Consequences of non-vascular trans-femoral amputation: a survey of quality of life, prosthetic use and problems

Individuals with unilateral trans-femoral amputations due to non-vascular causes were studied in a mailed survey designed to investigate health-related quality of life (HRQL), prosthetic use and problems. The Swedish SF-36 Health Survey and a structured questionnaire designed for trans-femoral amputees were used. The series consisted of 97 subjects (60 men, 37 women), aged 20 to 69 years with a mean of 22 years since the amputation. Trauma was the cause of amputation in 55%, tumour in 35% and other causes in 10%. Ninety-two (92) subjects (95%) had a prosthesis and 80 (82%) used it daily. General HRQL was significantly lower than Swedish age- and gender-matched norms in all dimensions as measured by SF-36. Most frequently reported problems that had led to reduction in quality of life were heat/sweating in the prosthetic socket (72%), sores/skin irritation from the socket (62%), inability to walk in woods and fields (61%) and inability to walk quickly (59%). Close to half were troubled by stump pain (51%), phantom limb pain (48%), back pain (47%) and pain in the other leg (46%). One fourth considered themselves to have a poor or extremely poor overall situation. Transfemoral amputation, due to non-vascular causes, has an evident impact on quality of life and there are considerable problems related to the amputation and the prosthesis. Efforts to improve the physical and the psychological well-being for this group, with a long life expectancy, are needed.     

Osseointegrated trans-femoral amputation prostheses: prospective results of general and condition-specific quality of life in 18 patients at 2-year follow-up

This is the first report on prospective outcome for individuals treated with bone-anchored trans-femoral amputation prostheses (OI-prostheses) using the method of osseointegration. The aim was to analyze general and condition-specific health related quality of life (HRQL) at 2-year follow-up as compared to the preoperative situation. The study population consists of the first 18 consecutively treated patients (8 male/10 female, mean age 45 years) in a clinical investigation with amputations mainly caused by trauma and tumour. At inclusion the mean time since the amputation was 15 years (10 months - 33 years). Two self-report questionnaires were answered preoperatively and at follow-up: the SF-36 Health Survey (SF-36) and the Questionnaire for persons with a Transfemoral Amputation (Q-TFA). At follow-up 17/18 patients used the OI-prosthesis; one did not due to pain and loosening of the implant. Four of the scales of the SF-36 (Physical Functioning, Role Functioning Physical, Bodily Pain and Physical Component Score) and all four scores of Q-TFA (Prosthetic Use, Prosthetic Mobility, Problems and Global Health) were statistically significantly improved at follow-up showing superior general physical HRQL, increased prosthetic use, better prosthetic mobility, fewer problems and a better global amputation situation. Thus, osseointegrated prostheses represent a promising development in the rehabilitation of individuals with transfemoral amputation and increase their quality of life.     

A comparison of two different prosthetic feet on functional capacity,pain severity,satisfaction level and quality of life in high activity patients with unilateral traumatic transtibial amputation

AimPrescribing optimal prosthetic feet to ensure successful rehabilitation is difficult since there are no generally established clinical guidelines based on objective data. The aim of the study was to compare functional capacity, pain intensity, satisfaction level and quality of life (QoL) of high activity patients with unilateral transtibial amputation using non-articulated carbon foot (non-articulating ankle, NAA) with those of using carbon foot with hydraulic ankle (articulating hydraulic ankle, AHA).MethodsForty-two patients (21 with NAA and 21 with AHA) with unilateral transtibial traumatic amputation from tertiary rehabilitation center were participated in this cross-sectional study. Outcome measures were six-minute walking test (6MWT), Visual Analogue Scale (VAS) and the Short Form-36 (SF-36). The level of difficulty experienced during ambulating on different terrains was recorded on a 5-point Likert scale.ResultsThere were no significant statistical differences in 6MWT, pain intensity, prosthetic foot satisfaction level and QoL between the two groups. The level of difficulty experienced during descending ramps was higher in the NAA group than in the AHA group (p = 0.016). The most common reason for dissatisfaction were inflexibility for the NAA group (14.3%), frequent dysfunction for the AHA group (28.6%).ConclusionOur results showed that the level of difficulty experienced during descending ramps was higher in the NAA group than in the AHA group. Further studies with larger sample sizes are needed comparing microprocessor AHAs with NAA and AHA.     

Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study

BACKGROUND: Diabetic foot ulcers, foot infection, Charcot foot arthropathy, and lower extremity amputation have a severe negative effect on the health-related quality of life in individuals with diabetes. The purpose of this study was to determine if there is a relationship between these negative effects and cognitive impairment or clinical depression. METHODS: Sixty adults with diabetes completed the Short Form 36 (SF-36) Health Survey questionnaire, two screening examinations for cognitive function (Mini Mental Exam and Clock-Drawing Test), and a screening examination for depression (Zung Self-Rating Depression Scale). The two focus groups were composed of 20 subjects each who were undergoing treatment for (1) diabetic foot ulcers or active Charcot foot arthropathy or (2) lower extremity amputation. Twenty diabetic individuals without foot-related morbidity but with evidence of peripheral neuropathy as measured by insensitivity to the Semmes-Weinstein 5.07 (10 gm) monofilament comprised the control group. RESULTS: The SF-36 Health Survey score was significantly impaired in both the diabetic foot ulcer and Charcot arthropathy group (p <0.001) and amputee (p <0.000) group. There was no evidence of cognitive impairment or depression in either group. The negative impact on health-related quality of life was similar in both focus groups (p <0.314). CONCLUSION: The results of this preliminary study suggest that the negative impact on health-related quality of life in diabetic patients with foot ulcers or Charcot foot arthropathy may be as severe as in similar patients with lower extremity amputation. The negative effect did not seem to cause cognitive impairment or clinical depression in either focus group.     

The functional outcome of severe, open tibial fractures managed with early fixation and flap coverage

We studied the outcome and functional status of 33 patients with 34 severe open tibial fractures (Gustilo grade IIIb and IIIc). The treatment regime consisted of radical debridement, immediate bony stabilisation and early soft-tissue cover using a muscle flap (free or rotational). The review included standardised assessments of health-related quality of life (SF-36 and Euroqol) and measurement of the following parameters: gait, the use of walking aids, limb-length discrepancy, knee and ankle joint function, muscle wasting and the cosmetic appearance of the limb. Personal comments and overall patient satisfaction were also recorded. The mean follow-up was 46 months (15 to 80). There were 30 Gustilo grade IIIb fractures and and four grade IIIc fractures. Of the 33 patients, 29 had primary internal fixation and four, external fixation; 11 (34%) later required further surgery to achieve union and two needed bone transport procedures to reconstruct large segmental defects. The mean time to union was 41 weeks (12 to 104). Two patients (6.1%) developed deep infection; both resolved with treatment. The mean SF-36 physical and mental scores were 49 and 62 respectively. The mean state of health score for the Euroqol was 68. Patients with isolated tibial fractures had a better outcome than those with other associated injuries on both scoring systems. Knee stiffness was noted in seven patients (21%) and ankle stiffness in 19 (56%); 12 patients (41%) returned to work. Our results compare favourably with previous outcome measurements published for both limb salvage and amputation. All patients were pleased to have retained their limbs.     

Long-term functional status and quality of life after lower extremity revascularization

OBJECTIVE: The objective of this study was to assess the longer term (up to 7 years) functional status and quality of life outcomes from lower extremity revascularization. METHODS: This study was designed as a cross-sectional telephone survey and chart review at the University of Minnesota Hospital. The subjects were patients who underwent their first lower extremity revascularization procedure or a primary amputation for vascular disease between January 1, 1989, and January 31, 1995, who had granted consent or had died. The main outcome measures were ability to walk, SF-36 physical function, SF-12, subsequent amputation, and death. RESULTS: The medical records for all 329 subjects were reviewed after the qualifying procedures for details of the primary procedure (62.6% arterial bypass graft, 36.8% angioplasty, 0.6% atherectomy), comorbidities (64% diabetics), severity of disease, and other vascular risk factors. All 166 patients who were living were surveyed by telephone between June and August 1996. At 7 years after the qualifying procedure, 73% of the patients who were alive still had the qualifying limb, although 63% of the patients had died. Overall, at the time of the follow-up examination (1 to 7.5 years after the qualifying procedure), 65% of the patients who were living were able to walk independently and 43% had little or no limitation in walking several blocks. In a multiple regression model, patients with diabetes and patients who were older were less likely to be able to walk at follow-up examination and had a worse functional status on the SF-36 and a lower physical health on the SF-12. Number of years since the procedure was not a predictor in any of the analyses. CONCLUSION: Although the long-term mortality rate is high in the population that undergoes lower limb revascularization, the survivors are likely to retain their limb over time and have good functional status.     

