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Skolasky RL, Finkelstein JA, Schwartz CE. Associations of cognitive appraisal and patient activation on disability and mental health outcomes: a prospective cohort study of patients undergoing spine surgery. BMC Musculoskelet Disord 2024; 25:595. [PMID: 39069610 DOI: 10.1186/s12891-024-07709-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 07/19/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND With the increased use of patient-reported outcomes measures (PROMs) to assess spine surgery outcomes, it is important to understand how patients interpret their health changes over time. The measurement of cognitive-appraisal processes enables the quantification of how individuals think about quality of life (QOL). This study examined how appraisal processes were associated with patients' views of their role in managing their health-patient activation. METHODS This longitudinal cohort study from August 2019 to January 2022 included 222 adults undergoing spine surgery for cervical (n = 107) and/or lumbar (n = 148) pathology at an academic medical center. PROMs assessed disability (Neck Disability Index for cervical or Oswestry Disability Index for lumbar) and mental health (PROMIS-29 v2.0), cognitive-appraisal processes (QOLAPv2-SF), and patient activation (Patient Activation Measure). ANOVA models were used to examine the relationships between QOL and cognitive appraisal processes before and after surgery, overall and stratified by patient-activation stage. Effect sizes facilitated interpretation. RESULTS There were significant improvements in pain-related disability and mental health following surgery. Cognitive appraisal processes explained substantial amounts of variance, particularly with changes in mental health (45% before surgery, 75% at three months, and 63%, at 12-months after surgery). With respect to physical disability, less disability was associated with a lesser focus on negative aspects of QOL. Appraisal explained the most variance before surgery for high-activation patients. At 12-months post-surgery, however, appraisal explained the most variance for the low-activation patients. Appraisal explained similar amounts of variance in mental health at baseline and three-months post-surgery for all activation groups, but substantially more variance in the low-activation group at 12-months post-surgery. There were differences in the direction of appraisal-outcome associations by activation group in selected appraisal items/domains. CONCLUSIONS Cognitive-appraisal processes demonstrate a significant relationship with QOL among spine surgery patients. These processes explain substantial variance in pain-related disability and mental health, especially among those high in activation before surgery and those low in activation at 12-months post-surgery. Our findings suggest that patients' ways of thinking about their health may be effective targets of motivational coaching, to help them become more engaged over the recovery trajectory.
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Affiliation(s)
- Richard L Skolasky
- Departments of Orthopaedic Surgery and Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Suite 5244, Baltimore, MD, 21287, USA.
| | - Joel A Finkelstein
- Department of Surgery, University of Toronto, Toronto, Canada
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Spine Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Carolyn E Schwartz
- DeltaQuest Foundation Inc, Concord, MA, USA
- Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA
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Schwartz CE, Borowiec K, Aman S, Rapkin BD, Finkelstein JA. Mental health after lumbar spine surgery: cognitive appraisal processes and outcome in a longitudinal cohort study. Spine J 2024; 24:1170-1182. [PMID: 38484913 DOI: 10.1016/j.spinee.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND CONTEXT A not uncommon finding following spine surgery is that many patients do not achieve mental health improvement up to population norms for their age cohort, despite improvement in pain and functioning. PURPOSE This study examined how patients who were categorized as depressed versus not depressed think about health-related quality of life as assessed by cognitive-appraisal processes. It examined cross-sectional and longitudinal differences over 12 months postsurgery. DESIGN Prospective longitudinal cohort study with data collected at presurgery and at ∼3- and ∼12-months postsurgery from August 2013 to August 2023. PATIENT SAMPLE We included 173 adults undergoing lumbar spine surgery for degenerative spinal conditions at an academic medical center. The study sample was 47% female, with a mean age of 61 (SD=15.0), and a median level of education of college graduate. OUTCOME MEASURES Depression was defined as a Mental Component Score (MCS)≤38 on the Rand-36, building on studies that equated MCS scores with significant depression as assessed by clinically validated depression scales. The Quality-of-Life Appraisal Profile assessed the cognitive-appraisal domains of Experience Sampling and Standards of Comparison. METHODS The analysis focused on two comparisons: cross-sectionally comparing those who were not depressed (n=82) to those who were depressed (n=77) at baseline; and comparing longitudinal trajectories among those depressed before surgery and improved (n=54) versus did not improve (n=23). T-tests characterized group differences in appraisal endorsement; analysis of variance evaluated appraisal items in terms of explained variance; and Pearson correlation coefficients assessed direction of association in predicting mental health. RESULTS There were presurgical and longitudinal differences in both cognitive appraisal domains. Before surgery, depressed patients were less likely than nondepressed patients to endorse emphasizing the positive; more likely to focus on worst moments, recent flare-ups, their spinal condition, and the future; and more likely to compare themselves to high aspirations (eg, perfect health). Over time, among those who were depressed before surgery, those who improved focused decreasingly on worst moments and on the time before their spinal condition, and increasingly on emphasizing the positive and balancing the positives/negatives. Appraisal explained more variance in mental health among those who did not improve as compared to those who did, at all timepoints. All appraisal items were more highly correlated with mental health among those who remained depressed as compared to those who improved, particularly over time. CONCLUSIONS Endorsement of cognitive appraisal processes was different for depressed versus nondepressed spine-surgery patients before surgery and distinguished those who were depressed before surgery and improved versus those who did not improve. These findings suggest that targeted interventions could be beneficial for addressing mental health concerns during the spine surgery recovery trajectory. These interventions might use appraisal measures to identify patients likely to remain depressed after surgery, and then focus on helping these patients shift their focus and standards of comparison.
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Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA 01742, USA; Departments of Medicine and Orthopaedic Surgery, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
| | - Katrina Borowiec
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA 01742, USA; Department of Measurement, Evaluation, Statistics, & Assessment, Boston College Lynch School of Education and Human Development, Campion Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | - Sara Aman
- Division of Spine Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave. RM D5-14 Toronto, ON M4N 3M5, Canada
| | - Bruce D Rapkin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Van Etten 3A2C 1300 Morris Park Avenue Bronx, NY 10461, USA
| | - Joel A Finkelstein
- Division of Spine Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave. RM D5-14 Toronto, ON M4N 3M5, Canada; Department of Surgery, University of Toronto, Stewart Building 149 College Street, 5th Floor Toronto, ON M5T 1P5, Canada; Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave. RM D5-14 Toronto, ON M4N 3M5, Canada
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Tian R, Duan X, Xing F, Zhao Y, Liu C, Li H, Kong N, Cao R, Guan H, Li Y, Li X, Zhang J, Wang K, Yang P, Wang C. Computed tomography radiomics in predicting patient satisfaction after robotic-assisted total knee arthroplasty. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03192-1. [PMID: 38836956 DOI: 10.1007/s11548-024-03192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE After robotic-assisted total knee arthroplasty (RA-TKA) surgery, some patients still experience joint discomfort. We aimed to establish an effective machine learning model that integrates radiomic features extracted from computed tomography (CT) scans and relevant clinical information to predict patient satisfaction three months postoperatively following RA-TKA. MATERIALS AND METHODS After careful selection, data from 142 patients were randomly divided into a training set (n = 99) and a test set (n = 43), approximately in a 7:3 ratio. A total of 1329 radiomic features were extracted from the regions of interest delineated in CT scans. The features were standardized using normalization algorithms, and the least absolute shrinkage and selection operator regression model was employed to select radiomic features with ICC > 0.75 and P < 0.05, generating the Rad-score as feature markers. Univariate and multivariate logistic regression was then used to screen clinical information (age, body mass index, operation time, gender, surgical side, comorbidities, preoperative KSS score, preoperative range of motion (ROM), preoperative and postoperative HKA angle, preoperative and postoperative VAS score) as potential predictive factors. The satisfaction scale ≥ 20 indicates patient satisfaction. Finally, three prediction models were established, focusing on radiomic features, clinical features, and their fusion. Model performance was evaluated using Receiver Operating Characteristic curves and decision curve analysis. RESULTS In the training set, the area under the curve (AUC) of the clinical model was 0.793 (95% CI 0.681-0.906), the radiomic model was 0.854 (95% CI 0.743-0.964), and the combined radiomic-clinical model was 0.899 (95% CI 0.804-0.995). In the test set, the AUC of the clinical model was 0.908 (95% CI 0.814-1.000), the radiomic model was 0.709 (95% CI 0.541-0.878), and the combined radiomic-clinical model was 0.928 (95% CI 0.842-1.000). The AUC of the radiomic-clinical model was significantly higher than the other two models. The decision curve analysis indicated its clinical application value. CONCLUSION We developed a radiomic-based nomogram model using CT imaging to predict the satisfaction of RA-TKA patients at 3 months postoperatively. This model integrated clinical and radiomic features and demonstrated good predictive performance and excellent clinical application potential.
