Poster 73

A18

ACADEMY ANNUAL ASSEMBLY ABSTRACTS

Poster 71 Preventing Venous Thromboembolism After Total Joint Replacement. A Multifactorial Approach. Alex Leali, MD (NYU School of Medicine, New York, NY); Alex Moroz, MD; Joseph F. Fetto, MD; John G. Gianutsos, PhD. Disclosure: None. Objective: To investigate the efficacy of a comprehensive protocol encompassing hypotensive epidural anesthesia, aspirin, intermittent compression devices, along with early mobilization and postoperative exercises in patients after noncemented total hip (THR) and knee (TKR) replacements. Design: Prospective observational 2-group study. Setting: University hospital. Participants: 360 consecutive patients after noncemented THR and TKR. Interventions: All patients were allowed full weight bearing on the first postoperative day. Ankle-high pneumatic boots (foot pumps) were used early after surgery. Aspirin (325mg/d every day) was given to all patients as a pharmacologic measure to prevent thromboembolic events. Most patients were transferred to an acute rehabilitation center and received physical therapy sessions on postoperative day 1. Main Outcome Measures: The presence of deep vein thrombosis (DVT) was determined with the use of venous duplex scans on a regular basis from postoperative day 5 to day 10 (mean, 6.8). The duration of follow-up was 3 months. No patients were lost to follow-up. Results: 6 patients (3%) developed DVT in the THR group and 4 patients (2.4%) in the TKR group. None of the patients developed symptomatic pulmonary embolism during the follow-up period. Conclusion: The use of epidural anesthesia, foot pumps, early full weight-bearing ambulation, aspirin, and systematic duplex ultrasonography surveillance constitutes an effective combination to prevent DVT (2%–3%) after total joint replacements. Key Words: Arthroplasty, replacement; Rehabilitation; Venous thrombosis. Poster 72 Patient Satisfaction After Total Knee Arthroplasty: At Least 9 Years of Follow-Up. Esther Page`s, MD, PhD (Vall d’Hebron Hospital, Barcelona, Spain); Jordi Iborra, MD, PhD; Susana Rodrı´guez, MD; Ampar Cuxart, MD, PhD, e-mail: [email protected]. Disclosure: Iborra, I⫹D, Novartis Farmace´ utica employee; Other authors: None. Objective: To identify factors associated with patient satisfaction after total knee arthroplasty (TKA). Design: Longitudinal design with prospectively collected data. Setting: Rehabilitation unit in level III trauma center. Participants: 290 consecutive patients with osteoarthritis who underwent primary or revision TKA (unilateral) between 1989 and 1993 and were evaluated in December 2002. Interventions: TKA and postoperative inpatient rehabilitation. Main Outcome Measures: We used a modified questionnaire of the British Orthopaedic Association. A scale to evaluate the patient satisfaction was used at 9- to 10-year follow-up with the following categories: excellent, good, fair, and poor. A multiple logistic regression analysis was performed to identify the variables that were independently associated to fair or poor personal satisfaction. Results: Personal satisfaction was excellent or good in 75% of the patients. In the multivariable analysis, pain (OR⫽7.34; 95% CI, 3.43–16.5) and aids for gait (OR⫽2.75; 95% CI, 1.23– 4.56) were factors associated with fair or poor personal satisfaction at 9 to 10 years postsurgery. Conclusion: In osteoarthritic patients and after 9 to 10 years of follow-up, only pain and gait aids were associated with the personal satisfaction. Key Words: Arthroplasty, replacement; Knee; Personal satisfaction; Rehabilitation. Poster 73 Does Inpatient Rehabilitation Affect Long-Term Perceived Health Status After Total Hip or Knee Replacement for Osteoarthritis? Francois A. Bethoux, MD (Cleveland Clinic Foundation, Cleveland, OH); Sarah Worley, MS; George Muschler, MD, e-mail: [email protected]. Disclosure: Muschler, Research grant from Howmedica Inc; Other authors: None. Objective: To compare baseline characteristics and change in perceived health status 1 year after total hip (THR) or knee (TKR) replacement between patients who received inpatient rehabilitation (IR) and those who did not (NR). Design: Longitudinal pre-post outcomes study. Assessments were conducted before and 10 to 14 months after surgery. Setting: Large tertiary care orthopedic surgery center. Participants: Consecutive patients, scheduled for primary unilateral THR or TKR, with a diagnosis of osteoarthritis (OA). Interventions: Inpatient subacute rehabilitation. Main Outcome Measures: Medical Outcomes Survey Short-Form 36-Item Health Survey (SF-36) Physical Component Summary (PCS); and questionnaires from the American Academy of Orthopaedic Surgeons Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS). Results: Baseline data was obtained on 299 patients, and 212 patients returned a follow-up questionnaire. 80% of respondents received inpatient rehabilitation. The IR and NR groups differed significantly in age (P⬍.001), gender (P⬍.001), presence of a caregiver (P⬍.002), education level (P⫽.008), number of comorbidities (P⬍.001), symptom severity (P⫽.001), and baseline PCS (median for IR, 29.1; for NR, 35.3; P⬍.001). After adjusting for significant predictors, regression analysis showed no significant association between inpatient rehabilitation and change in PCS scores. Conclusions: Inpatient rehabilitation does not affect long-term change in perceived health status after THR or TKR for OA. However, in practice, patients referred to inpatient rehabilitation are more likely to present a combination of unfavorable characteristics, which may negatively impact their functional recovery after surgery. A randomized controlled study is needed to further investigate the usefulness of inpatient rehabilitation in this population. Key Words: Arthroplasty; Health status; Osteoarthritis; Rehabilitation.