Symptoms, disability, and quality of life in patients with carpal tunnel syndrome

We used validated outcome instruments to measure symptoms, disability, and health-related quality of life in 58 patients with carpal tunnel syndrome (CTS). The patients completed the CTS instrument before and 6 weeks, 3 months, and 6 months after surgery and the Short Form-36 (SF-36) before and 3 months after surgery. The size of clinical change detected by each outcome measure was estimated by the standardized response mean (mean change/ standard deviation of the change). Large improvement was observed for the CTS symptom scale (mean standardized response, 1.4-1.9) and function scale (0.8-1.1). Improvement in SF-36 scales was large for pain (1.0) and moderate for physical role, mental health, and the physical component summary (0.5-0.6). Compared with the general population SF-36 norms (n = 2,181), CTS patients had significantly worse scores for physical functioning, physical role, pain, vitality, and the physical component summary before surgery. After surgery, SF-36 scores had normalized except for physical role and the physical component summary.     

Clinical Results and Failure Mechanisms of a Nonmodular Constrained Knee Without Stem Extensions

IntroductionIn the setting of persistent knee instability despite appropriate ligament balancing for primary total knee arthroplasty, most surgeons advocate the use of an implant with increased articular constraint. These implants are commonly supplemented with stem extensions to improve stress transfer and decrease the risk of aseptic loosening. However, disadvantages exist with the use of stem extensions, including increased cost, intramedullary invasion, and diaphyseal pain. The objectives of this study were to (1) compare the clinical results as assessed by the Knee Society, Hospital for Special Surgery, and SF-12 scores, (2) determine the incidence of failure as defined by the need for a revision procedure, and (3) to analyze the causes or modes of failure of a nonmodular constrained condylar knee without the use of stem extensions versus a conventional, posterior-stabilized design.ResultsThe mean age of patients in the NMC cohort was 72.3 ± 10.2 years, and the mean length of follow-up was 7.3 ± 2.1 years. The mean age of the PS cohort was 67.1 ± 8.7 years, with a mean follow-up of 6.1 ± 2.2 years. No statistically significant differences in the HSS, Knee Society, or SF-12 scores were appreciated between the two cohorts. The revision rate in the NMC cohort was 4.2 % compared to 4.3 % for the PS cohort. The most common cause of failure in the NMC cohort was femoral component loosening, all of which occurred when Palacos cement was used for fixation. NMC components (55.6 %) implanted with Palacos cement failed due to femoral component loosening. In contrast, all PS components requiring revision were revised for persistent instability.DiscussionAt mid-term follow-up, NMC prostheses without stem extensions have excellent clinical results and are a viable option for patients with ligamentous instability. The use of Palacos cement in this scenario was associated with a high rate of femoral component loosening, possibly due to the decreased intrusion depth of Palacos when compared to Simplex cement.     

Quality of life before and after intensive care

Quality of life is often thought to be poor before and after intensive care unit admission. The aim of this study was to investigate changes in quality of life before and after intensive care. A prospective cohort study of 300 consecutive patients admitted to intensive care was performed in a Scottish Teaching Hospital. Quality of life was assessed premorbidly and 3, 6 and 12 months after intensive care admission for surviving patients using SF-36 as well as EQ-5D scores at 12 months. The median value for age was 60.5 years and for APACHE II score, 18. The mean length of stay was 6.7 days. SF-36 physical component scores decreased from premorbid values at 3 months (p = 0.05) and then returned to premorbid values at 12 months (p < 0.001). The mean physical scores were below the population norm at all time points but the mean mental scores were similar or higher than these population norms. Patients who died after intensive care discharge had lower quality of life scores than did survivors (all p < 0.01). Poor premorbid quality of life was demonstrated and appears to reduce after ICU discharge. For survivors there was a slow increase in physical quality of life to premorbid levels by the end of the first year but these remained lower than in the general population. ICU patients experience a considerable longer-term burden of ill health.     

