Succes van een ingreep bepaald door patient gerelateerde factoren.

In de augustus editie van de Journal of Bone and Joint Surgery verscheen een artikel waarin de factoren werden bekeken die een ingreep (in dit geval een totale knieprothese) tot een succes maakten.

Het bleek dat patientgerelateerde factoren belangrijker waren dan techniek of chirurg gerelateerde factoren. Gekende factoren zijn bijvoorbeeld de algehele gezondheidstoestand, de aanwezigheid van angst of depressie en de wijze van omgaan met problemen (coping).

In deze tijden waarin de verzekeraars steeds meer gaan sturen op Patient Related Outcome Measures (PROM's) is het belangrijk dat de verdeling van de beschikbare budgetten niet alleen gebeurt op basis van economische motieven en uitkomstmaten zoals PROM's, maar dat ook patient gerelateerde facoren worden meegenomen in beslissingen.

J Bone Joint Surg Br. 2012 Aug;94(8):1058-66.

The effect of surgical factors on early patient-reported outcome measures (PROMS) following total knee replacement.

Baker PN, Deehan DJ, Lees D, Jameson S, Avery PJ, Gregg PJ, Reed MR.

Institute of Cellular Medicine, Medical school, Newcastle University, Framlington place, Newcastle upon Tyne NE1 7RU, UK.

Patient-reported outcome measures (PROMs) are increasingly being used to assess functional outcome and patient satisfaction. They provide a framework for comparisons between surgical units, and individual surgeons for benchmarking and financial remuneration. Better performance may bring the reward of more customers as patients and commissioners seek out high performers for their elective procedures.

Using National Joint Registry (NJR) data linked to PROMs we identified 22 691 primary total knee replacements (TKRs) undertaken for osteoarthritis in England and Wales between August 2008 and February 2011, and identified the surgical factors that influenced the improvements in the Oxford knee score (OKS) and EuroQol-5D (EQ-5D) assessment using multiple regression analysis.

After correction for patient factors the only surgical factors that influenced PROMs were implant brand and hospital type (both p < 0.001). However, the effects of surgical factors upon the PROMs were modest compared with patient factors. For both the OKS and the EQ-5D the most important factors influencing the improvement in PROMs were the corresponding pre-operative score and the patient's general health status.

Despite having only a small effect on PROMs, this study has shown that both implant brand and hospital type do influence reported subjective functional scores following TKR.

In the current climate of financial austerity, proposed performance-based remuneration and wider patient choice, it would seem unwise to ignore these effects and the influence of a range of additional patient factors.

Patiënten waarderen Orthopeden Elisabeth Tilburg

Patiënten kunnen op steeds meer websites hun mening geven over ziekenhuizen en specialisten. ZorgkaartNederland.nl is een van de populairste; de site wordt elke maand door circa een half miljoen mensen bezocht. Het EZ is een pilot gestart waarbij patiënten worden opgeroepen onze orthopeden op ZorgkaartNederland.nl te waarderen.

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Metaal op metaal heupprotheses geven geen hoger risico op kanker.

In de media wordt herhaaldelijk gewezen op het verhoogde risico op het ontwikkelen van een kwaadaardige ziekte als een patient een metaal op metaal heupprothese heeft.
Onderstaand Engels onderzoek laat zien dat het vermeende risico niet is bewezen en dat er nu zelfs bewijzen zijn dat dit risico niet verhoogd is.
Deze gegevens worden gehaald uit een nationale database waarin alle implantaten worden geregistreerd. In Nederland is een dergelijke database sinds kort (eerdere pogingen dit op te zetten mislukten door een gebrek aan financiering en tegenstrijdige belangen) ook in gebruik (LROI) en er wordt nu reeds een dekkingsgraad van 100% behaald: alle implantaten van de heup in Nederland worden hiermee geregistreerd.

Metal-on-Metal Hip Patients are at no greater risk for cancer after 7 years.

