RESUMEN
SUMMARY: The objective was measure quadricep strength after Total Hip Arthroplasty (THA) and kinetic treatment and then determine its impact on the functional recovery of patients with hip osteoarthritis. A total of 79 (25 were male and 54 were female) patients with THA. Exclusion criteria were previous extra-system kinetic treatment, operated on for hip fracture, not completing the treatment. Maximum Isometric Strength (MIS), Time Up and Go (TUG), Modified Harris Hip Score. There was a significant increase in the MIS of the post-treatment operated knee extension in both men and women (p < 0.0001 SE = 0.43; p < 0.0001 SE = 1.22, respectively). In the TUG, the execution time was significantly lower post-treatment in both men and women (p < 0.0001 SE = 0.77; p < 0.0001 SE = 0.94, respectively). The final Harris score increased significantly post-treatment in male and female (p < 0.0001 SE = 2.90; p < 0.0001 SE = 1.96, respectively). the association between MIS and the Harris score, it was noted that, for a 1 kg increase in this measure compared to the initial assessment, the Harris score, after 12 weeks of treatment, increased by 0.179 points (β = 0.179; p = 0.050). The conclusions were Indicate an increase in knee extension MIS of the operated hip after treatment in both sexes. At the same time, functionality increased post-treatment in both male and female.
El objetivo del estudio fue medir la fuerza del músculo cuádriceps femoral después de la artroplastia total de cadera (THA, por sus siglas en inglés) y el tratamiento kinésico, para determinar su impacto en la recuperación funcional de pacientes con osteoartritis de cadera. En el estudio participaron 79 pacientes con THA (25 hombres y 54 mujeres). Se excluyeron quienes tuvieron tratamiento Kinésico previo fuera del hospital, operación por fractura de cadera y no completar el tratamiento. Las principales medidas tomadas fueron: Fuerza Máxima Isométrica (MIS), Time UP and GO (TUG), Puntuación Modificada de Harris de Cadera. Hubo un aumento significativo en la MIS de la extensión de rodilla del lado operado después del tratamiento tanto en hombres (p<0,0001, EE=0,43) como en mujeres (p<0,0001, EE=1,22). En el TUG, el tiempo de ejecución fue significativamente menor después del tratamiento en hombres (p<0,0001, EE=0,77) y mujeres (p<0,0001, EE=0,94). La puntuación final de Harris aumentó significativamente después del tratamiento en hombres (p<0,0001, EE=2,90) y mujeres (p<0,0001, EE=1,96). En cuanto a la asociación entre MIS y la puntuación de Harris, se observó que por cada aumento de 1 kg en esta medida en comparación con la evaluación inicial, la puntuación de Harris aumentó en 0,179 puntos después de 12 semanas de tratamiento (β=0,179; p=0,050). En conclusión se observó un aumento en la MIS de la extensión de rodilla del lado operado después del tratamiento en ambos sexos. Al mismo tiempo, la funcionalidad aumentó después del tratamiento tanto en hombres como en mujeres.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Modalidades de Fisioterapia , Artroplastia de Reemplazo de Cadera/rehabilitación , Músculo Cuádriceps/fisiología , Modelos Logísticos , Estudios Retrospectivos , Fuerza Muscular , Contracción IsométricaRESUMEN
BACKGROUND: Total hip arthroplasty (THA) is a surgical procedure that can alter physical function and quality of life. OBJECTIVES: The aim was to verify the effects of aquatic exercises compared with exercises on land, control or other modalities, in patients undergoing THA on the primary outcomes: self-reported physical function, quality of life and pain; and secondary outcomes: muscle strength, functional capacity and gait. DESIGN: Systematic review that followed the PRISMA Statement and PROSPERO registered. The search was performed in the following databases: Web of Science, Embase, Medline, Cinahl, Lilacs, SPORTDiscus, Cochrane Library, Scopus, SciELO, and PEDro, from 1945 to 2022. The risk of bias assessment was performed using the Risk of Bias 2 (RoB2) from the Cochrane Collaboration. RESULTS: Three randomized controlled trials (RCTs) were included, with a total of 364 participants. In the selection process, two publications from the same study were found. The RoB2 assessment classified one RCT as "high risk of bias" and the others as "low risk of bias". Therefore, the analysis of the results considered only studies with a low risk of bias. For the self-reported physical function outcome, evaluated by WOMAC, improvement was observed in favor of aquatic exercises, when started on the 14th postoperative day. Pain improved after 24th week postoperative, in favor of exercise (effect size between 0.2 and 0.4). Quality of life, verified only by one RCT, improved at each time point evaluated (effect size between 0.01 and 0.10). The functional capacity showed no difference between the groups. This was the first systematic review to assess the benefits of aquatic exercises specifically in THA and it was possible to infer that the exercises initiated after 14 days of postoperative are safer. The protocol should include proprioceptive, coordination, and resistance exercises. The session can last around 30 min and is held three times a week. CONCLUSION: Decision making for treatment in the postoperative of THA may include aquatic exercises as a safe and efficacious alternative to improve self-reported physical function, pain, quality of life, and muscle resistance.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Humanos , Artroplastia de Reemplazo de Cadera/rehabilitación , Terapia por Ejercicio/métodos , Ejercicio Físico , Calidad de Vida , Dolor/etiologíaRESUMEN
Abstract Objective Evaluate the results of the implementation of the Fast Track Protocol (FTP), a medical practice based on scientific evidence, for elective total hip arthroplasty surgery, mainly comparing the National Average Hospital Admission Rate of 7.1 days. Methods 98 patients who underwent elective total hip arthroplasty surgery via the direct anterior approach, anterolateral approach and posterior approach were included in the FTP from December 2018 to March 2020, being followed up preoperatively, intraoperatively and immediately postoperatively. Results The average length of hospital stay was 2.8 days, being 2.1 days for the direct anterior approach, 3.0 days for the anterolateral access approach and 4.1 days for the posterior access approach. The average surgery time was 90 minutes, 19 (19.39%) of the patients were referred to the ICU in the postoperative period, however, none of them underwent surgery using the direct anterior approach. We had no cases of deep vein thrombosis (DVT), pulmonary embolism (PTE) or neurological injury, 19 (19.39%) patients had postoperative bleeding requiring dressing change, 4 (4.08%) needed blood transfusion, 2 (2.04%) patients had implant instability, 1 (1.02%) patient had a fracture during surgery and 1 (1.02%) patient died of cardiac complications. Conclusion FTP may be a viable alternative to reduce the length of stay and immediate postoperative complications for elective total hip arthroplasty surgery decreasing the length of stay of patients by 2 to 3 times when compared to the national average of 7.1 days.