Quality of life and educational benefit among orthopedic surgery residents: a prospective,multicentre comparison of the night float and the standard call systems

Background

Given recent evolving guidelines regarding postcall clinical relief of residents and emphasis on quality of life, novel strategies are required for implementing call schedules. The night float system has been used by some institutions as a strategy to decrease the burden of call on resident quality of life in level-1 trauma centres. The purpose of this study was to determine whether there are differences in quality of life, work-related stressors and educational experience between orthopedic surgery residents in the night float and standard call systems at 2 level-1 trauma centres.

Methods

We conducted a prospective cohort study at 2 level-1 trauma hospitals comprising a standard call (1 night in 4) group and a night float (5 14-hour shifts [5 pm–7 am] from Monday to Friday) group for each hospital. Over the course of a 6-month rotation, each resident completed 3 weeks of night float. The remainder of the time on the trauma service consists of clinical duties from 6:30 am to 5:30 pm on a daily basis and intermittent coverage of weekend call only. Residents completed the Short Form-36 (SF-36) general quality-of-life questionnaire, as well as questionnaires on stress level and educational experience before the rotation (baseline) and at 2, 4 and 6 months. We performed an analysis of covariance to compare between-group differences using the baseline scores as covariates and Wilcoxon signed-rank tests (nonparametric) to determine if the residents’ SF-36 scores were different from the age- and sex-matched Canadian norms. We analyzed predictors of resident quality of life using multivariable mixed models.

Results

Seven residents were in the standard call group and 9 in the night float group, for a total of 16 residents (all men, mean age 35.1 yr). Controlling for between-group differences at baseline, residents on the night float rotation had significantly lower role physical, bodily pain, social function and physical component scale scores over the 6-month observation period. Compared with the Canadian normative population, the night float group had significantly lower SF-36 scores in all subscales except for bodily pain. There were no differences noted between the standard call group and Canadian norms at 6 months. No differences in educational benefits and stress level were measured between the 2 groups. Lack of time for physical activity was only significant in the night float group. Regression analysis demonstrated that the increased number of hours in hospital correlated with significantly lower SF-36 scores in almost all domains.

Conclusion

Our study suggests that the residents in the standard call group had better health-related quality of life compared with those in the night float group. No differences existed in subjective educational benefits and stress level between the groups.     

Preinjury status: are orthopaedic trauma patients different than the general population?

OBJECTIVE: To describe the preinjury health-related quality of life (HRQL) of orthopaedic trauma patients admitted to Level I trauma centers relative to the general population. DESIGN: Prospective cohort study using retrospectively collected preinjury HRQL measures. SETTING: Two Level I adult trauma centers in Melbourne, Australia. PARTICIPANTS: A total of 2388 admitted orthopaedic trauma patients aged > or = 18 years were included, captured by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) between October 2003 and January 2006. Patients with a significant head injury (Abbreviated Injury Scale severity score >2), dementia, mental illness, mental disability, who were non-English speakers, or who were postoperatively confused were excluded. MAIN OUTCOME MEASUREMENTS: The 12-item Short Form Health Survey (SF-12). RESULTS: The preinjury SF-12 was obtained for 1839 patients [median (interquartile range) of 6 (3-12) days postinjury]. The VOTOR population reported mean physical SF-12 scores above population norms (50.9 vs. 48.9, P < 0.001). The differences were predominant in men and confined to patients aged 18 to 54 years. The mean mental SF-12 scores of the VOTOR population were also greater than population norms (54.5 vs. 52.4, P < 0.001) and this was most apparent for women. CONCLUSIONS: Establishing the preinjury HRQL of trauma patients is important for evaluating the quality of orthopaedic trauma patient outcomes. Reliance on population norms for this purpose may lead to an underestimation of the impact of injury in particular age and sex subgroups, but given the size of the differences seen, any underestimation would be small. Where individual preinjury data cannot be collected, population norms could be used as a reasonable estimate of preinjury patient status for assessing quality of recovery.     

Energy expenditure during treadmill walking before and after vertical banded gastroplasty: a one-year follow-up study in 11 obese women.

