Gesine H. Seeber

Purpose: Methods: Results: Conclusion:

This study aimed to learn from the experiences of patients who have undergone medical rehabilitation following hip or knee arthroplasty in the Netherlands and Germany. A qualitative focus group study was conducted among Dutch revision total hip and knee arthroplasty patients who had experience with initial rehabilitation in the Netherlands plus inpatient rehabilitation in Germany as part of the ‘Common Care’ pilot project. The focus group was recorded, transcribed verbatim and pseudonymised. A thematic analysis using an inductive approach was performed. Five patients and two family members joined the focus group. Analysis revealed five themes: language, location, therapy content, outcomes and structure. Content-wise, therapy, outcomes and structure of rehabilitation in Germany were perceived as more beneficial. In terms of location and language, patients favoured the Dutch approach. Participants generally expressed higher levels of satisfaction with the German rehabilitation trajectory versus the Dutch. The German approach’s main advantages were the more extensive therapy content and supervision plus a feeling of faster recovery, the Dutch were the home-sweet-home feeling, language and travel distance. Future research should further evaluate effects of rehabilitation policies especially on return to work.

Objective: Musculoskeletal pain is a global issue affecting millions of individuals. Healthcare provider gender bias (HCP-GB) in pain management or treatment may have implications. This study aimed to systematically (1) identify and map the scientific and grey literature as it relates to HCP-GB in the assessment, diagnosis and management of musculoskeletal pain, and (2) identify current gaps that necessitate further research. Design: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data sources: The following databases were searched: PubMed (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier), CINAHL Complete (Ovid), Academic Search Complete (EBSCOhost), Pre-Prints Database (National Library of Medicine) and Rehabilitation Reference Center from inception to August 2022 and updated in May 2025. Relevant grey literature was identified. Eligibility criteria for selecting articles: All screening was performed by two reviewers during title/abstract screening and full-text screening stages. Articles published in English, Spanish and German were included if they involved participants with musculoskeletal pain and examined HCP-GB as the dependent variable. Data extraction and synthesis: Two reviewers independently extracted data from the bibliometric, study characteristics and pain science variables. Results were descriptively mapped, and the frequency of concepts, population and characteristics was narratively reported. Results: 21 full-text articles were included. All articles were published in North America and Europe. A total of 3694 healthcare providers from various specialty areas were examined. A majority of studies (57.1%; n=12) measured HCP-GB using written case vignettes, 33.3% (n=7) used case vignettes plus virtual human pictures/videos, and 9.5% (n=2) used real patients. The influence of patients’ sex in HCP pain assessment was reported in 28.5% (n=6) of the articles, while 42.9% (n=9) reported gender bias regarding HCP non-pharmacological treatment recommendations. Male patients were more likely to receive exercise recommendations for back pain and laboratory testing, whereas female patients received more psychological treatment recommendations and counselling from their HCP. Conclusions: While there appears to be inconsistent use of the terms sex and gender, the literature informing this review suggests an existence of gender bias in the management of patients with musculoskeletal pain. Future research should be more purposeful in the use of sex/gender-related terms and consider exploring the impact of implicit bias training to rectify potential gender biases present in HCP.

To explore the relationship between sociocultural factors and three-dimensional (3D) hip and knee kinematics during low- and high-impact tasks (LIT, HIT). Eighteen active cis-gender females/women between 18 and 30 years completed three trials of bilateral and single-leg LIT and HIT. Hip and knee kinematic data were recorded and analysed. Gender Role Socialization (GRSS) and Trait Self-Objectification Scales (TSOS) assessed sociocultural factors. The association between 3D kinematics and sociocultural factors was explored during LIT and HIT. Scores on the TSOS demonstrated: (1) a moderate positive correlation with non-dominant frontal plane hip kinematics during the single-leg stand-to-sit task (Spearman ρ = 0.48, p =.043); (2) a moderate negative correlation with dominant hip frontal plane kinematics during the drop vertical jump (Spearman ρ = -0.52, p =.027); and (3) a moderate negative correlation with non-dominant knee transverse plane hip kinematics during the stand-to-sit transition (Spearman ρ = -0.52, p =.024). There were no significant correlations between GRSS and 3D hip or knee kinematics during LIT or HIT (p >.05). The TSOS correlated moderately with 3D hip and knee kinematics during LIT and HIT. These kinematic findings support the previously identified position of no return at the time of non-contact anterior cruciate ligament (ACL) injury. Clinical ramifications may include the need to incorporate self-objectification screening or inclusion in injury risk mitigation. Future research should continue to explore the role of other sociocultural factors and their influence on ACL injury risk in females/women, using updated assessment methods.