Resumo Objetivo Avaliar os resultados da implantação do Protocolo de Recuperação Rápida (PRR), prática médica baseada em evidências científicas, para cirurgia eletiva de artroplastia total do quadril principalmente comparando à Taxa Média de Internação Hospitalar nacional de 7.1 dias. Métodos 98 pacientes submetidos a cirurgia eletiva de artroplastia total do quadril pela via direta anterior, via anterolateral e via posterior foram incluídos no PRR no período de dezembro de 2018 a março de 2020 sendo acompanhados no pré-operatório, intraoperatório e pós-operatório imediato. Resultados a Taxa Média de Permanência Hospitalar foi de 2,8 dias, sendo 2,1 dias para a Via de Acesso Anterior, 3,0 dias para via de acesso anterolateral e 4,1 dias para via de acesso posterior. O tempo médio de cirurgia foi de 90 minutos, 19 (19,39%) dos pacientes foram encaminhados à UTI no pós-operatório, no entanto nenhum deles operado pela via direta anterior. Não tivemos casos de trombose venosa profunda (TVP), embolia pulmonar (TEP) ou lesão neurológica, 19 (19,39%) pacientes tiveram sangramento pós-operatório com necessidade de troca de curativo, 4 (4,08%) necessidade de transfusão sanguínea, 2 (2,04%) pacientes apresentaram instabilidade do implante, 1(1,02%) paciente teve fratura durante a cirurgia e 1(1,02%) paciente faleceu por complicações cardíacas. Conclusão O PRR pode ser uma alternativa viável para diminuir o tempo de internação e as complicações pós-operatórias imediatas para a cirurgia eletiva de artroplastia total do quadril diminuindo 2 a 3 vezes o tempo de internação dos pacientes quando comparado com a média nacional de 7,1 dias.
Asunto(s)
Humanos , Masculino , Femenino , Brasil , Protocolos Clínicos , Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Hospitales PúblicosRESUMEN
The objective of this scoping review is to characterize the current panorama of inertia sensors for the rehabilitation of hip arthroplasty. In this context, the most widely used sensors are IMUs, which combine accelerometers and gyroscopes to measure acceleration and angular velocity in three axes. We found that data collected by the IMU sensors are used to analyze and detect any deviation from the normal to measure the position and movement of the hip joint. The main functions of inertial sensors are to measure various aspects of training, such as speed, acceleration, and body orientation. The reviewers extracted the most relevant articles published between 2010 and 2023 in the ACM Digital Library, PubMed, ScienceDirect, Scopus, and Web of Science. In this scoping review, the PRISMA-ScR checklist was used, and a Cohen's kappa coefficient of 0.4866 was applied, implying moderate agreement between reviewers; 23 primary studies were extracted from a total of 681. In the future, it will be an excellent challenge for experts in inertial sensors with medical applications to provide access codes for other researchers, which will be one of the most critical trends in the advancement of applications of portable inertial sensors for biomechanics.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Aceleración , Artroplastia de Reemplazo de Cadera/rehabilitación , Fenómenos Biomecánicos , Articulación de la Cadera , Movimiento , HumanosRESUMEN
Abstract Objective Due to the popularity of 3D technology, surgeons can create specific surgical guides and sterilize them in their institutions. The aim of the present study is to compare the efficacy of the autoclave and ethylene oxide (EO) sterilization methods for objects produced by 3D printing with polylactic acid (PLA) material. Methods Forty cubic-shaped objects were printed with PLA material. Twenty were solid and 20 were hollow (printed with little internal filling). Twenty objects (10 solid and 10 hollow) were sterilized in autoclave, forming Group 1. The others (10 solid and 10 hollow) were sterilized in EO, composing Group 2. After sterilization, they were stored and referred to culture. Hollow objects of both groups were broken during sowing, communicating the dead space with the culture medium. The results obtained were statistically analyzed (Fisher exact test and residue analysis). Results In group 1 (autoclave), there was bacterial growth in 50% of solid objects and in 30% of hollow objects. In group 2 (EO), growth occurred in 20% of hollow objects, with no bacterial growth in solid objects (100% of negative samples). The bacteria isolated in the positive cases was non-coagulase-producing Staphylococcus Gram positive. Conclusions Sterilization by both autoclave and EO was not effective for hollow printed objects. Solid objects sterilized by autoclave did not demonstrate 100% of negative samples and were not safe in the present assay. Complete absence of contamination occurred only with solid objects sterilized by EO, which is the combination recommended by the authors.
Resumo Objetivo Devido à popularidade da tecnologia 3D, cirurgiões podem criar guias cirúrgicos específicos e esterilizá-los nas suas instituições. O objetivo do presente estudo é comparar a eficácia dos métodos de esterilização por autoclave e óxido de etileno (OE) de objetos produzidos pela impressão 3D com material ácido polilático (PLA, na sigla em inglês). Métodos Quarenta objetos em formato cúbico foram impressos com material de PLA. Vinte eram sólidos e 20 eram ocos (impressos com pouco enchimento interno). Vinte objetos (10 sólidos e 10 ocos) foram esterilizados em autoclave, formando o Grupo 1. Os demais (10 sólidos e 10 ocos) foram esterilizados em OE, compondo o Grupo 2. Após a esterilização, os objetos foram armazenados e encaminhados para cultura. Objetos ocos de ambos os grupos foram quebrados durante a semeadura, comunicando o espaço morto com o meio de cultura. Os resultados obtidos foram analisados estatisticamente (teste exato de Fisher e análise de resíduo). Resultados No grupo 1 (autoclave) houve crescimento bacteriano em 50% dos objetos sólidos e em 30% dos objetos ocos. No grupo 2 (OE) o crescimento ocorreu em 20% dos objetos ocos, com ausência de crescimento bacteriano nos objetos sólidos (100% de amostras negativas). A bactéria isolada nos casos positivos foi Staphylococcus Gram positivo não produtor de coagulase. Conclusões A esterilização tanto em autoclave quanto pelo OE não foi eficaz para objetos impressos no formato oco. Objetos sólidos esterilizados em autoclave não demonstraram 100% de amostras negativas, não sendo seguro no presente ensaio. Ausência completa de contaminação ocorreu apenas com objetos sólidos esterilizados pelo OE, sendo a combinação recomendada pelos autores.
Asunto(s)
Humanos , Artroplastia de Reemplazo de Cadera/rehabilitación , Analgesia , Inyecciones IntraarticularesRESUMEN
Los pacientes candidatos a artroplastía total de cadera con protrusio acetabular asociada generan distintos desafíos en los equipos quirúrgicos. Múltiples estrategias han sido utilizadas a lo largo de los años para optimizar los resultados. Mediante una revisión de la evidencia actualizada disponible, proponemos diez tácticas a realizar en el manejo de estos pacientes que pueden mejorar y hacer predecible el tratamiento de un paciente con protrusio acetabular al que se le realiza una artroplastía total de cadera. Nivel de Evidencia V.
