scholarly journals Gender Influences on Shoulder Arthroplasty

2022 ◽  
Author(s):  
Nicole J. Hung ◽  
Stephanie E. Wong
Keyword(s):  
Shoulder Arthroplasty ◽  
Perioperative Complications ◽  
Postoperative Outcomes ◽  
Female Patients ◽  
Increased Risk ◽  
Functional Scores ◽  
Hip And Knee Arthroplasty ◽  
Male Patients ◽  
Gender Based ◽  
Preoperative Expectations

Abstract Purpose of Review As the incidence of shoulder arthroplasty continues to increase, there is growing interest in patient-based factors that may predict outcomes. Based on existing literature demonstrating gender-based disparities following total hip and knee arthroplasty, gender may also influence shoulder arthroplasty. The purpose of this review is to discuss the recent literature on the influence of gender on shoulder arthroplasty, focusing on differences in preoperative parameters, perioperative complications, and postoperative outcomes. Recent Findings While both female and male patients generally benefit from shoulder arthroplasty, several differences may exist in preoperative factors, acute perioperative complications, and postoperative outcomes. Preoperatively, female patients undergo shoulder arthroplasty at an older age compared to their male counterparts. They may also have greater levels of preoperative disability and different preoperative expectations. Perioperatively, female patients may be at increased risk of extended length of stay, postoperative thromboembolic events, and blood transfusion. Postoperatively, female patients may achieve lower postoperative functional scores and decreased range of motion compared to male patients. Differences in postoperative functional scores may be influenced by gender-based differences in activities of daily living. Finally, female patients may be at greater risk for periprosthetic fracture and aseptic loosening while male patients appear to be at greater risk for periprosthetic infection and revision surgery. Summary Current literature on the influence of gender on shoulder arthroplasty is limited and conflicting. Further research is necessary to delineate how gender affects patients at the pre- and postoperative levels to better inform decision-making and outcomes.

scholarly journals P0118ANEMIA AS A RISK FACTOR FOR CONTRAST-INDUCED NEPHROPATHY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Emna Chaabouni ◽  
Hela Jbali ◽  
Najjar Mariem ◽  
Mzoughi Khadija ◽  
Zouaghi Karim
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Strong Predictor ◽  
Coronary Intervention ◽  
Severe Anemia ◽  
Contrast Induced Nephropathy ◽  
Female Patients ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Male Patients

Abstract Background and Aims Contrast-induced nephropathy is a potentially serious complication following coronary angiography and percutaneous coronary intervention . The association between severity of anemia and Contrast-induced nephropathy following coronary angiography is not well-established. In this prospective study, we aimed at assessing the association of anemia of various severity with the risk of Contrast-induced nephropathy in patients who underwent coronary angiography Method We prospectively enrolled 158 patients who underwent coronary angiography with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department . CIN was defined as an increase in serum creatinine level >25% or 0.5 mg/dL after 48 hours and anemia was defined as a value of Hb level ≤ 13 g/dl in male patients or ≤ 12 g/dl in female patients. Patients were stratified into three subgroups—mild (11.1 to 13.0 g/dL) in male patients and (11.1 to 12.0 g/dL) in female patients, moderate (9.1 to 11.0 g/dL) and severe anemia (7.0 to 9.0 g/dL). we used a multivariable logistic-regression model. Results 158 patients (females = 36.1%, mean age 60.0 ± 11 years) who underwent coronary angiography, 15 (9,5%) developed Contrast-induced nephropathy . Presence of anemia was associated with increased risk of developing Contrast-induced nephropathy (OR = 3.04, 95% confidence interval [CI] = 1.03 to 8.96, p= 0,043). Risk of Contrast-induced nephropathy was increasingly higher with increasing severity of the anemia; mild (OR = 1.67, 95% CI = 1.38 to 2.17, p=0,036), moderate (OR = 3.3, 95% CI = 0.61 to 10.6, p=0,028) .There was no patient with severe anemia. Conclusion In conclusion, severity of anemia is a strong predictor of CIN following coronary angiography.

