The effect of COVID-19 restrictions on rehabilitation and functional outcome following total hip and knee arthroplasty during the first wave of the pandemic

Aims The primary aim was to assess the patient-perceived effect of restrictions imposed due to COVID-19 on rehabilitation following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Secondary aims were to assess perceived restrictions, influence on mental health, and functional outcome compared to patients undergoing surgery without restriction. Methods During February and March 2020, 105 patients underwent THA (n = 48) or TKA (n = 57) and completed preoperative and six-month postoperative assessments. A cohort of 415 patients undergoing surgery in 2019 were used as the control. Patient demographic data, BMI, comorbidities, Oxford Hip Score (OHS) or Knee Score (OKS), and EuroQoL five-domain (EQ-5D) score were collected preoperatively and at six months postoperatively. At six months postoperatively, the 2020 patients were also asked to complete a questionnaire relating to the effect of the social restrictions on their outcome and their mental health. Results Nearly half of the patients (47.6%, n = 50/105) felt that the restrictions imposed by COVID-19 had limited their rehabilitation and were associated with a significantly worse postoperative OKS (p < 0.001), EQ-5D score (p < 0.001), and lower satisfaction rate (p = 0.019). The reasons for the perceived limited rehabilitation were: being unable to exercise (n = 32, 64%), limited access to physiotherapy (n = 30, 60%), and no face-to-face follow-up (n = 30, 60%). A quarter (n = 26) felt that their mental health had deteriorated postoperatively; 17.1% (n = 18) felt depressed and 26.7% (n = 28) felt anxious. Joint-specific scores and satisfaction for the 2020 group were no different to the 2019 group, however patients undergoing THA in 2020 had a significantly worse postoperative EQ-5D compared to the 2019 cohort (difference 0.106; p = 0.001) which was not observed in patients undergoing TKA. Conclusion Half of the 2020 cohort felt that their rehabilitation had been limited and was associated with worse postoperative Oxford and EQ-5D scores, and lower rates of patient satisfaction, but relative to the 2019 cohort their overall outcomes were no different, with the exception of THA patients who had a worse general health score. Level of evidence: Prospective study, Level 2 Cite this article: Bone Jt Open 2021;2(6):380–387.

Wearable technologies for children with chronic illness: A Proof-of-Concept Study

ObjectiveTo determine the feasibility of wearable technologies in physical activity assessment in three paediatric diseases, namely Niemann-Pick C (NP-C), Juvenile Idiopathic Arthritis (JIA) and Duchenne Muscular Dystrophy (DMD).DesignProof of concept feasibility studySetting and patientsThirty children were recruited across three UK hospitals (Royal Manchester’s Children Hospital, Great Ormond Street Children’s Hospital and the Great North Children’s Hospital). Ten were diagnosed with NP-C, eight with DMD and twelve with JIA.InterventionAll participants completed the 6-minute walk test (6MWT) at enrolment. Patients were provided with disease specific smartphone apps paired with a wearable device via Bluetooth. Ambulation was recorded in 30-minute epochs measuring average daily maximum (ADM), average daily steps (ADS), and average daily steps per 30-minute epoch (ASE).ResultsMedian 6MWT results were 450m, 325m and 434.5m for the NP-C, DMD and JIA cohorts respectively. Wearable data capture was feasible in all three disease groups, although complete data capture was not sustained. A statistically significant between-cohort difference was identified for ADM, ADS and ASE. Statistically significant differences were found between DMD/JIA for ADM; NP-C/DMD for ADS and DMD/JIA for ASE.DiscussionWearable sensor technologies have the potential to add important information to our understanding of ambulation in chronic paediatric disease. The wearable devices were easy to use and popular with patients although key features need to be addressed to ensure higher engagement in future deployments. As the technology continues to evolve at a rapid pace, opportunities to implement child friendly solutions are already available.

