10 results on '"Carr, Andrew"'
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2. The Role of Global Data Sets for Riverine Flood Risk Management at National Scales.
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Bernhofen, Mark V., Cooper, Sarah, Trigg, Mark, Mdee, Anna, Carr, Andrew, Bhave, Ajay, Solano‐Correa, Yady Tatiana, Pencue‐Fierro, Edgar Leonairo, Teferi, Ermias, Haile, Alemseged Tamiru, Yusop, Zulkifli, Alias, Nor Eliza, Sa'adi, Zulfaqar, Bin Ramzan, Muhamad Anwar, Dhanya, C. T., and Shukla, Prabhakar
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FLOOD risk ,FLOOD warning systems ,EMERGENCY management - Abstract
Over the last two decades, several data sets have been developed to assess flood risk at the global scale. In recent years, some of these data sets have become detailed enough to be informative at national scales. The use of these data sets nationally could have enormous benefits in areas lacking existing flood risk information and allow better flood management decisions and disaster response. In this study, we evaluate the usefulness of global data for assessing flood risk in five countries: Colombia, England, Ethiopia, India, and Malaysia. National flood risk assessments are carried out for each of the five countries using six data sets of global flood hazard, seven data sets of global population, and three different methods for calculating vulnerability. We also conduct interviews with key water experts in each country to explore what capacity there is to use these global data sets nationally. We find that the data sets differ substantially at the national level, and this is reflected in the national flood risk estimates. While some global data sets could be of significant value for national flood risk management, others are either not detailed enough, or too outdated to be relevant at this scale. For the relevant global data sets to be used most effectively for national flood risk management, a country needs a functioning, institutional framework with capability to support their use and implementation. Plain Language Summary: To adequately manage flood risk, it is important to understand where flood risk is greatest. This is done by carrying out a flood risk assessment, which combines flood hazard maps with data for exposure (who or what is flooded) and vulnerability (how affected exposure is by flooding). At the national level, flood risk assessments have typically been limited to countries with the necessary data and expertise to develop such assessments. In recent years, several flood risk data sets have been developed with global coverage, which means national flood risk can now be assessed in any country. We investigate how useful global data sets are for assessing national flood risk in five countries: Colombia, England, Ethiopia, India, and Malaysia. We find that there is significant disagreement between national flood risk estimates, suggesting not all global data sets are up to the task. Beyond that, we show that the usefulness of global flood risk data for national flood risk management is also determined by the national context in which they would be used. Key Points: Sixteen different global data sets are used to calculate national flood risk in Colombia, England, Ethiopia, India, and MalaysiaFlood risk estimates differ substantially at the national level and some data sets are not appropriate for use at the national scaleThe capability of regional and local governance in interpreting and using global data is addressed [ABSTRACT FROM AUTHOR]
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- 2022
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3. A method for rapid assessment of bat richness using woodland structure characteristics.
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Carr, Andrew, Weatherall, Andrew, Zeale, Matt R.K., Rachwald, Alek, and Jones, Gareth
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FORESTS & forestry ,FOREST surveys ,TEMPERATE forests ,NUMBERS of species ,BATS ,FOREST biodiversity - Abstract
• Woodland structural characteristics predict bat richness. • Influence of structure differs between bat guilds. • Clutter and stems per hectare are suitable predictors. • We propose a rapid method to assess woodland suitability for bats. 1. To conserve and restore forests we need greater and more efficient assessment of their biodiversity. Integrating species monitoring into woodland inventories provides opportunities to develop more targeted and sustainable management plans; however, such monitoring often requires specialist knowledge of species and survey techniques and can be prohibitively costly to undertake. Where such surveys are not a legal requirement, proxy-based biodiversity assessments can provide a rapid and cost-effective method for estimating species assemblages. We propose a method to assess the value of temperate woodland for bats based on measures of woodland structural characteristics that can be readily obtained during routine woodland inventories. 2. We sampled seven woodland characteristics together with bat richness (number of species) in 52 native broadleaved woodlands in England and Wales. We used generalized additive modelling to find the most parsimonious model that also explained the largest amount of variance in bat species richness. 3. The best model included the amount of understory vegetation (clutter) and number of stems per hectare. These woodland characteristics are informative for predicting the presence of several guilds of bats as they relate to a bats' ability to orientate and fly within a woodland. Our findings indicate that where clutter and stems per hectare are especially low or high, bat richness is markedly reduced. 4. Using woodland characteristics enables practitioners to estimate bat richness at the local level where direct species sampling is not possible or as a tool to target future species surveys. Structural characteristics can be captured during forest inventories without the need for specific taxonomic expertise. Following additional ground-truthing the proposed method could be expanded to cover a broader range of habitats and fauna with general application. [ABSTRACT FROM AUTHOR]
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- 2023
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4. PARot--assessing platelet-rich plasma plus arthroscopic subacromial decompression in the treatment of rotator cuff tendinopathy: study protocol for a randomized controlled trial.
