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Muderis MA, Tan YC, Lu W, Tetsworth K, Axelrod D, Haque R, Akhtar MA, Roberts C, Doshi K, Al-Jawazneh S, Hoellwarth JS. Transtibial osseointegration following unilateral traumatic amputation: An observational study of patients with at least two years follow-up. Injury 2024; 55:111568. [PMID: 38669890 DOI: 10.1016/j.injury.2024.111568] [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: 01/07/2024] [Revised: 03/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
IMPORTANCE Most patients use a traditional socket prosthesis (TSP) to ambulate independently following transtibial amputation. However, these patients generally require prosthesis repairs more than twice annually and an entirely new prosthesis every two years. Furthermore, transtibial amputation patients have four times the skin ulceration rate of transfemoral patients, prompting more frequent prosthesis refitting and diminished use. Trans-Tibial osseointegration (TTOI) is a promising technique to address the limitations of TSP, but remains understudied with only four cohorts totaling 41 total procedures reported previously. Continued concerns regarding the risk of infection and questions as to functional capacity postoperatively have slowed adoption of TTOI worldwide. OBJECTIVE This study reports the changes in mobility, quality of life (QOL), and the safety profile of the largest described cohort of patients with unilateral TTOI following traumatic amputation. DESIGN Retrospective observational cohort study. The cohort consisted of patients with data outcomes collected before and after osseointegration intervention. SETTING A large, tertiary referral, major metropolitan center. PARTICIPANTS Twenty-one skeletally mature adults who had failed socket prosthesis rehabilitation, with at least two years of post-osseointegration follow-up. MAIN OUTCOMES AND MEASURES Mobility was evaluated by K-level, Timed Up and Go (TUG), and Six Minute Walk Test (6MWT). QOL was assessed by survey: daily prosthesis wear hours, prosthesis problem experience, general contentment with prosthesis, and Short Form 36 (SF36). Adverse events included any relevant unplanned surgery such as for infection, fracture, implant loosening, or implant failure. RESULTS All patients demonstrated statistically significant improvement post osseointegration surgery with respect to K-level, TUG, 6MWT, prosthesis wear hours, prosthesis problem experience, general prosthesis contentment score, and SF36 Physical Component Score (p < 0.01 for all). Three patients had four unplanned surgeries: two soft tissue refashionings, and one soft tissue debridement followed eventually by implant removal. No deaths, postoperative systemic complications, more proximal amputations, or periprosthetic fractures occurred. CONCLUSIONS AND RELEVANCE TTOI is likely to confer mobility and QOL improvements to patients dissatisfied with TSP rehabilitation following unilateral traumatic transtibial amputation. Adverse events are relatively infrequent and not further disabling. Judicious use of TTOI seems reasonable for properly selected patients. LEVEL OF EVIDENCE 2 (Therapeutic investigation, Observational study with dramatic effect).
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Affiliation(s)
- Munjed Al Muderis
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| | - Yao Chang Tan
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - William Lu
- Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia; Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Daniel Axelrod
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia.
| | - Russel Haque
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| | - Muhammad Adeel Akhtar
- NHS Fife, UK; University of Edinburgh College of Medicine & Veterinary Medicine, UK; University of St. Andrews School of Medicine, UK
| | - Claudia Roberts
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| | - Karan Doshi
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| | - Shakib Al-Jawazneh
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| | - Jason Shih Hoellwarth
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia; Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY, USA
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Long G, Duo W, Man L, Haoning M, Ping Y, Mingsheng T, Yuxiang S. The impact of post-traumatic stress on the clinical outcome in a cohort of patients with knee osteoarthritis and knee arthroplasty: A prospective study. J Orthop Sci 2024; 29:847-853. [PMID: 37055273 DOI: 10.1016/j.jos.2023.03.017] [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: 05/20/2022] [Revised: 01/18/2023] [Accepted: 03/26/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders and commonly occurs in older adults, predominantly female populations. Both populations have intimate links with trauma-related stress. Therefore, we intended to evaluate the prevalence of post-traumatic stress disorder (PTSD), which arises from KOA and determine its effects on the postoperative results in patients undergoing total knee arthroplasty (TKA). METHODS The patients who fulfilled the diagnosis of KOA from February 2018 to October 2020 were interviewed. Patients were interviewed by a senior psychiatrist about evaluating their overall experience during their most difficult or stressful situations. KOA patients who underwent TKA were further analyzed to investigate whether PTSD influences the postoperative results. The PTSD Checklist-Civilian Version (PCL-C) and Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index were used to assess PTS symptoms and clinical outcomes after TKA, respectively. RESULTS 212 KOA patients completed this study with a mean follow-up of 16.7 months (7-36 months). The mean age was 62.5 ± 12.3 years, and 53.3% (113/212) were women. 64.6% of the sample (137/212) underwent TKA to relieve the symptoms of KOA. Patients with either PTS or PTSD tended to be younger (P < 0.05), female (P < 0.05) and undergo TKA (P < 0.05) than their counterparts. WOMAC-pain (P < 0.05), WOMAC-stiffness (P < 0.05), and WOMAC-physical function (P < 0.05) both before TKA and 6 months after TKA in the PTSD group is significantly higher compared to their counterparts. Logistic regression analysis showed that a history of OA-inducing trauma (adjusted OR = 2.0, 95% CI = 1.7-2.3, P = 0.003), posttraumatic KOA (adjusted OR = 1.7, 95% CI = 1.4-2.0, P < 0.001), and invasive treatment (adjusted OR = 2.0, 95% CI = 1.7-2.3, P = 0.032), were significantly associated with PTSD in KOA patients. CONCLUSIONS Patients with KOA, especially those undergoing TKA, are associated with PTS symptoms and PTSD, indicating the need to evaluate it and offer care for them.
