The subjective knee value is a valid single-item survey to assess knee function in common knee disorders

The Subjective Hip Value is a Valid, Reliable, and Responsive Instrument for Assessing Hip Function in Primary Total Hip Arthroplasty

BACKGROUND

Patient-reported outcome measures are essential tools in clinical decision-making and research. Multi-item scores like the modified Harris Hip Score (mHHS) are time-consuming to collect and evaluate. The subjective hip value (SHV), as a single-item value, assesses hip function with one question: "What is the overall percent value of your hip if a completely normal hip represents 100%?". The aims of our study were to assess the psychometric properties, and thus validity, reliability, and responsiveness; and to define the minimal clinically important difference (MCID) of the SHV in patients undergoing total hip arthroplasty.

METHODS

A total of 137 consecutive patients who underwent primary total hip arthroplasty between June 2020 and August 2021 were prospectively enrolled. A SHV and mHHS were collected preoperatively and at follow-ups (6 weeks, 3 months, 6 months, and 1 year). Validity, reliability, responsiveness, MCID, and floor/ceiling effects were evaluated.

RESULTS

There was a significant correlation between SHV and mHHS (P = .001) preoperatively (rs = 0.532), 6 weeks (rs = 0.649), 3 months (rs = 0.765), 6 months (rs = 0.854), and after 1 year (rs = 0.879). Test-retest reliability (rs = 0.74; P = .001) and responsiveness (rs = 0.24; P = .007) showed significant correlations. The MCID for SHV was 10.06%. Floor- and ceiling-effects were comparable to the mHHS.

CONCLUSIONS

The SHV is a valid, reliable, and responsive single-item score for the assessment of hip joint function in arthroplasty patients. It can detect clinically relevant changes in joint function and is easy to collect and interpret, which justifies its implementation in clinical practice.

Patients Regularly Return to Medium- and Low-Impact Types of Sporting Activities Following Distal Femoral or Proximal Tibial Replacement After Resection of a Primary Bone Sarcoma

BACKGROUND

Little is known about the resumption of sporting activities following megaprosthetic reconstruction of the distal femur and proximal tibia after resection of a bone sarcoma. Thus, the aims of our study were: (1) to assess the functional outcome; (2) to evaluate pre- and post-operatively performed sporting activities; and (3) to identify potential beneficial and limiting factors.

METHODS

Between 1993 and 2015, a total of 230 patients underwent distal femoral replacement (DFR), and 96 patients underwent proximal tibial replacement (PTR). The exclusion criteria were death, amputation, living overseas, and a congenital disability. Functional outcome and sporting activities were assessed using the Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), Forgotten Joint Score (FJS), subjective knee value (SKV), the Tegner activity score (TS), and the modified weighted activity score (WAS).

RESULTS

There were 93 patients who had a median follow-up of 182 months (interquartile range (IQR) 130 to 260) after DFR with the following median scores: MSTS 18 (IQR 12 to 23), TESS 75% (IQR 60 to 84), FJS 25 (IQR 8 to 40), SKV 53% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 0 to 8). There were 42 patients who had a median follow-up of 193 months (IQR 137 to 244) after PTR had the following median scores: MSTS 17 (IQR 15 to 22), TESS 78% (IQR 68 to 88), FJS 32 (IQR 20 to 46), SKV 60% (IQR 40 to 70), TS 3 (IQR 3 to 4), and WAS 4 (IQR 1 to 10). Postoperatively, 61% of DFR and 76% of PTR patients participated in at least one sporting activity.

CONCLUSIONS

The functional outcome is overall good with a regular resumption of sporting activities. Patients' age at surgery and higher preoperative sporting levels were associated with better functional outcomes and higher postoperative sporting activity.