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Carr, Andrew, Cooper, Cushla, Murphy, Richard, Watkins, Bridget, Wheway, Kim, Rombach, Ines, and Beard, David
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PLATELET-rich plasma , *RANDOMIZED controlled trials , *SURGICAL decompression , *TENDINITIS treatment , *ARTHROPLASTY , *JOINT surgery , *THERAPEUTICS , *SHOULDER joint surgery , *ROTATOR cuff surgery , *EXPERIMENTAL design , *TENDINOPATHY , *WOUND healing , *RESEARCH , *SHOULDER joint , *ARTHROSCOPY , *TIME , *RESEARCH methodology , *EVALUATION research , *MEDICAL cooperation , *TREATMENT effectiveness , *MEDICAL protocols , *COMPARATIVE studies , *COMBINED modality therapy , *ROTATOR cuff - Abstract
Background: Platelet-rich plasma (PRP) is an autologous platelet concentrate. It is prepared by separating the platelet fraction of whole blood from patients and mixing it with an agent to activate the platelets. In a clinical setting, PRP may be reapplied to the patient to improve and hasten the healing of tissue. The therapeutic effect is based on the presence of growth factors stored in the platelets. Current evidence in orthopedics shows that PRP applications can be used to accelerate bone and soft tissue regeneration following tendon injuries and arthroplasty. Outcomes include decreased inflammation, reduced blood loss and post-treatment pain relief. Recent shoulder research indicates there is poor vascularization present in the area around tendinopathies and this possibly prevents full healing capacity post surgery (Am J Sports Med36(6):1171-1178, 2008). Although it is becoming popular in other areas of orthopedics there is little evidence regarding the use of PRP for shoulder pathologies. The application of PRP may help to revascularize the area and consequently promote tendon healing. Such evidence highlights an opportunity to explore the efficacy of PRP use during arthroscopic shoulder surgery for rotator cuff pathologies.Methods/design: PARot is a single center, blinded superiority-type randomized controlled trial assessing the clinical outcomes of PRP applications in patients who undergo shoulder surgery for rotator cuff disease. Patients will be randomized to one of the following treatment groups: arthroscopic subacromial decompression surgery or arthroscopic subacromial decompression surgery with application of PRP.Trial Registration: Current Controlled Trials: ISRCTN10464365. [ABSTRACT FROM AUTHOR]- Published
- 2013
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5. Predictors of outcomes of total knee replacement surgery.
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Judge, Andy, Arden, Nigel K., Cooper, Cyrus, Kassim Javaid, M., Carr, Andrew J., Field, Richard E., and Dieppe, Paul A.
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ANALYSIS of covariance ,CHI-squared test ,DECISION making ,EPIDEMIOLOGY ,FISHER exact test ,LONGITUDINAL method ,OSTEOARTHRITIS ,HEALTH outcome assessment ,PATIENT satisfaction ,RHEUMATOID arthritis ,STATISTICS ,T-test (Statistics) ,TOTAL knee replacement ,LOGISTIC regression analysis ,TREATMENT effectiveness ,RECEIVER operating characteristic curves ,DATA analysis software ,DESCRIPTIVE statistics - Abstract
Objective. To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery.Methods. The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee Score (OKS). To classify whether patients had a clinically important outcome, we calculated a patient acceptable symptom state (PASS) for the 6-month OKS related to satisfaction with surgery. Potential predictor variables were pre-operative OKS, age, sex, BMI, deprivation, surgical side, diagnosis, operation type, American Society of Anesthesiologists grade and EQ5D anxiety/depression. Regression modelling was used to identify predictors of outcome.Results. The strongest determinants of outcome include pre-operative pain/function—those with less severe pre-operative disease obtain the best outcomes; diagnosis in relation to pain outcome—patients with RA did better than those with OA; deprivation—those living in poorer areas had worse outcomes; and anxiety/depression—worse pre-operative anxiety/depression led to worse pain. Differences were observed between predictors of pain and functional outcomes. Diagnosis of RA and anxiety/depression were associated with pain, whereas age and gender were specifically associated with function. BMI was not a clinically important predictor of outcome.Conclusion. This study identified clinically important predictors of attained pain/function post-TKR. Predictors of pain were not necessarily the same as functional outcomes, which may be important in the context of a patient’s expectations of surgery. Other predictive factors need to be identified to improve our ability to recognize patients at risk of poor TKR outcomes. [ABSTRACT FROM PUBLISHER]
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- 2012
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6. Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics.