Diagnostic Accuracy of Non-Invasive Thermal Evaluation of Ventriculoperitoneal Shunt Flow in Shunt Malfunction: A Prospective, Multi-Site, Operator-Blinded Study

BACKGROUND Thermal flow evaluation (TFE) is a non-invasive method to assess ventriculoperitoneal shunt function. Flow detected by TFE is a negative predictor of the need for revision surgery. Further optimization of testing protocols, evaluation in multiple centers, and integration with clinical and imaging impressions prompted the current study. OBJECTIVE To compare the diagnostic accuracy of 2 TFE protocols, with micropumper (TFE+MP) or without (TFE-only), to neuro-imaging in patients emergently presenting with symptoms concerning for shunt malfunction. METHODS We performed a prospective multicenter operator-blinded trial of a consecutive series of patients who underwent evaluation for shunt malfunction. TFE was performed, and preimaging clinician impressions and imaging results were recorded. The primary outcome was shunt obstruction requiring neurosurgical revision within 7 d. Non-inferiority of the sensitivity of TFE vs neuro-imaging for detecting shunt obstruction was tested using a prospectively determined a priori margin of −2.5%. RESULTS We enrolled 406 patients at 10 centers. Of these, 68/348 (20%) evaluated with TFE+MP and 30/215 (14%) with TFE-only had shunt obstruction. The sensitivity for detecting obstruction was 100% (95% CI: 88%-100%) for TFE-only, 90% (95% CI: 80%-96%) for TFE+MP, 76% (95% CI: 65%-86%) for imaging in TFE+MP cohort, and 77% (95% CI: 58%-90%) for imaging in the TFE-only cohort. Difference in sensitivities between TFE methods and imaging did not exceed the non-inferiority margin. CONCLUSION TFE is non-inferior to imaging in ruling out shunt malfunction and may help avoid imaging and other steps. For this purpose, TFE only is favored over TFE+MP.

COHORT DIFFERENCES IN THE IMPORTANCE OF SEXUALITY AND EVALUATION OF ONE’S SEX LIFE IN LATE MIDLIFE

Age-related declines in multiple aspects of sex life are well documented, but we know little about historical change in key sexuality facets. We examine cohort differences in the perceived importance of sexuality and the evaluation of one’s sex life among middle-aged adults. We compare data from 55 to 64-year-olds in the Longitudinal Aging Study Amsterdam (LASA) obtained in 1992–1993 (n = 718) vs. 2012–2013 (n = 860). Results revealed that later-born adults perceive sexuality as more important than their earlier-born peers. Effect sizes were small at the sample level (d &lt; .15), but substantial for particular subpopulations (women without partner: d = .56). In zero-order models, later-born adults evaluated their sex life as slightly less pleasant, but differences did not hold when covarying relevant individual and cohort difference factors. We conclude that historical changes in late-midlife sexuality are multifaceted and discuss theoretical and practical implications of our findings.

The Long-Run Effects of Teacher Collective Bargaining

We analyze how exposure to teacher collective bargaining affects long-run outcomes for students, exploiting the timing of state duty-to-bargain law passage in a cross-cohort difference-in-difference framework. Among men, exposure to a duty-to-bargain law in the first 10 years after passage depresses annual earnings by $2,134 (3.93 percent), decreases weekly hours worked by 0.42, and reduces employment and labor force participation. The earnings estimate implies that current duty-to-bargain laws reduce earnings by $213.8 billion annually. Effects grow with time since law passage, are largest among nonwhites, and are not evident for women. Duty-to-bargain laws reduce male noncognitive skills, supporting the labor market findings. (JEL I21, J22, J31, J45, J51, J52, K31)

The Association of Early Life Factors and Declining Incidence Rates of Dementia in an Elderly Population of African Americans

Objectives To explore the possible association of childhood residence, education levels, and occupation with declining incidence rates of dementia in 2 cohorts of elderly African Americans. Methods African Americans residing in Indianapolis without dementia were enrolled in 1992 and 2001 and evaluated every 2–3 years. The cohorts consist of 1,440 participants in 1992 and 1,835 participants in 2001 aged 70 years and older. Cox proportional hazard regression models were used to compare cohort differences in dementia and Alzheimer’s disease (AD) risk. Results The 2001 cohort had significantly decreased risk of both incident dementia and AD (hazard ratio [HR]: 0.62/0.57 for dementia/AD). Years of education was associated with decreased risk of dementia (HR = 0.93; p = .0011). A significant interaction (p = .0477) between education and childhood rural residence was found for the risk of AD that higher education level is significantly associated with reduced AD risk (HR = 0.87) in participants with childhood rural residence, but no association in those with urban upbringing. The cohort difference for dementia rates were attenuated by adjusting for the 3 risk factors but remained significant (HR = 0.75; p = .04). Discussion These results emphasize the importance of early life factors including rural residence and education for the risk for dementia later in life.