Severe Periodontitis Is Associated with Myocardial Infarction in Females

2018 ◽  
Vol 97 (10) ◽  
pp. 1114-1121 ◽  
Author(s):  
E. Nordendahl ◽  
A. Gustafsson ◽  
A. Norhammar ◽  
P. Näsman ◽  
L. Rydén ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Alveolar Bone ◽  
Dental Health ◽  
Diabetes Education ◽  
Female Patients ◽  
Increased Risk ◽  
Severe Periodontitis ◽  
Male Patients ◽  
Control Study

The aim of the present study was to test the hypothesis that there is a sex difference in the association between periodontitis (PD) and a first myocardial infarction (MI). The analysis in the case-control study was based on 785 patients (147 females and 638 males) with a first MI and 792 matched controls (147 females and 645 males), screened for cardiovascular risk factors and subjected to a panoramic dental X-ray. Periodontal status was defined by alveolar bone loss and diagnosed as no PD (≥80% remaining alveolar bone), mild to moderate PD (66% to 79%), or severe PD (<66%). Logistic regression was used when analyzing PD as a risk factor for MI, adjusting for age, smoking, diabetes, education, and marital status. The mean age was 64 ± 7 y for females and 62 ± 8 y for males. Severe PD was more common in female patients than female controls (14 vs. 4%, P = 0.005), with an increased risk for severe PD among female patients with a first MI (odds ratio [OR] = 3.92, 95% confidence interval [CI] =1.53 to 10.00, P = 0.005), which remained (OR = 3.72, 95% CI = 1.24 to 11.16, P = 0.005) after adjustments. Male patients had more severe PD (7% vs. 4%; P = 0.005) than male controls and an increased risk for severe PD (OR = 1.88, 95% CI = 1.14 to 3.11, P = 0.005), but this association did not remain following adjustment (OR = 1.67, 95% CI = 0.97 to 2.84, NS). Severe PD was associated with MI in both females and males. After adjustments for relevant confounders, this association did, however, remain only in females. These data underline the importance of considering poor dental health when evaluating cardiovascular risk, especially in females.

scholarly journals Driving after total knee and hip arthroplasty - an observational study from the perspective of rehabilitative orthopaedic therapy

2021 ◽  
Author(s):  
Tiberiu-Adrian Lazar ◽  
Martin Edelmann ◽  
Friedemann Awiszus ◽  
Christoph Lohmann
Keyword(s):  
Observational Study ◽  
Motor Vehicle ◽  
Place Of Residence ◽  
Fitness To Drive ◽  
Female Patients ◽  
Increased Risk ◽  
Total Knee ◽  
Male Patients ◽  
Knee And Hip Arthroplasty ◽  
Structured Questionnaire

Abstract Objective Considering the legal stipulations in Germany regarding fitness to drive a motor vehicle, the aim of this study is to find out when patients with a TKA or THA actually take up driving again after surgery; how the replaced joint, side, gender, place of residence and physician’s recommendations, influences the patient in making the decision to start driving again. Background For a large proportion of the population, especially those residing in the countryside, the use of a car for daily activities is indispensable. Following a TKA or THA procedure, the overseeing physician will usually recommend refraining from driving, sometimes up to 12 weeks after surgery with a major social and economical impact on patient’s life. Methods 92 eligible participants, contained within the frame of a prospective experimental observational study, were contacted via telephone 12 weeks after surgery and interviewed using a structured questionnaire. The answers were statistically analysed using SPSS®. Discussion There were statistically significant differences regarding operated side, gender and place of residence. Male patients drove in the 6th and 7th postoperative week, while female patients drove in the 8th and 9th postoperative week. For 58.6% of patients the reasoning for the first post-operative drive was medical: the journey to physiotherapy or to a doctor’s appointment. TKA impaired patients the most. Patients recovering from a TKA drive considerably later. Patients recovering from a right sided TKA have an increased risk by a factor of nine, not to become an “early driver”. Female patients who underwent TKA had an increased risk by a factor of 21, of becoming a “late driver”. Conclusions The rehabilitation following a right sided TKA proved a challenge with regard to the reuptake of driving. This should be taken into account when planning the course of therapy for patients who are regular drivers. Female patients could benefit from special training. Trial registration: DRKS00018693. Registered 20 September 2019 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00018693

Preoperative bisphosphonate treatment may adversely affect the outcome after shoulder arthroplasty

2019 ◽  
Vol 101-B (2) ◽  
pp. 147-153 ◽  
Author(s):  
D. H. Mai ◽  
C. Oh ◽  
M. E. Doany ◽  
A. S. Rokito ◽  
Y. W. Kwon ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Shoulder Arthroplasty ◽  
Intraoperative Complications ◽  
Statistical Significance ◽  
Previous Treatment ◽  
Primary Outcome Measure ◽  
Postoperative Outcomes ◽  
Bisphosphonate Treatment ◽  
Male Patients ◽  
One Year

