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Letters to the Editor to:

Scientific Articles:
Aileen M. Davis, Zoe Agnidis, Elizabeth Badley, Alex Kiss, James P. Waddell, and Allan E. Gross
Predictors of Functional Outcome Two Years Following Revision Hip Arthroplasty
J Bone Joint Surg Am 2006; 88: 685-691 [Abstract] [Full text] [PDF]
*Letters to the Editor: Submit a response to this article

Electronic letters published:

[Read Letter to the Editor] Dr. Davis et al respond to Dr El Masry et al
Aileen M. Davis, Ph.D., Zoe Agnidis, MScPT, Elizabeth Badley, Ph.D., Alex Kiss, Ph.D., James P. Waddell, M.D., FRCSC, and Allan E. Grocc, M.D., FRCSC   (5 June 2006)
[Read Letter to the Editor] Predictors of Functional Outcome Two Years Following Revision Hip Arthroplasty
Mohamed A El Masry, Sivaharan Thambapillay.   (15 May 2006)

Dr. Davis et al respond to Dr El Masry et al 5 June 2006
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Aileen M. Davis, Ph.D.,
Scientist
Outcomes and Population Health, ACREU, Toronto Western Research Institute,
Zoe Agnidis, MScPT, Elizabeth Badley, Ph.D., Alex Kiss, Ph.D., James P. Waddell, M.D., FRCSC, and Allan E. Grocc, M.D., FRCSC

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Re: Dr. Davis et al respond to Dr El Masry et al

adavis{at}uhnresearch.ca Aileen M. Davis, Ph.D., et al.

We thank Mahomed A. El Masry and colleagues for their comments and wish to respond to them.

In order to report the number of participants on combination therapy, the paper data collection sheets would have to be retrieved from storage at great cost as the electronic database does not capture these data.

El Masry et al correctly indicate that the post-operative pain scores may be confounded by a change in medications. Given that many individuals undergoing joint arthroplasty and, hence, revision arthroplasty have arthritis in multiple joints, it is possible that medication changes related to arthritis as opposed to the surgery were made over a two year period. People may experience problems in another joint or have had some injury that resulted in a medication change and/or affected their WOMAC scores. The WOMAC does specify that the patient is to respond based on their hip in an attempt to prevent this problem. However, we are also aware that questions are starting to be raised as to whether individuals can cognitively separate their experiences so as to ensure that responses are isolated to an individual joint.

Thank you for the opportunity to respond.
Predictors of Functional Outcome Two Years Following Revision Hip Arthroplasty 15 May 2006
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Mohamed A El Masry,
Specialist Registrar
Leeds General Infirmary,
Sivaharan Thambapillay.

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Re: Predictors of Functional Outcome Two Years Following Revision Hip Arthroplasty

drmedoelmasry{at}yahoo.co.uk Mohamed A El Masry, et al.

To the Editor:

We read with interest the paper “Predictors of Functional Outcome Two Years Following Revision Hip Arthroplasty". In presenting their results, the authors mentioned that the majority of patients (88 out of 126, 70%) were using Non Steroidal anti-inflammatory medications (NSAIDs) and/or pain medication. In other words, they consider NSAIDs as a non-pain medication. This is a point of contention as NSAIDs are part of the analgesic ladder i.e. a non-narcotic drug (1). In addition, the authors have not been clear about the number of patients being on combination therapy as table II clearly showed all patients to be on monotherapy only.

Secondly, they compared the preoperative and postoperative analgesic requirements and found a significant difference of 49% and 28% (p<0.001) respectively. This figure only compared patients taking pain medication pre- and post-operatively and not NSAID. However, table II showed a proportional increase in the use of NSAIDs preoperatively (26 patients; 21%) compared to postoperatively (55 patients, 44%) which was not commented on by the authors. We can only assume that the patients have been prescribed a NSAID rather than a narcotic / non-narcotic drug throughout their postoperative course for an unknown reason. Hence, the post –operative pain scores may be confounded by this particular factor.

References

1. http://bnf.org/bnf/bnf/51/3457.htm