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Affiliation(s)
| | - Wang Duo
- School of Music and Dance, Hubei Minzu University, China
| | - Li Man
- General Hospital of Enshi Tujia & Miao Autonomous Prefecture, China
| | | | - Yi Ping
- China-Japan Friendship Hospital, China
| | | | - Song Yuxiang
- Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China.
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Podurgiel J, Piscitelli D, Denegar C. Challenges in applying minimal clinically important difference: a critical review. Int J Rehabil Res 2024; 47:10-19. [PMID: 38250825 DOI: 10.1097/mrr.0000000000000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Healthcare clinicians strive to make meaningful changes in patient function and participation. A minimal clinically important difference (MCID) is an estimate of the magnitude of change needed to be meaningful to a patient. Clinicians and investigators may assume that a cited MCID is a valid and generalizable estimate of effect. There are, however, at least two concerns about this assumption. First, multiple methods exist for calculating an MCID that can yield divergent values and raise doubt as to which one to apply. Second, MCID values may be erroneously generalized to patients with dissimilar health conditions. With this in mind, we reviewed the methods used to calculate MCID and citations of reported MCID values for outcome measures commonly used in neurologic, orthopedic, and geriatric populations. Our goal was to assess whether the calculation methods were acknowledged in the cited work and whether the enrolled patients were similar to the sample from which the MCID estimate was derived. We found a concerning variation in the methods employed to estimate MCID. We also found a lack of transparency in identifying calculation methods and applicable health conditions in the cited work. Thus, clinicians and researchers must pay close attention and exercise caution in assuming changes in patient status that exceed a specific MCID reflect meaningful improvements in health status. A common standard for the calculation and reporting of an MCID is needed to address threats to the validity of conclusions drawn from the interpretation of an MCID.
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Affiliation(s)
- Joseph Podurgiel
- Doctor of Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
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Strauch M, Kaufmann V, Graichen H. Tibia-first, gap-balanced patient-specific alignment technique achieves well-balanced gaps in 90% of cases by rebuilding bony anatomy within boundaries. Knee Surg Sports Traumatol Arthrosc 2024; 32:381-388. [PMID: 38270248 DOI: 10.1002/ksa.12056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE Patient-specific alignment (PSA) technique tries to achieve balanced gaps and simultaneously rebuild the individual bony phenotype. The hypothesis was: PSA technique achieves balanced knees in a high percentage with more anatomical resections than adjusted mechanical alignment (AMA). METHODS Three hundred sixty-seven patients underwent navigated total knee arthroplasty (TKA) with a tibia-first gap-balanced PSA technique. Resection boundaries for medial proximal tibia angle (MPTA) of 86-92°, mechanical lateral distal femoral angle (mLDFA) of 86-92°, and hip-knee-ankle angle (HKA) of 175-185° were defined. Preoperative and intraoperative parameters of HKA, MPTA, mLDFA, and gap widths were recorded. Depending on the coronal deformity, the patients were divided into three groups: varus HKA < 178°; straight 178-182° and valgus HKA > 182°. The stability was analysed by assessing the difference between medial and lateral extension and flexion gaps as well as between flexion and extension gaps. All PSA measurements were compared with data from a previously published AMA series. RESULTS PSA achieved balanced gaps in extension, flexion and between flexion/extension in over 90% of cases, being similar to AMA. In PSA, MPTA and mLDFA were restored within 1°, except in extreme varus (MPTA difference 2°) and valgus knees (mLDFA difference 3°). This was caused by the defined boundaries of the alignment technique. This individualised reconstruction led to significantly more anatomical resections of all tibia and femur resections. CONCLUSION A tibia-first, gap-balanced PSA technique achieves balanced joints in more than 90% of cases. By maintaining preoperative MPTA and mLDFA to a high extent, far more anatomical resections, compared to AMA were performed. Future studies need to be conducted to investigate whether those promising intraoperative results correlate with postoperative patient outcomes and whether patients outside the 5° corridor have higher failure rates. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Marco Strauch
- Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Schwandorf, Germany
| | - Verena Kaufmann
- Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Schwandorf, Germany
| | - Heiko Graichen
- Department for Arthroplasty, Sports-Traumatology and General Orthopaedics, Asklepios Orthopaedic Hospital Lindenlohe, Schwandorf, Germany
