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"Simpson, W. R."
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The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty
Purpose
The aim of this study was to identify the minimal clinically important difference (MCID) in the Oxford knee score (OKS) and Short Form (SF-) 12 score after total knee arthroplasty (TKA).
Methods
Prospective pre-operative and 1 year post-operative OKS and SF-12 scores for 505 patients undergoing a primary TKA for osteoarthritis were collected during a one-year period. Patient satisfaction with their (1) patient relief and (2) functional outcome was used as the anchor questions. Their response to each question was recorded using a 5-point Likert scale: excellent, very well, well, fair, and poor. Simple linear regression was used to calculate the MCID for improvement in the OKS and physical component of the SF-12 score according to the level of patient satisfaction with their pain relief and function.
Results
The OKS improved by 15.5 (95 % CI 14.7–16.4) points and the SF-12 physical component score improved by 10.1 (95 % CI 9.1–11.2) points for the study cohort. The level of patient satisfaction with their pain relief and function correlated with the improvement in the OKS (
r
= 0.56;
p
< 0.001, and
r
= 0.56;
p
< 0.001) and the physical component of the SF-12 score (
r
= 0.51;
p
< 0.001, and
r
= 0.60;
p
< 0.001), respectively. The MCID for the OKS was 5.0 (95 % CI 4.4–5.5) and 4.3 (95 % CI 3.8–4.8) points and for the physical component of the SF-12, it was 4.5 (95 % CI 3.9–5.2) and 4.8 (95 % CI 4.2–5.4) points for pain relief and function, respectively.
Conclusion
The MCID identified for the OKS and SF-12 physical component score after TKA is the best available estimate and can be used to power studies and ensure that a statistical difference is also recognised by a patient.
Level of evidence
Retrospective diagnostic study, Level III.
Journal Article
Patient-reported outcome metrics following total knee arthroplasty are influenced differently by patients’ body mass index
Purpose
This study investigated the impact of body mass index (BMI) on improvement in patient outcomes (pain, function, joint awareness, general health and satisfaction) following total knee arthroplasty (TKA).
Methods
Data were obtained for primary TKAs performed at a single centre over a 12-month period. Data were collected pre-operatively and 12-month postoperatively with the Oxford Knee Score (OKS) measuring pain and function, the EQ-5D-3L measuring general health status, the Forgotten Joint Score-12 (FJS-12) measuring joint awareness and a single question on treatment satisfaction. Change in scores following surgery was compared across the BMI categories identified by the World Health Organization (< 25.0, 25.0–29.9, 30.0–34.9, 35.0–39.9 and ≥ 40.0). Differences in postoperative improvement between the BMI groups were analysed with an overall Kruskal–Wallis test, with post hoc pairwise comparisons between BMI groups with Mann–Whitney tests.
Results
Of 402 patients [mean age 70.7 (SD 9.2); 55.2% women] 15.7% were normal weight (BMI < 25.0), 33.1% were overweight (BMI 25.0–29.9), 28.2% had class I obesity (BMI 30.0–34.9), 16.2% had class II obesity (BMI 35.0–39.9), and 7.0% had class III obesity (BMI ≥ 40.0). Postoperative change in OKS (n.s.) and EQ-5D-3L (n.s.) was not associated with BMI. Higher BMI group was associated with less improvement in FJS-12 scores (
p
= 0.010), reflecting a greater awareness of the operated joint during activity in the most obese patients. Treatment satisfaction was associated with BMI category (
p
= 0.029), with obese patients reporting less satisfaction.
Conclusions
In TKA patients, outcome parameters are influenced differently by BMI. Our study showed a negative impact of BMI on postoperative improvement in joint awareness and satisfaction scores, but there was no influence on pain, function or general health scores. This information may be useful in terms of setting expectations expectation in obese patients planning to undergo TKA.
Level of evidence
Level 1.