NJR research finds metal-on-metal hip replacement patients are at no more risk of developing cancer in seven years following surgery (National Joint Registry) A study commissioned by the National Joint Registry, published online at bmj.com today (British Medical Journal, Wednesday 4 April), confirms that patients who have had a metal-on-metal hip replacement are at no more risk of developing cancer in the first seven years after surgery than the general population.
The authors of the research add that a longer study is required, to monitor incidences for cancers that take many years to develop.
The study was carried out by the NJR statistical support, analysis and research team led by Professor of Orthopaedic Surgery Ashley Blom at the University of Bristol, who said: “The results, using a large representative sample, show that there is no association between metal-on-metal hip replacements and increased incidence of cancer in the first seven years after hip replacement.”
“The data also shows that the incidence of cancer diagnosis is low after hip replacement in general and lower than that predicted for the age and sex matched general population. However comparisons with the general population are not straightforward as hip replacement patients tend to be healthier than others of the same gender and age group.” The study looked at incidence of new diagnoses of cancer for more than 40,000 patients with a metal-on-metal implant and compared them to those with different bearing surfaces (over 245,000 patients) and the general population. The chance of a 60 year-old man with a metal-on-metal hip being diagnosed with cancer in the five years following surgery is 6.2%, compared to 6.7% chance with hip replacement using other bearing surfaces. For women, these figures were 4.0% for metal-on-metal and 4.4% for other bearing surfaces.
Recent coverage on metal-on-metal hip replacements has highlighted concerns about the effect metal ions, from the wear of metal-on-metal implants, have on the body. As yet, there is no proven link between DNA changes and an increased incidence of cancer.
National Joint Registry Lead Elaine Young said: “Each year we commission special topic studies, to accompany the annual reporting process. This time the studies are looking at the metal-on-metal hip replacements and we are pleased to have this second paper published at BMJ online, following the recent stemmed metal-on-metal paper in The Lancet.”
“The National Joint Registry is an extremely valuable source of information based on a mature data set (7 years). We are committed to supporting and enabling further research so that clinicians can use this information to make the best choices for their joint replacement patient. Importantly too, we are sharing more data with patients, to enable them to seek out up-to-date information and advice.”

Notes:
The National Joint Registry (NJR) of England and Wales was established in 2002. Its purpose is to define, improve and maintain the quality of care of individuals receiving hip, knee and ankle joint replacement surgery across the NHS and independent healthcare sector.
Data collection began in April 2003 and the registry now holds over 1.2 million records and more records about certain procedure types than any other registry in the world. As a result of the increasing volume and quality of data it is possible to make accurate analysis available to all stakeholders and contribute significantly to good practice and patient safety.

bmj.com: The risk of cancer in the first seven years after metal-on-metal hip replacement compared with other bearings and the general population: a linkage study between the National Joint Registry of England and Wales and Hospital Episode Statistics

PRP bij achillespeesrupturen: sneller en beter herstel

Overgenomen van http://www.healio.com/orthopedics:

MANCHESTER — Results of a small, randomized controlled pilot study that involved mechanobiologic and clinical assessments showed that platelet-rich plasma improved healing in acute Achilles tendon tears that were either percutaneously sutured or nonoperatively treated.

Joseph Alsousou, LMSSA Lon, MD , MRCS Ed, of Nuffield Department of Orthopaedic Rheumatology and Musculoskeletal Sciences  at the University of Oxford, United Kingdom, presented the findings of the PATH study — platelet-rich plasma (PRP) in accelerated Achilles tendon healing — at the British Orthopaedic Association Congress, here. He received the Young Investigator Award sponsored by Arthritis Research United Kingdom .

“Our findings showed that platelet-rich plasma had the potential to accelerate regeneration of the Achilles tendon in acute tears and really helped the return to function,” Alsousou said.

