A sensitivity analysis was performed to assess the effect that variation of key model parameters had on the overall outcome of the model.
Results: This Markov model favored early total knee arthroplasty over nonoperative treatment across all plausible values for most input parameters assessed during one-way sensitivity analysis. Total knee arthroplasty was more expensive during the first 3.5 years because of higher initial costs, but over thirty years the cost benefit of total knee arthroplasty was $69,800 (2012 U.S. dollars). Only when lost wages were <17.7 equivalent work days per year for patients treated nonoperatively or when the rate of returning to work after total knee arthroplasty was <81% did the model
favor nonoperative treatment.
Conclusions: The results of the current study demonstrated that the total economic cost to compound inhibitor society for treatment of severe knee osteoarthritis
in a relatively young working person is markedly lower with total knee arthroplasty than it is with nonoperative treatment. The increasing financial restrictions on health-care this website providers in the U.S. necessitate careful consideration of the economic impact of different treatment options from the societal perspective.”
“Osteonecrosis of the femoral head (ONFH) typically affects relatively young, active patients and frequently follows an unrelenting course resulting in considerable loss of function. In human immunodeficiency virus-infected patients, ONFH is a growing problem. Etiology, pathogenesis, and treatment of ONFH in these patients remain controversial. We analyzed retrospectively patients with ONFH in a series of 815 patients followed in our AIDS reference center. Six patients out of the 815 were affected by ONFH (0.74%). The sex ratio was 1. Two of the six patients (33.3%) had
no evidence of risk factor, whereas four patients (66.6%) had risk factors. One patient had three cumulated risk factors which were corticosteroids, chemotherapy, and radiotherapy. For this patient, the onset time for ONFH was shorter (36 months). It is difficult to attribute the effect to any single class of antiretroviral agents because combination therapy is standard of care, and a change in therapies is common. All classes of antiretroviral drugs have been used: protease inhibitors (mean use duration of 15.2 months before the ONFH onset), non-nucleoside reverse transcriptase CBL0137 Apoptosis inhibitor inhibitors (12 months), and nucleoside reverse transcriptase inhibitors (40.5 months). ONFH was bilateral in four cases (66.6%) and unilateral in two cases (33.3%). One patient had other osteonecrosis location (both shoulders). ONFH was classified on plain radiography stage IV in five patients and stage III in one patient. All patients received initial medical treatment. It consisted of painkillers and non-weight bearing of the hip. All were finally operated on by total hip arthroplasty (THA). The average interval between ONFH diagnosis and the first THA was 10.