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Longo UG, De Salvatore S, Piergentili I, Lalli A, Bandini B, Denaro V. Minimum Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) Applied to the SF-36 in Patients Who Underwent Arthroscopic Rotator Cuff Repair. J Clin Med 2023; 13:178. [PMID: 38202185 PMCID: PMC10779461 DOI: 10.3390/jcm13010178] [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: 10/19/2023] [Revised: 12/08/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
The 36-Item Short-Form Health Survey questionnaire (SF-36) is a reliable tool to assess the health-related quality of life of patients. If a mean difference between pre-operative evaluation and final follow-up is found to be statistically significant, then the change in score is not random. However, a statistically significant mean change may not correspond to a clinical amelioration for the patient or mean that the patient's state of health is to be considered acceptable. For this reason, interest in the concepts of minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) has grown within recent years. The goal of the present work of research was to determine the MCID and PASS values for the SF-36 in patients who received rotator cuff repair (RCR). Forty-six patients (18 women and 28 men, mean age 58.5 ± 12.9) previously diagnosed with rotator cuff disease were enrolled. All of these patients underwent RCR. They were evaluated pre-operatively and six months after the surgical intervention as a final follow-up. The SF-36 questionnaire was assessed at each evaluation. The MCID cut-offs of the total, physical, and mental dimensions of the SF-36 for patients who underwent RCR were 23.1, 32.5, and 18.1, respectively. A 23.1 improvement in the SF-36 score at six months following RCR can be correlated with patients having reached a clinically significant improvement in health status. If 81.9 or more is attained in the SF-36 score after surgical repair, the symptom state can be judged as satisfactory by the majority of patients.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.D.S.); (A.L.); (B.B.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Sergio De Salvatore
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.D.S.); (A.L.); (B.B.); (V.D.)
- Research Unit of Ospedale Pediatrico Bambin Gesù, Department of Medicine and Surgery, Via della Torre di Palidoro, 00050 Fiumicino, Italy
| | - Ilaria Piergentili
- CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, 00185 Rome, Italy;
| | - Alberto Lalli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.D.S.); (A.L.); (B.B.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Benedetta Bandini
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.D.S.); (A.L.); (B.B.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (S.D.S.); (A.L.); (B.B.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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Zhang Y, Ren J, Zang Y, Guo W, Disantis A, Martin RL. Cross-Culturally Adapted Versions of Patient Reported Outcome Measures for the Lower Extremity. Int J Sports Phys Ther 2023; V18:653-686. [PMID: 37425110 PMCID: PMC10324371 DOI: 10.26603/001c.74528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background A large number of patient reported outcome measures (PROMs) have been developed in the English language for various lower extremity orthopaedic pathologies. Twenty different PROMs were recommended for 15 specific musculoskeletal lower extremity pathologies or surgeries. However, the availability of cross-culturally adapted versions of these recommended PROMs is unknown. Purpose The purpose of this study was to identify the cross-culturally adapted versions of recommended PROMs for individuals experiencing orthopedic lower extremity pathologies or undergoing surgeries, and to identify the psychometric evidence that supports their utilization. Study design Literature Review. Methods PubMed, Embase, Medline, Cochrane, CINAHL, SPORTDisucs and Scopus were searched for cross-culturally adapted translated studies through May 2022. The search strategy included the names of the 20 recommended PROMs from previous umbrella review along with the following terms: reliability, validity, responsiveness, psychometric properties and cross-cultural adaptation. Studies that presented a non-English language version of the PROM with evidence in at least one psychometric property to support its use were included. Two authors independently evaluated the studies for inclusion and independently extracted data. Results Nineteen PROMS had cross-culturally adapted and translated language versions. The KOOS, WOMAC, ACL-RSL, FAAM, ATRS, HOOS, OHS, MOXFQ and OKS were available in over 10 different language versions. Turkish, Dutch, German, Chinese and French were the most common languages, with each language having more than 10 PROMs with psychometric properties supporting their use. The WOMAC and KOOS were both available in 10 languages and had all three psychometric properties of reliability, validity, and responsiveness supporting their use. Conclusion Nineteen of the 20 recommended instruments were available in multiple languages. The PROM most frequently cross-culturally adapted and translated were the KOOS and WOMAC. PROMs were most frequently cross-culturally adapted and translated into Turkish. International researchers and clinicians may use this information to more consistently implement PROMs with the most appropriate psychometric evidence available to support their use. Level of evidence 3a.