Poster 74 Cognitive and Affective Predictors of Rehabilitation Outcome in Patients With Hip Fracture. Eric J. Lenze, MD (University of Pittsburgh, Pittsburgh, PA); Michael C. Munin, MD; Tanya Quear Jr, BS; Mary A. Dew, PhD; Joan C. Rogers, PhD; Charles F. Reynolds III, MD, e-mail: [email protected]. Disclosure: None. Objective: To identify cognitive (eg, executive function, memory) and affective (depression, apathy) factors in terms of their prediction of rehabilitation outcome in elderly patients with hip fracture. Design: Prospective naturalistic study. Setting: Community acute care hospital. Participants: 42 patients aged ⱖ60 years admitted for hip fracture. Interventions: Not applicable. Main Outcome Measure: Improvement in function as determined by change in the 13 motor items of the

Arch Phys Med Rehabil Vol 84, September 2003

FIM™ instrument. Results: Subjects were evaluated at baseline and 2 weeks later using measures of depression, apathy, and cognitive impairment. They were also measured throughout their rehabilitation (at either inpatient rehabilitation hospitals or skilled nursing facilities) using the Pittsburgh Rehabilitation Participation Scale, which was highly correlated (r⫽.57) with 2-week functional outcome. Participation scores, in turn, correlated moderately with depression scores, apathy scores, executive function scores, and memory scores. However, depression scores did not correlate significantly with functional outcome, while apathy, executive function, and memory scores did moderately correlate with outcome. Conclusions: The is the first prospective, in-depth evaluation of both cognitive and affective factors as predictors of hip fracture recovery. Although depressive symptoms were not a predictor of functional outcome, cognitive factors such as executive function and memory as well as apathy were common and moderately predictive of functional outcome. Participation scores were highly predictive of outcome; affective and cognitive problems may influence rehabilitation outcome mainly by causing poorer participation in therapy. Key Words: Cognition disorders; Depression; Hip fracture; Rehabilitation. Poster 75 Concurrent (Tandem) Cervical and Lumbar Spinal Stenosis: A 10-Year Review of 54 Hospitalized Patients. Myron M. LaBan, MD, MMSc (William Beaumont Hospital, Royal Oak, MI); Monica L. Green, MD, e-mail: [email protected]. Disclosure: None. Objective: To determine the prevalence of simultaneous cervical and lumbar spinal stenosis, that is, tandem spinal stenosis based on a 10-year review of hospital admissions. Design: A retrospective study of 460,964 hospital admissions. Setting: A 940-bed academic community hospital. Participants: A base population of 54 patients with tandem spinal stenosis. Intervention: Not applicable. Main Outcome Measures: Patients presented with multiple complaints including, among others, neurogenic claudication, progressive gait disturbances, as well as neurologic signs of both upperand lower-motoneuron dysfunction. Since 1964, when tandem spinal stenosis was first described, estimates as to its prevalence have varied widely from a low of 5% to a high of 28%. Results: 54 (.012%) cases of tandem spinal stenosis were identified in 460,964 patient admissions during a 10-year period. Of this number, 36 (66.7%) were men and 18 (33.3%) were women. 