Background: Knee injury risk screening protocols predominantly employ high-impact tasks (HIT), but there is a need for low-impact movement screening alternatives. This study aimed to investigate kinematic carryover between low-impact tasks (LIT) and HIT. Methods: This study employed a cross-sectional design. Eighteen healthy, active females with no history of injury within the last six months, aged between 18–35 years completed three trials of LIT (stand-to-sit, single-leg stand-to-sit) and HIT (drop vertical jump, single-leg drop vertical jump). Hip and knee three-dimensional kinematics were evaluated during LIT and HIT. Pearson correlation analyses were used to assess kinematic relationships between LIT and HIT. A post-hoc exploratory analysis examined the consistency of kinematic directionality across tasks. Results: In the frontal plane, the dominant hip, dominant knee, and non-dominant knee during LIT demonstrated a strong positive correlation and directional consistency with the corresponding values during HITs (p < 0.001). In the transverse plane, non-dominant hip, dominant knee, and non-dominant knee kinematics during LITs demonstrated directional consistency and a strong positive correlation with respective kinematics during HITs (p < 0.001). Conclusion: The similarities in hip and knee kinematic patterns suggest that motor responses may generalize across varying task intensities. Thus, LITs may be a useful tool in early knee injury risk identification.

Objective Total hip arthroplasty (THA) is considered a highly effective treatment for end-stage hip osteoarthritis (OA). THA management in Germany and the Netherlands significantly differs. This study aims to give a first glimpse of the extent to which the way of management in both countries influences patients’ preoperative expectations, self-efficacy, and, consequently, their postoperative satisfaction. Methods This was a transnational, prospective, multicenter observational study that included a cohort of primary THA patients from Germany and the Netherlands. Preoperatively, patients completed the Hospital for Special Surgery Hip Replacement Expectations Survey (HSS-HRES), Self-Efficacy of Rehabilitation questionnaire (SER), and the Hip disability and Osteoarthritis Outcome Score (HOOS). Postoperatively, patients rated their satisfaction on a Likert scale (0-10). Scores of German and Dutch patients were compared using student t-tests and Chi-square tests. Simple and multiple regression analyses were used to assess the relationship between preoperative expectations and self-efficacy on postoperative satisfaction with country as the categorical variable. Results A total of 138 German and 152 Dutch participants were included. German patients showed significantly higher levels of preoperative expectations and self-efficacy. In the simple regression analysis, preoperative self-efficacy showed a statistically significant relationship with postoperative satisfaction (SER: B 0.129 (95%CI 0.004 - 0.255), p=.044). In the multiple regression analysis, preoperative HOOS Sport and HOOS QOL (Quality Of Life) showed a statistically significant relationship with postoperative satisfaction (HOOS Sport: B -0.020 (95%CI -0.040 to -.001), p=.042; HOOS QOL: B 0.025 (95%CI 0.002-0.048), p=.034). The country had no influence. Conclusion There is a difference in preoperative expectations and self-efficacy between German and Dutch patients. Moreover, preoperative self-efficacy influences postoperative satisfaction. However, this effect disappeared in the multiple regression analysis, nor was the country of treatment influential. On the other hand, we do see that higher preoperative scores on HOOS Sports and HOOS QOL lead to higher postoperative satisfaction.