OBJECTIVE: To find out whether weight reduction induced by vertical banded gastroplasty (VBG) alters the energy expenditure in severely obese women during treadmill walking. DESIGN: A prospective one year follow-up study, patients being their own controls. SETTING: University hospital, Sweden. SUBJECTS: A consecutive series of 11 women who had VBG. MAIN OUTCOME MEASURES: Indirect calorimetry, body mass index (BMI), preset and comfortable walking speeds, heart rate, perceived exertion, and quality of life. RESULTS: 11 patients were evaluated. Mean BMI (kg/ml) decreased from 41 (range 36-46) before to 32 (range 25-37) 12 months postoperatively. The energy expenditure decreased significantly both at comfortable and preset walking speeds. The comfortable walking speed increased from 2.7 km x h(-1) (range 1.3-3.4) before operation to 3.8 (range 2.0-4.2) one year postoperatively (p = 0.003). All bodily variables in the SF-36 questionnaire showed improvement from 6 months onwards. CONCLUSION: Weight reduction in women reduces the energy expenditure during walking both at comfortable and preset speeds. The comfortable walking speed is increased. The improvements are reflected in the patients' own assessment.     

Does Use of a Powered Ankle-foot Prosthesis Restore Whole-body Angular Momentum During Walking at Different Speeds?

Background

Whole-body angular momentum (H) influences fall risk, is tightly regulated during walking, and is primarily controlled by muscle force generation. People with transtibial amputations using passive-elastic prostheses typically have greater H compared with nonamputees.

Questions/purposes

(1) Do people with unilateral transtibial amputations using passive-elastic prostheses have greater sagittal and frontal plane H ranges of motion during walking compared with nonamputees and compared with using powered prostheses? (2) Does use of powered ankle-foot prostheses result in equivalent H ranges in all planes of motion compared with nonamputees during walking as a result of normative prosthetic ankle power generation?

Methods

Eight patients with a unilateral transtibial amputation and eight nonamputees walked 0.75, 1.00, 1.25, 1.50, and 1.75 m/s while we measured kinematics and ground reaction forces. We calculated H for participants using their passive-elastic prosthesis and a powered ankle-foot prosthesis and for nonamputees at each speed.

Results

Patients using passive-elastic prostheses had 32% to 59% greater sagittal H ranges during the affected leg stance phase compared with nonamputees at 1.00 to 1.75 m/s (p < 0.05). Patients using passive-elastic prostheses had 5% and 9% greater sagittal H ranges compared with using powered prostheses at 1.25 and 1.50 m/s, respectively (p < 0.05). Participants using passive-elastic prostheses had 29% and 17% greater frontal H ranges at 0.75 and 1.50 m/s, respectively, compared with nonamputees (p < 0.05). Surprisingly, patients using powered prostheses had 26% to 50% greater sagittal H ranges during the affected leg stance phase compared with nonamputees at 1.00 to 1.75 m/s (p < 0.05). Patients using powered prostheses also had 26% greater frontal H range compared with nonamputees at 0.75 m/s (p < 0.05).

Conclusions

People with a transtibial amputation may more effectively regulate H at two specific walking speeds when using powered compared with passive-elastic prostheses.

Clinical Relevance

Our results support the hypothesis that an ankle-foot prosthesis capable of providing net positive work during the stance phase of walking reduces sagittal plane H; future studies are needed to validate our biomechanical findings with larger numbers of patients and should determine whether powered prostheses can decrease the risk of falls in patients with a transtibial amputation.     

Evaluation of physical capacity and quality of life in osteoporotic women

Introduction: Osteoporotic vertebral fractures result in increased kyphosis angle, an alteration that may lead to disturbance in physical capacity. Objective: We sought to evaluate physical capacity and disability in a group of osteoporotic patients. Material and methods: Fifteen women with osteoporosis and vertebral fractures (G1), 20 women with osteoporosis without vertebral fractures (G2), and 20 control women (G3) were selected. The variables of physical capacity were measured using a treadmill. The patients spent 4 min standing quietly, 4 min walking at 3 km/h, and 10 min walking at 4 km/h. The SF-36 questionnaire was also applied. Results: The results showed that women with osteoporosis and vertebral fractures (G1) had increased kyphosis angle (median 60°), while the angle was 43.5° for G2 and 37° for G3. Oxygen consumption (VO₂ (kg)), METS (metabolic equivalent), and energy expenditure (kcal/h) during the standing period were higher in G1 than in G2 (G1 vs G2, p=0.016, p=0.017, and p=0.012, respectively), whereas no difference in these parameters was observed between groups during the walking period. The energy expenditure during walking at 3 km/h and at 4 km/h showed a correlation with thoracic kyphosis in G1 (p=0.01 and p=0.017, respectively). No difference in SF-36 scores was observed between the three groups. Conclusion: Energy expenditure showed a correlation with the angle of thoracic kyphosis. Patients with or without osteoporosis showed the same energy expenditure during the walking period. The SF-36 score was similar for the three groups.     