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Affiliation(s)
- Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xudong Duan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fangze Xing
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiwei Zhao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - ChengYan Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Heng Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ning Kong
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruomu Cao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huanshuai Guan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiyang Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinghua Li
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiewen Zhang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Chunsheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Davey AP, Connors JP, Hewitt CR, Grosso MJ. Patient-Reported Outcomes of Total Hip Arthroplasty at an Ambulatory Surgery Center Versus a Hospital-Based Center. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202406000-00007. [PMID: 38866724 PMCID: PMC11175860 DOI: 10.5435/jaaosglobal-d-24-00124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION The utilization of ambulatory surgery centers (ASCs) and same-day discharge (SDD) from hospital-based centers (HBCs) after total hip arthroplasty (THA) continues to increase. There remains a paucity of literature directly comparing patient-reported outcomes by surgery site. We sought to compare outcomes between patients undergoing THA at an ASC versus HBC while controlling for medical comorbidities. METHODS Patients undergoing primary THA with SDD (postoperative day 0) from a single HBC (1,015 patients) or stand-alone ASC (170 patients) from December 2020 to 2021 were identified. Patient demographics, comorbidities, and 90-day complications were collected. Hip Osteoarthritis Outcome Score (HOOS JR), VR-12, and procedural satisfaction scores were collected preoperatively and at 3, 6, and 12 months. Patients were matched by age and American Society of Anesthesiologists (ASA). Chi-squared analysis was conducted to compare categorical variables, and a Wilcoxon rank-sum test was used for continuous variables. Linear regression models were conducted considering age, sex, and presence of comorbidities. RESULTS Patients undergoing THA at an ASC had markedly higher VR-12 Physical Component Scores at all time points and improved VR-12 Mental Component Scores at preoperative visit and 6 months. These patients had increased procedural satisfaction at 3 months, although there was no difference at 1 year. No notable difference was observed in 90-day complication rates between groups. After matching by age and ASA, each group had 170 patients. In the matched analysis, preoperative HOOS JR scores were markedly lower in the HBC group. However, there was no notable difference in HOOS JR scores, change in HOOS JR scores, and procedural satisfaction, at any postoperative time point. CONCLUSIONS No notable difference was observed in patient-reported outcomes at any time point for SDD after THA performed at an ASC or an HBC when controlling for age and comorbidities. This study suggests noninferiority of stand-alone ASCs for outpatient THA, regarding patient satisfaction and patient-reported outcomes.
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Affiliation(s)
- Annabelle P. Davey
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Davey, Dr. Connors, and Dr. Hewitt), and the Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
| | - John P. Connors
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Davey, Dr. Connors, and Dr. Hewitt), and the Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
| | - Cory R. Hewitt
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Davey, Dr. Connors, and Dr. Hewitt), and the Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
| | - Matthew J. Grosso
- From the Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT (Dr. Davey, Dr. Connors, and Dr. Hewitt), and the Connecticut Joint Replacement Institute, Hartford, CT (Dr. Grosso)
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Sobba W, Lawrence KW, Haider MA, Thomas J, Schwarzkopf R, Rozell JC. The influence of body mass index on patient-reported outcome measures following total hip arthroplasty: a retrospective study of 3,903 Cases. Arch Orthop Trauma Surg 2024; 144:2889-2898. [PMID: 38796819 DOI: 10.1007/s00402-024-05381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The influence of obesity on patient-reported outcome measures (PROMs) following total hip arthroplasty (THA) is currently controversial. This study aimed to compare PROM scores for pain, functional status, and global physical/mental health based on body mass index (BMI) classification. METHODS Primary, elective THA procedures at a single institution between 2018 and 2021 were retrospectively reviewed, and patients were stratified into four groups based on BMI: normal weight (18.5-24.99 kg/m2), overweight (25-29.99 kg/m2), obese (30-39.99 kg/m2), and morbidly obese (> 40 kg/m2). Patient-Reported Outcome Measurement Information System (PROMIS) and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) scores were collected. Preoperative, postoperative, and pre/post- changes (pre/post-Δ) in scores were compared between groups. Multiple linear regression was used to assess for confounders. RESULTS We analyzed 3,404 patients undergoing 3,903 THAs, including 919 (23.5%) normal weight, 1,374 (35.2%) overweight, 1,356 (35.2%) obese, and 254 (6.5%) morbidly obese cases. HOOS, JR scores were worse preoperatively and postoperatively for higher BMI classes, however HOOS, JR pre/post-Δ was comparable between groups. All PROMIS measures were worse preoperatively and postoperatively in higher BMI classes, though pre/post-Δ were comparable for all groups. Clinically significant improvements for all BMI classes were observed in all PROM metrics except PROMIS mental health. Regression analysis demonstrated that obesity, but not morbid obesity, was independently associated with greater improvement in HOOS, JR. CONCLUSIONS Obese patients undergoing THA achieve lower absolute scores for pain, function, and self-perceived health, despite achieving comparable relative improvements in pain and function with surgery. Denying THA based on BMI restricts patients from clinically beneficial improvements comparable to those of non-obese patients, though morbidly obese patients may benefit from additional weight loss to achieve maximal functional improvement.
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Affiliation(s)
- Walter Sobba
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Muhammad A Haider
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Jeremiah Thomas
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street 15 Fl Suite 1518, New York, NY, USA.
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Razmjou H, Robarts S, Denis S, Wainwright A, Dickson P, Murnaghan J. Discordance between self-report and performance-based outcomes: Contribution of psychosocial factors. J Health Psychol 2024:13591053241253895. [PMID: 38801110 DOI: 10.1177/13591053241253895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
The purpose of this study was to examine the role of psychosocial factors in the discordance between perceived and observed physical disability in patients with osteoarthritis of the hip or knee joint. This was a cross-sectional study of patients seen for consideration of joint arthroplasty surgery. Patients completed a psychosocial outcome measure, a patient self-reported functional scale, and two performance-based tests. Data of 121 patients, mean age, 67 (8), 81 (67%) females were used for analysis. The fear avoidance and positive affect domains had the strongest association with the discordance between the self-report and both performance outcome measures. Age, gender, and severity of osteoarthritis were associated with discordance in relation to walking. Fear avoidance beliefs and positive affect play important roles in perception of pain and function. Age, gender, and severity of arthritis should be taken into consideration for a more holistic approach to arthritis care.
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Affiliation(s)
- Helen Razmjou
- Sunnybrook Health Sciences Centre, Canada
- University of Toronto, Canada
| | - Susan Robarts
- Sunnybrook Health Sciences Centre, Canada
- University of Toronto, Canada
| | - Suzanne Denis
- Sunnybrook Health Sciences Centre, Canada
- University of Toronto, Canada
| | - Amy Wainwright
- Sunnybrook Health Sciences Centre, Canada
- University of Toronto, Canada
| | - Patricia Dickson
- Sunnybrook Health Sciences Centre, Canada
- University of Toronto, Canada
| | - John Murnaghan
- Sunnybrook Health Sciences Centre, Canada
- University of Toronto, Canada
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Pean CA, Buddhiraju A, Shimizu MR, Chen TLW, Esposito JG, Kwon YM. Prediction of 30-Day Mortality Following Revision Total Hip and Knee Arthroplasty: Machine Learning Algorithms Outperform CARDE-B, 5-Item, and 6-Item Modified Frailty Index Risk Scores. J Arthroplasty 2024:S0883-5403(24)00528-X. [PMID: 38797444 DOI: 10.1016/j.arth.2024.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Although risk calculators are used to prognosticate postoperative outcomes following revision total hip and knee arthroplasty (total joint arthroplasty [TJA]), machine learning (ML) based predictive tools have emerged as a promising alternative for improved risk stratification. This study aimed to compare the predictive ability of ML models for 30-day mortality following revision TJA to that of traditional risk-assessment indices such as the CARDE-B score (congestive heart failure, albumin (< 3.5 mg/dL), renal failure on dialysis, dependence for daily living, elderly (> 65 years of age), and body mass index (BMI) of < 25 kg/m2), 5-item modified frailty index (5MFI), and 6MFI. METHODS Adult patients undergoing revision TJA between 2013 and 2020 were selected from the American College of Surgeons National Surgical Quality Improvement Program database and randomly split 80:20 to compose the training and validation cohorts. There were 3 ML models - extreme gradient boosting, random forest, and elastic-net penalized logistic regression (NEPLR) - that were developed and evaluated using discrimination, calibration metrics, and accuracy. The discrimination of CARDE-B, 5MFI, and 6MFI scores was assessed individually and compared to that of ML models. RESULTS All models were equally accurate (Brier score = 0.005) and demonstrated outstanding discrimination with similar areas under the receiver operating characteristic curve (AUCs, extreme gradient boosting = 0.94, random forest = NEPLR = 0.93). The NEPLR was the best-calibrated model overall (slope = 0.54, intercept = -0.004). The CARDE-B had the highest discrimination among the scores (AUC = 0.89), followed by 6MFI (AUC = 0.80), and 5MFI (AUC = 0.68). Albumin < 3.5 mg/dL and BMI (< 30.15) were the most important predictors of 30-day mortality following revision TJA. CONCLUSIONS The ML models outperform traditional risk-assessment indices in predicting postoperative 30-day mortality after revision TJA. Our findings highlight the utility of ML for risk stratification in a clinical setting. The identification of hypoalbuminemia and BMI as prognostic markers may allow patient-specific perioperative optimization strategies to improve outcomes following revision TJA.