Aims The aim of this study was to investigate the effects of preoperative bisphosphonate treatment on the intra- and postoperative outcomes of arthroplasty of the shoulder. The hypothesis was that previous bisphosphonate treatment would adversely affect both intra- and postoperative outcomes. Patients and Methods A retrospective cohort study was conducted involving patients undergoing arthroplasty of the shoulder, at a single institution. Two patients with no previous bisphosphonate treatment were matched to each patient who had received this treatment preoperatively by gender, age, race, ethnicity, body mass index (BMI), and type of arthroplasty. Previous bisphosphonate treatment was defined as treatment occurring during the three-year period before the arthroplasty. The primary outcome measure was the incidence of intraoperative complications and those occurring at one and two years postoperatively. A total of 87 patients were included: 29 in the bisphosphonates-exposed (BP+) group and 58 in the non-exposed (BP-) group. In the BP+ group, there were 26 female and three male patients, with a mean age of 71.4 years (51 to 87). In the BP- group, there were 52 female and six male patients, with a mean age of 72.1 years (53 to 88). Results Previous treatment with bisphosphonates was positively associated with intraoperative complications (fracture; odds ratio (OR) 39.40, 95% confidence interval (CI) 2.42 to 6305.70) and one-year postoperative complications (OR 7.83, 95% CI 1.11 to 128.82), but did not achieve statistical significance for complications two years postoperatively (OR 3.45, 95% CI 0.65 to 25.28). The power was 63% for complications at one year. Conclusion Patients who are treated with bisphosphonates during the three-year period before shoulder arthroplasty have a greater risk of intraoperative and one-year postoperative complications compared with those without this previous treatment.

scholarly journals Study of Gender-based In-Hospital Mortality Difference in Patients with Acute Myocardial Infarction

2018 ◽  
Vol 32 (2) ◽  
pp. 119-124
Author(s):  
NK Majumder ◽  
MR Khan ◽  
Nupur Kar ◽  
M Akhtaruzzaman ◽  
TA Choudhury ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Female Group ◽  
Male Counterpart ◽  
Factors Affecting ◽  
Female Patients ◽  
Significant Difference ◽  
Male Patients ◽  
Gender Based

Background: In-hospital mortality in female patients with acute myocardial infarction (AMI) and factors affecting this may be different from those of their male counterpart. The aim of the current study was to compare the in-hospital mortality between female and male patients with AMI and to compare the differences in age, risk factors, treatment given and complications between them.Methods: Total 200 nonrandomised patients with a definite diagnosis of AMI admittedover a period of one year (January 2008 - December 2008) were enrolled in the study, in which 100 female patients were considered as cases and 100 male patients as controls. Both groups were studied prospectively.Datawere collected in prefixed questionnaire and data sheet and were analysed using SPSS software.Results: mean age of the female patients was significantly higher than that of their male counterpart (57.0±10.1 years and 53.3±10.3 years respectively, p=0.029). Diabetes mellitus and hyperlipidemia were significantly higher in females than those in males (39% vs 24%, p=0.022 and 45% vs 32%, p=0.040 respectively), while smoking was staggeringly higher among the males (59%) compared to the females (4%) (p<0.001). However, no significant difference was observed between the groups in terms of hypertension (p=0.666).Pre-hospital delay (more than 12 hours after onset of chest pain) was significantly higher in the female group than that in the male group (72% vs 58%,p=0.038). Streptokinase was significantly underused in females (15.6%) compared to that used in males (32.2%) (p=0.011). The use of b-receptor blockerswas also significantly less in females than that in males (63% vs 75%, p=0.046).Death was significantly higher in the females (21%) than that in the males (10%) (p=0.032). Unstable angina, re-infarction and congestive heart failure were somewhat higher in the female subjects compared to their male counterparts (40% vs 34%, 2% vs 1% and 32% vs 23% respectively) though the differences did not seem significant (p=0.380, p=0.561 and p=0.154 respectively). Arrhythmias did not differ significantly between the groups (p1>0.05).Conclusion: Female patients with AMI had significantly higher in-hospital mortality. Early hospitalization and optimal treatment are crucial to decrease mortality in female patients.Bangladesh Heart Journal 2017; 32(2) : 119-124

scholarly journals Prospective Comparative Study of Preoperative Expectations and Postoperative Outcomes in Anatomic and Reverse Shoulder Arthroplasty