51 (94.4%) were older than 51 years of age. For all ages, the incidence rate of tandem spinal stenosis in this series was 12 per 100,000. Conclusion: With tandem spinal stenosis the symptoms of either the cervical and/or the lumbar clinical complaints are usually preeminent. Only after the primary pathology is treated does the secondary problem become evident, that is, a decompressive lumbar laminectomy unmasks Babinski reflexes as the first clinical sign of a previously occult cervical spinal stenosis. Although significant tandem spinal stenosis occurs relatively infrequently, in this series (⬎1%) its potential for interfering with patient recovery should not be overlooked. Key Words: Low back pain; Neck pain; Rehabilitation; Spinal stenosis. Poster 76 “Young” Cervical Spinal Stenosis: A Review of 118 Patients Less Than 51 Years of Age. Myron M. LaBan, MD, MMSc (William Beaumont Hospital, Royal Oak, MI); Monica L. Green, MD, e-mail: [email protected]. Disclosure: None. Objective: To determine the frequency of cervical spinal stenosis in an inpatient population ⬍51 years of age. Design: A retrospective analysis. Setting: A 940-bed community teaching hospital. Participants: 460,964 total hospital admissions over a 10-year period. 555 with cervical spinal stenosis, 118 of whom (73 men, 45 women) were identified as ⬍51 years of age. Interventions: Not applicable. Main Outcome Measures: Diagnosis of cervical spinal stenosis in an inpatient population, age, and gender. Results: Of 460,964 total hospital admissions, 555 (.12%) had cervical spinal stenosis, with an incidence rate of 120 per 100,000 and a mean age of 63.24 years. Of the 555 patients with cervical spinal stenosis, 118 (21%) were ⬍51 years of age, with an incidence rate of 26 per 100,000. Based on age stratification by decade (21–30y, 31– 40y, 41–50y), no significant differences were found between gender and age groups (P⫽.574). Each age group with cervical spinal stenosis had a proportional distribution of men and women. Using the exact test to analyze the data of this 10-year review relative to age, a preponderance of young stenotics was demonstrated in the last 5 years of the decade. Conclusion: Although spinal stenosis (both cervical and lumbar) has been regarded primarily as a disorder of the elderly, 21% of those with cervical spinal stenosis and 10% with lumbar spinal stenosis can be anticipated to be younger than 51 years of age. The notable increase in the total number of cases with cervical spinal stenosis in the last half of this 10-year review suggests that there is a growing clinical awareness of cervical spinal stenosis occurring not only in the elderly but also in the young. Key Words: Neck pain; Rehabilitation; Spinal stenosis.

Poster 77 Nocturnal Lumbosacral Pain as a Consequence of Cardiomyopathy and Lumbar Spinal Stenosis: Is Pulmonary Hypertension the Dynamic Link in Precipitating These Symptoms of Vesper’s Curse? Myron M. LaBan, MD, MMSc (William Beaumont Hospital, Royal Oak, MI); Susan R. Grabowski, DO; Ronald S. Taylor, MD, e-mail: [email protected]. Disclosure: None. Objective: To describe a “link” between the syndromes of lumbar spinal stenosis (LSS) and cardiomyopathy presenting as nocturnal lumbosacral radiculopathy (Vesper’s curse). Design: Prospective pilot study of patients with a history of cardiac disease and LSS who presented with complaints of lumbosacral pain that worsen at night and who were also identified as having pulmonary hypertension (PH). Setting: Outpatient practice. Participants: 6 patients selected from those self-identified as having nocturnal low back pain (LBP) with sciatic radiculopathy in association with LSS who also had a history of cardiomyopathy, that is, arrhythmia, previous myocardial infarction, and/or congestive heart failure. Interventions: Not applicable. Main Outcome Measures: In each case, lumbar spine imaging studies (computed tomography, magnetic resonance imaging) were obtained and complemented by electrodiagnostic testing (electromyography and/or somatosensory evoked potentials). Tricuspid valve pressure gradients were obtained by echocardi-