = 0.68) and the lowest values for the radiologist ([kappa] = 0.14). Interrater reliability was comparable among participants, regardless of skill or specialty, and rated a moderate level of reliability ([kappa] = 0.29-0.41) for all pairings. Conclusion: The Engh Grading Scale appears to be reliable when used by a single, experienced arthroplasty surgeon. Caution must be exercised when multiple raters are used, regardless of experience, as the interrater reliability achieved lower ratings. Contexte : L'evaluation radiographique joue un role de premier plan dans le suivi des resultats a long terme de l'arthroplastie totale de la hanche (ATH) non cimentee. L'echelle d'evaluation de Engh (score de Engh) est la plus importante signalee dans les etudes, mais peu de publications en ont evalue la fiabilite. Methodes : Nous avons evalue la fiabilite intra-evaluateur et inter-evaluateurs du score de Engh dans le cas de l'ATH non cimentee en utilisant 26 radiographies de suivi de patients qui avaient subi une ATH primitive non cimentee. Quatre evaluateurs de divers degres de competence et de specialites differentes ont participe : 2 chirurgiens en arthroplastie, 1 medecin resident en orthopedie et 1 radiologiste. On a mesure la fiabilite au moyen d'un coefficient k pondere pour des comparaisons appariees entre les evaluateurs. Resultats : La fiabilite intra-evaluateur a varie en fonction des competences et de la specialite de l'evaluateur. Les chirurgiens en arthroplastie ont obtenu les valeurs les plus elevees ([kappa] = 0,52 et [kappa] = 0,68) et les radiologistes, les moins elevees ([kappa] = 0,14). La fiabilite inter-evaluateurs etait comparable entre les participants, sans egard au degre de competence ou a la specialite, et toutes les paires ont conclu a une fiabilite moderee ([kappa] = 0,29-0,41). Conclusion : Le score de Engh semble fiable lorsqu'il est utilise par 1 seul chirurgien en arthroplastie chevronne. Il faut faire preuve de prudence dans le cas de multiples evaluateurs, sans egard a l'experience, car la fiabilite inter-evaluateurs a ete plus basse., As the population ages, the absolute number of adults older than 65 years increases, and people are living longer. Furthermore, the annual numbers of total hip arthroplasties (THAs) have been [...]

Introduction: Infection after total hip replacement (THR) adversely affects patients' function and health-related quality of life (HRQL). A prosthesis with antibiotic-loaded acrylic cement (PROSTALAC) was designed to improve the function [...]

Introduction: Infection after total hip replacement (THR) is a serious medical complication with significant negative ramifications for both the patient and the health care system. The prosthesis of antibiotic-loaded acrylic [...]

Compares the preliminary rate and amount of bony ingrowth and calcar resorption between patients receiving either a standard anatomical medullary locking (AML) or a tricalcium phosphate (TCP)-coated AML femoral prosthesis. Comparison of preliminary clinical results; Interventions; Objective of TCP-coating.

Describes a method of reducing the costs of implants in hip and knee arthroplasty. What catapulted the restructuring of the health care system in Alberta, Canada; Initiatives attempted to reduce costs; Other cost-cutting initiatives included in the restructuring.