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Background: Immigrants and refugees face unique challenges navigating the health care system to manage severe arthritis, because of unfamiliarity, lack of awareness of surgical options, or access. The purpose of this study was to assess total knee arthroplasty (TKA) uptake, surgical outcomes, and hospital utilization among immigrants and refugees compared with Canadian-born patients. Methods: We included all adults undergoing primary TKA from January 2011 to December 2020 in Ontario. Cohorts were defined as Canadian-born or immigrants and refugees. We assessed change in yearly TKA utilization for trend. We compared differences in 1-year revision, infection rates, 30-day venous thromboembolism (VTE), presentation to emergency department, and hospital readmission between matched Canadian-born and immigrant and refugee groups. Results: We included 158 031 TKA procedures. A total of 11 973 (7.6%) patients were in the immigrant and refugee group, and 146 058 (92.4%) patients were in the Canadian-born group. The proportion of TKAs in Ontario performed among immigrants and refugees nearly doubled over the 10-year study period (p < 0.001). After matching, immigrants were at relatively lower risk of 1-year revision (0.9% v. 1.6%, p < 0.001), infection (p < 0.001), death (p = 0.004), and surgical complications (p < 0.001). No differences were observed in rates of 30-day VTE or length of hospital stay. Immigrants were more likely to be discharged to rehabilitation (p < 0.001) and less likely to present to the emergency department (p < 0.001) than Canadian-born patients. Conclusion: Compared with Canadian-born patients, immigrants and refugees have favourable surgical outcomes and similar rates of resource utilization after TKA. We observed an underutilization of these procedures in Ontario relative to their proportion of the population. This may reflect differences in perceptions of chronic pain or barriers accessing arthroplasty. Contexte : Les personnes immigrantes et r fugi es la recherche de soins pour une arthrite grave sont confront es des difficult s particuli res lorsqu'elles veulent s'y retrouver dans les m andres du syst me de sant , cause d'une m connaissance du syst me et des options th rapeutiques ou de probl mes d'acc s. Cette tude avait pour but d' valuer le recours l'arthroplastie pour proth se totale du genou (PTG), les r sultats chirurgicaux et le recours aux ressources hospitali res chez les personnes immigrantes et r fugi es comparativement aux malades n s au Canada. M thodes : Nous avons inclus tous les adultes soumis une intervention pour PTG primaire de janvier 2011 d cembre 2020 en Ontario. Les cohortes taient n es au Canada ou immigrantes et r fugi es. Nous avons valu les changements annuels du recours la PTG pour d gager une tendance. Nous avons compar les diff rences de taux de r vision 1 an et d'infection, de thromboembolie veineuse (TEV) 30 jours, les consultations aux services d'urgence, et les r admissions entre les groupes de patients n s au Canada et immigrants et r fugi s. R sultats : Nous avons inclus 158 031 cas de PTG. En tout, 11 973 (7,6%) appartenaient au groupe de personnes immigrantes et r fugi es, et 146 058 (92,4%), au groupe n au Canada. La proportion de PTG effectu es chez des personnes immigrantes et r fugi es en Ontario a presque doubl au cours de la p riode de 10 ans tudi e (p < 0,001). Apr s appariement, les personnes immigrantes taient expos es un risque relativement moindre de r vision 1 an (0,9% c. 1,6%, p < 0,001), d'infection (p < 0,001), de mortalit (p = 0,004), et de complications chirurgicales (p < 0,001). On n'a observ aucune diff rence quant au taux de TEV 30 jours ou quant la dur e du s jour hospitalier. Les personnes immigrantes taient plus susceptibles de recevoir leur cong pour aller en centre de r adaptation (p < 0,001) et moins susceptibles de consulter dans un service d'urgence (p < 0,001) que les personnes n es au Canada. Conclusion : Comparativement aux personnes n es au Canada, les personnes immigrantes et r fugi es obtiennent de bons r sultats chirurgicaux et des taux similaires d'utilisation des ressources apr s leur PTG. Nous avons observ une sous-utilisation de ces interventions par rapport leur proportion dans la population. Cela pourrait t moigner des diff rences de perception de la douleur chronique ou des probl mes d'acc s l'arthroplastie., Total knee arthroplasty (TKA) is a successful procedure performed more than 75 000 times a year in Canada. (1) Whereas the outcomes of this procedure are well documented, there has [...]

