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.     

Porosity and Color of Maxillofacial Silicone Elastomer

Purpose: Prosthesis color production and stability as a result of pore entrapment during mixing has not been investigated for maxillofacial silicone prostheses. The purpose of this study was to investigate pore numbers and percentages of a maxillofacial silicone elastomer mixed by two different techniques, using X‐ray microfocus computerized tomography (Micro‐CT), and to investigate the effect of porosity on color reproducibility and stability after two different aging conditions. Materials and Methods: Sixty‐four disk‐shaped specimens were prepared (8‐mm diameter, 3‐mm thick) by mixing TechSil S25 silicone elastomer (Technovent, Leeds, UK) following two techniques: manual mixing (n = 32) and mechanical mixing under vacuum (n = 32). Half the specimens in each group were intrinsically pigmented, and the other half remained unpigmented. Pore numbers, volumes, and percentages were calculated using the Micro‐CT, and then specimens of each subgroup were stored in simulated sebum for 6 months (n = 8), and exposed to accelerated daylight aging for 360 hours (n = 8). Color change (ΔE) was measured at the start and end of conditioning. Pore numbers and percentages were analyzed using one‐way Analysis of Variance (ANOVA) and Dunnett’s‐T3 post‐hoc tests (p < 0.05). Independent t‐test was used to detect differences (p < 0.05) in ΔE between manually and mechanically mixed specimens, in both unpigmented and pigmented states and to detect differences (p < 0.05) in ΔE before and after conditioning within each mixing method. Results: Mechanical mixing under vacuum reduced the number and percentage of pores in comparison to manual mixing, within pigmented and unpigmented silicone specimens (p < 0.05). Perceptible ΔE between manual and mechanical mixing techniques were 5.93 and 5.18 for both unpigmented and pigmented specimens, respectively. Under sebum storage, manually mixed unpigmented specimens showed lower ΔE (p < 0.05) than those that were mechanically mixed; however, pigmented silicone specimens showed the same ΔE (p > 0.05). After light aging, mixing method had no effect on ΔE of unpigmented specimens (p > 0.05). Furthermore, mechanically mixed pigmented specimens showed lower ΔE (p < 0.05). Conclusions: Within silicone elastomers (whether pigmented or unpigmented), mechanical mixing under vacuum reduced pore numbers and percentages in comparison to manual mixing. For selected skin shade, pores affected the resultant color of prosthesis (color reproducibility). Additionally, silicone pores affected silicone color stability upon service. Clinical significance: In fabricating maxillofacial prostheses, mechanically mixing silicone under vacuum produces pore‐free prostheses, tending to enhance their color production and stability.     

The constructs ''stress'' and ''coping'' as a rationale for nursing activities

In this paper the constructs 'stress' and 'coping' as defined in an earlier paper (Clarke 1984) are used as a perspective for the interpretation of disease processes. The second half of the paper is devoted to an examination of the nurse's role which is seen as concerned with helping patients in the reduction or avoidance of stress and the strengthening of coping. General hospital nursing and district nursing is analysed in greater depth than other types of nursing.