Postoperative Shoulder Function Assessment: Proposing the Concept of "Forgotten Shoulder" Over "Normal Shoulder" as the New Standard in Single Assessment Numerical Evaluation

A major limitation of Patient-Reported Outcomes Measures (PROMs) postoperatively is the ceiling effect, where patients report the maximum score, making it difficult to differentiate between different conditions. Our findings regarding the SSV-Sport reveal a significant ceiling effect post-surgery, indicating the need for improvements in PROMs, including the Single Assessment Numerical Evaluation (SANE). One of the problems with SANE is scoring a 'normal' joint as the maximum. Patients might tolerate some subtle imperfections in their recovery and still consider their joint 'normal'. Proposing the concept of a 'forgotten' joint into the SANE could be a more accurate assessment tool and c which could diminish the ceiling effect. We suggest a shift from 'normal joint' to 'forgotten joint' as a standard for evaluating postoperative recovery and function in SANE.

Subjective Shoulder Value for Sport Is a Simple, Reliable, and Valid Score to Assess Shoulder Function in Athletes

PURPOSE

To validate the subjective shoulder value for sport (SSV-Sport) by measuring its correlation with existing patient-reported outcome measures (PROMs) and defining its psychometric properties.

METHODS

Between May 2021 and May 2022, we established 2 patient groups. Group 1 included those (1) aged 18 years or older, who were (2) consulting for the first time for any shoulder condition, (3) regularly participated in sports, and were capable of accessing a questionnaire independently. There were asked to rate their SSV and SSV-Sport at admission and 2 weeks later; they also were asked to answer a questionnaire including other PROMS. Group 2 comprised patients who had (1) undergone shoulder stabilization surgery and had (2) a minimum follow-up period of 6 months.

RESULTS

For the shoulder disability patients (group 1, n = 62), there was a strong and significant correlation between SSV-Sport and other PROMs: Quick Disabilities of the Arm, Shoulder and Hand Sport (r = 0.84), Walch-Duplay (r = 0.65), Rowe (r = 0.74), Western Ontario Shoulder Instability (r = 0.78), and SSV (r = 0.75) (P = .0001). The SSV-Sport was reliable at baseline and 2 weeks after (0.91, 95% confidence interval 0.85-0.94), and was responsive to change (P < .001). For the anterior instability patients (group 2, n = 83), SSV was on average 50 points greater than SSV-Sport (29.2 vs 79.4, P < .001) for preoperative values. In both groups, the values of SSV were constantly and significantly higher than the values of SSV-Sport (81.9 ± 21.3 vs 54.8 ± 30.9; P < .001).

CONCLUSIONS

The SSV-Sport is an easily administered, reliable, responsive, and valid measure of shoulder function in athletes that is highly correlated with other PROMs. SSV-Sport is better adapted than SSV to quantify pre- and postoperative shoulder deficiency in athletes.

LEVEL OF EVIDENCE

Level III, cohort study (diagnosis).

Validation of the Subjective Spine Value: A new single item score for the assessment of spine-specific function

BACKGROUND

Spinal function can be assessed through different patient reported outcome measures (PROMs).

PURPOSE

The aim of the present study was to evaluate a novel single-item score for the assessment of spinal function: The Subjective Spine Value (SSpV). It was hypothesized that the SSpV correlates with the established scores Oswestry disability index (ODI) and Core Outcome Measures Index (COMI).

METHODS

Between 08/2020 and 11/2021 151 consecutive patients were prospectively enrolled and completed a questionnaire with the ODI, COMI as well as the SSpV. Patients were divided into 4 groups depending on their specific pathology (Group 1: Degenerative pathologies, Group 2: Tumor, Group 3: Inflammatory / Infection, Group 4: Trauma). Pearson correlation coefficient was used to evaluate correlation between the SSpV and the ODI and COMI separately. Floor and ceiling effects were evaluated.

RESULTS

Overall, the SSpV correlated significantly with both ODI (p =  < 0.001; r = - 0.640) and COMI (p =  < 0.001; r = - 0.640). This was also observed across all investigated groups (range - 0.420-0.736). No relevant floor or ceiling effects were noticed.

CONCLUSIONS

The SSpV is a valid single-item score for the assessment of spinal function. The SSpV offers a useful tool to efficiently assess spinal function in a variety of spinal pathologies.

LEVEL OF EVIDENCE

I, prospective cohort study.