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Kendal, Adrian R., Prieto-Alhambra, Daniel, Arden, Nigel K., Carr, Andrew, and Judge, Andrew
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CONFIDENCE intervals ,TOTAL hip replacement ,PROPORTIONAL hazards models ,RETROSPECTIVE studies ,DESCRIPTIVE statistics ,KAPLAN-Meier estimator - Abstract
The article compares the 10-year mortality rates between patients undergoing metal-on-metal (MoM) hip resurfacing and those undergoing total hip replacement in England. It cites reports of soft tissue complications, release of systemic metal ions, and early failure rates with the use of MoM hip resurfacings. It showed a survival advantage for patients undergoing MoM hip resurfacing compared with total hip replacement. Statistics on mortality rates for both procedures are also presented.
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- 2013
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7. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial.
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Beard, David J., Rees, Jonathan L., Cook, Jonathan A., Rombach, Ines, Cooper, Cushla, Merritt, Naomi, Shirkey, Beverly A., Donovan, Jenny L., Gwilym, Stephen, Savulescu, Julian, Moser, Jane, Gray, Alastair, Jepson, Marcus, Tracey, Irene, Judge, Andrew, Wartolowska, Karolina, Carr, Andrew J., and CSAW Study Group
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SHOULDER pain treatment , *PLACEBOS , *BONE spurs , *ARTHROSCOPY , *SURGICAL decompression , *ACROMION , *COMPARATIVE studies , *EXERCISE therapy , *RESEARCH methodology , *MEDICAL cooperation , *METAPLASTIC ossification , *RESEARCH , *RESEARCH funding , *SHOULDER pain , *EVALUATION research , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *DISEASE complications , *WOUNDS & injuries - Abstract
Background: Arthroscopic sub-acromial decompression (decompressing the sub-acromial space by removing bone spurs and soft tissue arthroscopically) is a common surgery for subacromial shoulder pain, but its effectiveness is uncertain. We did a study to assess its effectiveness and to investigate the mechanism for surgical decompression.Methods: We did a multicentre, randomised, pragmatic, parallel group, placebo-controlled, three-group trial at 32 hospitals in the UK with 51 surgeons. Participants were patients who had subacromial pain for at least 3 months with intact rotator cuff tendons, were eligible for arthroscopic surgery, and had previously completed a non-operative management programme that included exercise therapy and at least one steroid injection. Exclusion criteria included a full-thickness torn rotator cuff. We randomly assigned participants (1:1:1) to arthroscopic subacromial decompression, investigational arthroscopy only, or no treatment (attendance of one reassessment appointment with a specialist shoulder clinician 3 months after study entry, but no intervention). Arthroscopy only was a placebo as the essential surgical element (bone and soft tissue removal) was omitted. We did the randomisation with a computer-generated minimisation system. In the surgical intervention groups, patients were not told which type of surgery they were receiving (to ensure masking). Patients were followed up at 6 months and 1 year after randomisation; surgeons coordinated their waiting lists to schedule surgeries as close as possible to randomisation. The primary outcome was the Oxford Shoulder Score (0 [worst] to 48 [best]) at 6 months, analysed by intention to treat. The sample size calculation was based upon a target difference of 4·5 points (SD 9·0). This trial has been registered at ClinicalTrials.gov, number NCT01623011.Findings: Between Sept 14, 2012, and June 16, 2015, we randomly assigned 313 patients to treatment groups (106 to decompression surgery, 103 to arthroscopy only, and 104 to no treatment). 24 [23%], 43 [42%], and 12 [12%] of the decompression, arthroscopy only, and no treatment groups, respectively, did not receive their assigned treatment by 6 months. At 6 months, data for the Oxford Shoulder Score were available for 90 patients assigned to decompression, 94 to arthroscopy, and 90 to no treatment. Mean Oxford Shoulder Score did not differ between the two surgical groups at 6 months (decompression mean 32·7 points [SD 11·6] vs arthroscopy mean 34·2 points [9·2]; mean difference -1·3 points (95% CI -3·9 to 1·3, p=0·3141). Both surgical groups showed a small benefit over no treatment (mean 29·4 points [SD 11·9], mean difference vs decompression 2·8 points [95% CI 0·5-5·2], p=0·0186; mean difference vs arthroscopy 4·2 [1·8-6·6], p=0·0014) but these differences were not clinically important. There were six study-related complications that were all frozen shoulders (in two patients in each group).Interpretation: Surgical groups had better outcomes for shoulder pain and function compared with no treatment but this difference was not clinically important. Additionally, surgical decompression appeared to offer no extra benefit over arthroscopy only. The difference between the surgical groups and no treatment might be the result of, for instance, a placebo effect or postoperative physiotherapy. The findings question the value of this operation for these indications, and this should be communicated to patients during the shared treatment decision-making process.Funding: Arthritis Research UK, the National Institute for Health Research Biomedical Research Centre, and the Royal College of Surgeons (England). [ABSTRACT FROM AUTHOR]- Published
- 2018
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8. Geographical Variation in Outcomes of Primary Hip and Knee Replacement.
