The Rise in Single-Mother Families and Children's Cognitive Development: Evidence From Three British Birth Cohorts.

This article assessed changes in the association between single motherhood and children's verbal cognitive ability at age-11 using data from three cohorts of British children, born in 1958 (n = 10,675), 1970 (n = 8,933) and 2000 (n = 9,989), and mediation analysis. Consistent with previous studies, direct effects were small and insignificant. For those born in 1958 and 1970 indirect effects, operating through reduced economic and parental resources, were associated with -.

EARLY, LATE OR NEVER? WHEN DOES PARENTAL EDUCATION IMPACT CHILD OUTCOMES?

We estimate the causal effect of parents' education on their children's education and examine the timing of the impact. We identify the causal effect by exploiting the exogenous shift in (parents') education levels induced by the 1972 minimum school leaving age reform in England. Increasing parental education has a positive causal effect on children's outcomes that is evident in preschool assessments at age 4 and continues to be visible up to and including high-stakes examinations taken at age 16.

Implant Optimisation for Primary Hip Replacement in Patients over 60 Years with Osteoarthritis: A Cohort Study of Clinical Outcomes and Implant Costs Using Data from England and Wales.

Background: Hip replacement is one of the most commonly performed surgical procedures worldwide; hundreds of implant configurations provide options for femoral head size, joint surface material and fixation method with dramatically varying costs. Robust comparative evidence to inform the choice of implant is needed. This retrospective cohort study uses linked national databases from England and Wales to determine the optimal type of replacement for patients over 60 years undergoing hip replacement for osteoarthritis.

No functional benefit of larger femoral heads and alternative bearings at 6 months following primary hip replacement.

Background And Purpose: There has been a recent trend towards the use of greater femoral head sizes in an attempt to improve function and enhance stability after primary hip replacement. This has been associated with the use of alternative bearings, theoretically to reduce wear and improve implant longevity.

Methods: We examined the influence of these variables on patient-reported outcome measures (PROMs) for a consecutive series of primary hip replacements using National Joint Registry (NJR) and PROMs-linked data.

Have cementless and resurfacing components improved the medium-term results of hip replacement for patients under 60 years of age?

Background And Purpose: The optimal hip replacement for young patients remains unknown. We compared patient-reported outcome measures (PROMs), revision risk, and implant costs over a range of hip replacements.

Methods: We included hip replacements for osteoarthritis in patients under 60 years of age performed between 2003 and 2010 using the commonest brand of cemented, cementless, hybrid, or resurfacing prosthesis (11,622 women and 13,087 men).

A comparison of surgical approaches for primary hip arthroplasty: a cohort study of patient reported outcome measures (PROMs) and early revision using linked national databases.

The posterior and lateral approaches to primary hip arthroplasty were compared using national data from England and Wales. Specific component combinations of the most commonly used cemented and cementless implant brands were analysed separately. There was no significant difference between the approaches for all-cause revision risk (cemented: P = 0.

Center and surgeon volume influence the revision rate following unicondylar knee replacement: an analysis of 23,400 medial cemented unicondylar knee replacements.

Background: Revision rates following unicondylar knee replacement vary among reporting institutions. Revision rates from institutions involved in the design of these implants and independent single-center series are comparable with those following total knee replacement, suggesting that higher operative volumes and surgical enthusiasm improve revision outcomes.

Methods: This registry-based cohort study involved the analysis of 23,400 medial cemented Oxford unicondylar knee replacements for the treatment of osteoarthritis.

Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis.

Objective: To compare the cost effectiveness of the three most commonly chosen types of prosthesis for total hip replacement.

Design: Lifetime cost effectiveness model with parameters estimated from individual patient data obtained from three large national databases.

Setting: English National Health Service.

Mid-term survival following primary hinged total knee replacement is good irrespective of the indication for surgery.

Purpose: The use of 'hinged' knee prostheses for primary knee arthroplasty procedures is increasing. This analysis reports the rates of implant survival, modes of failure, revision details and functional outcomes with particular reference to the primary indication for surgery for a cohort of patients treated with primary hinged knee replacement.

Methods: Systematic review with supplementary analysis using data from the National Joint Registry and Department of Health.

Revision for unexplained pain following unicompartmental and total knee replacement.

Background: Unicompartmental knee arthroplasty has been associated with consistently worse implant survival rates than total knee arthroplasty in worldwide arthroplasty registers. The rate of revision and the proportion of revisions performed for unexplained knee pain after either a unicompartmental or total knee arthroplasty were studied to assess if there is evidence to support the hypothesis that the numbers of revisions performed for unexplained knee pain differ between these two implant types.

Methods: Using data from the National Joint Registry (NJR) of England and Wales, we identified 402,714 primary knee arthroplasties (366,965 total knee arthroplasties and 35,749 unicompartmental knee arthroplasties) that were consecutively entered from April 2003 to December 2010.

