Type D Personality is Not Associated with Coronary Heart Disease Risk in a North American Sample of Retirement-aged Adults

Background

Type D personality is associated with recurrent coronary heart disease (CHD) risk but there is limited and inconsistent evidence regarding incident risk among persons free of clinical CHD.

Purpose

We examined the association between Type D personality and coronary heart disease (CHD) risk in apparently healthy adults. We also explored the association of these traits with waist circumference, body mass index (BMI), and inhibited physician consultation behavior.

Methods

Cross-sectional study of North American retirement-aged residents (N?=?303). The primary outcome variable was a modified 10-year absolute CHD risk score from the Framingham Heart Study. Secondary outcomes included adiposity and a 5-item measure of patient/provider interaction inhibition. We regressed CHD risk on negative affect (NA), social inhibition (SI), and the NAxSI interaction (i.e., the Type D personality) and repeated these analyses for adiposity and for patient/provider interaction inhibition. We also contrasted CHD risk across Type D and non-Type D categories.

Results

None of the personality variables were associated with CHD risk for the whole sample (regression coefficients from ?0.11 to .10, Ps?>?0.29) or in gender-specific analyses. For adiposity, NA was positively associated and SI was negatively associated with BMI in women (Ps?<?0.05), but there were no other personality associations. Patient/provider interaction inhibition was associated with SI (P?<?0.001) but not NA or the NAxSI interaction (P?=?0.42). The contrast between Type D and non-Type D personality revealed no differences in CHD risk (P?=?0.93).

Conclusions

Neither Type D nor its constituent NA and SI traits were associated with absolute incident CHD risk in retirement-aged adults free of reported CHD. Optimal analytic practices and attention to patient/provider interaction behavior will improve our understanding of the association between Type D personality traits and health.     

What Is the Learning Curve for the Anterior Approach for Total Hip Arthroplasty?

Background

There are many factors that may affect the learning curve for total hip arthroplasty (THA) and surgical approach is one of these. There has been renewed interest in the direct anterior approach for THA with variable outcomes reported, but few studies have documented a surgeon’s individual learning curve when using this approach.

Questions/purposes

(1) What was the revision rate for all surgeons adopting the anterior approach for placement of a particular implant? (2) What was the revision rate for surgeons who performed > 100 cases in this fashion? (3) Is there a minimum number of cases required to complete a learning curve for this procedure?

Methods

The Australian Orthopaedic Association National Joint Replacement Registry prospectively collects data on all primary and revision joint arthroplasty surgery. We analyzed all conventional THAs performed up to December 31, 2013, with a primary diagnosis of osteoarthritis using a specific implant combination and secondarily those associated with surgeons performing more than 100 procedures. Ninety-five percent of these procedures were performed through the direct anterior approach. Procedures using this combination were ordered from earliest (first procedure date) to latest (last procedure date) for each individual surgeon. Using the order number for each surgeon, five operation groups were defined: one to 15 operations, 16 to 30 operations, 31 to 50 operations, 51 to 100 operations, and > 100 operations. The primary outcome measure was time to first revision using Kaplan-Meier estimates of survivorship.

Results

Sixty-eight surgeons performed 5499 THAs using the specified implant combination. The cumulative percent revision at 4 years for all 68 surgeons was 3% (95% confidence interval [CI], 2.5–3.8). For surgeons who had performed over 100 operations, the cumulative revision rate was 3% (95% CI, 2.0–3.5). It was not until surgeons had performed over 50 operations that there was no difference in the cumulative percent revision compared with over 100 operations. The cumulative percent revision for surgeons performing 51 to 100 operations at 4 years was 3% (95% CI, 1.5–5.4) and over 100 operations 2% (95% CI, 1.2–2.7; hazard ratio, 1.40 [95% CI, 0.7–2.7]; p = 0.33).

Conclusions

There is a learning curve for the anterior approach for THA even when using a prosthesis combination specifically marketed for that approach. We found that 50 or more procedures need to be performed by a surgeon before the rate of revision is no different from performing 100 or more procedures. Surgeons should be aware of this initial higher rate of revision when deciding which approach delivers the best outcome for their patients.     

Bone Cement Dislodgement: One of Complications Following Bone Cement Augmentation Procedures for Osteoporotic Spinal Fracture

Bone cement augmentation procedures have been getting more position as a minimally invasive surgical option for osteoporotic spinal fractures. However, complications related to these procedures have been increasingly reported. We describe a case of bone cement dislodgement following cement augmentation procedure for osteoporotic spinal fracture by reviewing the patient''s medical records, imaging results and related literatures. A 73-year-old woman suffering back and buttock pain following a fall from level ground was diagnosed as an osteoporotic fracture of the 11th thoracic spine. Percutaneous kyphoplasty was performed for this lesion. Six weeks later, the patient complained of a recurrence of back and buttock pain. Radiologic images revealed superior dislodgement of bone cement through the 11th thoracic superior endplate with destruction of the lower part of the 10th thoracic spine. Staged anterior and posterior fusion was performed. Two years postoperatively, the patient carries on with her daily living without any significant disability. Delayed bone cement dislodgement can occur as one of complications following bone cement augmentation procedure for osteoporotic spinal fracture. It might be related to the presence of intravertebral cleft, lack of interdigitation of bone cement with the surrounding trabeculae, and possible damage of endplate during ballooning procedure.