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Affiliation(s)
- Christian A Pean
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Trauma and Reconstruction Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Anirudh Buddhiraju
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michelle R Shimizu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tony L-W Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John G Esposito
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Corsi MP, Nham FH, Kassis E, El-Othmani MM. Bibliometric analysis of machine learning trends and hotspots in arthroplasty literature over 31 years. J Orthop 2024; 51:142-156. [PMID: 38405126 PMCID: PMC10891287 DOI: 10.1016/j.jor.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Background Artificial intelligence has demonstrated utility in orthopedic research. Algorithmic models derived from machine learning have demonstrated adaptive learning with predictive application towards outcomes, leading to increased traction in the literature. This study aims to identify machine learning arthroplasty research trends and anticipate emerging key terms. Methods Published literature focused on machine learning in arthroplasty from 1992 to 2023 was selected through the Web of Science Core Collection of Clarivate Analytics. Following that, bibliometric indicators were attained and brought in to perform an additional examination using Bibliometrix and VOSviewer to identify historical and present patterns within the literature. Results A total of 235 documents were obtained through bibliometric sourcing based on machine learning applications within the arthroplasty literature. Thirty-four countries published articles on the topic, and the United States was demonstrated to be the largest global contributor. Four hundred-five institutions internationally contributed articles, with Harvard Medical School and the University of California system as the most relevant institutes, with 75 and 44 articles produced, respectively. Kwon YM was the most productive author, while Haeberle HS and Ramkumar PN were the most impactful based on h-index. The Thematic map and Co-occurrence visualization helped identify both major and niche themes present in the scientific databases. Conclusions Machine learning in arthroplasty research continues to gain traction with a growing annual production rate and contributions from international authors and institutions. Institutions and authors based in the United States are the leading contributors to machine learning applications within arthroplasty research. This research discerns trends that have occurred, are presently ongoing, and are emerging within this field, aiming to inform future hotspot development.
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Affiliation(s)
- Matthew P. Corsi
- Wayne State University School of Medicine, 540 E. Canfield St, Detroit, MI, 48201, USA
| | - Fong H. Nham
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, 48201, USA
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Hunter J, Soleymani F, Viktor H, Michalowski W, Poitras S, Beaulé PE. Using Unsupervised Machine Learning to Predict Quality of Life After Total Knee Arthroplasty. J Arthroplasty 2024; 39:677-682. [PMID: 37770008 DOI: 10.1016/j.arth.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are an important metric to assess total knee arthroplasty (TKA) patients. The purpose of this study was to use a machine learning (ML) algorithm to identify patient features that impact PROMs after TKA. METHODS Data from 636 TKA patients enrolled in our patient database between 2018 and 2022, were retrospectively reviewed. Their mean age was 68 years (range, 39 to 92), 56.7% women, and mean body mass index of 31.17 (range, 16 to 58). Patient demographics and the Functional Comorbidity Index were collected alongside Patient-Reported Outcome Measures Information System Global Health v1.2 (PROMIS GH-P) physical component scores preoperatively, at 3 months, and 1 year after TKA. An unsupervised ML algorithm (spectral clustering) was used to identify patient features impacting PROMIS GH-P scores at the various time points. RESULTS The algorithm identified 5 patient clusters that varied by demographics, comorbidities, and pain scores. Each cluster was associated with predictable trends in PROMIS GH-P scores across the time points. Notably, patients who had the worst preoperative PROMIS GH-P scores (cluster 5) had the most improvement after TKA, whereas patients who had higher global health rating preoperatively had more modest improvement (clusters 1, 2, and 3). Two out of Five patient clusters (cluster 4 and 5) showed improvement in PROMIS GH-P scores that met a minimally clinically important difference at 1-year postoperative. CONCLUSIONS The unsupervised ML algorithm identified patient clusters that had predictable changes in PROMs after TKA. It is a positive step toward providing precision medical care for each of our arthroplasty patients.
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Affiliation(s)
- Jennifer Hunter
- Division of Orthopaedics, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Farzan Soleymani
- Faculty of Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Herna Viktor
- Faculty of Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Wojtek Michalowski
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedics, The Ottawa Hospital, Ottawa, Ontario, Canada
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Clement ND, Clement R, Clement A. Letter to the Editor on: The Impact of Machine Learning on Total Joint Arthroplasty Patient Outcomes: A Systematic Review. J Arthroplasty 2024; 39:e1. [PMID: 38182323 DOI: 10.1016/j.arth.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Rosie Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Abigail Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Karlin EA, Lin CC, Meftah M, Slover JD, Schwarzkopf R. Reply to the Letter to the Editor on: The Impact of Machine Learning on Total Joint Arthroplasty Patient Outcomes: A Systematic Review. J Arthroplasty 2024; 39:e2. [PMID: 38182326 DOI: 10.1016/j.arth.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Elan A Karlin
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Charles C Lin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Clement ND, Clement R, Clement A. Predicting Functional Outcomes of Total Hip Arthroplasty Using Machine Learning: A Systematic Review. J Clin Med 2024; 13:603. [PMID: 38276109 PMCID: PMC10816364 DOI: 10.3390/jcm13020603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this review was to assess the reliability of machine learning (ML) techniques to predict the functional outcome of total hip arthroplasty. The literature search was performed up to October 2023, using MEDLINE/PubMed, Embase, Web of Science, and NIH Clinical Trials. Level I to IV evidence was included. Seven studies were identified that included 44,121 patients. The time to follow-up varied from 3 months to more than 2 years. Each study employed one to six ML techniques. The best-performing models were for health-related quality of life (HRQoL) outcomes, with an area under the curve (AUC) of more than 84%. In contrast, predicting the outcome of hip-specific measures was less reliable, with an AUC of between 71% to 87%. Random forest and neural networks were generally the best-performing models. Three studies compared the reliability of ML with traditional regression analysis: one found in favour of ML, one was not clear and stated regression closely followed the best-performing ML model, and one showed a similar AUC for HRQoL outcomes but did show a greater reliability for ML to predict a clinically significant change in the hip-specific function. ML offers acceptable-to-excellent discrimination of predicting functional outcomes and may have a marginal advantage over traditional regression analysis, especially in relation to hip-specific hip functional outcomes.
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Affiliation(s)
- Nick D. Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK
- Southwest of London Orthopaedic Elective Centre, Epsom KT18 7EG, UK
| | - Rosie Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK
| | - Abigail Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK
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Nozaki K, Nanri Y, Kawabata M, Shibuya M, Nihei M, Shirota T, Masuma H, Maeda T, Fukushima K, Uchiyama K, Takahira N, Takaso M. Association of affected and non-affected side ability with postoperative outcomes in patients undergoing total hip arthroplasty. Hip Int 2024; 34:33-41. [PMID: 37720956 DOI: 10.1177/11207000231199169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Although several reports have examined the association between preoperative function and postoperative outcomes in patients undergoing total hip arthroplasty (THA), it is unclear whether the ability of the affected or non-affected side particularly impacts on outcomes. We aimed to investigate the association between affected and non-affected side ability and walking independence. METHODS We prospectively enrolled 721 consecutive patients who underwent THA. Preoperatively, quadriceps isometric strength (QIS) and one-leg standing time (OLST) were measured. The endpoints were walking independence within 3, 5, 7, 10, and 14 days postoperatively. The associations between preoperative abilities and outcomes were examined using multivariate Cox hazard model, and the area under the curves (AUCs) for outcomes were compared. RESULTS We analysed 540 patients after excluding patients who met the exclusion criteria. Both affected and non-affected QIS predicted walking independence within 3 (p = 0.006 and 0.001, respectively), 5, 7, 10, and 14 (both p < 0.001) days postoperatively. For OLST, only the affected side did not predict walking independence within 3 days postoperatively (p = 0.154 and 0.012, respectively), and both sides did at days 5 (p = 0.019 and <0.001, respectively), 7, 10, and 14 (both p < 0.001). The AUCs of the non-affected side ability for walking independence were significantly greater than those of the affected side on postoperative days 3 (0.66 vs. 0.73; p = 0.021) and 5 (0.67 vs. 0.71; p = 0.040), with no significant difference after day 7. CONCLUSIONS Both sides abilities were associated with walking independence after THA, but non-affected side was found to be particularly crucial for early walking independence.
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Affiliation(s)
- Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Yuta Nanri
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Masashi Kawabata
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Manaka Shibuya
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Manami Nihei
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takehiro Shirota
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Hiroyoshi Masuma
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takuya Maeda
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Patient Safety and Healthcare Administration, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Zhou Y, Shadbolt C, Thuraisingam S, Schilling C, Choong P, Dowsey M. Differences in Outcomes Between Initial Responders and Subsequent Responders to Health Questionnaires for Total Hip and Knee Arthroplasty: An Australian Tertiary Institutional Registry Study. J Arthroplasty 2023; 38:2561-2567. [PMID: 37286051 DOI: 10.1016/j.arth.2023.05.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Patient-reported outcome measure (PROM) questionnaires in national arthroplasty registries often have low response rates leading to questions about data reliability. In Australia, the SMART (St. Vincent's Melbourne Arthroplasty Outcomes) registry captures all elective total hip (THA) and total knee (TKA) arthroplasty patients with an approximate 98% response rate for preoperative and 12-month PROM scores. This high response rate is due to dedicated registry staff following up patients who do not initially respond (subsequent responders). This study compared initial responders to subsequent responders to find differences in 12-month PROM outcomes for THA and TKA. METHODS All elective THA and TKA patients for osteoarthritis from 2012 to 2021 captured by the SMART registry were included. In total, 1,333 THA and 1,340 TKA patients were included. The PROM scores were assessed using the Veterans-RAND 12 (VR12) and Western Ontario and McMasters Universities Arthritis Index (WOMAC) questionnaires. The primary outcome was differences in mean 12-month PROM scores between initial and subsequent responders. RESULTS Baseline characteristics and PROM scores were similar between initial and subsequent responders. However, 12-month PROM scores varied significantly. The adjusted mean difference showed that for the WOMAC pain score, subsequent responders scored 3.4 points higher in the THA cohort and 7.4 points higher in the TKA cohort compared to initial responders. Significant differences were also found in other WOMAC and VR12 scores for both THA and TKA cohorts at the 12-month timepoint. CONCLUSION This study found that significant differences in PROM outcomes postsurgery occurred in THA and TKA patients based on response to PROM questionnaires, suggesting that loss to follow-up in PROM outcomes should not be treated as missing completely at random (MCAR).
