Update on hip and knee arthroplasty: current state of evidence.
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Arthroplasty, Replacement, Hip↗
Biomedical subjects
Dina L Jones
Publications and source records attributed to Dina L Jones.
Helical computed tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the cervical spine after high-energy trauma.
BACKGROUND: Current literature supports the use of the three-view plain-radiograph series supplemented, when necessary, with helical computed tomography to evaluate the cervical spine in patients who have sustained trauma injury. The purpose of this study was to determine if helical computed tomography alone can be used to evaluate the cervical spine for acute osseous injury following high-energy trauma, thus eliminating the need to make radiographs. METHODS: Patients were prospectively evaluated with helical computed tomography scanning of the cervical spine and standard three-view plain radiography. At a later date, the plain radiographs and computed tomography scans were independently reviewed by two radiologists who were blinded to both the initial interpretation and the interpretation of the corresponding study. The radiologists documented whether the plain radiographs were adequate and whether they showed an acute process. The findings in the study were compared with the initial findings and, when necessary, with the discharge summaries to determine if an injury had been identified. The accuracy of the plain radiographs, of the plain radiographs that had been deemed adequate, and of helical computed tomography used alone was ascertained. RESULTS: Plain radiographs and helical computed tomography scans were made for 407 patients, and traumatic injuries were identified in fifty-eight of them. Plain radiographs alone were adequate for 194 (48%) of the 407 patients. Plain radiographs had a sensitivity of 45%, a specificity of 97%, a positive predictive value of 74%, and a negative predictive value of 91%. Adequate plain radiographs had a sensitivity of 52%, a specificity of 98%, a positive predictive value of 81%, and a negative predictive value of 93%. Helical computed tomography had a sensitivity and specificity of 98%, a positive predictive value of 89%, and a negative predictive value of >99%. The sensitivity, positive predictive value, and negative predictive value of adequate plain radiographs differed significantly from those of helical computed tomography alone (p < 0.001). Twelve (48%) of twenty-five adequate plain radiographs of patients in whom an injury had been identified on computed tomography missed that injury. Helical computed tomography alone missed one (2%) of the fifty-eight injuries. CONCLUSIONS: Although helical computed tomography has a limited ability to detect pure ligamentous injury, it can be safely used without plain radiographs to evaluate the cervical spine for osseous abnormalities such as fractures and dislocations after high-energy trauma.
Adolescent↗
Physical activity and risk of revision total knee arthroplasty in individuals with knee osteoarthritis: a matched case-control study.
OBJECTIVE: To determine if physical activity was a risk factor for revision arthroplasty after primary total knee arthroplasty (TKA) due to osteoarthritis (OA) within the previous 15 years. METHODS: This was a matched case-control study. The cases had primary TKA followed by revision arthroplasty. Controls had primary TKA and no revision arthroplasty. Cases and controls were matched for age, sex, number of knees replaced, and date of primary TKA. Standardized telephone interviews were conducted to assess historical leisure activity, occupational activity, and instrumental activities of daily living after primary TKA in metabolic equivalent (MET)-hours per week. Conditional logistic regression was performed to identify the variables that predicted the need for revision arthroplasty. RESULTS: Seventeen female and 9 male pairs, aged 47 to 85 years, participated. Most of the reported activity was of low impact and low or moderate intensity. Cases reported a median of 44.5 (range 0 to 137) MET-hours of total historical physical activity per week compared with controls' 55.1 (range 0 to 278) MET-hours. Total historical physical activity was not associated with the risk of revision arthroplasty (OR 0.99, 95% CI 0.99-1.01). Participants with primary TKA (controls) consistently reported more MET-hours of leisure and occupational activity than those with revision arthroplasty (cases) regardless of the number of knees replaced or whether or not walking was accounted for. CONCLUSION: This study quantified and described patterns of physical activity in a population with TKA. Physical activity did not appear to be a risk factor for revision arthroplasty. Our results suggest that individuals undergoing primary TKA should be encouraged to remain active after surgery.
Aged↗