Blog
About

3
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      A influência da osteoartrose e da artroplastia da anca sobre a atividade laboral em doentes em idade ativa

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          O impacto da artroplastia total da anca sobre a atividade laboral em doentes jovens com coxartrose é um tema pouco explorado na literatura. Com o objetivo de avaliar a dimensão do problema e reconhecer os fatores clínicos que influenciam o retorno ao emprego nesta população, revimos 81 doentes com uma média etária de 47 anos, submetidos a artroplastia entre 2006 e 2010 (98 ancas). O estudo revelou que antes do procedimento 27 doentes já se encontravam aposentados e que mais 17 se reformaram depois da cirurgia. Os números finais demonstram que apenas 37 dos 81 doentes operados (45,6%) se mantêm a trabalhar depois da intervenção, sendo que o regresso ao trabalho acontece em média 6,7 meses depois da cirurgia. Existem fatores que favorecem positivamente o regresso ao trabalho: sexo masculino, juventude, coxartrose idiopática, prontidão na realização da cirurgia, unilateralidade, hastes metafisárias, postos de chefia e trabalho fisicamente pouco exigente. Apesar da elevada satisfação na resolução dos sintomas conseguido com a artroplastia, existe uma taxa de reforma em idade ativa de 54,4%. Sendo o problema do emprego multifatorial, os médicos sempre tiveram uma palavra sobre o retorno ao trabalho, a qual ainda se encontra baseada na experiência artroplástica do passado. A imergência de novos implantes dotados de maior resistência ao desgaste, aliada ao aprimoramento das técnicas cirúrgicas bem como as condições sociais que se atravessam, devem em nossa opinião introduzir a questão se não será tempo de reformular as restrições medicamente impostas aos pacientes jovens com artroplastia da anca.

          Translated abstract

          The impact of hip osteoarthritis and total hip arthroplasty in the employability of young patients patient is a relatively unexplored subject in the literature. In order to assess the problem and recognize the clinical factors that influence the return to work in this population we reviewed 81 patients (98 operated hips) with a mean age of 47 years, submitted to hip arthroplasty between 2006 and 2010. The study revealed that 27 patients had already retired before surgery and 17 more retired after arthroplasty. Furthermore only 37 patients (45.6%) are still working after the intervention, and the return to work happens, on average, 6.7 months after surgery. Certain factors were found to be associated with a higher probability of returning to work: male gender, youth age, idiopathic coxarthrosis, readiness to perform the surgery, unilateral disease, metaphyseal support femoral stems, leadership positions and no physically engaging activities required for proper job fullfilment. Despite the high satisfaction in the mitigation of symptoms achieved with arthroplasty, there is a high rate of post-intervention retirement (54.4%). With the introduction of new materials, the improvements in surgical techniques and the actual social conditions we question if this is not the time to reformulate medically imposed activity restriction concepts for young patients subjected to arthroplasty.

          Related collections

          Most cited references 32

          • Record: found
          • Abstract: found
          • Article: not found

          A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip.

          To quantify the trade-off between the expected increased short- and long-term costs and the expected increase in quality-adjusted life expectancy (QALE) associated with total hip arthroplasty (THA) for persons with functionally significant hip osteoarthritis. A cost-effectiveness study was performed from the societal perspective by constructing stochastic tree, decision analytic models designed to estimate lifetime functional outcomes and costs of THA and nonoperative managements. A modified four-state American College of Rheumatology functional status classification was used to measure effectiveness. These functional classes were assigned utility values to allow the relative effectiveness of THA to be expressed in quality-adjusted life years (QALYs). Lifetime costs included costs associated with primary and potential revision surgeries and long-term care costs associated with the functionally dependent class. DATA USED IN THE COST-EFFECTIVENESS MODEL: Probability and incidence rate data were summarized from the literature. The THA hospital cost data were obtained from local teaching hospitals' cost accounting systems. Estimates of recurring medical costs for functionally significant hip osteoarthritis and for custodial care were derived from the literature. The THA cost-effectiveness ratio increases with age and is higher for men than for women. In the base-case scenario for 60-year-old white women who have functionally significant but not dependent hip osteoarthritis, the model predicts that THA is cost saving because of the high costs of custodial care associated with dependency due to worsening hip osteoarthritis and that the procedure increases QALE by about 6.9 years. In the base-case scenario for men aged 85 years and older, the average lifetime cost associated with THA is $9100 more than nonoperative management, with an average increase in QALE of about 2 years. Thus, the THA cost-effectiveness ratio for men aged 85 years and older is $4600 per QALY gained, less than that of procedures intended to extend life such as coronary artery bypass surgery or renal dialysis. Worst-case analysis suggests that THA remains minimally cost-effective for this oldest age category ($80,000/QALY) even if probabilities, rates, utilities, costs, and the discount rate are simultaneously varied to extreme values that bias the analysis against surgery. For persons with hip osteoarthritis associated with significant functional limitation, THA can be cost saving or, at worst, cost- effective in improving QALE when both short- and long-term outcomes are considered. Further research is needed to determine whether this procedure is actually being used in this cost-effective manner, especially in older age categories.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Quality of life and functional outcome after primary total hip replacement. A five-year follow-up.

            We have evaluated the quality of life and functional outcome after unilateral primary total hip replacement (THR). Between 5 January 1998 and 31 July 2000, we recruited a consecutive series of 627 patients undergoing this procedure and investigated them prospectively. Each was assessed before operation and reviewed after six months, 18 months, three years and five years. The Short Form-36 Health Survey (SF-36) and Harris Hip scores were evaluated at each appointment. All dimensions of the SF-36 except for mental health and general health perception, improved significantly after operation and this was maintained throughout the follow-up. The greatest improvement was seen at the six-month assessment. On average, women reported lower SF-36 scores pre-operatively, but the gender difference did not continue post-operatively. The Harris Hip scores improved significantly after operation, reaching a plateau after 18 months. The improved quality of life was sustained five years after THR.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Patient satisfaction and function after primary and revision total hip replacement.

              This study assessed and compared satisfaction and function before and after total hip replacement as reported by 531 patients who had primary and revision surgery and 1087 patients who had primary surgery only. All operations were registered by the Norwegian Arthroplasty Register during the years 1987 to 1993, with time from last surgery to followup ranging from 0.6 to 6.4 years. Sixty-one percent of the patients who underwent revision surgery and 84% of the patients who did not undergo revision surgery rated their overall satisfaction with the hip implant as good or very good. With adjustment for primary diagnosis, gender, age, bilaterality, and time since the primary operation, a substantial benefit of total hip replacement was observed in both groups with regard to pain, walking ability, and need of help. However, improvement was less among patients who underwent revision total hip replacement than among those who did not undergo revision surgery. A deterioration was seen among patients who underwent revision surgery with regard to employment status and exercise habits.
                Bookmark

                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rpot
                Revista Portuguesa de Ortopedia e Traumatologia
                Rev. Port. Ortop. Traum.
                Sociedade Portuguesa de Ortopedia e Traumatologia (Lisboa )
                1646-2122
                September 2013
                : 21
                : 3
                : 371-379
                Affiliations
                [1 ] Centro Hospitalar do Porto Portugal
                Article
                S1646-21222013000300014
                Product
                Product Information: website
                Categories
                ORTHOPEDICS

                Comments

                Comment on this article