The Charted Care Collection (05/04/2021)

May 4, 2021 Jessica Kluetz

The Chartered Care Collection (05/04/2021)

The Chartered Care Collection provides a review of the latest, pertinent publications from the medical literature on aging. I have selected interesting articles that describe some of the most current research that may be relevant to the loved one in your care. Each article will be referenced if you desire to read more of the study, but I will give a brief synopsis of each study so you are aware of the latest research. Let’s get to The Collection!

The Chartered Care Collection

Here we are again with the once-monthly wrap-up of the latest research out in the scientific journals. This month, I am leaning more on the musculoskeletal aspects of rehabilitation and quality of life.

Let me first start with a study that looked at something all too common in the elderly. This study by Alessandro Aprato and colleagues looked at the correlation between early mobility after a femur/hip fracture and decreased mortality. All of the subjects in the study were patients greater than 65 years of age who required surgical treatment of a hip fracture. The data looked at age, gender, time to surgery, BMI, type of fracture, anesthesia score, the ability to walk within 10 days after the fracture and mortality at six and 12 months.

The data showed that having surgery within 48 hours of the fracture was associated with a reduced risk of mortality at six and 12 months compared to those who had surgery delayed for various reasons. The data also showed that those who walked within ten days of the fracture also had a reduced mortality at six and 12 months post-fracture.

There are multiple factors that contribute to when a surgery can be performed and when the patient can walk. In general, a surgery will be held up due to a medical issue, thus pointing to the fact that that person might have some underlying health issues leading to a more complicated recovery. In addition, those who might be late ambulators after a surgery might not have been very ambulatory prior to the surgery, thus also pointing towards possible underlying health issues or frailty. What can be gleaned from this, however, is that for those who are capable, don’t delay in the treatment and don’t delay in moving with rehabilitation!

The next study published in Journal of Orthopaedics, Trauma and Rehabilitation looked at 80 patients undergoing a total knee replacement with a standard rehabilitation program afterwards. The data collected from the participants included age, sex and body mass index (BMI)(separated in BMI of 29.9 or less and 30 or greater). The outcome of the surgery looked specifically at the health-related quality of life, which was measured with pain and stiffness, condition in daily life, general activities and health conditions.

In short, this study showed that BMI was not a significant predictor of health-related quality of life. It did show that females had a worse health-related quality of life recovery than males. There are several aspects of quality of life and health that are related to BMI, however, an elevated BMI should not be the one thing keeping someone from undergoing a total knee replacement if it will possibly lead to an improvement in knee pain, and eventually an increase in activity.

(Related blog post: What To Expect After A Knee Replacement)

Moving on, let’s look at the next study regarding treatment for osteoarthritis (OA). John Belk and colleagues compared Platelet-Rich Plasma (PRP) to Hyaluronic Acid (HA) for the treatment of knee osteoarthritis. Participants in the study all had OA and were divided into groups that received either PRP or HA. There were further subcategories within these two main groups, but in general, it was found that the patients treated with PRP showed significantly better pain scores than those who received HA. I want to see people keep moving as long as possible, so I think it is important to report on studies that show better efficacy of one treatment over another to help in making decisions on which treatment one might try to have to manage pain.

(Related blog post: Should I Get A Knee Replacement?)

The final study I want to mention is one I read regarding possible complications after carpal tunnel decompression surgery. This study was published in the journal The Lancet Rheumatology. Carpal tunnel syndrome (CTS) is very common. Initially, it is managed by treatments such as splinting and steroid injections. Unfortunately, these conservative treatments are not always successful, and patients often require surgery to release the nerve.

This study looked at data from a nationwide group of adults who underwent this surgery in England and reviewed complications that occurred within 30 and 90 days. In short, post-surgical complications were quite rare, affecting just 0.7% within 30 days of the surgery and 0.82% within 90 days of the surgery. It did find that males had an increased incidence of serious local complications. The most common complications were opening of the surgical wound site and tendon injury.

That covers this month for the Chartered Care Collection. I hope you are able to let these studies give you some peace of mind, especially if you or a loved one are considering one of the procedures mentioned in this review.

References:

Aprato, A., et al. No Rest for Elderly Femur Fracture Patients: Early Surgery and Early Ambulation Decrease Mortality. J Orthopedic Traumatology. 2020, Aug, 30;21(1):12.

Belk, J., et al. Platelet-Rich Plasma versus Hyaluronic Acid for Knee Osteoarthritis. A Systematic Review and Meta-Analysis Randomized Controlled Trial. Clinical Sports Medicine Update. Am J Sports Med. 2021, January; 49(1): 249-260.

Lane, J., et al. Serious Postoperative Complications and Reoperation after Carpal Tunnel Decompression Surgery in England: A Nationwide Cohort Analysis. Lancet Rheumat. 2021, January; 3:e49-e57.

Tanaka, S., et al. Does Body Mass Index Influence Quality of Life Recovery in Individuals who Underwent Total Knee Arthroplasty: A Prospective Study. J Orthop Trauma Rehabil. 2020, December: 27(2):107-112.

Share your thoughts on these articles in the Comments section.