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia; Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Peter Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
| | - Michelle Dowsey
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, Victoria, Australia
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Michelsen C, Jørgensen CC, Heltberg M, Jensen MH, Lucchetti A, Petersen PB, Petersen T, Kehlet H, Madsen F, Hansen TB, Gromov K, Jakobsen T, Varnum C, Overgaard S, Rathsach M, Hansen L. Machine-learning vs. logistic regression for preoperative prediction of medical morbidity after fast-track hip and knee arthroplasty-a comparative study. BMC Anesthesiol 2023; 23:391. [PMID: 38030979 PMCID: PMC10685559 DOI: 10.1186/s12871-023-02354-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Machine-learning models may improve prediction of length of stay (LOS) and morbidity after surgery. However, few studies include fast-track programs, and most rely on administrative coding with limited follow-up and information on perioperative care. This study investigates potential benefits of a machine-learning model for prediction of postoperative morbidity in fast-track total hip (THA) and knee arthroplasty (TKA). METHODS Cohort study in consecutive unselected primary THA/TKA between 2014-2017 from seven Danish centers with established fast-track protocols. Preoperative comorbidity and prescribed medication were recorded prospectively and information on length of stay and readmissions was obtained through the Danish National Patient Registry and medical records. We used a machine-learning model (Boosted Decision Trees) based on boosted decision trees with 33 preoperative variables for predicting "medical" morbidity leading to LOS > 4 days or 90-days readmissions and compared to a logistical regression model based on the same variables. We also evaluated two parsimonious models, using the ten most important variables in the full machine-learning and logistic regression models. Data collected between 2014-2016 (n:18,013) was used for model training and data from 2017 (n:3913) was used for testing. Model performances were analyzed using precision, area under receiver operating (AUROC) and precision recall curves (AUPRC), as well as the Mathews Correlation Coefficient. Variable importance was analyzed using Shapley Additive Explanations values. RESULTS Using a threshold of 20% "risk-patients" (n:782), precision, AUROC and AUPRC were 13.6%, 76.3% and 15.5% vs. 12.4%, 74.7% and 15.6% for the machine-learning and logistic regression model, respectively. The parsimonious machine-learning model performed better than the full logistic regression model. Of the top ten variables, eight were shared between the machine-learning and logistic regression models, but with a considerable age-related variation in importance of specific types of medication. CONCLUSION A machine-learning model using preoperative characteristics and prescriptions slightly improved identification of patients in high-risk of "medical" complications after fast-track THA and TKA compared to a logistic regression model. Such algorithms could help find a manageable population of patients who may benefit most from intensified perioperative care.
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Affiliation(s)
- Christian Michelsen
- The Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100, Copenhagen, Denmark
| | - Christoffer C Jørgensen
- Department of Anesthesia and Intensive Care, Hospital of Northern Zealand, Dyrehavevej 29 3400, Hillerød, Denmark.
- The Centre for Fast-Track Hip and Knee Replacement, 7621, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Mathias Heltberg
- The Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100, Copenhagen, Denmark
| | - Mogens H Jensen
- The Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100, Copenhagen, Denmark
| | - Alessandra Lucchetti
- The Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100, Copenhagen, Denmark
| | - Pelle B Petersen
- Department of Anesthesia and Intensive Care, Hospital of Northern Zealand, Dyrehavevej 29 3400, Hillerød, Denmark
- The Centre for Fast-Track Hip and Knee Replacement, 7621, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Troels Petersen
- The Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, 2100, Copenhagen, Denmark
| | - Henrik Kehlet
- The Centre for Fast-Track Hip and Knee Replacement, 7621, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Section of Surgical Pathophysiology, 7621, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Karlin EA, Lin CC, Meftah M, Slover JD, Schwarzkopf R. The Impact of Machine Learning on Total Joint Arthroplasty Patient Outcomes: A Systemic Review. J Arthroplasty 2023; 38:2085-2095. [PMID: 36441039 DOI: 10.1016/j.arth.2022.10.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Supervised machine learning techniques have been increasingly applied to predict patient outcomes after hip and knee arthroplasty procedures. The purpose of this study was to systematically review the applications of supervised machine learning techniques to predict patient outcomes after primary total hip and knee arthroplasty. METHODS A comprehensive literature search using the electronic databases MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews was conducted in July of 2021. The inclusion criteria were studies that utilized supervised machine learning techniques to predict patient outcomes after primary total hip or knee arthroplasty. RESULTS Search criteria yielded n = 30 relevant studies. Topics of study included patient complications (n = 6), readmissions (n = 1), revision (n = 2), patient-reported outcome measures (n = 4), patient satisfaction (n = 4), inpatient status and length of stay (LOS) (n = 9), opioid usage (n = 3), and patient function (n = 1). Studies involved TKA (n = 12), THA (n = 11), or a combination (n = 7). Less than 35% of predictive outcomes had an area under the receiver operating characteristic curve (AUC) in the excellent or outstanding range. Additionally, only 9 of the studies found improvement over logistic regression, and only 9 studies were externally validated. CONCLUSION Supervised machine learning algorithms are powerful tools that have been increasingly applied to predict patient outcomes after total hip and knee arthroplasty. However, these algorithms should be evaluated in the context of prognostic accuracy, comparison to traditional statistical techniques for outcome prediction, and application to populations outside the training set. While machine learning algorithms have been received with considerable interest, they should be critically assessed and validated prior to clinical adoption.
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Affiliation(s)
- Elan A Karlin
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Charles C Lin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Schwartz CE, Borowiec K, Rapkin BD. Depression trajectories during the COVID-19 pandemic: a secondary analysis of the impact of cognitive-appraisal processes. J Patient Rep Outcomes 2023; 7:67. [PMID: 37439964 DOI: 10.1186/s41687-023-00600-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/04/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE This study characterized depression trajectories during the COVID pandemic and investigated how appraisal and changes in appraisal over time related to these depression trajectories. METHODS This longitudinal study of the psychosocial impact of the COVID-19 pandemic included 771 people with data at three timepoints over 15.5 months. The depression index was validated using item-response-theory methods and receiver-operating-characteristic curve analysis. The Quality of Life (QOL) Appraisal Profilev2 Short-Form assessed cognitive-appraisal processes. Sequence analysis characterized depression-trajectory groups, and random effects models examined appraisal main effects, appraisal-by-group, and appraisal-by-group-by-time interactions. RESULTS Sequence analysis generated six trajectory groups: Stably Well (n = 241), Stably Depressed (n = 299), Worsening (n = 79), Improving (n = 83), Fluctuating Pattern 1 (No-Yes-No; n = 41), and Fluctuating Pattern 2 (Yes-No-Yes; n = 28). While all groups engaged in negative appraisal processes when they were depressed, the Stably Depressed group consistently focused on negative aspects of their life. Response-shift effects were revealed such that there were differences in the appraisal-depression relationship over time for standards of comparison and recent changes for the Stably Depressed, and in health goals for those Getting Better. CONCLUSION The present work is, to our knowledge, the first study of response-shift effects in depression. During these first 15.5 pandemic months, group differences highlighted the connection between negative appraisals and depression, and response-shift effects in these relationships over time. Egregious life circumstances may play a lesser role for the Stably Depressed but a greater role for people who have transient periods of depression as well as for those with improving trajectories (i.e., endogenous vs. reactive depression). How one thinks about QOL is intrinsically linked to mental health, with clear clinical implications.
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Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA.
- Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA.
| | - Katrina Borowiec
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA
- Department of Measurement, Evaluation, Statistics, and Assessment, Boston College Lynch School of Education and Human Development, Chestnut Hill, MA, USA
| | - Bruce D Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Nham FH, Court T, Zalikha AK, El-Othmani MM, Shah RP. Assessing the predictive capacity of machine learning models using patient-specific variables in determining in-hospital outcomes after THA. J Orthop 2023; 41:39-46. [PMID: 37304653 PMCID: PMC10248727 DOI: 10.1016/j.jor.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
Background Machine learning is a subset of artificial intelligence using algorithmic modeling to progressively learn and create predictive models. Clinical application of machine learning can aid physicians through identification of risk factors and implications of predicted patient outcomes. Aims The aim of this study was to compare patient-specific and situation perioperative variables through optimized machine learning models to predict postoperative outcomes. Methods Data from 2016 to 2017 from the National Inpatient Sample was used to identify 177,442 discharges undergoing primary total hip arthroplasty, which were included in the training, testing, and validation of 10 machine learning models. 15 predictive variables consisting of 8 patient-specific and 7 situational specific variables were utilized to predict 3 outcome variables: length of stay, discharge, and mortality. The machine learning models were assessed in responsiveness via area under the curve and reliability. Results For all outcomes, Linear Support Vector Machine had the highest responsiveness among all models when using all variables. When utilizing patient-specific variables only, responsiveness of the top 3 models ranged between 0.639 and 0.717 for length of stay, 0.703-0.786 for discharge disposition, and 0.887-0.952 for mortality. The top 3 models utilizing situational variables only produced responsiveness of 0.552-0.589 for length of stay, 0.543-0.574 for discharge disposition, and 0.469-0.536 for mortality. Conclusions Linear Support Vector Machine was the most responsive machine learning model of the 10 algorithms trained, while decision list was most reliable. Responsiveness was observed to be consistently higher with patient-specific variables than situational variables, emphasizing the predictive capacity and value of patient-specific variables. The current practice in machine learning literature generally deploys a single model, it is suboptimal to develop optimized models for application into clinical practice. The limitation of other algorithms may prohibit potential more reliable and responsive models.Level of Evidence III.