Patients with acetabular protrusio and osteoarthritis are a challenge for the surgical team. Many strategies have been developed to anticipate, plan and optimize the surgical results of these patients. Based on the current available clinical evidence, we propose ten tips to improve the surgical management of hip arthroplasty patients with protrusio acetabuli. Level of Evidence V.
Asunto(s)
Humanos , Masculino , Femenino , Artroplastia de Reemplazo de Cadera/métodos , Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/rehabilitación , Lesiones de la Cadera/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagenRESUMEN
BACKGROUND: Recovery of physical activity (PA) after telerehabilitation following knee and hip arthroplasty (TKA-THA) has rarely been studied. An improved understanding of PA recovery is needed, as it could be influenced by many factors such as age, gender or pre-operative physical function. OBJECTIVES: To assess PA recovery weekly for 3 months after TKA-THA and to determine perioperative factors that could help predict PA recovery at 3 months. METHODS: From one week before until 3 months after surgery, 132 patients wore a fitness tracker continuously. Each patient received personalized and daily exercises and feedback through a tablet. Before and after surgery, patient-reported outcome measures of symptoms, pain, activities of daily living and quality of life were recorded. A one-way repeated-measure ANOVA was used to assess the time effect on step count for each post-operative week. To predict the absolute step count at 3 months post-surgery, a backward multiple linear regression was used. RESULTS: Patients reached their pre-operative PA level at week 7, with no significant additional improvement by 3 months post-surgery. Pre-operative step count, the number of days using crutches and pre-operative symptoms explained 35% of the variability of step count at 3 months. CONCLUSION: This patient population receiving telerehabilitation reached their pre-operative PA level at 7-week post-surgery with no further improvement over the subsequent 5 weeks. The PA level at 3 months could be predicted by pre-operative step count, duration of crutches use, and pre-operative symptoms.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla/fisiopatología , Actividades Cotidianas , Artroplastia de Reemplazo de Cadera/rehabilitación , Estudios de Cohortes , Ejercicio Físico , Humanos , Articulación de la Rodilla/fisiopatología , Estudios Longitudinales , Medición de Resultados Informados por el Paciente , Calidad de VidaRESUMEN
OBJECTIVES: compare an accelerated physiotherapeutic protocol to a conventional physiotherapeutic protocol in total hip arthroplasty patients. METHODS: a randomized double blinded clinical trial performed from August 2013 to November 2014. Forty-eight patients diagnosed with hip osteoarthritis submitted to a total hip arthroplasty surgery. An accelerated rehabilitation physiotherapy applied three times a day and start gait training on the first day or standard physiotherapy applied once a day and start gait training on the second or third day of hospitalization. The Merle dAubigné and Postel score (mobility, pain and gait), muscle strength force, range of motion, in hospital stay and time to start of gait training, were the outcomes. RESULTS: the mean age was 64.46 years (10.37 years standard deviation). No differences were observed in age in different genders, and the two randomization groups were homogeneous. In hospital stay was lower in the intervention group compared to the control group, 3 (3-4) days [median (interquartile range)] versus 4 (4-5) days. Time to the start of gait training was early in the intervention group compared to the control group, 1 (1-1) days versus 2 (2-2) days. Higher muscle strength values were observed in the postoperative results in the intervention group compared to the control group for internal rotation, external rotation and abduction. CONCLUSIONS: an accelerated physiotherapeutic protocol should be encouraged, because it shows favourable results in gait, muscle strength and length of hospital stay, even upon hospital discharge.
Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Marcha , Osteoartritis de la Cadera/cirugía , Cuidados Posoperatorios/métodos , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular , Modalidades de Fisioterapia , Rango del Movimiento Articular , Recuperación de la Función , Resultado del TratamientoRESUMEN
INTRODUCTION: Medicare Advantage (MA) has increased popularity among eligible participants by providing additional benefits from a private insurer, but these plans are omitted from several government cost savings programs, including bundled payment models. The purpose of this study was to determine whether 90-day episode-of-care (EOC) costs and outcomes were different for patients with MA plans undergoing total joint arthroplasty compared with traditional Medicare patients. METHODS: We reviewed claims data for a consecutive series of patients undergoing primary total hip and knee arthroplasty from 2015 to 2018 at our institution with traditional Medicare coverage or MA through a single private insurer. Demographics, comorbidities, 90-day costs, readmissions, complications, and discharge disposition were compared between the groups. A multivariate regression analysis was performed to determine the independent effect of insurance status on EOC costs and outcomes. RESULTS: Of the 10,869 patients in the study, 1,076 (9.9%) were covered under an MA plan. MA patients were more likely to be discharged to a rehabilitation facility (19% versus 14%, P < 0.0001). No significant differences were observed in length of stay (1.88 versus 1.88 days, P = 0.1439), complications (3.9% versus 3.5%, P = 0.4554), or readmissions (5.9% versus 4.9%, P = 0.1893). EOC costs were significantly higher for the MA group ($21,347 versus $19,551, P < 0.0001). DISCUSSION: Patients with MA have higher total EOC costs than traditional Medicare beneficiaries with comparable short-term outcomes after total hip and knee arthroplasty. Further study is needed to determine whether alternative payment models in MA patients can improve care and reduce costs.
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Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Rodilla/economía , Ahorro de Costo , Beneficios del Seguro/economía , Medicare Part C/economía , Medicare/economía , Anciano , Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Femenino , Humanos , Tiempo de Internación , Masculino , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
ABSTRACT Objectives: compare an accelerated physiotherapeutic protocol to a conventional physiotherapeutic protocol in total hip arthroplasty patients. Methods: a randomized double blinded clinical trial performed from August 2013 to November 2014. Forty-eight patients diagnosed with hip osteoarthritis submitted to a total hip arthroplasty surgery. An accelerated rehabilitation physiotherapy applied three times a day and start gait training on the first day or standard physiotherapy applied once a day and start gait training on the second or third day of hospitalization. The Merle dAubigné and Postel score (mobility, pain and gait), muscle strength force, range of motion, in hospital stay and time to start of gait training, were the outcomes. Results: the mean age was 64.46 years (10.37 years standard deviation). No differences were observed in age in different genders, and the two randomization groups were homogeneous. In hospital stay was lower in the intervention group compared to the control group, 3 (3-4) days [median (interquartile range)] versus 4 (4-5) days. Time to the start of gait training was early in the intervention group compared to the control group, 1 (1-1) days versus 2 (2-2) days. Higher muscle strength values were observed in the postoperative results in the intervention group compared to the control group for internal rotation, external rotation and abduction. Conclusions: an accelerated physiotherapeutic protocol should be encouraged, because it shows favourable results in gait, muscle strength and length of hospital stay, even upon hospital discharge.