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Affiliation(s)
- Yongni Zhang
- Rangos School of Health Sciences Duquesne- China Health Institute
| | - Jiayi Ren
- Shuguang Hospital of Shanghai University of Traditional Chinese Medicine
| | - Yaning Zang
- Department of Kinesiology Shanghai University of Sport
| | - Wenhao Guo
- Rangos School of Health Sciences Duquesne- China Health Institute
| | - Ashley Disantis
- Department of Physical Therapy Duquesne University
- UPMC Children's Hospital of Pittsburgh
| | - Robroy L Martin
- Department of Physical Therapy Duquesne University
- UPMC Center for Sports Medicine
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Hoelen TCA, Schotanus M, van Kuijk S, Bastiaenen C, Boonen B, Most J. The relation between socioeconomic status and patient symptoms before and one year after lower extremity arthroplasty. J Orthop 2023; 39:11-17. [PMID: 37089622 PMCID: PMC10120353 DOI: 10.1016/j.jor.2023.03.011] [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: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Aims To determine whether there was a relation between socioeconomic status (SES) and patient symptoms before and one year after total knee arthroplasty (TKA), and/or total hip arthroplasty (THA) and whether a change in symptoms was clinically relevant. Patients and methods A secondary analysis of a prospective cohort study was conducted on SES and osteoarthritis symptoms of patients (≥45 years old) who received a primary TKA or THA between 2016 and 2018. The relation between SES and respectively pre- and postoperative and change in patient-reported outcome measures including the Oxford Knee Score (OKS), Oxford Hip Score (OHS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), the visual analog scale (VAS) for pain and the EuroQol 5-Dimensions (EQ-5D) were assessed using linear mixed-effects regression models adjusted for age and sex. The following potential confounding variables were considered in the regression models: body mass index (BMI), American Society of Anesthesiologists (ASA)- classification, Charnley-classification, smoking status, and alcohol consumption. Results Patients with lower SES were mostly female, had a higher BMI and ASA-classification compared to patients with a higher SES. Patients with lower SES reported lower OKS (β = 3.78, P = 0.001). Patients undergoing THA reported lower scores for the OHS (β = 4.78, P = 0.001), WOMAC (β = 11.7, P = 0.001), and less pain (VAS, β = -0.91, P = 0.001). No statistically significant differences between SES groups were seen in the quality of life and health status as measured with the EQ-5D. Conclusion Patients with a lower socioeconomic status reported worse symptoms and showed less clinically relevant improvement at one-year follow-up.
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Affiliation(s)
- Thomáy-Claire Ayala Hoelen
- Dept Orthopedic Surgery, CAPHRI, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Dept Orthopedics and Traumatology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6161 BG, Sittard, the Netherlands
| | - Martijn Schotanus
- Dept Orthopedic Surgery, CAPHRI, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Dept Orthopedics and Traumatology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6161 BG, Sittard, the Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Caroline Bastiaenen
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Bert Boonen
- Dept Orthopedic Surgery, CAPHRI, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Jasper Most
- Dept Orthopedics and Traumatology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6161 BG, Sittard, the Netherlands
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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Deckey DG, Verhey JT, Christopher ZK, Gerhart CRB, Clarke HD, Spangehl MJ, Bingham JS. Discordance Abounds in Minimum Clinically Important Differences in THA: A Systematic Review. Clin Orthop Relat Res 2023; 481:702-714. [PMID: 36398323 PMCID: PMC10013655 DOI: 10.1097/corr.0000000000002434] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The minimum clinically important difference (MCID) is intended to detect a change in a patient-reported outcome measure (PROM) large enough for a patient to appreciate. Their growing use in orthopaedic research stems from the necessity to identify a metric, other than the p value, to better assess the effect size of an outcome. Yet, given that MCIDs are population-specific and that there are multiple calculation methods, there is concern about inconsistencies. Given the increasing use of MCIDs in total hip arthroplasty (THA) research, a systematic review of calculated MCID values and their respective ranges, as well as an assessment of their applications, is important to guide and encourage their use as a critical measure of effect size in THA outcomes research. QUESTIONS/PURPOSES We systematically reviewed MCID calculations and reporting in current THA research to