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Affiliation(s)
- Fong H. Nham
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Tannor Court
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Abdul K. Zalikha
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Mouhanad M. El-Othmani
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, 10032, USA
| | - Roshan P. Shah
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, 10032, USA
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Foster NE, L E, L D, M H. Osteoarthritis year in review 2022: epidemiology & therapy. Osteoarthritis Cartilage 2023:S1063-4584(23)00730-6. [PMID: 36963607 DOI: 10.1016/j.joca.2023.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
This 'Year in Review' provides a synopsis of key research themes and individual studies from the clinical osteoarthritis (OA) field, focused on epidemiology and therapy. The electronic database search for the review was adapted from the 2021 year in review search, to increase search specificity for relevant study designs, and was conducted in Medline, Embase and medRxiv (31st March 2021 to 4th March 2022). Following screening for eligibility, studies were grouped according to their key research design, including reviews, cohorts and randomised trials. 11 key themes emerged, including the importance of several comorbidities in predicting OA incidence and prevalence, surgical approaches that can reduce the risk of post-traumatic OA, the heterogenous but nevertheless relatively stable nature of OA subgroup trajectories, the paucity of robust studies particularly of surgery for OA and the very modest benefit of many therapies under evaluation in trials. A particular interest of the authors was to consider whether new studies are helping determine how to better ensure the right patient with OA is matched to the right treatment at the right time. There are several new studies developing improved predictive models through big data analytics and machine learning which show promise, need validation, and may support new approaches to stratified care.
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Affiliation(s)
- Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, Australia.
| | - Eriksson L
- Lars Eriksson, The University of Queensland, UQ Library, Herston Qld 4006, Queensland, Australia.
| | - Deveza L
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Rheumatology, Northern Clinical School, Royal North Shore Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Hall M
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia.
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Artificial intelligence and machine learning as a viable solution for hip implant failure diagnosis-Review of literature and in vitro case study. Med Biol Eng Comput 2023; 61:1239-1255. [PMID: 36701013 DOI: 10.1007/s11517-023-02779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
The digital health industry is experiencing fast-paced research which can provide digital care programs and technologies to enhance the competence of healthcare delivery. Orthopedic literature also confirms the applicability of artificial intelligence (AI) and machine learning (ML) models to medical diagnosis and clinical decision-making. However, implant monitoring after primary surgery often happens with a wellness visit or when a patient complains about it. Neglecting implant design and other technical errors in this scenario, unmonitored circumstances, and lack of post-surgery monitoring may ultimately lead to the implant system's failure and leave us with the only option of high-risk revision surgery. Preventive maintenance seems to be a good choice to identify the onset of an irreversible prosthesis failure. Considering all these aspects for hip implant monitoring, this paper explores existing studies linking ML models and intelligent systems for hip implant diagnosis. This paper explores the feasibility of an alternative continuous monitoring technique for post-surgery implant monitoring backed by an in vitro ML case study. Tribocorrosion and acoustic emission (AE) data are considered based on their efficacy in determining irreversible alteration of implant material to prevent total failures. This study also facilitates the relevance of developing an artificially intelligent implant monitoring methodology that can function with daily patient activities and how it can influence the digital orthopedic diagnosis. AI-based non-invasive hip implant monitoring system enabling point-of-care testing.
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Sergooris A, Verbrugghe J, De Baets L, Meeus M, Roussel N, Smeets RJEM, Bogaerts K, Timmermans A. Are contextual factors associated with activities and participation after total hip arthroplasty? A systematic review. Ann Phys Rehabil Med 2023; 66:101712. [PMID: 36680879 DOI: 10.1016/j.rehab.2022.101712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 09/12/2022] [Accepted: 10/07/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES After total hip arthroplasty (THA), over 30% of individuals report activity limitations and participation restrictions. This systematic review aimed to determine the association between contextual factors and outcomes in the activity and participation domain after THA for hip osteoarthritis (OA). METHODS This systematic review was developed according to the PRISMA guidelines for systematic reviews. PubMed, Web of Science, Embase and Scopus were searched until August 2022. Risk of bias was assessed with the Quality in Prognosis Studies tool (QUIPS). RESULTS Twenty-nine articles were included. Eighteen had a high risk of bias, 3 had a low risk of bias, and 8 had a moderate risk of bias. Anxiety was only investigated in studies with high risk of bias but showed a consistent negative association with activities and participation after THA across multiple studies. Evidence was inconsistent regarding the associations between depression, trait anxiety, sense of coherence, big 5 personality traits, educational level, marital status, employment status, job position, expectations and social support, and the activity and participation domain. Optimism, general self-efficacy, cognitive appraisal processes, illness perception, ethnicity, and positive life events were associated with activities and participation but were only investigated in 1 study. No associations were identified across multiple studies for living or smoking status. Control beliefs, kinesiophobia, race, discharge location, level of poverty in neighbourhood, negative life events and occupational factors, were not associated with the activity and participation domain but were only investigated in 1 study. CONCLUSION Methodological quality of the included studies was low. Anxiety was the only factor consistently associated with worse outcomes in the activity and participation domain after THA but was only investigated in studies with high risk of bias. Further research is needed to confirm relationships between other contextual factors and activities and participation after THA. REGISTRATION PROSPERO CRD42020199070.
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Affiliation(s)
- Abner Sergooris
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium.
| | - Jonas Verbrugghe
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium
| | - Liesbet De Baets
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion Research Group (PAIN), Belgium
| | - Mira Meeus
- Department Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium; Pain in Motion Research Group (PAIN), Belgium
| | - Nathalie Roussel
- Department Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium; Pain in Motion Research Group (PAIN), Belgium
| | - Rob J E M Smeets
- Department Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Research School CAPHRI and CIR Revalidatie, Eindhoven, the Netherlands; Pain in Motion Research Group (PAIN), Belgium
| | - Katleen Bogaerts
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium; Department Health Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, UHasselt, Diepenbeek, Belgium
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22
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Patel I, Nham F, Zalikha AK, El-Othmani MM. Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:2. [PMID: 36593482 PMCID: PMC9808997 DOI: 10.1186/s42836-022-00156-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/22/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary THA (THA) is a successful procedure for end-stage hip osteoarthritis. In the setting of a failed THA, revision total hip arthroplasty (rTHA) acts as a salvage procedure. This procedure has increased risks, including sepsis, infection, prolonged surgery time, blood loss, and increased length of stay. Increasing focus on understanding of demographics, comorbidities, and inpatient outcomes can lead to better perioperative optimization and post-operative outcomes. This epidemiological registry study aimed to compare the demographics, comorbidity profiles, and outcomes of patients undergoing THA and rTHA. METHODS A retrospective review of discharge data reported from 2006 to the third quarter of 2015 using the National Inpatient Sample registry was performed. The study included adult patients aged 40 and older who underwent either THA or rTHA. A total of 2,838,742 THA patients and 400,974 rTHA patients were identified. RESULTS The primary reimbursement for both THA and rTHA was dispensed by Medicare at 53.51% and 65.36% of cases respectively. Complications arose in 27.32% of THA and 39.46% of rTHA cases. Postoperative anemia was the most common complication in groups (25.20% and 35.69%). Common comorbidities in both groups were hypertension and chronic pulmonary disease. rTHA indications included dislocation/instability (21.85%) followed by mechanical loosening (19.74%), other mechanical complications (17.38%), and infection (15.10%). CONCLUSION Our data demonstrated a 69.50% increase in patients receiving THA and a 28.50% increase in rTHA from the years 2006 to 2014. The data demonstrated 27.32% and 39.46% complication rate with THA and rTHA, with postoperative anemia as the most common cause. Common comorbidities were hypertension and chronic pulmonary disease. Future analyses into preoperative optimizations, such as prior consultation with medical specialists or improved primary hip protocol, should be considered to prevent/reduce postoperative complications amongst a progressive expansion in patients receiving both THA and rTHA.