Joints ◽  
2021 ◽  
Author(s):  
Cassandra Lawrence ◽  
Mark Lazarus ◽  
Joseph Abboud ◽  
Gerald Williams ◽  
Surena Namdari
Keyword(s):  
Shoulder Arthroplasty ◽  
Functional Outcomes ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Linear Regression Analysis ◽  
Postoperative Outcomes ◽  
Consecutive Series ◽  
Multivariate Linear Regression Analysis ◽  
Significant Difference ◽  
Preoperative Expectations

Abstract Background Compared with anatomic total shoulder arthroplasty (aTSA), reverse total shoulder arthroplasty (RTSA) is associated with lower preoperative and postoperative outcome scores and range of motion. It is unknown whether patients' preoperative expectations of surgery are lower in RTSA compared with aTSA. The purpose of this study was to assess preoperative patient expectations and postoperative outcomes in aTSA and RTSA. Methods A consecutive series of patients undergoing primary aTSA for diagnosis of osteoarthritis or primary RTSA for diagnosis of rotator cuff tear arthropathy were studied prospectively. Expectations were evaluated using the validated Hospital for Special Surgery's Shoulder Surgery Expectations Survey. Baseline demographics, comorbidities, and social factors were collected. Baseline and 2 years postoperative American Shoulder and Elbow Surgeons (ASES) score, visual analog scale pain, Single Assessment Number Evaluation (SANE), and patient satisfaction were obtained. Results There were 128 patients (64 aTSA and 64 RTSA). There was no significant difference in total preoperative expectations score between groups. On multivariate linear regression analysis, aTSA (p = 0.024) and younger age (p = 0.018) were associated with higher expectations for improved ability to exercise. Changes in preoperative to postoperative ASES (p = 0.004) and SANE (p = 0.001) scores were higher in the aTSA group. Total preoperative expectations score was not correlated with postoperative functional outcomes or satisfaction in either group. In the aTSA group, expectations for participation in exercise were positively correlated with changes in preoperative to postoperative ASES score (p = 0.01) and SANE score (p = 0.01). Conclusion Though patients undergoing primary aTSA demonstrated greater improvement in functional outcome than those undergoing primary RTSA, both groups reported similar aggregate preoperative expectations. Those undergoing aTSA had higher expectations for return to exercise which was positively correlated with postoperative functional outcomes. Level of Evidence Level II, prospective cohort study.

scholarly journals Driving After Total Knee and Hip Arthroplasty - an Observational Study From the Perspective of Rehabilitative Orthopaedic Therapy

2020 ◽  
Author(s):  
Tiberiu-Adrian Lazar ◽  
Martin Edelmann ◽  
Christoph Lohmann ◽  
Friedemann Awiszus
Keyword(s):  
Observational Study ◽  
Hip Arthroplasty ◽  
Physical Therapist ◽  
Place Of Residence ◽  
Female Patients ◽  
Increased Risk ◽  
Total Knee ◽  
Male Patients ◽  
Knee And Hip Arthroplasty ◽  
Structured Questionnaire

Abstract Background: For a large proportion of the population, especially those residing in the countryside, the use of a car for daily activities is indispensable. Following a total knee – (TKA) or hip arthroplasty (THA) the overseeing doctor or physical therapist will usually recommend refraining from driving for several weeks. The aim of this study is to find out when patients with TKA or THA actually take up driving again, and how the replaced joint, side, gender and place of residence influences this decision. Methods: 92 eligible participants, contained within the frame of a prospective experimental observational study, were contacted via telephone 12 weeks after surgery and interviewed using a structured questionnaire. The answers were statistically analysed using SPSS®.Discussion: There were statistically significant differences regarding operated side, gender and place of residence. Male patients drove in the 6th and 7th postoperative week, while female patients drove in the 8th and 9th postoperative week. For 58.6% of patients the reasoning for the first post-operative drive was medical: the journey to physiotherapy or to a doctor’s appointment. TKA impaired patients the most. Patients recovering from a TKA drive considerably later. Patients recovering from a right sided TKA have an increased risk by a factor of nine, not to become an “early driver”. Female patients who underwent TKA had an increased risk by a factor of 21, of becoming a “late driver”. Conclusions: The rehabilitation following a right sided TKA proved a challenge with regard to the reuptake of driving. This should be taken into account when planning the course of therapy for patients who are regular drivers. Female patients could benefit from special training. Trial registration: DRKS00018693. Registered 20 September 2019 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00018693

scholarly journals Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048312
Author(s):  
Peter D Mark ◽  
Martin Frydland ◽  
Ole Kristian Lerche Helgestad ◽  
Lene Holmvang ◽  
Jacob Eifer Møller ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Natriuretic Peptide ◽  
Prospective Cohort ◽  
St Elevation Myocardial Infarction ◽  
University Hospitals ◽  
Female Patients ◽  
Increased Risk ◽  
All Cause Mortality ◽  
St Elevation ◽  
Male Patients

