PubMed · 13967415
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S V BENET. 1962. Poem.. https://doi.org/10.1002/art.1780050608
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Deprivation correlates with poor health and psychosocial variables can affect the symptoms of knee arthritis. Our aim was to determine the effect of deprivation on the level of knee function and health-related quality of life at the time of arthroplasty and 12 months after total knee replacement. From our database of over 2500 knee replacements, we analysed both clinical and quality of life outcome measures. We analysed the relationship between deprivation (by Townsend score), knee function (Knee Society Score) and health-related quality of life (Nottingham Health Profile) before total knee replacement (TKR) and at 12 months post-operation. There was no significant correlation between Townsend score, Knee Society Score and Nottingham Health Profile preoperatively or at 12 months after knee replacement, thus showing that there was no association between deprivation and the severity of knee arthritis at the time of joint replacement nor was there a relationship between deprivation and the short-term outcome from total knee replacement.
The issue of the safety of performing simultaneous, bilateral total knee replacement (SBTKR) for patients with bilateral knee osteoarthritis remains controversial. Several small series have reported inconclusive findings and the few large series published are contradictory. We present data retrieved from the Scottish Arthroplasty Project on over 19,000 total knee replacements (TKR) performed in Scotland between 1989 and 1999. The trends in the practice of SBTKR are shown together with the associated mortality from the procedure compared with unilateral or staged, bilateral TKR. The data shows that there was no statistically significant difference in the 90-day mortality between unilateral TKR, staged TKR or SBTKR. In addition, the length of stay for SBTKR has reduced, equaling that of unilateral TKR since 1993. Despite an initial increase in the percentage of consultants performing SBTKR early in the decade, since 1993, only approximately 25% of knee arthroplasty surgeons in Scotland per year ever performed a SBTKR.
Focal bone loss around inflamed joints in patients with autoimmune disease, such as rheumatoid arthritis, remains a serious clinical problem. The recent elucidation of the RANK/RANK-ligand/OPG pathway and its role as the final effector of osteoclastogenesis and bone resorption has brought a tremendous understanding of the pathophysiology of inflammatory bone loss, and has heightened expectation of a novel intervention. Here, we review the etiology of inflammatory bone loss, the RANK/RANK-ligand/OPG pathway, and the clinical development of anti-RANK-ligand therapy.