Journal Article
Implications for prediction and hazard assessment from the 2004 Parkfield earthquake
Obtaining high-quality measurements close to a large earthquake is not easy: one has to be in the right place at the right time with the right instruments. Such a convergence happened, for the first time, when the 28 September 2004 Parkfield, California, earthquake occurred on the San Andreas fault in the middle of a dense network of instruments designed to record it. The resulting data reveal aspects of the earthquake process never before seen. Here we show what these data, when combined with data from earlier Parkfield earthquakes, tell us about earthquake physics and earthquake prediction. The 2004 Parkfield earthquake, with its lack of obvious precursors, demonstrates that reliable short-term earthquake prediction still is not achievable. To reduce the societal impact of earthquakes now, we should focus on developing the next generation of models that can provide better predictions of the strength and location of damaging ground shaking.
Parkfield 2004: late verdict
About 20 years ago seismologists recognized the 40-km-long Parkfield section of the San Andreas fault as their best bet if they were to obtain high-quality measurements close to a large earthquake. A dense network of instruments was installed to monitor a region where at least six large earthquakes had occurred since 1857. The anticipated event did not occur by the predicted date of 1993, but monitoring continued and in September 2004 a magnitude 6.0 earthquake arrived. The data reveal aspects of the earthquake process never before seen, but no signs of obvious precursors to the 2004 Parkfield earthquake. So reliable short-term earthquake prediction seems still to be beyond reach, even in such a densely monitored area.
Journal Article
Local Arctic Air Pollution: A Neglected but Serious Problem
Air pollution in the Arctic caused by local emission sources is a challenge that is important but often overlooked. Local Arctic air pollution can be severe and significantly exceed air quality standards, impairing public health and affecting ecosystems. Specifically in the wintertime, pollution can accumulate under inversion layers. However, neither the contributing emission sources are well identified and quantified nor the relevant atmospheric mechanisms forming pollution are well understood. In the summer, boreal forest fires cause high levels of atmospheric pollution. Despite the often high exposure to air pollution, there are neither specific epidemiological nor toxicological health impact studies in the Arctic. Hence, effects on the local population are difficult to estimate at present. Socioeconomic development of the Arctic is already occurring and expected to be significant in the future. Arctic destination shipping is likely to increase with the development of natural resource extraction, and tourism might expand. Such development will not only lead to growth in the population living in the Arctic but will likely increase emission types and magnitudes. Present‐day inventories show a large spread in the amount and location of emissions representing a significant source of uncertainty in model predictions that often deviate significantly from observations. This is a challenge for modeling studies that aim to assess the impacts of within Arctic air pollution. Prognoses for the future are hence even more difficult, given the additional uncertainty of estimating emissions based on future Arctic economic development scenarios. Key Points Local Arctic air pollution is among the most severe world wide Arctic meteorological conditions exacerbate air pollution and create unique pollution formation mechanisms Future economic activities in the Arctic are expected to increase local air pollution
Journal Article
Patterns of Hamstring Muscle Tears in the General Population: A Systematic Review
Hamstring tears are well recognised in the sporting population. Little is known about these injuries in the general population.
Evaluating the rates, patterns and risk factors of non-sporting hamstring tears, compared to sporting related hamstring tears.
MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (1989-2015).
Studies reporting patients with a grade 2 or 3 hamstring muscle tear, identified clinically, confirmed by MRI imaging or direct visualisation during surgical exploration.
144 sets of linked data were extracted for analysis. Most injuries were in males (81.3%), where mean age at injury was lower (30.2, 95% CI 29.1-31.3) than in females (35.4, 95% CI 32.4-38.4) p = 0.06. Key differences were found in the proportion of non-sporting injuries in patients under and over the age 40 (p = 0.001). The proportion of non-sporting injuries was significantly higher in females compared to males (25.9% female non-sporting injuries, versus 8.5% male; p = 0.02). Avulsions were more frequently reported in non-sporting activities (70.5%). The proportion of such injuries was notably higher in females, though this failed to meet significance (p = 0.124). Grouped by age category a bimodal distribution was noted, with the proportion of avulsions greater in younger (age <15) and older patients (age > 40) (p = 0.008). 86.8% of patients returned to pre-injury activity levels with a similar frequency across all study variables; age, activity (sporting vs non-sporting) and injury type (avulsion vs tear).