ObjectiveTo determine the predictive value of pro-C-type natriuretic peptide (pro-CNP) measurement in plasma sampled on admission from patients presenting with ST-elevation myocardial infarction (STEMI).DesignProspective cohort study.SettingTwo University Hospitals in Denmark.Participants1760 consecutive patients (470 females and 1290 males) with confirmed STEMI.Main outcomes and measuresThe main outcome was all-cause mortality at 1 year after presentation and the primary measure was pro-CNP concentration in plasma at admission in all patients and longitudinal measurements in a consecutive subgroup of 287 patients. A reference population (n=688) defined cut-off values of increased pro-CNP concentrations.ResultsIn all patients, an increased pro-CNP concentration was associated with a higher all-cause mortality after 1 year (HR 1.6, 95% CI 1.1 to 2.4, Plogrank=0.009) including an interaction of sex (p=0.03). In separate sex-stratified analyses, female patients showed increased all-cause mortality (HR1 year 2.6, 95% CI 1.5 to 4.6), Plogrank <0.001), whereas no differences were found in male patients (HR1 year 1.1, 95% CI 0.7 to 1.9, Plogrank=0.66). After adjusting for potential risk factors, we found increased pro-CNP concentrations≥the median value to be independently associated with increased risk of mortality in female patients within 1 year (HR per 1 pmol/L increase: 1.04, 95% CI 1.01 to 1.06, p=0.007). Moreover, we found indications of sex differences in pro-CNP concentrations over time (higher pro-CNP in males (4.4, 95% CI −0.28 to 9.1 pmol/L, p=0.07) and interaction of sex and time (p=0.13)), and that hypertension was independently associated with higher pro-CNP (4.5, 95% CI 0.6 to 8.4 pmol/L, p=0.03).ConclusionsIn female but not male patients presenting with STEMI, high concentrations of pro-CNP (≥median) at admission independently indicate a higher risk of all-cause mortality. The findings are remarkably specific for female patients, suggesting a different vascular phenotype beyond traditional measures of coronary artery flow compared with male patients.

The use of tobacco is a modifiable risk factor for poor outcomes and readmissions after shoulder arthroplasty

2020 ◽  
pp. 1-6
Author(s):  
Andrew M Schwartz ◽  
Kevin Xavier Farley ◽  
Susanne H Boden ◽  
Jacob M Wilson ◽  
Charles A Daly ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Shoulder Arthroplasty ◽  
Surgical Complications ◽  
Total Shoulder Arthroplasty ◽  
Multivariate Regression Analysis ◽  
Wound Complications ◽  
Increased Risk ◽  
Hip And Knee Arthroplasty ◽  
The Usa ◽  
The Impact

Aims The impact of tobacco use on readmission and medical and surgical complications has been documented in hip and knee arthroplasty. However, there remains little information about the effect of smoking on the outcome after total shoulder arthroplasty (TSA). We hypothesized that active smokers are at an increased risk of poor medical and surgial outcomes after TSA. Methods Data for patients who underwent arthroplasty of the shoulder in the USA between January 2011 and December 2015 were obtained from the National Readmission Database, and 90-day readmissions and complications were documented using validated coding methods. Multivariate regression analysis was performed to quantify the risk of smoking on the outcome after TSA, while controlling for patient demographics, comorbidities, and hospital-level confounding factors. Results A total of 196,325 non-smokers (93.1%) and 14,461 smokers (6.9%) underwent TSA during the five-year study period. Smokers had significantly increased rates of 30- and 90-day readmission (p = 0.025 and 0.001, respectively), revision within 90 days (p < 0.001), infection (p < 0.001), wound complications (p < 0.001), and instability of the prosthesis (p < 0.001). They were also at significantly greater risk of suffering from pneumonia (p < 0.001), sepsis (p = 0.001), and myocardial infarction (p < 0.001), postoperatively. Conclusion Smokers have an increased risk of readmission and medical and surgical complications after TSA. These risks are similar to those found for smokers after hip and knee arthroplasty. Many surgeons choose to avoid these elective procedures in patients who smoke. The increased risks should be considered when counselling patients who smoke before undertaking TSA.

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