RESUMO Objetivos: comparar um protocolo fisioterapêutico acelerado com um protocolo fisioterapêutico convencional em pacientes submetidos a artroplastia total do quadril. Métodos: ensaio clínico randomizado, duplo-cego, realizado de agosto/2013 a novembro/2014. Quarenta e oito pacientes diagnosticados com coxartrose submetidos a cirurgia de artroplastia total do quadril. Fisioterapia de reabilitação acelerada aplicada três vezes ao dia com início de marcha no primeiro dia ou fisioterapia convencional aplicada uma vez ao dia e início de marcha no segundo ou terceiro dia de hospitalização. Os escores de Merle dAubigné e Postel (mobilidade, dor e marcha), força muscular, amplitude de movimento, internação hospitalar e tempo para o início de marcha foram os desfechos. Resultados: a idade média foi 64,46 anos (desvio padrão 10,37 anos). Não foram observadas diferenças na idade nos diferentes sexos, e os grupos de randomização foram homogêneos. O tempo de internação hospitalar foi menor no grupo intervenção em comparação ao grupo controle, 3 (3-4) dias [mediana (intervalo interquartil)] versus 4 (4-5) dias. O tempo para início da marcha foi precoce no grupo de intervenção em comparação ao grupo controle, 1 (1-1) dias versus 2 (2-2) dias. Maiores valores de força muscular foram observados nos resultados pós-operatórios no grupo intervenção em comparação ao grupo controle para rotação interna, rotação externa e abdução. Conclusões: um protocolo fisioterapêutico acelerado deve ser incentivado, pois apresenta resultados favoráveis na marcha, força muscular e tempo de internação, mesmo após a alta hospitalar.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Cuidados Posoperatorios/métodos , Osteoartritis de la Cadera/cirugía , Artroplastia de Reemplazo de Cadera/rehabilitación , Marcha , Método Doble Ciego , Rango del Movimiento Articular , Modalidades de Fisioterapia , Resultado del Tratamiento , Recuperación de la Función , Fuerza Muscular , Persona de Mediana EdadRESUMEN
BACKGROUND: Multiple papers have purported the superiority of spinal anesthesia used in total joint arthroplasty (TJA). However, there is a paucity of data available for modern general anesthesia (GA) regimens used at high-volume joint replacement centers. METHODS: We retrospectively reviewed a series of 1527 consecutive primary TJAs (644 total hip arthroplasties and 883 total knee arthroplasties) performed over a 3-year span at a single institution that uses a contemporary GA protocol and report on the length of stay, early recovery rates, perioperative complications, and readmissions. RESULTS: From the elective TJAs performed using a modern GA protocol, 96.3% (n = 1471) of patients discharged on postoperative day 1, and 97.2% (n = 1482) of subjects were able to participate with physical therapy on the day of surgery. Only 6 patients (0.4%) required an intensive care unit stay postoperatively. The 90-day readmission rate over this time was 2.4% (n = 36), while the reoperation rate was 1.3% (n = 20). DISCUSSION: Neuraxial anesthesia for TJA is commonly preferred in high-volume institutions utilizing contemporary enhanced recovery pathways. Our data support the notion that the utilization of modern GA techniques that limit narcotics and certain inhalants can be successfully used in short-stay primary total joint arthroplasty. LEVEL OF EVIDENCE: IV- Case series.
Asunto(s)
Anestesia General/efectos adversos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Anciano , Anestesia General/métodos , Arkansas/epidemiología , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/rehabilitación , Procedimientos Quirúrgicos Electivos , Recuperación Mejorada Después de la Cirugía , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: Recent data suggested that unsupervised, self-directed physical therapy (SDPT) is both safe and efficacious for patients undergoing total hip arthroplasty (THA) and that formal outpatient physical therapy (OPPT) may not be routinely required. The purpose of this study was to evaluate the routine use of an SDPT program in a nonselect patient population. METHODS: This is a multi-surgeon, single-institution, retrospective study of 941 consecutive patients discharged home, from January 2016 to December 2016, after primary, unilateral THA and enrolled in a web-based SDPT program. Patients were seen 4 weeks after surgery and OPPT was prescribed for perceived need, patient request, or if unable to use the web-based program. Patient-reported outcomes, medical comorbidities, and assessment of home environment were prospectively recorded. RESULTS: Overall, 646 of 941 patients (68.7%) were not prescribed OPPT (SDPT-only group) while 295 of 941 patients (31.3%) were prescribed OPPT (SDPT + OPPT group). In the SDPT + OPPT group, 88.2% were for perceived need, 10.8% for patient request, and 1.0% due to inability to use the web-based platform. Multivariate analysis identified male sex (odds ratio, 0.64; 0.45-0.90; P = .012) and a higher preoperative Short Form-12 physical component (odds ratio, 0.98; 0.96-0.99; P = .036) as independent variables protective against requiring OPPT. At a minimum 6-month follow-up, the SDPT-only group had statistically higher hip disability and osteoarthritis outcome score junior compared to the SDPT + OPPT cohort (85.0 vs 80.9; P = .012). CONCLUSION: Web-based SDPT is safe and effective for most, but not all, patients eligible for home discharge after THA. It is critical to preserve OPPT services for the one-third of patients who require them. LEVEL OF EVIDENCE: Level III.
Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Modalidades de Fisioterapia/estadística & datos numéricos , Autocuidado/estadística & datos numéricos , Anciano , Comorbilidad , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Alta del Paciente , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUÇÃO: A Artoplastia de Quadril (AQ) é um procedimento cirúrgico realizado em casos de fratura de colo do fêmur (FF) e osteoartrose de quadril (OQ), e é responsável por causar danos funcionais aumentando o nível de dependência funcional do idivíduo idoso. OBJETIVO: analisar o nível de dependênciaonentre idosos que foram submetidos a AQ. MÉTODOS: indivíduos idosos internados na enfermaria traumato-ortopédica do Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA) foram avaliados quanto ao seu nível de dependência funcional através da Medida de Independência Funcional (MIF) e quanto ao nível de dor por meio da Escala Visual Analógica (EVA), tanto no pré quanto no pós-operatório de AQ. Os voluntários foram divididos em grupo A, com diagnóstico de (OQ), e grupo B, com diagnóstico de (FF). O teste t não pareado foi utilizado para comparar os resultados no pré e pós-operatório, adotando-se nível de significância p<0,05. RESULTADOS: um total de 46 idosos compuseram a amostra, 17 (37%) do sexo masculino e 29 (63%) do sexo feminino. O grupo A apresentou menor nível de dependência funcional no pré-operatório em comparação aos sujeitos do grupo B, porém, a avaliação da dor revelou índices maiores para o grupo A no pré-operatório. A análise comparativa dos resultados da EVA no pré e pós-operatório se mostrou estatisticamente significante para ambos os grupos. Os resultados da MIF para o grupo A não foram estatisticamente significantes, para o grupo B, porém, os domínios autocuidados, mobilidade, locomoção e total apresentaram valores estatisticamente significantes. CONCLUSÃO: O grupo A apresentou maiores médias na EVA no pré-operatório e menor nível de dependência funcional pela MIF em comparação ao grupo B, este apresentou as maiores médias de idade e maior presença de co-morbidades. [AU]
INTRODUCTION: Hip Arthroplasty (HA) is a surgical procedure performed in cases of femoral neck fracture (FF) and hip osteoarthrosis (HO), and is responsible for causing functional damage by increasing the level of functional dependence of the elderly individual. OBJECTIVE: analyze the level of functional dependence among elderly patients who underwent AQ. METHODS: elderly subjects hospitalized at the trauma-orthopedic ward of the University Hospital of the Federal University of Maranhão (HU-UFMA) were evaluated for their level of functional dependence through the Functional Independence Measure (FIM) and the level of pain through Visual Analogue Scale (VAS), both in the pre and postoperative periods. The volunteers were divided into group A, with diagnosis of hip osteoarthrosis, and group B, with diagnosis of femoral neck fracture. The unpaired t test was used to compare the results in the pre and postoperative period, adopting a significance level of p <0.05. RESULTS: A total of 46 elderly individuals comprised the sample, 17 (37%) males and 29 (63%) females, group A presented a lower level of functional dependence in the preoperative period compared to the subjects in group B, however, the evaluation of pain revealed larger indices for group A in the preoperative period. The comparative analysis of the VAS results in the pre and postoperative periods was statistically significant for both groups. The FIM results for group A were not statistically significant for group B, but the self-care domains, mobility, locomotion and total domains presented statistically significant values. CONCLUSION: Group A had higher mean values in the preoperative VAS and lower level of functional dependence for the FIM compared to group B, which had the highest mean age and greater presence of comorbidities. [AU]
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Actividades Cotidianas , Artroplastia de Reemplazo de Cadera , Periodo Posoperatorio , Autocuidado , Dimensión del Dolor , Osteoartritis de la Cadera/cirugía , Estudios Transversales , Cognición , Comunicación , Artroplastia de Reemplazo de Cadera/rehabilitación , Limitación de la Movilidad , Fracturas del Cuello Femoral/cirugía , LocomociónRESUMEN
O controle na formação do biofilme em implantes e próteses ortopédicas continua sendo um dos grandes desafios acerca da infeção relacionada aos dispositivos na área da saúde. O objetivo desta pesquisa foi investigar biomateriais com aplicabilidade na ortopedia, visando os avanços e enfrentamentos dos desafios na área da infectologia. Uma revisão integrativa foi realizada a respeito da formação de biofilme em biomateriais de próteses de quadril com a finalidade de contribuir com as medidas de prevenção e controle aos agravos infecciosos. Além disso, a formação in vitro do biofilme em função dos biomateriais (titânio e titânio revestido com biovidro F18), microrganismos (Staphylococcus epidermidis e Candida albicans) e tempos de incubação (2, 4 e 8 horas) foi avaliada por microscopia de fluorescência. A revisão integrativa foi realizada no portal PubMed da National Library of Medicine, bem como nas bases Cochrane, Embase, Web of Science, CINAHL e LILACS com a inclusão de estudos primários sobre a temática, publicados online até novembro de 2017, em português, inglês e espanhol. Na fase experimental / laboratorial, biofilmes de S. epidermidis (ATCC 12228) e C. albicans (ATCC 90028) foram formados em corpos de prova de titânio e titânio revestido com biovidro F18 após 2, 4 e 8 horas de incubação a 37?C sob agitação orbital. As áreas das imagens dos corpos de prova, em porcentagem, recobertas com biofilme (células vivas) foram avaliadas por microscopia de fluorescência. Os dados coletados foram submetidos à análise estatística empregando-se os testes de normalidade Shapiro Wilk, U de Mann-Whitney e t de Student por meio do software IBM SPSS Statistics (versão 25) e nível de significância ?=5%. Na revisão integrativa, os resultados demonstraram que dos 16 estudos primários, 81,25% eram pesquisas experimentais in vitro e que novos biomateriais foram desenvolvidos para prevenir a formação de biofilme. Com relação à fase experimental / laboratorial, houve menor formação de biofilme por S. epidermidis e C. albicans (p<0,001) no titânio revestido com biovidro F18 do que no titânio, após 8 horas de incubação. Entretanto, houve maior formação de biofilme por S. epidermidis e C. albicans após 8 horas do que em 2 horas de incubação, tanto no titânio quanto no titânio revestido com biovidro F18 (p<0,05). Em suma, a revista da literatura mencionou o desenvolvimento de biomateriais novos para prevenir a formação de biofilme. Na fase laboratorial / experimental, o titânio revestido com biovidro F18 apresentou atividade antibiofilme em comparação com o titânio, e os tempos de incubação de 2 para 8 horas aumentaram a formação de biofilme em ambos os biomateriais. Ainda, pesquisas futuras acerca do biovidro F18 fundamentadas nos aspectos físicoquímicos, bioquímicos e microbiológicos são importantes para a elucidação dos mecanismos de ação relacionados ao controle dos biofilmes