answer the following: (1) What are the most-reported PROM MCIDs in THA, and what is their range of values? (2) What proportion of studies report anchor-based versus distribution-based MCID values? (3) What are the most common methods by which anchor-based MCID values are derived? (4) What are the most common derivation methods for distribution-based MCID values? (5) How do the reported medians and corresponding ranges compare between calculation methods for each PROM? METHODS The EMBASE, MEDLINE, and PubMed databases were systematically reviewed from inception through March 2022 for THA studies reporting an MCID value for any PROMs. Two independent authors reviewed articles for inclusion. All articles calculating new PROM MCID scores after primary THA were included for data extraction and analysis. MCID values for each PROM, MCID calculation method, number of patients, and study demographics were extracted from each article. In total, 30 articles were included. There were 45 unique PROMs for which 242 MCIDs were reported. These studies had a total of 1,000,874 patients with a median age of 64 years and median BMI of 28.7 kg/m 2 . Women made up 55% of patients in the total study population, and the median follow-up period was 12 months (range 0 to 77 months). The overall risk of bias was assessed as moderate using the modified Methodological Index for Nonrandomized Studies criteria for comparative studies (the mean score for comparative papers in this review was 18 of 24, with higher scores representing better study quality) and noncomparative studies (for these, the mean score was 10 of a possible 16 points, with higher scores representing higher study quality). Calculated values were classified as anchor-based, distribution-based, or not reported. MCID values for each PROM, MCID calculation method, number of patients, and study demographics were extracted from each study. Anchor-based and distribution-based MCIDs were compared for each unique PROM using a Wilcoxon rank sum test, given the non-normal distribution of values. RESULTS The Oxford Hip Score (OHS) and the Hip Injury and Osteoarthritis Score (HOOS) Pain and Quality of Life subscore MCIDs were the most frequently reported, comprising 12% (29 of 242), 8% (20 of 242), and 8% (20 of 242), respectively. The EuroQol VAS (EQ-VAS) was the next-most frequently reported (7% [17 of 242]) followed by the EuroQol 5D (EQ-5D) (7% [16 of 242]). The median anchor-based value for the OHS was 9 (IQR 8 to 11), while the median distribution-based value was 6 (IQR 5 to 6). The median anchor-based MCID values for HOOS Pain and Quality of Life were 33 (IQR 28 to 35) and 25 (14 to 27), respectively; the median distribution-based values were 10 (IQR 9 to 10) and 13 (IQR 10 to 14), respectively. Thirty percent (nine of 30) of studies used an anchor-based method to calculate a new MCID, while 40% (12 of 30) used a distribution-based technique. Thirty percent of studies (nine of 30) calculated MCID values using both methods. For studies reporting an anchor-based calculation method, a question assessing pain relief, satisfaction, or quality of life on a five-point Likert scale was the most commonly used anchor (30% [eight of 27]), followed by a receiver operating characteristic curve estimation (22% [six of 27]). For studies using distribution-based calculations, the most common method was one-half the standard deviation of the difference between preoperative and postoperative PROM scores (46% [12 of 26]). Most reported median MCID values (nine of 14) did not differ by calculation method for each unique PROM (p > 0.05). The OHS, HOOS JR, and HOOS Function, Symptoms, and Activities of Daily Living subscores all varied by calculation method, because each anchor-based value was larger than its respective distribution-based value. CONCLUSION We found that MCIDs do not vary very much by calculation method across most outcome measurement tools. Additionally, there are consistencies in MCID calculation methods, because most authors used an anchor question with a Likert scale for the anchor-based approach or used one-half the standard deviation of preoperative and postoperative PROM score differences for the distribution-based approach. For some of the most frequently reported MCIDs, however, anchor-based values tend to be larger than distribution-based values for their respective PROMs. CLINICAL RELEVANCE We recommend using a 9-point increase as the MCID for the OHS, consistent with the median reported anchor-based value derived from several high-quality studies with large patient groups that used anchor-based approaches for MCID calculations, which we believe are most appropriate for most applications in clinical research. Likewise, we recommend using the anchor-based 33-point and 25-point MCIDs for the HOOS Pain and Quality of Life subscores, respectively. We encourage using anchor-based MCID values of WOMAC Pain, Function, and Stiffness subscores, which were 29, 26, and 30, respectively.