等待肺移植患者生存质量及其影响因素研究

目的了解等待肺移植患者的生存质量及其影响因素。方法采用简明健康问卷(SF-36)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和领悟社会支持量表(PSSS)对55例等待肺移植患者进行调查。结果等待肺移植患者SF-36各维度得分23.18~74.57,显著低于常模(均P<0.01);SAS、SDS得分分别为48.09±9.06、52.18±9.98,显著高于常模(均P<0.01);PSSS社会总支持因子得分为5.56±1.04,其中家庭内支持因子得分显著高于家庭外支持因子(P<0.05)。多因素分析结果显示生存质量的影响因素为呼吸困难和抑郁(P<0.05,P<0.01)。结论等待肺移植患者的生存质量较低,其生存质量受呼吸困难和抑郁的影响。医务人员应从患者生理及心理方面进行有效干预,以提高其生存质量。     

Objective assessment of quality of life following panproctocolectomy and ileostomy for ulcerative colitis.

A panproctocolectomy and permanent ileostomy improves the quality of life of those suffering from ulcerative colitis. However, it is not known how the quality of life of patients who had this operation compares with that of the general population. The aim of this study was to measure the quality of life of these patients using a reliable and validated instrument, and to determine whether these patients enjoy a similar quality of life to the general population. Forty-nine consecutive patients (31 males and 18 females, median age 49 years), who had a panproctocolectomy with a permanent ileostomy for ulcerative colitis in one of three hospitals in Tayside, UK from 1992-1997, participated in the study. The median number of months (range) post-surgery was 29 (12-72). Participants answered a well-validated generic questionnaire on health-related quality of life: the new SF-36 version 2.0 (SF-36II). The results were then compared with population norms of similar age and gender, derived from the Third Oxford Healthy Lifestyle Survey and published by the Health Services Research Unit of the University of Oxford. The mean score difference between patient and population SF-36II scores (95% confidence intervals) were as follows: physical functioning (PF): -3.9 (-9.4, 1.6); role-physical (RP): -4.1 (-9.9, 1.7); role-emotional (RE): -0.1 (-5.6, 5.4); energy-vitality (EV): 8.2 (2.8-13.6); body pain (BP): 6.6 (0.3, 12.9); social functioning (SF): 3.7 (-2.7, 10.1); mental health (MH): 2.5 (-2.5, 7.5); general health perception (GHP): -1.8 (-7.6, 4.0). Despite the fact that these patients underwent major surgery and have a permanent stoma, their quality of life as measured by the SF-36II was very similar to that of the general population.     

%VO2max as an indicator of prosthetic rehabilitation outcome after dysvascular amputation

In this study, independent ambulation of at least 100 metres with/without a cane was regarded as successful prosthetic rehabilitation. The subjects were classified into two groups according to this criterion at the time of discharge. The successful group attained this performance, the other group failed to reach this level. The successful group included 8 unilateral trans-femoral amputees aged 72.2 +/- 2.1 years who underwent amputation at more than 70 years, and succeeded in walking with a prosthesis. The group which failed included 9 unilateral trans-femoral amputees aged 63.2 +/- 2.1 years who underwent amputation between the ages of 60-65 years, and had great difficulty in walking with a prosthesis. The purpose of this research was to investigate whether or not %VO2max as an indicator of physical fitness is useful in predicting prosthetic rehabilitation outcome after dysvascular amputation by comparing these two groups. Evaluation of physical fitness was conducted before the subjects began prosthetic rehabilitation. Information about each subject before fitting with a prosthesis was collected retrospectively from clinical charts made during admission. The successful group were capable of strenuous exercise, reaching the intensity of 50% VO2max or more. In the group which failed only one reached the intensity of 50% VO2max. The working capacity of 50% VO2max or greater would appear to be a valid initial guideline level of physical fitness at which an amputee can expect to succeed in walking with a prosthesis. Apart from physical fitness, a lesser number of comorbidity, good ability to stand on the remaining leg, and a strong will to walk were found to be important factors contributing to successful prosthetic rehabilitation. This study also showed that age alone was not an important factor.     