The control of biofilm formation on implants and orthopedic prostheses still is one of the major challenges concerning infection related to devices in the health field. The objective of this research was to investigate biomaterials with applicability in orthopedics, aiming for advances and facing challenges in the infectology area. An integrative review was performed regarding biofilm formation on hip prosthesis biomaterials in order to contribute to the preventive and infection control measures. Moreover, the in vitro biofilm formation according to biomaterials (titanium and titanium coated with F18 bioglass), microorganisms (Staphylococcus epidermidis and Candida albicans) and incubation times (2, 4 and 8 hours) was evaluated by fluorescence microscopy. The integrative review was performed on PubMed portal from National Library of Medicine as well as on Cochrane, Embase, Web of Science, CINAHL and LILACS databases with the inclusion of primary studies about the topic, published online up until November 2017, in Portuguese, English and Spanish. In the experimental / laboratory step, S. epidermidis (ATCC 12228) and C. albicans (ATCC 90028) biofilms were formed on proof bodies of titanium and titanium coated with F18 bioglass after 2, 4 and 8 hours of incubation at 37?C under orbital shaking. The image areas of proof bodies, in percentage, coated with biofilm (living cells) were evaluated by fluorescence microscopy. The data collected were submitted to statistical analysis using normality tests Shapiro Wilk, U from Mann-Whitney and t from Student through IBM SPSS Statistics (version 25) software and significance level ?=5%. In the integrative review, the results showed that among 16 primary studies, 81.25% were in vitro experimental studies and that new biomaterials were developed to prevent biofilm formation. Regarding experimental / laboratory step, there was less biofilm formation by S. epidermidis and C. albicans (p<0.001) on titanium coated with F18 bioglass than on titanium, after 8 hours of incubation. However, there was more biofilm formation by S. epidermidis and C. albicans after 8 hours than in 2 hours of incubation, both on titanium and on titanium coated with F18 bioglass (p<0.05). In sum, the literature review mentioned the development of new biomaterials to prevent biofilm formation. In laboratory / experimental step, titanium coated with F18 bioglass presented antibiofilm activity in comparison with titanium, and the incubation times of 2 to 8 hours increased biofilm formation on both materials. Besides, future studies about F18 bioglass based on physicochemical, biochemical and microbiological aspects are important for the elucidation of action mechanisms related to biofilms control
Asunto(s)
Humanos , Materiales Biocompatibles/uso terapéutico , Biopelículas , Artroplastia de Reemplazo de Cadera/rehabilitación , Prótesis de CaderaRESUMEN
Introdução: Artroplastia Total de Quadril é a substituição da articulação do quadril por prótese, sendo indicada para o tratamento de comprometimentos importantes na articulação coxofemoral. Objetivos: identificar as informações para o pós-operatório e reabilitação de idosos submetidos à Artroplastia Total de Quadril e apontar as dificuldades para implementá-las após a alta hospitalar. Metodologia: estudo observacional, transversal, de abordagem quantitativa. Os dados foram coletados com 159 participantes com idade igual ou superior a 60 anos, durante a primeira consulta pós-operatória, 14 a 21 dias após a alta, no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad, localizado no município do Rio de Janeiro. Realizada entre fevereiro de 2016 e fevereiro de 2017, através da aplicação de um checklist elaborado a partir de revisão integrativa de literatura. Foi realizada uma busca em bases de dados e foram encontrados 101 artigos que continham informações sobre a temática. Resultados: foi possível concluir que a faixa etária predominante em ambos os gêneros foi de 60 a 69 anos, 94 participantes são do gênero feminino, 63.29% são casados e 50.31% não possuem ensino fundamental. A maior frequência para a indicação de Artroplastia Total de Quadril é a coxartrose seguida de fratura de colo de fêmur. O maior período de tempo de cirurgia é compreendido entre 3 horas e 4 horas e 59 minutos, o tempo de internação pré-operatória para a maioria está entre 1 a 5 dias, e após a cirurgia é de 5 dias. A comorbidade de maior incidência é a hipertensão arterial sistêmica. Intercorrências e complicações: transfusão sanguínea, dor aguda, desorientação, sinais flogísticos em ferida operatória, dismetria, infecção em ferida operatória e hiperemia em região glútea. No check list foram analisadas as dificuldades em relação a locomoção com a andador e muletas: não adaptação, dificuldades para deambular, medo de queda, déficit no treinamento e incômodo ou dor nos braços. Uso de triângulo abdutor ou travesseiro: irritação na pele, incômodo para dormir e não adaptação. Sentar em local rígido e não se sentar em locais baixo: dores na coluna, a preferência por permanecerem sentados, dificuldades em elevar a altura do vaso sanitário, necessidade de elevação da altura da cama e uma parte dos participantes não se recordam desta informação. Curativo de ferida: o auxílio para a manutenção do curativo para a grande maioria dos participantes, o medo em participar do cuidado, a utilização somente de água e sabão de coco, e alguns não compreenderam as orientações. Retorno ao trabalho ou atividades: medo e insegurança. Não girar o corpo, não fazer rotação com o membro operado e não cruzar as pernas: dificuldades para dormir em posição dorsal ou ventral, dores na coluna devido posição e alguns se esqueceram, não compreendem ou não se recordam de terem recebido estas informações. Sinais de trombose venosa profunda: dificuldades em realizar os exercícios de prevenção e alguns não compreenderam esta informação durante o período de internação. Exercícios orientados pela Fisioterapia: dificuldades na realização ou dor limitante durante os exercícios, alguns se esqueceram da necessidade. Administração de medicamentos: dependência de auxílio da família para seguirem os horários e a medicação correta. Ressaltaram também que algumas orientações foram fornecidas somente aos acompanhantes e não direcionadas também aos pacientes. Retorno a unidade diante de qualquer complicação: dificuldades no transporte de urgência até a unidade e relataram também que não foram esclarecidas em quais circunstâncias eles deveriam retornar a unidade. Necessidade de adaptação da casa após a cirurgia: alterações de móveis, mudança de residência por presença de animais domésticos, difícil localização ou por residirem sozinhos, troca de pisos para antiderrapante, alteração na limpeza na residência, retirada de tapetes e colocação de barras de segurança no banheiro e alteração no vaso sanitário. Conclusão: as dificuldades apresentadas neste estudo devem ser valorizadas por toda a equipe assistencial interdisciplinar, para que assim a assistência ao paciente idosos submetido a Artroplastia Total de Quadril e o reforço das informações, sejam direcionados para as dificuldades relatadas pelos próprios pacientes. Mesmo tento sido acompanhado e devidamente informados, apresentam grandes limitações para a execução dos cuidados propostos para o domicílio, ou por não terem sido devidamente compreendidos, treinados ou adequados à sua realidade. E que a assistência ao paciente idoso submetido à cirurgia ortopédica seja da maior qualidade e segurança possível, reduzindo morbidade e mortalidade nesse grupo.