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Affiliation(s)
- David G. Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jens T. Verhey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | | | - Henry D. Clarke
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Mark J. Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Joshua S. Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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Bullen ME, Babazadeh S, van Bavel D, McKenzie DP, Dowsey MM, Choong PF. Reduction in Offset Is Associated With Worse Functional Outcomes Following Total Hip Arthroplasty. J Arthroplasty 2023; 38:329-334. [PMID: 36096271 DOI: 10.1016/j.arth.2022.09.001] [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: 06/02/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Conflicting reports exist about the effect of offset variation on functional outcomes following total hip arthroplasty. Reproducing native hip offset is thought to optimize function by restoring biomechanics and appropriately tensioning the hip abductor muscles. The aim of this study is to assess the effect of failing to restore global hip offset in comparison to the native contralateral hip. METHODS A retrospective analysis of a prospective patient cohort was performed on patients undergoing an elective primary total hip arthroplasty. A total of 414 patients who had a minimum of 12 months of follow-up were included. Postoperative plain radiographs were analyzed for offset and compared to the contralateral native hip. Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Veterans RAND 12 (VR-12) scores were assessed preoperatively and at 12 months postoperatively. RESULTS Regression analyses indicated that a reduction in offset of >20 mm resulted in worse WOMAC pain (P = .005) and motion (P = .015) scores compared to those with maintained offset. WOMAC function (P = .063), global (P = .025), and VR-12 scores were not affected (physical P = .656; mental P = .815). Reduction in offset up to 20 mm and increased offset were not significantly associated with patient-reported outcome measures (P-values ranged from .102 to .995). CONCLUSION This study demonstrated an association between reduction in offset by >20 mm and worse WOMAC pain and motion scores following total hip arthroplasty. Surgeons should avoid decreases in offset >20 mm in order to optimize functional outcomes.
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Affiliation(s)
- Michael E Bullen
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia
| | - Sina Babazadeh
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia
| | - Dirk van Bavel
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia
| | - Dean P McKenzie
- Department of Epidemiology and Preventive Medicine, Epworth HealthCare, Monash University, Melbourne, Australia
| | - Michelle M Dowsey
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia; University of Melbourne Department of Surgery at St. Vincent's Hospital Melbourne, Level 2 Clinical Sciences Building, Fitzroy, Australia
| | - Peter F Choong
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia; University of Melbourne Department of Surgery at St. Vincent's Hospital Melbourne, Level 2 Clinical Sciences Building, Fitzroy, Australia
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10
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Goh GS, Tarabichi S, Baker CM, Qadiri QS, Austin MS. Should We Aim to Help Patients "Feel Better" or "Feel Good" After Total Hip Arthroplasty? Determining Factors Affecting the Achievement of the Minimal Clinically Important Difference and Patient Acceptable Symptom State. J Arthroplasty 2023; 38:293-299. [PMID: 35964857 DOI: 10.1016/j.arth.2022.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Recent attempts have been made to use preoperative patient-reported outcome measure (PROM) thresholds as prior authorization criteria based on the assumption that patients who have higher baseline scores are less likely to achieve the minimal clinically important difference (MCID). This study aimed to identify factors affecting the achievement of MCID and patient acceptable symptom state (PASS) after total hip arthroplasty (THA), and to determine the overlap between the two outcomes. METHODS We identified 3,581 primary, unilateral THAs performed at a single practice in 2015-2019. PROMs including Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and 12-item Short Form Health Survey were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS according to attainment of MCID was assessed. Multivariable regression was used to identify independent predictors of MCID and PASS. RESULTS In total, 79.8% achieved MCID and 73.6% achieved PASS for HOOS-JR. Approximately 1 in 7 patients who achieved MCID did not eventually achieve PASS. Worse preoperative HOOS-JR (odd ratio 0.933) was associated with MCID attainment. Better preoperative HOOS-JR (odd ratio 1.015) was associated with PASS attainment. Men, lower body mass index, better American Society of Anesthesiologists score, and better preoperative 12-item Short Form Health Survey mental score were predictors of MCID and PASS. Age, race, ethnicity, Charlson Comorbidity Index, and smoking status were not significant predictors. CONCLUSION Preoperative PROMs were associated with achieving MCID and PASS after THA, albeit in opposite directions. Clinicians should strive to help patients "feel better" and "feel good" after surgery. Preoperative PROMs should not solely be used to prioritize access to care.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Qudratullah S Qadiri
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Morimoto H, Kishita N, Kondo H, Tanaka N, Abe Y, Muto T. Reliability and validity of the Japanese version of the experiential avoidance in caregiving questionnaire (EACQ). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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12
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Evaluating the Functional and Psychological Outcomes Following Periprosthetic Femoral Fracture After Total Hip Arthroplasty. Arthroplast Today 2022; 18:57-62. [PMID: 36262668 PMCID: PMC9574344 DOI: 10.1016/j.artd.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 06/29/2022] [Accepted: 08/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background A fall after total hip arthroplasty (THA) that results in a periprosthetic femoral fracture (PPF) can have devastating functional and psychological consequences in older adults. There are few studies that have evaluated both functional and psychological outcomes of PPF post-THA in the same cohort. Methods This is a retrospective study of 130 people who underwent revision THA between 2005 and 2019 due to PPF. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC), Harris Hip Score (HHS), and Short Form-12 (SF-12) assessed physical function, hip joint function, and psychological well-being, respectively. Descriptive statistics using means and standard deviation or frequencies and percentages were used to define the sample. The association between baseline demographic, clinical, and surgical factors on WOMAC, HHS, and SF-12 scores at 1-year post-PPF surgery was modelled using multivariable linear regression. The mean age (n = 130) was 80.6 ± 9.0 years, and 55.4% (n = 72) were female. The mortality rate was 15.4% (n = 20) at 1-year post-PPF surgery. One-year follow-up data were available for 35.4% (n = 46) of patients. Results The WOMAC (n = 37), HHS (n = 32), and SF-12 mental component summary (n = 46) scores at 1-year post-PPF surgery were 67.9 ± 20.3, 78.3 ± 15.0, and 52.7 ± 9.1, respectively. No significant association was found among age, gender, previous history of lower extremity surgery, Vancouver classification, and femoral bone grafting on WOMAC, HHS, and SF-12 scores. Conclusions Our study found that patients with PPF have fair hip joint function, poor physical function and psychological well-being, and a high mortality rate at 1-year post-PPF surgery.