Cohort Difference in Age-Related Trajectories in Network Size in Old Age: Are Networks Expanding?

Objectives Contemporary societal views on old age as well as a rise in retirement age raise the question whether patterns of stability and/or decline in network size as found in earlier studies similarly apply to later birth cohorts of older adults. Methods Change score models are estimated to determine cohort differences in age-related trajectories in network size. Two birth cohorts (1928–37 and 1938–47, 55–64 at baseline in 1992 and 2002) of the Longitudinal Aging Study Amsterdam are followed across 4 observations over a time span of 9 years. Results Age-related trajectories in network size differ between the early and late birth cohort. The late birth cohort makes large gains in network size around retirement age, but this increase does not hold over time. Increased educational level and larger diversity in social roles relate to the cohort difference. Nonetheless, cohort difference prevails even after adjusting for these factors. Discussion The peak level in the network size in the late birth cohort hints at stronger preference and more opportunities to gain and maintain social relationships around retirement age in the current societal structure and culture. The subsequent drop-off in network size suggests that these ties are mostly used to adapt to the retirement transition.

Prosthetic Joint Infection Following Invasive Dental Procedures and Antibiotic Prophylaxis in Patients With Hip or Knee Arthroplasty

OBJECTIVESWe aimed to clarify whether invasive dental treatment is associated with increased risk of prosthetic joint infection (PJI) and whether prophylactic antibiotics may lower the infection risk remain unclear.DESIGNRetrospective cohort study.PARTICIPANTSAll Taiwanese residents (N=255,568) who underwent total knee or hip arthroplasty between January 1, 1997, and November 30, 2009, were screened.METHODSThe dental cohort consisted of 57,066 patients who received dental treatment and were individually matched 1:1 with the nondental cohort by age, sex, propensity score, and index date. The dental cohort was further divided by the use or nonuse of prophylactic antibiotics. The antibiotic and nonantibiotic subcohorts comprised 6,513 matched pairs.RESULTSPJI occurred in 328 patients (0.57%) in the dental subcohort and 348 patients (0.61%) in the nondental subcohort, with no between-cohort difference in the 1-year cumulative incidence (0.6% in both, P=.3). Multivariate-adjusted Cox regression revealed no association between dental procedures and PJI. Furthermore, PJI occurred in 13 patients (0.2%) in the antibiotic subcohort and 12 patients (0.18%) in the nonantibiotic subcohorts (P=.8). Multivariate-adjusted analyses confirmed that there was no association between the incidence of PJI and prophylactic antibiotics.CONCLUSIONSThe risk of PJI is not increased following dental procedure in patients with hip or knee replacement and is unaffected by antibiotic prophylaxis.Infect Control Hosp Epidemiol. 2017;38:154–161

An Anatomy of Change: Profiling Cohort Difference in Beliefs and Attitudes among Anglicans in England

Conservatism in theological belief, moral values and attitude toward ecclesiastical practices was measured in a sample of 5967 ordained and lay Anglicans in the Church of England. Average scores were compared between those who classed themselves as Anglo-catholic, broad church or evangelical, and by six different age cohorts. Overall, most measures of conservatism showed decline among more recent cohorts, but there were marked differences between traditions. Younger evangelicals showed little or no decline in theological or moral conservatism, and, in the case of Bible beliefs, were more conservative than their older counterparts. In ecclesiastical variables, however, Anglo-catholics were often more conservative and younger evangelicals showed less conservatism than other traditions or older evangelicals. The findings suggest that the divide between traditions is increasing among younger generations mainly because those in Anglo-catholic and broad-church traditions are becoming more liberal on theological or moral matters, whereas evangelicals are maintaining traditional conservative views of theology and morality but becoming less traditional in matters ecclesiastical.