This review highlights a proportion of adults suffering grade 2 or 3 hamstring injuries from activities other than the classic sports trauma. The majority of these non-sporting injuries were avulsion injuries that clustered in older female and skeletally immature patients suggesting a potential link to bone mineral density.
Journal Article
Dependence of the vertical distribution of bromine monoxide in the lower troposphere on meteorological factors such as wind speed and stability
Multiple axis differential absorption spectroscopy (MAX-DOAS) measurements of bromine monoxide (BrO) probed the vertical structure of halogen activation events during March–May 2012 at Barrow, Alaska. An analysis of the BrO averaging kernels and degrees of freedom obtained by optimal-estimation-based inversions from raw MAX-DOAS measurements reveals the information is best represented by reducing the retrieved BrO profile to two quantities: the integrated column from the surface through 200 m (VCD200 m), and the lower tropospheric vertical column density (LT-VCD), which represents the integrated column of BrO from the surface through 2 km. The percentage of lower tropospheric BrO in the lowest 200 m was found to be highly variable ranging from shallow layer events, where BrO is present primarily in the lowest 200 m, to distributed column events where BrO is observed at higher altitudes. The highest observed LT-VCD events occurred when BrO was distributed throughout the lower troposphere, rather than concentrated near the surface. Atmospheric stability in the lowest 200 m influenced the percentage of LT-VCD that is in the lowest 200 m, with inverted temperature structures having a first-to-third quartile range (Q1–Q3) of VCD200 m/LT-VCD from 15–39%, while near-neutral-temperature structures had a Q1–Q3 range of 7–13%. Data from this campaign show no clear influence of wind speed on either lower tropospheric bromine activation (LT-VCD) or the vertical distribution of BrO, while examination of seasonal trends and the temperature dependence of the vertical distribution supported the conclusion that the atmospheric stability affects the vertical distribution of BrO.
Journal Article
Temporal and spatial characteristics of ozone depletion events from measurements in the Arctic
Following polar sunrise in the Arctic springtime, tropospheric ozone episodically decreases rapidly to near-zero levels during ozone depletion events (ODEs). Many uncertainties remain in our understanding of ODE characteristics, including the temporal and spatial scales, as well as environmental drivers. Measurements of ozone, bromine monoxide (BrO), and meteorology were obtained during several deployments of autonomous, ice-tethered buoys (O-Buoys) from both coastal sites and over the Arctic Ocean; these data were used to characterize observed ODEs. Detected decreases in surface ozone levels during the onset of ODEs corresponded to a median estimated apparent ozone depletion timescale (based on both chemistry and the advection of O3-depleted air) of 11 h. If assumed to be dominated by chemical mechanisms, these timescales would correspond to larger-than-observed BrO mole fractions based on known chemistry and assumed other radical levels. Using backward air mass trajectories and an assumption that transport mechanisms dominate observations, the spatial scales for ODEs (defined by time periods in which ozone levels ≤15 nmol mol−1) were estimated to be 877 km (median), while areas estimated to represent major ozone depletions (<10 nmol mol−1) had dimensions of 282 km (median). These observations point to a heterogeneous boundary layer with localized regions of active, ozone-destroying halogen chemistry, interspersed among larger regions of previously depleted air that retain reduced ozone levels through hindered atmospheric mixing. Based on the estimated size distribution, Monte Carlo simulations showed it was statistically possible that all ODEs observed could have originated upwind, followed by transport to the measurement site. Local wind speed averages were low during most ODEs (median of ~3.6 m s−1), and there was no apparent dependence on local temperature.
Journal Article
A Survey of Orthopedic Surgical Management of Pressure Ulcer–Related Pelvic Osteomyelitis
Abstract
Pressure-ulcer related pelvic osteomyelitis is managed with little high-quality evidence. We undertook an international survey of orthopedic surgical management, covering diagnostic parameters, multidisciplinary input, and surgical approaches (indications, timing, wound closure, and adjunctive therapies). This identified areas of consensus and disagreement, representing a starting point for future discussion and research.
Journal Article