Prior to treatment, investigators collected 55 mL whole blood from patients for processing into PRP. Patients were blinded as to whether or not they received PRP.

Ten patients with an Achilles tendon gap smaller than 5 mm formed the nonoperative group: five patients received a PRP injection and five control patients had a pseudo injection to the skin. Ten patients with a tendon gap greater than 5 mm formed the operative group: five patients had their tendon tears percutaneously sutured and received a concomitant PRP injection and five control patients underwent suture repair alone.

All patients were casted in a standard manner following treatment, Alsousou said.

Investigators used a Magellan automated platelet separator system (Arteriocyte Medical System; Hopkinton, Mass., USA) for PRP preparation. They followed up all patients at 1, 3, 6, 12, and 24 weeks with the Achilles Tendon Rupture Score, the Victoria Institute of Sport Activity-Achilles score, and the Foot and Ankle Outcome Score, and they also performed a foot ultrasound elasticity scan for all patients.

The scans showed larger and thicker tendons in both PRP-treated groups, according to the study abstract.

Among the study limitations were the small number of patients included, Alsousou said. There is more work to do in this area, he said, and “to achieve statistically significant power in this study we need 360 patients, so we recommend continuing study to achieve this.”

Reference:

Alsousou J, Handley R, Thompson M, et al. Platelet-rich plasma in accelerated Achilles tendon healing (PATHT): A randomized controlled trial –  pilot phase. Presented at the British Orthopaedic Association Congress 2012. Sept. 11-14. Manchester.

Disclosure: Alsousou’s research was funded by the BOA Joint Action program, NIHR and the Oxford University BRC.

Orthopedie Elisabeth Tilburg viert 65e verjaardag van Michel Bonnet

De poli orthopedie van het St. Elisabeth Ziekenhuis in Tilburg staat vandaag in het teken van de 65e verjaardag van Michel Bonnet, de pater familias van de Tilburgse orthopedie. Aan het eind van 2012 zal hij zijn carrière beëindigen, maar zoals de foto laat zien is hij nog volop in actie in de orthopedie!

Orthopedie Elisabeth Tilburg verguld met nieuwe traumakamers op SEH

Recentelijk verscheen in het Brabants Dagblad onderstaand artikel over de nieuwe traumakamers op de Spoedeisende Hulp afdeling van het St. Elisabeth ziekenhuis in Tilburg. Ook de afdeling orthopedie die zeer betrokken is bij de zorg voor de getraumatiseerde patient beaamt dat met deze nieuwe en verbeterd uitgeruste opvangkamer een verbeterslag heeft doorggemaakt.

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Summerclass 2012: Orthopedie Elisabeth Tilburg deed mee!

Vandaag op de afsluitende dag mocht dr. Taco Gosens Orthopedie Elisabeth Tilburg vertegenwoordigen op de Summerclass 2012 in Delft.

Aan studenten geneeskunde en co-assistenten uit het gehele land deed hij uit de doeken dat de peesproblemen lastig te behandelen zijn en dat het vaak een kwestie is van het combineren van diverse behandelingen, waarbij de biologie een sleutelrol speelt.
Op de twee eerdere dagen werden lezingen en workshops door zowel de Delftse orthopeden als enkele sprekers uit de rest van Nederland over diverse orthopedische en traumatologische onderwerpen gecombineerd met vele andere (sport)activiteiten.
De bedoeling van dit initiatief is de studenten geneeskunde enthousiast(er) te maken voor de specialisatie orthopedie.

Deze tweede editie heeft de hooggespannen verwachtingen na vorig jaar op zijn minst geevenaard, aldus de Delftse orthopeden.
De Nederlandse Orthopedische vereniging omarmt dit initiatief van harte en zo zijn er meer organisaties en bedrijven die deze driedaagse combinatie van vermaak en orthopedie mogelijk maken.

Zie voor meer sfeerindrukken van de editie van 2012: http://summerclassdelft.nl/