Background: The belief that cannabis has analgesic and anti-inflammatory properties continues to attract patients with chronic musculoskeletal (MSK) pain towards its use. However, the role that cannabis will play in the management of chronic MSK pain remains to be determined. This study examined 1) the rate, patterns of use, and self-reported efficacy of cannabis use among patients with chronic MSK pain and 2) the interest and potential barriers to cannabis use among patients with chronic MSK pain not currently using cannabis. Methods: Self-reported cannabis use and perceived efficacy were prospectively collected from chronic MSK pain patients presenting to the Orthopaedic Clinic at the University Health Network, Toronto, Canada. The primary dependent variable was current or past use of cannabis to manage chronic MSK pain; bivariate and multivariable logistic regression were used to identify patient characteristics independently associated with this outcome. Secondary outcomes were summarized descriptively, including self-perceived efficacy among cannabis users, and interest as well as barriers to cannabis use among cannabis non-users. Results: The sample included 629 patients presenting with chronic MSK pain (mean age: 56±15.7 years; 56% female). Overall, 144 (23%) reported past or present cannabis use to manage their MSK pain, with 63.7% perceiving cannabis as very or somewhat effective and 26.6% considering it as slightly effective. The strongest predictor of cannabis use in this study population was a history of recreational cannabis use (OR 12.7, p<0.001). Among cannabis non-users (N=489), 65% expressed interest in using cannabis to manage their chronic MSK pain, but common barriers to use included lack of knowledge regarding access, use and evidence, and stigma. Conclusions: One in five patients presenting to an orthopaedic surgeon with chronic MSK pain are using or have used cannabis with the specific intent to manage their pain, and most report it to be effective. Among non-users, two-thirds reported an interest in using cannabis to manage their MSK pain, but common barriers to use existed. Future double-blind placebo-controlled trials are required to understand if this reported efficacy is accurate, and what role, if any, cannabis may play in the management of chronic MSK pain. [ABSTRACT FROM AUTHOR]

Introduction: Although differential outcomes based on sex are widespread in medicine and surgery, evaluation of sex-specific differences in the field of orthopaedic surgery in general – and arthroplasty in particular – are lacking. We hypothesised that morbidly obese male and female patients would have differing risks of surgical complications following primary total hip replacement. Methods: We reviewed data contained within the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database from 2015 through 2018, inclusive. A multivariable binary logistic regression model was used to determine the adjusted odds ratios (OR) of relevant variables on primary and secondary outcomes. Results: A total of 86,684 patients undergoing THR were identified, of whom 9972 patients (4095 male and 5877 female) were morbidly obese. Among morbidly obese patients, odds of surgical site infection were higher in females than males within 30 days of surgery (adjusted OR 1.40; 95% CI, 1.10–1.79; p = 0.007). This comprised the odds of both superficial infection (1.8% vs. 1.1%, adjusted OR 1.67; 95% CI, 1.16–2.40; p = 0.006) and deep infection (1.9% vs. 1.4%, adjusted OR 1.22; 95% CI, 0.88–1.68; p = 0.24). Unexpected return to the operating room (i.e., reoperation) within 30 days of the surgical procedure was also higher among females than males (4.2% vs. 3.1%, adjusted OR 1.38, 95% CI, 1.10–1.71, p = 0.005). There were no differences between male and female patients in the non-obese cohort. Conclusions: Among patients with morbid obesity, the risk of surgical site infection and reoperation within the first 30 days is greater in women as compared to men. Future research must address whether this early increased risk among morbidly obese women persists in the longer term, and whether it results in compromised function or quality of life. [ABSTRACT FROM AUTHOR]