Clinical impact of tamsulosin on generic and symptom-specific quality of life for benign prostatic hyperplasia patients: Using international prostate symptom score and Rand Medical Outcomes Study 36-item Health Survey

AIM: To examine the efficiency of alpha1-blocker treatment on disease-specific and generic quality of life (QOL) in men with clinically diagnosed benign prostatic hyperplasia (BPH), the improvement of QOL scores with International prostate symptom score (I-PSS) and Rand Medical Outcomes Study 36-item Health Survey (SF-36) was prospectively analyzed. METHODS: A total of 68 newly diagnosed patients with symptomatic BPH that satisfied all inclusion and none of the exclusion criteria were prospectively recruited. All patients received 0.2 mg/day of tamsulosin for 12 weeks. All patients underwent pretreatment documentation of lower urinary tract symptoms (LUTS) and assessment of symptom-specific QOL. Symptoms and general health-related QOL (HRQOL) were assessed using the I-PSS and SF-36, respectively. Also, other objective variables, such as prostate volume, maximal urinary flow and postvoid residual urine volume, were evaluated. RESULTS: After 12 weeks, decrease in I-PSS was 27% compared with baseline (from 16.4 +/- 7.18 to 11.9 +/- 7.56). All questionnaires in the I-PSS showed improvement after tamsulosin treatment and the I-PSS QOL score was improved from 4.51 +/- 1.14 to 3.17 +/- 1.38 (P < 0.0001) at 12 weeks after tamsulosin administration. In intragroup comparisons of HRQOL scores with age-gender adjusted SF-36 Japanese national norms, three SF-36 subscales (bodily pain, BP; social function, SF; and mental health, MH) were worse in the BPH group aged over 70 years, while younger BPH groups aged <70 had better mean SF-36 physical function (PF) scores compared with age-gender adjusted Japanese national norms. In the BPH group with a prostatic volume > or =20 mL, three mean SF-36 scales (BP, SF and MH) were significantly improved after tamsulosin treatment. It is noteworthy that these SF-36 subscales were identical to those observed to worsen in the older BPH group compared to Japanese national norms. CONCLUSIONS: Treatment with tamsulosin for symptomatic BPH patients is associated with significant improvement in the generic HRQOL, in addition to disease-specific QOL and symptoms, at 3 months after drug administration. In particularly, for generic HRQOL with SF-36, tamsulosin treatment can efficiently improve three mean SF-36 subscales (BP, SF and MH) that are decreased in older BPH patients.     

Large-diameter metal-on-metal cementless total hip arthroplasty in the elderly

To evaluate the clinical effectiveness and complications of large-diameter metal-on-metal prostheses, particularly in the elderly, we performed cementless total hip arthroplasty (THA) using metal-on-metal prostheses with large-diameter femoral heads (mean, 45 mm) in 59 patients (average age, 75.1 years) between January 2004 and December 2005. All procedures were performed using a posterolateral approach and spinal anesthesia. Average follow-up was 65 months. Pre- and postoperative Harris Hip Scores and SF-36 questionnaire results were recorded for all patients to evaluate the level of pain relief, improvement in physical function, and changes in quality of life. Postoperative radiographic images were used to document areas of osteolysis and probable aseptic loosening. Average preoperative Harris Hip Score was 36.1±5.7, compared to 69.4±8.3 at last follow-up (P<.01). Average preoperative SF-36 score was 33.6±7.4, compared to 71.8±6.4 at last follow-up (P<.01). There were no dislocations, aseptic loosening, or revisions. Our findings suggest that metal-on-metal cementless prostheses with large-diameter femoral heads in THA can produce satisfactory results with good durability, a low rate of dislocation and aseptic loosening, and a low incidence of revisions in the short term. The benefits of this technique for elderly patients, especially those with weak muscle power and reduced cognitive function, include avoidance of severe cement-injection complications and early functional recovery.