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Garriga C, Leal J, Sánchez-Santos MT, Arden N, Price A, Prieto-Alhambra D, Carr A, Rangan A, Cooper C, Peat G, Fitzpatrick R, Barker K, and Judge A
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- Aged, England, Female, Humans, Male, Patient Reported Outcome Measures, Registries, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Geographic Information Systems, Outcome Assessment, Health Care
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Importance: Little is known about variation in outcomes of surgery or about the factors associated with such variation., Objectives: To evaluate variation in patient outcomes and costs for primary hip and knee replacement across health areas in England and to identify whether patient, surgical, or hospital factors are associated with such variation., Design, Setting, and Participants: This cohort study used data from the National Joint Registry, linked to English Hospital Episode Statistics and Patient Reported Outcome Measures data sets, for 383 382 adult patients who underwent primary total hip replacement (THR) or primary total and unicompartmental knee replacement (TKR) surgical procedures from January 2014 to December 2016. Geographical Information Systems were used to display maps describing adjusted estimates of variation in outcomes across health areas. Data analysis took place from January 2018 to August 2019., Exposures: Patient characteristics (eg, age, sex, body mass index [BMI], and socioeconomic deprivation), surgical factors (eg, surgeon volume and grade), and hospital organizational factors (eg, number of operating theaters, number of specialist consultants, and hospital volume)., Main Outcomes and Measures: Length of stay (LOS), bed-day costs, change in Oxford hip or knee scores 6 months after surgery, and complications 6 months after surgery., Results: A total of 173 107 patients (mean [SD] age, 69.3 [10.7] years; mean [SD] BMI, 28.9 [5.2]) underwent primary THR and 210 275 patients (mean [SD] age 69.7 [9.4] years; mean [SD] BMI, 31.1 [5.5]) underwent primary TKR, nested in 207 health areas. A number of factors were associated with longer LOS, higher bed-day costs, smaller changes in Oxford hip or knee scores, and a higher percentage of complications, including a workforce with a higher number of less experienced physicians (eg, LOS for less experienced surgeons, THR: regression coefficient, 0.02; 95% CI, 0.01 to 0.03; P < .001; TKR: regression coefficient, 0.01; 95% CI, 0.01 to 0.02; P < .001), public hospitals (eg, bed-day costs for private hospitals, THR: regression coefficient, -0.15; 95% CI, -0.15 to -0.14; P < .001; TKR: regression coefficient, -0.19; 95% CI, -0.19 to -0.19; P < .001), low volume of surgical procedures per surgeon (eg, change in Oxford hip or knee scores for lead surgeon with ≤10 vs >150 surgical procedures per year, THR: regression coefficient, -1.03; 95% CI, -1.47 to -0.58; P < .001; TKR: regression coefficient, -0.54; 95% CI, -1.01 to -0.06), and low volume of surgical procedures per hospital (eg, percentage of complications for hospitals with ≤200 vs ≥500 surgical procedures per year, THR: regression coefficient, 0.12; 95% CI, 0.04 to 0.21; P < .001; TKR: regression coefficient, 0.09; 95% CI, 0.01 to 0.18; P = .03). Although these factors did not attenuate the magnitude of variation across health areas, they had ecological correlations with the observed geographical variations in outcomes of surgery by health area. For example, the percentage of public and private hospitals was ecologically correlated at the health area level with longer and shorter stays, respectively (public hospital, THR: ρ, 0.41; public hospital, TKR: ρ, 0.44; private hospital, THR: ρ, -0.37; private hospital, THR: ρ, -0.38). Across health areas, estimated mean length of stay ranged from 3 to 7 days, and associated bed-day costs ranged from £4727 ($5827) to £8800 ($10 848) for both total hip and knee replacement. The absolute estimated mean change in Oxford hip score varied from 18.7 to 24.6 points and, for Oxford knee score, from 13.1 to 18.8. Estimated 6-month complications ranged from 2.9% to 5.8% for both THR and TKR., Conclusions and Relevance: In this study, models indicated that higher surgical volume by surgeon and by hospital as well as private hospitals were associated with better patient outcomes, which could be explained by the changing case mix of public hospitals treating an increasing number of more complex patients. A higher proportion of less experienced physicians was associated with poorer outcomes. This variation was observed geographically.