Survival rates of lower extremity musculoskeletal tumours (LEMTs) have been increasing. However, patients continue to experience functional limitations after LEMT followed by limb-salvage surgery (LSS). This study aimed to identify factors influencing functional recovery after LSS for LEMT. A qualitative study was conducted using semi-structured interviews with a purposive sample of adult patients who underwent LSS for LEMT (n=7) and healthcare professionals (HCPs) with expertise in orthopaedic oncology (n=7). Recruitment continued until data saturation. A combination of deductive and inductive qualitative content analysis was performed to analyse the transcribed data, producing subthemes under the main International Classification of Functioning, disability and health (ICF)-model domains. Four themes were described: (1) bodily functions and structures, (2) activities and participation, (3) environmental factors, and (4) expectations. Physical aspects such as larger resection size and complications negatively affected recovery. The importance of communication strategies of tertiary HCPs and the unfamiliarity of the primary physical therapists with the disease, its surgical treatment, and related consequences were emphasised by both the interviewed patients and HCPs. Functional recovery after LSS for LEMT is a multifactorial process. To improve patient care, improving (intercollegiate) communication strategies on treatment details and expectations about functional outcomes is warranted.Implications for rehabilitationHealthcare professionals should be aware some patients experience limited functional recovery after limb-salvage surgery (LSS) for lower extremity musculoskeletal tumours.Healthcare professionals should use multiple communication strategies to bridge the gap between the information provided and what the patient recalls.Knowledge exchange and communication between primary and tertiary care should be more extensive.Multidisciplinary consultations and/or case managers are needed to address all aspects of the individual's functional recovery after LSS.

Background/Objectives: Short-stem prostheses were introduced as an alternative to conventional straight-stem prostheses. Despite their benefits, including minimally invasive approaches, soft-tissue- and bone-sparing implantation, and physiological load transfer to the metaphysis, data on postoperative complication and revision rates as well as on implant survival are scarce. Methods: A retrospective analysis of 1327 patients who underwent primary total hip arthroplasty (THA) using the Metha^® short stem between 2006 and 2023 was conducted. Complication and revision rates were analysed for the intraoperative, direct postoperative, and follow-up episodes. Implant survival was analysed with the endpoint of all-cause stem revision. Results: Intraoperative complications were observed in 3.77% of the cases and included 44 hairline cracks and 6 fractures. In 15 cases (30.0%), conversion to a straight-stem or revision implant was necessary. The direct postoperative complication rate was 2.44%, and 11 revision procedures were performed during inpatient stay (0.84%). Mean follow-up was 7 years (range 1–17). During follow-up, femoral component revision was performed in 60 cases. Aseptic loosening and stem subsidence accounted for a combined percentage of 80% of all indications. Implant survival rate was 95.66% after 5 years, 95.58% after 10 years, and 95.50% after 15 years. Conclusions: Our study provides a comprehensive analysis of postoperative complication and revision rates in a large sample undergoing primary short-stem THA. Postoperative complication rates were favourable, and the long-term implant survival rates were comparable to conventional straight-stem prostheses. Therefore, short-stem THA may be considered an alternative for younger patients.

Although healthcare systems across Europe face rather similar challenges, their organization varies widely. Even neighbouring countries substantially differ with respect to healthcare structures, processes, and resulting outcomes. Focusing on Germany and the Netherlands as examples of such neighbouring countries, this paper will first identify and discuss similarities and major differences between both systems on the macro-level of healthcare. It further argues that it is often unknown how these differences trickle down to individual healthcare organizations, providers, patients or citizens, i.e., to the meso- and micro-level of healthcare. Hence, in a second step, potential implications of macro-level differences are described by considering the examples of total hip arthroplasty, antibiotic prescription practices and resistance, and nursing home care in Germany and the Netherlands. The paper concludes with an outlook on how these differences can be studied using the example of the project “Comparison of healthcare structures, processes and outcomes in the Northern German and Dutch cross-border region” (CHARE-GD). It further discusses potential prospects and challenges of corresponding cross-national research.