Introduction: Total Hip Arthroplasty is the replacement of the hip joint by prosthesis, being indicated for the treatment of important compromises in the hip joint. Objectives: To identify the information for the post- operative and rehabilitation of elderly patients submitted to Total Hip Arthroplasty and to point out the difficulties to implement them after hospital discharge. Methodology: observational, transversal study, with a quantitative approach. Data were collected with 159 participants aged 60 years or older, during the first postoperative visit, 14 to 21 days after discharge, at the Jamil Haddad National Institute of Traumatology and Orthopedics, located in the city of Rio de Janeiro. Held between February 2016 and February 2017, through the application of a checklist elaborated from an integrative literature review. A database search was carried out and 101 articles containing information on the subject were found. Results: it was possible to conclude that the predominant age group in both genders was from 60 to 69 years, 94 participants are female, 63.29% are married and 50.31% do not have elementary education. The highest frequency for the indication of Total Hip Arthroplasty is coxarthrosis followed by a femoral neck fracture. The longest surgery time is between 3 hours and 4 hours and 59 minutes, the preoperative time for most is between 1 to 5 days, and after surgery is 5 days. The most frequent comorbidity is systemic arterial hypertension. Intercurrences and complications: blood transfusion, acute pain, disorientation, phlogistic signs in operative wound, dysmetria, infection in operative wound and hyperemia in the gluteal region. In the checklist we analyzed the difficulties in relation to the locomotion with the walker and crutches: no adaptation, difficulties to walk, fear of falling, lack of training and discomfort or pain in the arms. Use of abductor triangle or pillow: irritation in the skin, uncomfortable to sleep and no adaptation. Sit in a hard place and do not sit in low places: pains in the spine, preference to remain seated, difficulties in raising the height of the toilet, need to raise the height of the bed and some of the participants do not remember this information. Beware of wound: the aid to maintain the dressing for the great majority of the participants, the fear of participating in the care, the use of only coconut soap and water, and some did not understand the guidelines. Return to work or activities: fear and insecurity. Do not rotate the body, do not rotate with the limb operated and do not cross the legs: difficulty sleeping in the back or ventral, pain in the spine due position and some have forgotten, do not understand or can not remember receiving this information. Signs of deep venous thrombosis: difficulties in performing the prevention exercises and some did not understand this information during the period of hospitalization. Physiotherapy-oriented exercises: difficulties in achieving or limiting pain during the exercises, some have forgotten the need. Medication administration: dependence on the family's help to follow the schedule and the correct medication. They also emphasized that some guidelines were given only to the companions and not directed also to the patients. Return to the unit in the face of any complication: difficulties in the transportation of urgency to the unit and also reported that they were not clarified under what circumstances they should return the unit. Need to adapt the house after surgery: changes of furniture, relocation due to the presence of domestic animals, difficult location or by residing alone, changing floors to anti-slip, alteration in cleaning at home, removal of carpets and placement of bars security in the bathroom and change in the toilet. Conclusion: The difficulties presented in this study should be valued by the entire interdisciplinary care team, so that the assistance to the elderly patient submitted to Total Hip Arthroplasty and the reinforcement of the information, are directed to the difficulties reported by the patients themselves. Even if I have been accompanied and properly informed, they present great limitations for the execution of the proposed care for the home, or because they were not properly understood, trained or adequate to their reality. And that assistance to the elderly patient submitted to orthopedic surgery is of the highest quality and possible safety, reducing morbidity and mortality in this group.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Complicaciones Posoperatorias , Salud del Anciano , Artroplastia de Reemplazo de Cadera/rehabilitación , Dolor Postoperatorio , Alta del Paciente , Calidad de Vida , Infección de la Herida Quirúrgica , Transfusión Sanguínea , Comorbilidad , Ataxia Cerebelosa , Estudios Transversales , Cuidadores , Trombosis de la Vena , HiperemiaRESUMEN
CONTEXT AND OBJECTIVES: Quality-of-life results have increasingly been evaluated among patients undergoing joint replacements. The objective of this study was to compare two assessment instruments for health-related quality of life (one generic and the other specific), among elderly patients undergoing total hip arthroplasty.DESIGN AND SETTING: Cross-sectional descriptive study in a reference hospital in the region of Campinas.METHODS: The subjects were 88 elderly outpatients aged 60 years or over who underwent primary total hip arthroplasty. Two instruments for assessing health-related quality of life were applied: the generic Medical Study 36-item Short-Form Health Survey (SF-36) and the specific Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Cronbach's alpha and the ceiling and floor effects of the instruments were evaluated.RESULTS: The scores from both instruments showed that issues of a physical nature affected these elderly people's quality of life most. The pain and stiffness dimensions of WOMAC showed ceiling effects and only the functional capacity and pain dimensions of the SF-36 did not show the ceiling effect. The SF-36 presented floor effects in the dimensions of physical and emotional aspects. Cronbach's alpha was considered satisfactory in both instruments (α > 0.70).CONCLUSIONS: The floor and ceiling effects that were observed suggest that these instruments may present some limitations in detecting changes to the majority of the SF-36 dimensions, except for functional capacity and pain, and to the pain and stiffness dimensions of WOMAC, when applied to elderly people with total hip arthroplasty.
CONTEXTO E OBJETIVO: Os resultados sobre a qualidade de vida têm sido cada vez mais avaliados em pacientes submetidos a substituições articulares. Este estudo objetivou comparar dois instrumentos de avaliação de qualidade de vida relacionada à saúde (um genérico e outro específico), em pacientes idosos submetidos a artroplastia total de quadril.TIPO DE ESTUDO E LOCAL: Estudo descritivo transversal em hospital de referência da região de Campinas.MÉTODOS: Os sujeitos foram 88 pacientes idosos ambulatoriais, com 60 anos ou mais, submetidos a artroplastia total de quadril primária. Foram aplicados dois instrumentos de avaliação de qualidade de vida relacionada à saúde: Medical Study 36-item Short-Form Health Survey (SF-36) (genérico) e Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (específico). O coeficiente alfa de Cronbach e os efeitos teto e chão dos instrumentos foram avaliados.RESULTADOS: Os escores de ambos os instrumentos mostraram que as questões de natureza física são as que mais afetam a qualidade de vida desses idosos. As dimensões dor e rigidez do WOMAC apresentaram efeito teto e apenas as dimensões capacidade funcional e dor do SF- 36 não mostraram o efeito teto. O SF-36 apresentou efeito de chão nas dimensões: aspectos físicos e aspectos emocionais. O coeficiente alfa de Cronbach foi considerado satisfatório nos dois instrumentos (α > 0.70).CONCLUSÕES: A constatação dos efeitos chão e teto sugere que esses instrumentos podem apresentar algumas limitações, quando aplicados em idosos com artroplastia total de quadril, para detectar alterações na maioria das dimensões do SF-36, exceto capacidade funcional e dor, e nas dimensões dor e rigidez do WOMAC.