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Affiliation(s)
- Ishan Patel
- grid.413184.b0000 0001 0088 6903DMC Orthopaedics & Sports Medicine, 3990 John R Street, Detroit, MI 48201 USA
| | - Fong Nham
- grid.413184.b0000 0001 0088 6903DMC Orthopaedics & Sports Medicine, 3990 John R Street, Detroit, MI 48201 USA
| | - Abdul K. Zalikha
- grid.413184.b0000 0001 0088 6903DMC Orthopaedics & Sports Medicine, 3990 John R Street, Detroit, MI 48201 USA
| | - Mouhanad M. El-Othmani
- grid.239585.00000 0001 2285 2675Department of Orthopaedic Surgery, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032 USA
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23
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Wu JM, Cheng BW, Ou CY, Chiu JE, Tsou SS. Applying machine learning methods to predict the hospital re-admission within 30 days of total hip arthroplasty and hemiarthroplasty. J Healthc Qual Res 2022:S2603-6479(22)00104-X. [PMID: 36581557 DOI: 10.1016/j.jhqr.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/09/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Total hip arthroplasty (THA) and hemiarthroplasty are common treatments for severe hip joint disease. To predict the probability of re-admission after discharge when patients are hospitalized will support providing appropriate health education and guidance. METHODS The research aims to use logistic regression (LR), decision trees (DT), random forests (RF), and artificial neural networks (ANN) to establish predictive models and compare their performances on re-admissions within 30 days after THA or hemiarthroplasty. The data of this study includes patient demographics, physiological measurements, disease history, and clinical laboratory test results. RESULTS There were 508 and 309 patients in the THA and hemiarthroplasty studies respectively from September 2016 to December 2018. The accuracies of the four models LR, DT, RF, and ANN in the THA experiment are 94.3%, 93.2%, 97.3%, and 93.9%, respectively. In the hemiarthroplasty experiment, the accuracies of the four models are 92.4%, 86.1%, 94.2%, and 94.8%, respectively. Among these, we found that the RF model has the best sensitivity and ANN model has the best area under the receiver operating characteristic (AUROC) score in both experiments. CONCLUSIONS The THA experiment confirmed that the performance of the RF model is better than the other models. The key factors affecting the prognosis after THA surgery are creatinine, sodium, anesthesia duration, and dialysis. In the hemiarthroplasty experiment, the ANN model showed more accurate results. Poor kidney function increases the risk of hospital re-admission. This research highlights that RF and ANN model perform well on the hip replacement surgery outcome prediction.
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Affiliation(s)
- J-M Wu
- Tungs' Taichung MetroHarbor Hospital, Taichung City, Taiwan, ROC; Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin City, Taiwan, ROC
| | - B-W Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin City, Taiwan, ROC
| | - C-Y Ou
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin City, Taiwan, ROC
| | - J-E Chiu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin City, Taiwan, ROC
| | - S-S Tsou
- Tungs' Taichung MetroHarbor Hospital, Taichung City, Taiwan, ROC.
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24
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Polisetty TS, Jain S, Pang M, Karnuta JM, Vigdorchik JM, Nawabi DH, Wyles CC, Ramkumar PN. Concerns surrounding application of artificial intelligence in hip and knee arthroplasty. Bone Joint J 2022; 104-B:1292-1303. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0922.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Literature surrounding artificial intelligence (AI)-related applications for hip and knee arthroplasty has proliferated. However, meaningful advances that fundamentally transform the practice and delivery of joint arthroplasty are yet to be realized, despite the broad range of applications as we continue to search for meaningful and appropriate use of AI. AI literature in hip and knee arthroplasty between 2018 and 2021 regarding image-based analyses, value-based care, remote patient monitoring, and augmented reality was reviewed. Concerns surrounding meaningful use and appropriate methodological approaches of AI in joint arthroplasty research are summarized. Of the 233 AI-related orthopaedics articles published, 178 (76%) constituted original research, while the rest consisted of editorials or reviews. A total of 52% of original AI-related research concerns hip and knee arthroplasty (n = 92), and a narrative review is described. Three studies were externally validated. Pitfalls surrounding present-day research include conflating vernacular (“AI/machine learning”), repackaging limited registry data, prematurely releasing internally validated prediction models, appraising model architecture instead of inputted data, withholding code, and evaluating studies using antiquated regression-based guidelines. While AI has been applied to a variety of hip and knee arthroplasty applications with limited clinical impact, the future remains promising if the question is meaningful, the methodology is rigorous and transparent, the data are rich, and the model is externally validated. Simple checkpoints for meaningful AI adoption include ensuring applications focus on: administrative support over clinical evaluation and management; necessity of the advanced model; and the novelty of the question being answered. Cite this article: Bone Joint J 2022;104-B(12):1292–1303.
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Affiliation(s)
- Teja S. Polisetty
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Samagra Jain
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Michael Pang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jaret M. Karnuta
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Danyal H. Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Cody C. Wyles
- Department of Orthopaedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Prem N. Ramkumar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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25
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Comparative Analysis of the Ability of Machine Learning Models in Predicting In-hospital Postoperative Outcomes After Total Hip Arthroplasty. J Am Acad Orthop Surg 2022; 30:e1337-e1347. [PMID: 35947826 DOI: 10.5435/jaaos-d-21-00987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/02/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Machine learning (ML) methods have shown promise in a wide range of applications including the development of patient-specific predictive models before surgical interventions. The purpose of this study was to develop, test, and compare four distinct ML models to predict postoperative parameters after primary total hip arthroplasty. METHODS Data from the Nationwide Inpatient Sample were used to identify patients undergoing total hip arthroplasty from 2016 to 2017. Linear support vector machine (LSVM), random forest (RF), neural network (NN), and extreme gradient boost trees (XGBoost) predictive of mortality, length of stay, and discharge disposition were developed and validated using 15 predictive patient-specific and hospital-specific factors. Area under the curve of the receiver operating characteristic (AUCROC) curve and accuracy were used as validity metrics, and the strongest predictive variables under each model were assessed. RESULTS A total of 177,442 patients were included in this analysis. For mortality, the XGBoost, NN, and LSVM models all had excellent responsiveness during validation while RF had fair responsiveness. LSVM had the highest responsiveness with an AUCROC of 0.973 during validation. For the length of stay, the LSVM and NN models had fair responsiveness while the XGBoost and random forest models had poor responsiveness. LSVM had the highest responsiveness with an AUCROC of 0.744 during validation. For the discharge disposition outcome, LSVM had good responsiveness while the XGBoost, NN, and RF models all had fair responsiveness. LSVM had the highest responsiveness with an AUCROC of 0.801. DISCUSSION The ML methods tested demonstrated a range of poor-to-excellent responsiveness and accuracy in the prediction of the assessed metrics, with LSVM being the best performer. Such models should be further developed, with eventual integration into clinical practice to inform patient discussions and management decision making, with the potential for integration into tiered bundled payment models.
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26
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Schwartz CE, Rapkin BD, Borowiec K, Finkelstein JA. Cognitive Processes during Recovery: Moving toward Personalized Spine Surgery Outcomes. J Pers Med 2022; 12:jpm12101545. [PMID: 36294682 PMCID: PMC9605664 DOI: 10.3390/jpm12101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
This paper focuses on a novel application of personalized medicine: the ways one thinks about health (i.e., appraisal processes) as relevant predictors of spine-surgery response. This prospective longitudinal cohort study (n = 235) investigated how appraisal processes relate to outcomes of spinal decompression and/or fusion surgery, from pre-surgery through one-year post-surgery. Patient-reported outcomes assessed spine-specific disability (Oswestry Disability Index (ODI)), mental health functioning (Rand-36 Mental Component Score (MCS)), and cognitive appraisal processes (how people recall past experiences and to whom they compare themselves). Analysis of Variance examined the appraisal-outcomes association in separate models at pre-surgery, 3 months, and 12 months. We found that appraisal processes explained less variance at pre-surgery than later and were differentially relevant to health outcomes at different times in the spine-surgery recovery trajectory. For the ODI, recall of the seriousness of their condition was most prominent early in recovery, and comparing themselves to positive standards was most prominent later. For the MCS, not focusing on the negative aspects of their condition and/or on how others see them was associated with steady improvement and higher scores at 12 months. Appraisal processes are relevant to both spine-specific disability and mental-health functioning. Such processes are modifiable objects of attention for personalizing spine-surgery outcomes.
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Affiliation(s)
- Carolyn E. Schwartz
- DeltaQuest Foundation, Inc., Concord, MA 02111, USA
- Departments of Medicine and Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA 02111, USA
- Correspondence: ; Tel.: +1-978-318-7914
| | - Bruce D. Rapkin
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Katrina Borowiec
- DeltaQuest Foundation, Inc., Concord, MA 02111, USA
- Department of Measurement, Evaluation, Statistics & Assessment, Boston College Lynch School of Education and Human Development, Chestnut Hill, MA 02467, USA
| | - Joel A. Finkelstein
- Department of Surgery, University of Toronto, Toronto, ON M4N 3M5, Canada
- Division of Orthopedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Spine Surgery, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
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27
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Golinelli D, Grassi A, Tedesco D, Sanmarchi F, Rosa S, Rucci P, Amabile M, Cosentino M, Bordini B, Fantini MP, Zaffagnini S. Patient reported outcomes measures (PROMs) trajectories after elective hip arthroplasty: a latent class and growth mixture analysis. J Patient Rep Outcomes 2022; 6:95. [PMID: 36085337 PMCID: PMC9462642 DOI: 10.1186/s41687-022-00503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are an extensively used tool to assess and improve the quality of healthcare services. PROMs can be related to individual demographic and clinical characteristics in patients undergoing hip arthroplasty (HA). The aim of this study is to identify distinct subgroups of patients with unique trajectories of PROMS scores and to determine patients’ features associated with these subgroups.
