Total Hip and Knee Arthroplasty in Patients with Multiple Sclerosis

Abstract

CME/CNE Information Activity Available Online: To access the article, post-test, and evaluation online, go to http://www.cmscscholar.org. Target Audience: The target audience for this activity is physicians, physician assistants, nursing professionals, and other health-care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: Accreditation Statement: In support of improving patient care, this activity has been planned and implemented by the Consortium of Multiple Sclerosis Centers (CMSC) and Delaware Media Group. CMSC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Physician Credit The CMSC designates this journal-based activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurse Credit The CMSC designates this enduring material for 0.5 contact hours (none in the area of pharmacology). Disclosures: Editor in Chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has disclosed no relevant financial relationships.Francois Bethoux, MD, has served as reviewer for this activity. She has disclosed no relevant financial relationships.Laurie Scudder, DNP, NP, has disclosed no relevant financial relationships.Josef Maxwell Gutman, MD, has disclosed no relevant financial relationships.Kelvin Kim, BA, has received consulting fees from Smith & Nephew and Intelijoint that are unrelated to this work.Ran Schwarzkopf, MD, MSc, served on the scientific advisory boards for Biogen and Genentech and received research support from the Guthy-Jackson Charitable Foundation, National Multiple Sclerosis Society, Biogen, EMD Serono, Genzyme, and Novartis.Ilya Kister, MD, One peer reviewer for the IJMSC has received consulting fees from Biogen, Sanofi Genzyme, Ibsen Pharmaceutical, and Teva and has done contracted research for Astellas, Merck, and Biogen. The other peer reviewer has disclosed no relevant financial relationships. The staff at the IJMSC, CMSC, and Delaware Media Group who are in a position to influence content have disclosed no relevant financial relationships. Note: Disclosures listed for authors are those applicable at the time of their work on this project and within the previous 12 months. Method of Participation: Release Date: October 1, 2018 Valid for Credit Through: October 1, 2019 In order to receive CME/CNE credit, participants must: Statements of Credit are awarded upon successful completion of the post-test with a passing score of >70% and the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. CMSC and Delaware Media Group do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of CMSC or Delaware Media Group. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health-care professionals without first evaluating their patients' conditions, considering possible contraindications or risks, reviewing any applicable manufacturer's product information, and comparing any therapeutic approach with the recommendations of other authorities.

Total Hip Arthroplasty in Multiple Sclerosis

“…The average postoperative pain, measured by the visual analogue scale, was significantly reduced compared to the preoperative situation (8.6 vs. 2.9). 70 % of patients would recommend the operation [16]. The modified Harris Hip Score indicated a significantly less favorable functional outcome in the MS cohort (average 66 vs. 80 points; p < 0.001).…”

“…Existing studies on hip arthroplasty in multiple sclerosis. Newman et al 2017 [5] US database analysis (NIS) 5899 MS vs. 2 723 652 non-MS patients Rondon et al 2018 [15] Retrospective cohort study with control group 76 MS vs. 187 non-MS patients (62 THAs and 46 TKAs) Total hip arthroplasty, TKA = Total knee arthroplastymid-term revision rate of 13% was observed in an smaller retrospective study with 30 MS patients[16]. Lower revision rates of 7.3 % were found in the work of Newman et al, where the THA survival rate after 8 years was also 91.5 %[14].…”

Total Hip Arthroplasty in Patients With Neurological Conditions: A Systematic Review

“…MS patients demonstrated lower modified Harris Hip Score and Hip Disability and Osteoarthritis Outcome Score Joint Replacement hip function scores than control despite receiving increased physiotherapy care although this may be partly reflective of progression of their disease during the period of this study as demonstrated by worsening of mMSIS scores. Results from the included MS THA studies are displayed in [ 53 ] Figure 4 .

Figure 4 Total hip arthroplasty in multiple sclerosis results.

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Postoperative Outcomes Following Posterior Lumbar Fusion in Patients With Multiple Sclerosis

“…22 Our findings corroborate the literature in regards to the increased risk of UTI. 14,15,17,23 Almost 96% of patients with MS have bladder dysfunction, which predisposes patients to UTI. 24 This fact along with the high prevalence of use of steroids and other immunologic therapies can exacerbate their risk for infections.…”

“…There have been several orthopedic studies analyzing postoperative complications of patients with neuromuscular conditions undergoing total hip arthroplasty 12,14–17. These studies demonstrated that patients with MS are at increased risk for postoperative complications, postoperative infections, and other medical complications.…”