The association between body mass index and the outcomes of total knee arthroplasty.

Background: In the United Kingdom, organizations involved in health-care commissioning have recently introduced legislation limiting access to total knee arthroplasty through the introduction of arbitrary thresholds unsupported by the literature and based on body mass index. This study aimed to establish the relationship between body mass index and patient-reported specific and general outcomes on total knee arthroplasty.

Methods: Using national patient-reported outcome measures (PROMs) linked to the National Joint Registry, we identified 13,673 primary total knee arthroplasties performed for the treatment of osteoarthritis.

Patient reported outcome measures after revision of the infected TKR: comparison of single versus two-stage revision.

Purpose: Two-stage revision is the 'gold standard' treatment for infected total knee replacement. Single-stage revision has been successful in the hip and, in carefully chosen knee revisions, may offer the advantage of a single surgical insult with improved functional outcome.

Methods: Patient Reported Outcome Measures (PROMs) for 33 single- and 89 two-stage revisions performed for infection were analysed in combination with data from the National Joint Registry for England and Wales.

Reason for revision influences early patient outcomes after aseptic knee revision.

Background: Revision TKA less consistently produces improvements in clinical function and quality of life when compared with primary TKA. The reasons for this difference are unclear.

Questions/purposes: We determined differences in patient-reported outcomes and rates of satisfaction between primary and revision TKAs, and determine whether the reason for revision influences patient-reported outcomes after revision TKA.

Monitoring the introduction and performance of a joint replacement: the United Kingdom metal-on-metal alert.

Recent events have made us question our ability to monitor the introduction and performance of a new prosthetic joint replacement. These concerns are mirrored in many other countries, even those with joint registries and other systems for detecting poorly performing implants. In the United Kingdom, as is the case in most European Union countries, we have assessment processes in place, particularly the CE (Conformité Européenne) mark, the National Joint Registry, and the Orthopaedic Data Evaluation Panel.

Revision following patello-femoral arthoplasty.

Purpose: To describe the population of patients undergoing patello-femoral arthroplasty (PFA) revision and the reasons for which these implants are being revised. To compare this information with the observed failure patterns described in other national registries and with those seen for total knee replacement (TKR).

Methods: Using data accessed from the National Joint Registry for England and Wales, we identified 4634 primary PFA implanted between 1 April 2003 and 30 June 2010.

Functional outcome of PFC Sigma fixed and rotating-platform total knee arthroplasty. A prospective randomised controlled trial.

The aim of this study was to determine whether there is a difference in functional outcome between the PFC Sigma fixed-bearing and rotating-platform total knee replacement systems. One hundred twenty patients were randomised to receive either a fixed-bearing or rotating-platform PFC Sigma total knee replacement. Range of movement (ROM), Oxford knee score (OKS) and Knee Society score (KSS) were assessed independently before and one year after surgery.

Revision rates after primary hip and knee replacement in England between 2003 and 2006.

Background: Hip and knee replacement are some of the most frequently performed surgical procedures in the world. Resurfacing of the hip and unicondylar knee replacement are increasingly being used. There is relatively little evidence on their performance.

Assessing bone loss on radiographs of the knee in osteoarthritis: a cross-sectional study.

Objective: The only established system to grade subchondral bone attrition in knee osteoarthritis (OA) has low interobserver reliability. In this study, our aim was to convert this system into a reliable tool for the assessment of subchondral bone loss in knee OA.

Methods: Templates that were designed to outline the normal contours of the knee were overlaid onto conventional radiographs of a random sample of 100 knees of OA patients who were awaiting total knee replacement (TKR).

Equity and need when waiting for total hip replacement surgery.

Objectives: To explore sociodemographic and health status factors associated with waiting times both for first outpatient appointment and for total hip replacement surgery (THR).

Methods: A survey of THR in five former English regions was conducted between September 1996 and October 1997. Every patient listed for THR was asked to fill out a questionnaire preoperatively.

Mortality, morbidity, and 1-year outcomes of primary elective total hip arthroplasty.

No representative data exist on the risks of adverse outcomes of total hip arthroplasty (THA) in the United Kingdom. A prospective observational study of unselected THA operations was carried out in 5 U.K.

Does waiting for total hip replacement matter? Prospective cohort study.

Objectives: To assess the impact on the outcome of total hip replacement of the length of timing spent waiting for surgery.

Methods: One hundred and forty-three orthopaedic and general hospitals provided information about aspects of surgical practice for each total hip replacement conducted between September 1996 and October 1997 for publicly and privately funded operations in five English health regions. These data were linked to patient information about hip-related pain and disability status (measured using the Oxford Hip Score) before operation and at 3 and 12 months after.