Patterns of Compartment Involvement in End‐stage Knee Osteoarthritis in a Chinese Orthopedic Center: Implications for Implant Choice

Objectives

Knee osteoarthritis (OA) is a prevalent disease in the elderly, causing pain and contributing to poor quality of life. Surgical intervention, such as knee arthroplasty, can be used in those with end‐stage knee OA. Total knee arthroplasty (TKA) is one of the most common surgical procedures for end‐stage knee OA, with promising clinical outcomes. However, a large proportion of patients with isolated compartment OA can be treated with unicompartmental knee arthroplasty (UKA) instead. UKA has shown better patient‐reported functional outcomes, and lower mortality and major complication rates than TKA. The percentage of UKA in knee arthroplasty varied in different orthopedic centers, and we believed that the requirement for UKA was underestimated in many centers. A retrospective study was carried out on our Chinese patient population presenting for knee arthroplasty; it aimed to identify the proportion of patients that might be suitable for UKA.

Methods

A retrospective cross‐sectional study of 155 consecutive patients (168 knees) awaiting TKA for end‐stage primary OA was performed. The pattern and grade of OA was recorded from preoperative weight‐bearing anteroposterior and non‐weight‐bearing lateral radiographs. The medial, lateral, patellofemoral compartment was given an individual Kellgren–Lawrence grade on the radiographs, and those grade ≥3 were defined as end‐stage OA. The compartments involvement was established then. The integrity of the anterior cruciate ligament (ACL) was determined by the modified Keyes classification on lateral radiographs. The applicability for total or partial knee arthroplasty was determined according to the compartments involvement.

Results

Medial compartment involvement was found in 154 (91.7%) knees, while the involvement of the lateral compartment and patellofemoral joint was found in 54 (32.1%) and 57 (33.9%) knees, respectively. Eighty‐one (48.2%) of the knees showed medial compartment OA with or without patellofemoral joint involvement, and modified Keyes classification grade 1, indicating an intact ACL, and, hence, potential suitability for medial UKA. Isolated lateral OA indicating possible suitability for lateral UKA was identified in 11 knees (6.5%). No patients showed isolated patellofemoral joint OA. The other 76 (45.2%) knees could be treated by TKA.

Conclusions

The medial compartment was the most commonly affected in our Chinese patients indicated for knee arthroplasty. More than half of the patients in this group could be treated by either medial or lateral UKA.

     

The report of the clinical standards advisory group: standards of care for people with schizophrenia in the UK and implications for mental health nursing

The report of the clinical standards advisory group: standards of care for people with schizophrenia in the UK and implications for mental health nursing
The Clinical Standards Advisory Group Schizophrenia Committee has spent two years (1993–1995) developing a standards protocol to assist all Purchasers and Providers with the task of producing optimum services for people with schizophrenia and other serious and enduring mental illnesses. This work has been underpinned by research that included visits to a representative sample of services throughout the UK. The report of this initiative, which was published in the summer of 1995, has many implications for mental health nursing. These include the continuing necessity to focus on serious mental illness; more effort to develop multidisciplinary working and the use of the Care Programme Approach; an increased focus on relevant training in case management and psychosocial interventions; the need to recognize physical health problems; the importance of medication management; and, as the Review of Mental Health Nursing emphasized, the issue of leadership should be targeted as a priority for action.     

Staff perception of their roles during the transition of psychiatric care into the community

RED A S. (1995) Journal of Psychiatric and Mental Health Nursing 2 , 13–22: Staff perception of their roles during the transition of psychiatric care into the community. : The objective of this study was to investigate the staff's experiences involved in the processes of the transition of 20 non-demented long-stay psychiatric patients. Staff members expressed satisfaction from working outside the hospital. They believed that the patients' condition and their quality of life had improved and that they were likely to achieve successful resettlement after a lengthy process of rehabilitation. However, staff members considered that their roles were demanding and involved a lot of domestic activities. They recommended gradual and slow preparation for the patients, and an educational programme for the public as well as appropriate preparation and continuing professional support for staff.     

A trainer's perspective of an innovative programme teaching health visitors about the detection, treatment and prevention of postnatal depression

Health visitors in North Staffordshire, Edinburgh and Lewisham were given the opportunity to participate in a training programme in the detection, treatment and prevention of postnatal depression, based on previously reported successful intervention strategies They were trained in the use of the Edinburgh Postnatal Depression Scale (EPDS), and given information about the value and practice of non-directive counselling and about preventatiave strategies Knowledge acquisition was evaluation by self-report questionnaires given before and after training The health visitors were encouraged to screen postnatal women at three specified times using the EPDS and to offer non-directive counselling to women who obtained high scores A baseline measure of the incidence of postnatal depression was obtained by asking health visitors to give an EPDS form to all women in     

First Trimester Aneuploidy Screening Using Nuchal Iranslucency, Free Beta Human Chorionic Gonadotrophin and Maternal Age

Summary: Screening for aneuploidy using maternal age has a low detection rate and high false positive rate. Second trimester maternal serum screening increases trisomy 21 detection and decreases die false positive rate. First trimester screening would enable definitive diagnosis with chorionic villus sampling, and simple surgical termination of affected pregnancies would still be an option. Nuchal translucency (NT), free beta human chorionic gonadotrophin (fβHCG) and maternal age were assessed in 302 patients before chorionic villus sampling. NT positively and fβHCG negatively correlated with gestation, but neither correlated with maternal age nor with each other. Both NT and fβHCG were increased in trisomy 21. NT was increased and fβHCG was decreased in trisomy 18. Multivariate discriminant analysis enabled 87.5% detection of trisomy 21 in this high-risk population, for a 14% false positive rate. In a simulated normal population, using a risk cut-off of 1 in 250, 71% detection was achieved for a 7% false positive rate. The combination of NT, fβHCG and maternal age is a simple, readily available and viable first trimester screening strategy.