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Clement ND, Smith KM, Baron YJ, McColm H, Deehan DJ, Holland J. Increasing age does not influence hip-specific functional outcome or health-related quality of life following total hip arthroplasty. Bone Jt Open 2022; 3:692-700. [DOI: 10.1302/2633-1462.39.bjo-2022-0085.r1] [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] [Indexed: 11/05/2022] Open
Abstract
Aims The primary aim of our study was to assess the influence of age on hip-specific outcome following total hip arthroplasty (THA). Secondary aims were to assess health-related quality of life (HRQoL) and level of activity according to age. Methods A prospective cohort study was conducted. All patients were fitted with an Exeter stem with a 32 mm head on highly cross-linked polyethylene (X3RimFit) cemented acetabulum. Patients were recruited into three age groups: < 65 years, 65 to 74 years, and ≥ 75 years, and assessed preoperatively and at three, 12, 24, and 60 months postoperatively. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and Hip disability and Osteoarthritis Outcome Score (HOOS), were used to assess hip-specific outcome. EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 36-Item Short Form Survey (SF-36) scores were used to assess HRQoL. The Lower Extremity Activity Scale (LEAS) and Timed Up and Go (TUG) were used to assess level of activity. Results There were no significant (p > 0.05) differences in the WOMAC scores, HSS, HOOS, or EQ-5D-5L at any postoperative timepoint between the age groups. Patients aged ≥ 75 years had significantly lower physical function (p ≤ 0.010) and physical role (p ≤ 0.047) SF-36 scores at 12, 24, and 60 months, but were equal to that expect of an age-matched population. No differences according to age were observed for the other six domains of the SF-36 (p > 0.060). The ≥ 75 years group had a lower LEAS (p < 0.001) and longer TUG test times (p ≤ 0.032) compared to the < 65 years group, but older age groups had significant (p < 0.001) improvement relative to their preoperative baseline measures. Conclusion Age did not influence postoperative hip-specific outcome or HRQoL (according to the EQ-5D) following THA. Despite a significant improvement, older patients had lower postoperative activity levels compared to younger patients, but this may be reflective of the overall physical effect of ageing. Cite this article: Bone Jt Open 2022;3(9):692–700.
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Affiliation(s)
- Nick D. Clement
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Karen M. Smith
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
| | - Y. J. Baron
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
| | - Heidi McColm
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
| | - David J. Deehan
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
| | - James Holland
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
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Goh GS, Baker CM, Tarabichi S, Clark SC, Austin MS, Lonner JH. The Paradox of Patient-Reported Outcome Measures: Should We Prioritize "Feeling Better" or "Feeling Good" After Total Knee Arthroplasty? J Arthroplasty 2022; 37:1751-1758. [PMID: 35436528 DOI: 10.1016/j.arth.2022.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of preoperative patient-reported outcome measure (PROM) thresholds for patient selection in arthroplasty care has been questioned recently. This study aimed to identify factors affecting achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) after total knee arthroplasty (TKA) and determine the overlap between the two outcomes. METHODS We identified 1,239 primary, unilateral TKAs performed at a single institution in 2015-2019. PROMs including the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and 12-item Short Form Health Survey (SF-12) were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS as per attainment of MCID was assessed. A multivariable regression was used to identify predictors of MCID and PASS. RESULTS In total, 71.3% achieved MCID and 75.5% achieved PASS for KOOS-JR. Only 7.7% achieved MCID but not PASS, whereas almost twice this number did not achieve MCID but did achieve PASS (11.9%). Poorer preoperative KOOS-JR (OR 0.925), better SF-12 physical (OR 1.025), and mental (OR 1.027) were associated with MCID attainment. In contrast, better preoperative KOOS-JR (OR 1.030) and SF-12 mental (OR 1.025) were associated with PASS attainment. Age, gender, race, ethnicity, body mass index, Charlson index, American Society of Anesthesiologists classification, and smoking status were not significant predictors. CONCLUSION Preoperative PROMs were associated with achieving MCID and PASS after TKA, albeit some positively and some negatively. In the era of value-based care, clinicians should not only strive to help patients "feel better" but also ensure that patients "feel good" after surgery. This study does not support the use of PROMs in prioritizing access to care.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Sean C Clark