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- 2019
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9. Long-term rates of knee arthroplasty in a cohort of 834 393 patients with a history of arthroscopic partial meniscectomy.
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Abram SGF, Judge A, Beard DJ, Carr AJ, and Price AJ
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- Adult, Age Factors, Aged, Disease Progression, England epidemiology, Female, Follow-Up Studies, Humans, Knee Joint surgery, Male, Middle Aged, Osteoarthritis, Knee etiology, Osteoarthritis, Knee surgery, Retrospective Studies, Risk, Risk Factors, Sex Factors, Tibial Meniscus Injuries complications, Tibial Meniscus Injuries surgery, Arthroplasty, Replacement, Knee statistics & numerical data, Osteoarthritis, Knee epidemiology, Tibial Meniscus Injuries epidemiology
- Abstract
Aims: The aim of this study was to determine the long-term risk of undergoing knee arthroplasty in a cohort of patients with meniscal tears who had undergone arthroscopic partial meniscectomy (APM)., Patients and Methods: A retrospective national cohort of patients with a history of isolated APM was identified over a 20-year period. Patients with prior surgery to the same knee were excluded. The primary outcome was knee arthroplasty. Hazard ratios (HRs) were adjusted by patient age, sex, year of APM, Charlson comorbidity index, regional deprivation, rurality, and ethnicity. Risk of arthroplasty in the index knee was compared with the patient's contralateral knee (with vs without a history of APM). A total of 834 393 patients were included (mean age 50 years; 37% female)., Results: Of those with at least 15 years of follow-up, 13.49% (16 256/120 493; 95% confidence interval (CI) 13.30 to 13.69) underwent subsequent arthroplasty within this time. In women, 22.07% (95% CI 21.64 to 22.51) underwent arthroplasty within 15 years compared with 9.91% of men (95% CI 9.71 to 10.12), corresponding to a risk ratio (RR) of 2.23 (95% CI 2.16 to 2.29). Relative to the general population, patients with a history of APM were over ten times more likely (RR 10.27; 95% CI 10.07 to 10.47) to undergo arthroplasty rising to almost 40 times more likely (RR 39.62; 95% CI 27.68 to 56.70) at a younger age (30 to 39 years). In patients with a history of APM in only one knee, the risk of arthroplasty in that knee was greatly elevated in comparison with the contralateral knee (no APM; HR 2.99; 95% CI 2.95 to 3.02)., Conclusion: Patients developing a meniscal tear undergoing APM are at greater risk of knee arthroplasty than the general population. This risk is three-times greater in the patient's affected knee than in the contralateral knee. Women in the cohort were at double the risk of progressing to knee arthroplasty compared with men. These important new reference data will inform shared decision making and enhance approaches to treatment, prevention, and clinical surveillance. Cite this article: Bone Joint J 2019;101-B:1071-1080.
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- 2019
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10. Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics.
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Kendal AR, Prieto-Alhambra D, Arden NK, Carr A, and Judge A
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- Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip methods, Cause of Death, England epidemiology, Female, Hospitals, Public statistics & numerical data, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Osteoarthritis, Hip mortality, Prosthesis Design, Regression Analysis, Retrospective Studies, Arthroplasty, Replacement, Hip mortality, Hip Joint surgery, Metal-on-Metal Joint Prostheses statistics & numerical data, Osteoarthritis, Hip surgery
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Objectives: To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England., Design: Retrospective cohort study., Setting: English hospital episode statistics database linked to mortality records from the Office for National Statistics., Population: All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation., Main Outcome Measures: All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts., Results: 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22,311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24,303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex., Conclusions: Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in the long term compared with those undergoing cemented or uncemented total hip replacement. This difference persisted after extensive adjustment for confounding factors available in our data. The study results can be applied to matched populations, which exclude patients who are very old and have had complex total hip replacements. Although residual confounding is possible, the observed effect size is large. These findings require validation in external cohorts and randomised clinical trials.
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- 2013
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