Methods We conducted a prospective, cohort study in which PROMs questionnaires (Euro Quality 5 Dimensions 3L, EQ-5D-3L, Euro-Quality-Visual-Analytic-Score, EQ-VAS, Hip disability and Osteoarthritis Outcome Score, HOOS-PS) were administered to patients undergoing elective HA pre-operatively, and at 6 and 12 months after surgery. For each measure, latent class growth analysis and growth mixture models were used to identify subgroups of patients with distinct trajectories of scores. Demografic and clinical predictors of the latent classes in growth mixture model were identified using a 3-step approach.
Results We found three distinct trajectories for each PROM score. These trajectories indicated a response heterogeneity to the HA among the patients (n = 991). Patient’s gender, ASA score, and obesity were significantly associated with different PROMs trajectories. Conclusions We identified three distinct trajectories for each of the three PROMs indicators. Several demographic and clinical characteristics are associated with the different trajectories of PROMs at 6 and 12 months after HA and could be used to identify groups of patients with different outcomes following HA surgery. These findings underline the importance of patient-centered care, supporting the usefulness of integrating PROMs data alongside routinely collected healthcare records for guiding clinical care and maximizing patients’ positive outcomes. Trial registration: Protocol version (1.0) and trial registration data are available on the platform www.clinicaltrial.gov with the identifier NCT03790267, posted on December 31, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00503-5.
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Endoscopic Surgical Treatment of Osteoarthritis and Prognostic Model Construction. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1799177. [PMID: 36105246 PMCID: PMC9467768 DOI: 10.1155/2022/1799177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/15/2022] [Accepted: 08/20/2022] [Indexed: 11/27/2022]
Abstract
Purpose Osteoarthritis (OA) is a degenerative disease of joints. Currently, there is still a lack of effective tools to predict the long-term efficacy of surgical treatment of OA. The purpose of this study was to explore the prognostic factors of endoscopic surgery for OA and to predict the long-term efficacy of this type of surgery for OA by establishing a prognostic model. Methods Baseline and follow-up data on 236 OA patients who underwent surgery in our hospital from January 2017 to December 2021 were selected and patients were randomly assigned to a training set (n = 165) and a test set (n = 71). The Pearson correlation coefficient was used to analyze the correlation between features. Feature selection was performed by recursive feature elimination (RFE) and linear regression. K-means clustering analysis was performed on the selected features to obtain the number of output layers. Finally, a single hidden layer error backpropagation (BP)-artificial neural network (ANN) model was established on the training set, and receiver operating characteristic (ROC) curve was drawn on the test set for verification. Results Correlation analysis revealed no redundancy among features. RFE and linear regression screened out the features associated with postoperative prognosis under endoscopic surgery: sex, age, BMI, region, morning stiffness time, step count, and osteophyte area. K-means clustering yielded that the optimal number of categories was three, the same as the number of categories for the outcome variable. Therefore, a 7-1-3 BP neural network model was established based on these 7 features, and this model could predict the postoperative situation within one year to a relatively accurate extent: area under curve values (AUC) were 0.814, 0.700, and 0.761 in patients with worse, unchanged, and improved conditions one year after surgery, respectively, higher than the multiclass AUC value (0.646). Conclusion The prognostic model of endoscopic surgery for OA constructed in this study can well predict the disease progression of patients within one year after surgery.
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29
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Schwartz CE, Rapkin BD, Sniderman J, Finkelstein JA. Appraisal and patient-reported outcomes following total hip arthroplasty: a longitudinal cohort study. J Patient Rep Outcomes 2022; 6:93. [PMID: 36064834 PMCID: PMC9445109 DOI: 10.1186/s41687-022-00498-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Total hip arthroplasty (THA) is a successful procedure that provides pain relief, restores function, and improves quality of life (QOL) for patients with advanced arthritis in their hip joint. To date, little research has examined the role of cognitive appraisal processes in THA outcomes. This study examined the role of cognitive appraisal processes in THA outcomes in the first year post-surgery. Methods This longitudinal cohort study collected data at pre-surgery, 6 weeks post-surgery, 3 months post-surgery, and 12 months post-surgery. Adults (n = 189) with a primary diagnosis of osteoarthritis were consecutively recruited from an active THA practice at a Canadian academic teaching hospital. Measures included the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Mental Component Score (MCS) of the Rand-36, and the Brief Appraisal Inventory (BAI). Analysis of Variance examined the association between BAI items and the HOOS or MCS scores. Random effects models investigated appraisal main effects and appraisal-by-time interactions for selected BAI items. Results HOOS showed great improvement over the first 12 months after THA, and was mitigated by three appraisal processes in particular: focusing on problems with healthcare or living situation, and preparing one’s family for health changes. MCS was stable and low over time, and the following appraisal processes were implicated by very large effect sizes: not comparing themselves to healthier people, focusing on money problems, preparing their family for their health changes, or trying to shed responsibilities. Conclusions Appraisal processes are relevant to health outcomes after THA, with different processes coming into play at different points in the recovery trajectory. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00498-z.
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Klemt C, Tirumala V, Habibi Y, Buddhiraju A, Chen TLW, Kwon YM. The utilization of artificial neural networks for the prediction of 90-day unplanned readmissions following total knee arthroplasty. Arch Orthop Trauma Surg 2022; 143:3279-3289. [PMID: 35933638 DOI: 10.1007/s00402-022-04566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A reliable predictive tool to predict unplanned readmissions has the potential to lower readmission rates through targeted pre-operative counseling and intervention with respect to modifiable risk factors. This study aimed to develop and internally validate machine learning models for the prediction of 90-day unplanned readmissions following total knee arthroplasty. METHODS A total of 10,021 consecutive patients underwent total knee arthroplasty. Patient charts were manually reviewed to identify patient demographics and surgical variables that may be associated with 90-day unplanned hospital readmissions. Four machine learning algorithms (artificial neural networks, support vector machine, k-nearest neighbor, and elastic-net penalized logistic regression) were developed to predict 90-day unplanned readmissions following total knee arthroplasty and these models were evaluated using ROC AUC statistics as well as calibration and decision curve analysis. RESULTS Within the study cohort, 644 patients (6.4%) were readmitted within 90 days. The factors most significantly associated with 90-day unplanned hospital readmissions included drug abuse, surgical operative time, and American Society of Anaesthesiologist Physical Status (ASA) score. The machine learning models all achieved excellent performance across discrimination (AUC > 0.82), calibration, and decision curve analysis. CONCLUSION This study developed four machine learning models for the prediction of 90-day unplanned hospital readmissions in patients following total knee arthroplasty. The strongest predictors for unplanned hospital readmissions were drug abuse, surgical operative time, and ASA score. The study findings show excellent model performance across all four models, highlighting the potential of these models for the identification of high-risk patients prior to surgery for whom coordinated care efforts may decrease the risk of subsequent hospital readmission. LEVEL OF EVIDENCE Level III, case-control retrospective analysis.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Venkatsaiakhil Tirumala
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Yasamin Habibi
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Anirudh Buddhiraju
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Tony Lin-Wei Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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31
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Klemt C, Laurencin S, Uzosike AC, Burns JC, Costales TG, Yeo I, Habibi Y, Kwon YM. Machine learning models accurately predict recurrent infection following revision total knee arthroplasty for periprosthetic joint infection. Knee Surg Sports Traumatol Arthrosc 2022; 30:2582-2590. [PMID: 34761306 DOI: 10.1007/s00167-021-06794-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to develop and validate machine-learning models for the prediction of recurrent infection in patients following revision total knee arthroplasty for periprosthetic joint infection. METHODS A total of 618 consecutive patients underwent revision total knee arthroplasty for periprosthetic joint infection. The patient cohort included 165 patients with confirmed recurrent periprosthetic joint infection (PJI). Potential risk factors including patient demographics and surgical characteristics served as input to three machine-learning models which were developed to predict recurrent periprosthetic joint. The machine-learning models were assessed by discrimination, calibration and decision curve analysis. RESULTS The factors most significantly associated with recurrent PJI in patients following revision total knee arthroplasty for PJI included irrigation and debridement with/without modular component exchange (p < 0.001), > 4 prior open surgeries (p < 0.001), metastatic disease (p < 0.001), drug abuse (p < 0.001), HIV/AIDS (p < 0.01), presence of Enterococcus species (p < 0.01) and obesity (p < 0.01). The machine-learning models all achieved excellent performance across discrimination (AUC range 0.81-0.84). CONCLUSION This study developed three machine-learning models for the prediction of recurrent infections in patients following revision total knee arthroplasty for periprosthetic joint infection. The strongest predictors were previous irrigation and debridement with or without modular component exchange and prior open surgeries. The study findings show excellent model performance, highlighting the potential of these computational tools in quantifying increased risks of recurrent PJI to optimize patient outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Samuel Laurencin
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Akachimere Cosmas Uzosike
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Jillian C Burns
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Timothy G Costales
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Ingwon Yeo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Yasamin Habibi
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
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Muertizha M, Cai X, Ji B, Aimaiti A, Cao L. Factors contributing to 1-year dissatisfaction after total knee arthroplasty: a nomogram prediction model. J Orthop Surg Res 2022; 17:367. [PMID: 35902950 PMCID: PMC9330701 DOI: 10.1186/s13018-022-03205-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Identifying risk factors and early intervention are critical for improving the satisfaction rate of total knee arthroplasty (TKA). Our study aimed to identify patient-specific variables and establish a nomogram model to predict dissatisfaction at 1 year after TKA. Methods This prospective cohort study involved 208 consecutive primary TKA patients with end-stage arthritis who completed self-reported measures preoperatively and at 1 year postoperatively. All participants were randomized into a training cohort (n = 154) and validation cohort (n = 54). Multiple regression models with preoperative and postoperative factors were used to establish the nomogram model for dissatisfaction at 1 year postoperatively. The least absolute shrinkage and selection operator method was used to screen the suitable and effective risk factors (demographic variables, preoperative variables, surgical variable, and postoperative variables) collected. These variables were compared between the satisfied and dissatisfied groups in the training cohort. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis were used to validate the discrimination, calibration, and clinical usefulness of the model. Results were evaluated by internal validation of the validation cohort. Results The overall satisfaction rate 1 year after TKA was 77.8%. The nomogram prediction model included the following risk factors: gender; primary diagnosis; postoperative residual pain; poor postoperative range of motion; wound healing; and the rate of change in the degree of coronal lower limb alignment (hip–knee–ankle angle, HKA).The ROC curves of the training and validation cohorts were 0.9206 (95% confidence interval [CI], 0.8785–0.9627) and 0.9662 (0.9231, 1.0000) (95% CI, 0.9231, 1.0000), respectively. The Hosmer–Lemeshow test showed good calibration of the nomogram (training cohort, p = 0.218; validation cohort, p = 0.103). Conclusion This study developed a prediction nomogram model based on partially modifiable risk factors for predicting dissatisfaction 1 year after TKA. This model demonstrated good discriminative capacity for identifying those at greatest risk for dissatisfaction and may help surgeons and patients identify and evaluate the risk factors for dissatisfaction and optimize TKA outcomes.