Simple foot an ankle value: a simple evaluation correlated to the existing PROMs

PURPOSE

The SFAV (Simple Foot and Ankle Value) consists in asking patients how they rate their joint function on the day of the examination, as a percentage of that of a normal joint (0-100% scale with 100% being normal). The main objective was to validate the SFAV by determining its correlation with validated foot and ankle function scores.

METHODS

This was a prospective study. 90 patients were included in three groups: patients 16 to 54 years old with an acute or subacute ankle pathology (foot/ankle trauma patient group), patients more than 55 years old with ankle or foot osteoarthritis (foot/ankle degeneration patient group), and adults of any age without foot or ankle pathology (control group). A self-administered questionnaire with the American Orthopedic Foot and Ankle Society, The European Foot and Ankle Society, the Foot and Ankle Outcome Score, the Visual Analogic Scale, and the SFAV was given at three different timepoints (enrollment, preoperative visit, and 6-month postoperative visit) to the patients. The validity of the SFAV was investigated by determining its correlation with the existing foot and ankle PROMs using Spearman's correlation; test-retest reliability, the responsiveness to change, and the discriminative ability of the SFAV were also analyzed. The significance threshold was set at 0.05.

RESULTS

The SFAV was significantly correlated with the AOFAS, EFAS, and FAOS at all tested time points, with all p values below 0.033. SFAV scoring was reliable over time, as p values resulting from the comparison between initial and preoperative SFAV were all above the significance threshold. SFAV scoring was responsive to change, based on the comparison between pre- and postoperative SFAV (p < 0.05). Like for the AOFAS, EFAS, and FAOS, SFAV provides good discrimination between a healthy subject and a patient. The control group scores and initial consultation scores of the pooled patient's groups were statistically correlated (p < 0.05).

CONCLUSION

The SFAV is a valid outcome measure correlated with the AOFAS, EFAS, FAOS, and VAS.

LEVEL OF EVIDENCE

Level of evidence III.

A Single-Centre, Retrospective, Observational Study to Assess Safety and Functional Outcomes of Arthroscopic Meniscal Repair Using Surestitch All Inside Implant

Introduction The meniscus plays a vital role in maintaining knee stability. It acts as a shock absorber and knee filler. The incidence of meniscal tears is estimated to be 60 per 100,000 people. Due to lack of awareness among patients, only 10% of the meniscus tears were treated through partial or total meniscectomy. Recently, the concept of meniscus preservation surgery has emerged to preserve early degeneration of the knee joint. In the current retrospective study, safety and functional outcomes of arthroscopic meniscal repair surgery using Surestitch All inside implants (Sironix Arthroscopy Solutions, Healthium Medtech Limited, Bengalaru, India) were assessed. Methods Fifty-two patients who underwent arthroscopic meniscal repair surgery between January 2019 to July 2022 at Epic Hospital in Gujarat, India, were enrolled in the study. Retrospective data including demographics, injury details, surgery details, and post-surgery complications were collected from the medical records of the patients. Then, the patients were followed up telephonically to document safety and functional outcomes using patient-reported instruments such as International Knee Documentation Committee (IKDC) score, Single Assessment Numeric Evaluation (SANE) score, Tegner activity level, and Lysholm knee score. Results The recruited patients had the mean age, height, and weight of 37.56 ± 12.52 years, 167.61 ± 7.28 cm, and 75.87 ± 10.7 kgs, respectively. Seventy-one percent of patients were male and 29% were female. Majority of the patients had the routine of doing mild exercise. During pre-surgery representations, medial meniscal tear was observed in majority of patients. The mean length of the tear was 1.32 ± 0.84 cm. In addition, patients were also diagnosed with anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) tears, and osteochondral defects. Surgeries for meniscal repair were performed using Surestitch All inside implant. In patient-reported outcomes, the mean IKDC, SANE, and Lysholm scores were 81.72 ± 14.23, 94.02 ± 13.79, and 93.32 ± 14.63, respectively. When the mean Tegner scores of pre-injury and post-surgery periods were compared, this resulted in no significant difference (p>0.05) in the activity levels of the patients. Conclusion Based on our findings, arthroscopic meniscal repair with Surestitch All inside meniscal repair implant provides satisfactory and favorable functional outcomes with no remarkable adverse events.