Asunto(s)
Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Artroplastia de Reemplazo de Cadera/rehabilitación , Indicadores de Salud , Calidad de Vida/psicología , Encuestas y Cuestionarios/normas , Estudios Transversales , Articulación de la Cadera/fisiopatología , Dolor Postoperatorio/psicología , Satisfacción del PacienteRESUMEN
CONTEXT AND OBJECTIVES: Quality-of-life results have increasingly been evaluated among patients undergoing joint replacements. The objective of this study was to compare two assessment instruments for health-related quality of life (one generic and the other specific), among elderly patients undergoing total hip arthroplasty. DESIGN AND SETTING: Cross-sectional descriptive study in a reference hospital in the region of Campinas. METHODS: The subjects were 88 elderly outpatients aged 60 years or over who underwent primary total hip arthroplasty. Two instruments for assessing health-related quality of life were applied: the generic Medical Study 36-item Short-Form Health Survey (SF-36) and the specific Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Cronbach's alpha and the ceiling and floor effects of the instruments were evaluated. RESULTS: The scores from both instruments showed that issues of a physical nature affected these elderly people's quality of life most. The pain and stiffness dimensions of WOMAC showed ceiling effects and only the functional capacity and pain dimensions of the SF-36 did not show the ceiling effect. The SF-36 presented floor effects in the dimensions of physical and emotional aspects. Cronbach's alpha was considered satisfactory in both instruments (α > 0.70). CONCLUSIONS: The floor and ceiling effects that were observed suggest that these instruments may present some limitations in detecting changes to the majority of the SF-36 dimensions, except for functional capacity and pain, and to the pain and stiffness dimensions of WOMAC, when applied to elderly people with total hip arthroplasty.
Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Indicadores de Salud , Calidad de Vida/psicología , Encuestas y Cuestionarios/normas , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Articulación de la Cadera/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/psicología , Satisfacción del PacienteRESUMEN
BACKGROUND: Total hip arthroplasty (THA) is an increasingly common treatment for older patients with hip osteoarthritis. The best strategy for a physiotherapy intervention for older people after THA is not clear in the literature. The purpose of this protocol study is to test the feasibility of undertaking a full trial clinical to evaluate the effect of ergometer cycling-associated conventional exercises on functional results and health-related quality of life (HRQOL) of older patients with THA. METHODS/DESIGN: This study protocol is a prospective, single center, randomized controlled pilot clinical trial. Older patients (≥60 years) in the postoperative phase after primary unilateral THA for hip osteoarthritis will be consecutively recruited for this study and randomly allocated to 2 treatment groups. Group I will perform cycle ergometer and conventional exercises, and group II will perform only conventional exercises. The sessions will be conducted twice a week for 8 weeks. Assessments will be made at baseline (2 weeks postoperatively: the moment that the patients receive a referral for physical therapy, which will start after suture removal), after intervention (10 weeks postoperatively), and at 6 months of follow-up (24 weeks postoperatively). The primary outcomes are the function, evaluated using the Harris Hip Score (HHS) and the Short Physical Performance Battery (SPPB). The secondary outcome is HRQOL, measured using 2 evaluation instruments: the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data collectors will be blinded and will not have contact with participants during the interventions. DISCUSSION: This randomized controlled trial will provide evidence regarding the effect of this exercise therapy on physical function and quality of life in older patients after THA. If our hypothesis is correct, both interventions will be effective, but the exercises on the cycle ergometer conferring better results in function, physical performance and quality of life. The study follows Consolidated Standards of Reporting Trials (CONSORT) guidelines, and the approval of the local ethics committee has been obtained. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01622465 (14 June 2012).
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Artroplastia de Reemplazo de Cadera/rehabilitación , Terapia por Ejercicio/métodos , Anciano , Ciclismo , Protocolos Clínicos , Ergometría , Estudios de Factibilidad , Humanos , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Evaluación de Resultado en la Atención de Salud , Modalidades de Fisioterapia , Estudios Prospectivos , Calidad de Vida , Encuestas y CuestionariosRESUMEN
BACKGROUND: To address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries. One outcome of TJR of particular interest is physical activity (PA) since it is strongly linked to general health. This study evaluates the amount of postoperative participation in PA in low-income patients who received total joint replacement in the Dominican Republic and identifies preoperative predictors of postoperative PA level. METHODS: We used the Yale Physical Activity Survey (YPAS) to assess participation in postoperative PA 1-4 years following total knee or hip replacement. We compared the amount of aerobic PA reported by postoperative TJR patients with the levels of PA recommended by the CDC and WHO. We also analyzed preoperative determinants of postoperative participation in aerobic PA in bivariate and multivariate analyses. RESULTS: 64 patients out of 170 eligible subjects (52/128 TKR and 14/42 THR) who received TJR between 2009-2012 returned for an annual follow-up visit in 2013, with a mean treatment-to-follow-up time of 2.1 years. 43.3% of respondents met CDC/WHO criteria for sufficient participation in aerobic PA. Multivariate analyses including data from 56 individuals identified that patients who were both younger than 65 and at least two years postoperative had an adjusted mean activity dimensions summary index (ADSI) 22.9 points higher than patients who were 65 or older and one year postoperative. Patients who lived with friends or family had adjusted mean ADSI 17.2 points higher than patients living alone. Patients who had the most optimistic preoperative expectations of outcome had adjusted mean ADSI scores that were 19.8 points higher than those who were less optimistic. CONCLUSION: The TJR patients in the Dominican cohort participate in less PA than recommended by the CDC/WHO. Additionally, several associations were identified that potentially affect PA in this population; specifically, participants who are older than 65, recently postoperative, less optimistic about postoperative outcomes and who live alone participate in less PA.
Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Actividad Motora , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticipación Psicológica , Artroplastia de Reemplazo de Cadera/psicología , Artroplastia de Reemplazo de Rodilla/psicología , Evaluación de la Discapacidad , República Dominicana , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Pobreza , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. OBJECTIVE: To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. METHODS: A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. RESULTS: The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. CONCLUSIONS: There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.
antecedentes: la alta prevalencia de artrosis en los países occidentales, el elevado costo de las intervenciones de artroplastia de cadera y rodilla y las amplias variaciones en la práctica médica generan gran interés por comparar los costos asociados antes y después de la cirugía. Objetivo: conocer el costo de las intervenciones de reemplazo total de cadera y rodilla durante la estancia hospitalaria y al año de seguimiento posterior al alta. material y métodos: estudio multicéntrico y prospectivo efectuado en 15 hospitales de tres comunidades autónomas. La relación entre las variables independientes con el costo de la estancia y costo post-alta, se analizó con modelos multinivel y para agrupar los casos se utilizó la variable "hospital." Las variables independientes fueron: edad, sexo, índice de masa corporal, calidad de vida prequirúrgica (cuestionarios ED-5D, SF-12 y Womac), intervención (cadera-rodilla), índice Charlson, complicaciones, número de camas y dependencia económico-institucional del hospital, comunidad autó-noma y presencia de cuidador. Resultados: el costo promedio por paciente, sin incluir el costo de la prótesis, fue de 4,734 Euros ± 2,136 y el costo del seguimiento post alta de 554 Euros ± 509. Si se incluye el costo de la prótesis, al final del año el costo total asciende a 7,645 Euros ± 2,248. Conclusiones: existe un margen considerable en la reducción de los costos de estancia; más de 44% de la variabilidad observada no está determinada por las condiciones clínicas de los pacientes sino por el comportamiento de los centros hospitalarios.