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Affiliation(s)
- Mieralimu Muertizha
- Department of Orthopedics, First Affiliated Hospital of Xinjiang Medical University, 137th South LiYuShan Road, Urumqi, 830054, Xinjiang, China
| | - XinTian Cai
- Xinjiang Medical University Urumqi, People's Republic of China, 137th South LiYuShan Road, Urumqi, Xinjiang, China
| | - Baochao Ji
- Department of Orthopedics, First Affiliated Hospital of Xinjiang Medical University, 137th South LiYuShan Road, Urumqi, 830054, Xinjiang, China
| | - Abudousaimi Aimaiti
- Department of Orthopedics, First Affiliated Hospital of Xinjiang Medical University, 137th South LiYuShan Road, Urumqi, 830054, Xinjiang, China
| | - Li Cao
- Department of Orthopedics, First Affiliated Hospital of Xinjiang Medical University, 137th South LiYuShan Road, Urumqi, 830054, Xinjiang, China.
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The Utility of Machine Learning Algorithms for the Prediction of Early Revision Surgery After Primary Total Hip Arthroplasty. J Am Acad Orthop Surg 2022; 30:513-522. [PMID: 35196268 DOI: 10.5435/jaaos-d-21-01039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (THA) is associated with increased morbidity, mortality, and healthcare costs due to a technically more demanding surgical procedure when compared with primary THA. Therefore, a better understanding of risk factors for early revision THA is essential to develop strategies for mitigating the risk of patients undergoing early revision. This study aimed to develop and validate novel machine learning (ML) models for the prediction of early revision after primary THA. METHODS A total of 7,397 consecutive patients who underwent primary THA were evaluated, including 566 patients (6.6%) with confirmed early revision THA (<2 years from index THA). Electronic patient records were manually reviewed to identify patient demographics, implant characteristics, and surgical variables that may be associated with early revision THA. Six ML algorithms were developed to predict early revision THA, and these models were assessed by discrimination, calibration, and decision curve analysis. RESULTS The strongest predictors for early revision after primary THA were Charlson Comorbidity Index, body mass index >35 kg/m2, and depression. The six ML models all achieved excellent performance across discrimination (area under the curve >0.80), calibration, and decision curve analysis. CONCLUSION This study developed ML models for the prediction of early revision surgery for patients after primary THA. The study findings show excellent performance on discrimination, calibration, and decision curve analysis for all six candidate models, highlighting the potential of these models to assist in clinical practice patient-specific preoperative quantification of increased risk of early revision THA.
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JOHANNESDOTTIR KB, KEHLET H, PETERSEN PB, AASVANG EK, SØRENSEN HBD, JØRGENSEN CC. Machine learning classifiers do not improve prediction of hospitalization > 2 days after fast-track hip and knee arthroplasty compared with a classical statistical risk model. Acta Orthop 2022; 93:117-123. [PMID: 34984485 PMCID: PMC8815306 DOI: 10.2340/17453674.2021.843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose: Prediction of postoperative outcomes and length of hospital stay (LOS) of patients is vital for allocation of healthcare resources. We investigated the performance of prediction models based on machinelearning algorithms compared with a previous risk stratification model using traditional multiple logistic regression, for predicting the risk of a LOS of > 2 days after fast-track total hip and knee replacement. Patients and methods: 3 different machine learning classifiers were trained on data from the Lundbeck Centre for Fast-track Hip and Knee Replacement Database (LCDB) collected from 9,512 patients between 2016 and 2017. The chosen classifiers were a random forest classifier (RF), a support vector machine classifier with a polynomial kernel (SVM), and a multinomial Naïve-Bayes classifier (NB). Results: Comparing performance measures of the classifiers with the traditional model revealed that all the models had a similar performance in terms of F1 score, accuracy, sensitivity, specificity, area under the receiver operating curve (AUC), and area under the precision-recall curve (AUPRC). A feature importance analysis of the RF classifier found hospital, age, use of walking aid, living alone, and joint operated on to be the most relevant input features. None of the classifiers reached a clinically relevant performance with the input data from the LCDB. Interpretation: Despite the promising prospects of machine-learning practices for disease and risk prediction, none of the machine learning models tested outperformed the traditional multiple regression model in predicting which patients in this cohort had a LOS > 2 days.
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Affiliation(s)
- Katrin B JOHANNESDOTTIR
- Biomedical Signal Processing & AI research group, Digital Health Section, DTU Health Tech, Technical University of Denmark, Lyngby
| | - Henrik KEHLET
- Section of Surgical Pathophysiology 7621, Rigshospitalet, Copenhagen
| | - Pelle B PETERSEN
- Section of Surgical Pathophysiology 7621, Rigshospitalet, Copenhagen
| | - Eske K AASVANG
- Section of Surgical Pathophysiology 7621, Rigshospitalet, Copenhagen,Department of Anesthesiology, Center for Cancer and Organ Diseases, Copenhagen, Denmark
| | - Helge B D SØRENSEN
- Biomedical Signal Processing & AI research group, Digital Health Section, DTU Health Tech, Technical University of Denmark, Lyngby
| | - Christoffer C JØRGENSEN
- Section of Surgical Pathophysiology 7621, Rigshospitalet, Copenhagen,The Centre for Fast-track Hip and Knee Replacement Collaborative Group: Frank MADSEN, Dept. of Orthopedics, Aarhus University Hospital, Aarhus, DK; Torben Bæk HANSEN, Dept. of Orthopedics, Regional Hospital Holstebro, Holstebro, DK; Thomas JAKOBSEN, Aalborg University Hospital Northern Orthopaedic Division, Aalborg, DK; Lars Tambour HANSEN, Dept. of Orthopedics, Sydvestjysk Hospital Esbjerg/Grindsted, Grindsted, DK; Claus VARNUM, Dept. of Orthopedics, Lillebælt Hospital Vejle, DK; Mikkel Rathsach ANDERSEN, Dept. of Orthopedics, Gentofte University Hospital, Copenhagen, DK; Niels Harry KRARUP, Dept. of Orthopedics, Viborg Hospital, Viborg, DK; and Henrik PALM, Dept. of Orthopaedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, DK
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Kuo FC, Hu WH, Hu YJ. Periprosthetic Joint Infection Prediction via Machine Learning: Comprehensible Personalized Decision Support for Diagnosis. J Arthroplasty 2022; 37:132-141. [PMID: 34543697 DOI: 10.1016/j.arth.2021.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The criteria outlined in the International Consensus Meeting (ICM) in 2018, which were prespecified and fixed, have been commonly practiced by clinicians to diagnose periprosthetic joint infection (PJI). We developed a machine learning (ML) system for PJI diagnosis and compared it with the ICM scoring system to verify the feasibility of ML. METHODS We designed an ensemble meta-learner, which combined 5 learning algorithms to achieve superior performance by optimizing their synergy. To increase the comprehensibility of ML, we developed an explanation generator that produces understandable explanations of individual predictions. We performed stratified 5-fold cross-validation on a cohort of 323 patients to compare the ML meta-learner with the ICM scoring system. RESULTS Cross-validation demonstrated ML's superior predictive performance to that of the ICM scoring system for various metrics, including accuracy, precision, recall, F1 score, Matthews correlation coefficient, and area under receiver operating characteristic curve. Moreover, the case study showed that ML was capable of identifying personalized important features missing from ICM and providing interpretable decision support for individual diagnosis. CONCLUSION Unlike ICM, ML could construct adaptive diagnostic models from the available patient data instead of making diagnoses based on prespecified criteria. The experimental results suggest that ML is feasible and competitive for PJI diagnosis compared with the current widely used ICM scoring criteria. The adaptive ML models can serve as an auxiliary system to ICM for diagnosing PJI.
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Affiliation(s)
- Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Wei-Huan Hu
- College of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yuh-Jyh Hu
- College of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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