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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6-Month Follow-up of Lateral Femoral Circumflex Artery Embolization to Control Pain Related to Hip Osteoarthritis and Greater Trochanteric Pain Syndrome. Cardiovasc Intervent Radiol 2022; 45:1710-1715. [PMID: 36002538 PMCID: PMC9401195 DOI: 10.1007/s00270-022-03253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/06/2022] [Indexed: 11/12/2022]
Abstract
Purpose To present the preliminary results of a cohort of 13 patients with hip osteoarthritis (OA) and great trochanteric pain syndrome (GTPS) refractory to conservative management or physical therapy and no indication for surgery treated with embolization of the lateral femoral circumflex artery. Material and Methods This is a single-center prospective cohort from July 2019 to September 2020. Visual analogue scale (VAS) and Western Ontario and MacMaster Universities (WOMAC) were used to compare the symptoms before and after 6-month follow-up. Technical success was considered when at least one artery responsible for the hyperemic synovium was embolized. Complications and adverse events were noted. Results In total, 13 patients were included; mean age was 62.4 (± 11.0) years. 10 (76.9%) patients were treated for GTPS and 3 (23.1%) for hip OA. Nine patients were treated with imipenem/cilastatin (I/C) alone. Microsphere 100–300 μm and I/C were combined in 4 patients. The WOMAC Index had a statistically significant decrease in the total from 77 to 27 points (p = 0.001). Pain, rigidity and physical activity have also significantly reduced (19 to 5, p = 0.001; 6 to 2, p = 0.002 and 53 to 22, p = 0.001, respectively). VAS score had a significant decrease (10 to 2, p = 0.002). Two patients present posterior tight numbness, spontaneously improved within 30 days. Conclusion In this cohort, lateral femoral circumflex artery embolization was a safe and effective treatment for patients with hip pain due to OA and GTPS.
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16
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Pereira TV, Jüni P, Saadat P, Xing D, Yao L, Bobos P, Agarwal A, Hincapié CA, da Costa BR. Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis. BMJ 2022; 378:e069722. [PMID: 36333100 PMCID: PMC9258606 DOI: 10.1136/bmj-2022-069722] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of viscosupplementation for pain and function in patients with knee osteoarthritis. DESIGN Systematic review and meta-analysis of randomised trials. DATA SOURCES Searches were conducted of Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to 11 September 2021. Unpublished trials were identified from the grey literature and trial registries. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised trials comparing viscosupplementation with placebo or no intervention for knee osteoarthritis treatment. MAIN OUTCOME MEASURES The prespecified primary outcome was pain intensity. Secondary outcomes were function and serious adverse events. Pain and function were analysed as standardised mean differences (SMDs). The prespecified minimal clinically important between group difference was -0.37 SMD. Serious adverse events were analysed as relative risks. METHODS Two reviewers independently extracted relevant data and assessed the risk of bias of trials using the Cochrane risk of bias tool. The predefined main analysis was based only on large, placebo controlled trials with ≥100 participants per group. Summary results were obtained through a random effects meta-analysis model. Cumulative meta-analysis and trial sequential analysis under a random effects model were also performed. RESULTS 169 trials provided data on 21 163 randomised participants. Evidence of small study effects and publication biases was observed for pain and function (Egger's tests with P<0.001 and asymmetric funnel plots). Twenty four large, placebo controlled trials (8997 randomised participants) included in the main analysis of pain indicated that viscosupplementation was associated with a small reduction in pain intensity compared with placebo (SMD -0.08, 95% confidence interval -0.15 to -0.02), with the lower bound of the 95% confidence interval excluding the minimal clinically important between group difference. This effect corresponds to a difference in pain scores of -2.0 mm (95% confidence interval -3.8 to -0.5 mm) on a 100 mm visual analogue scale. Trial sequential analysis for pain indicated that since 2009 there has been conclusive evidence of clinical equivalence between viscosupplementation and placebo. Similar conclusions were obtained for function. Based on 15 large, placebo controlled trials on 6462 randomised participants, viscosupplementation was associated with a statistically significant higher risk of serious adverse events than placebo (relative risk 1.49, 95% confidence interval 1.12 to 1.98). CONCLUSION Strong conclusive evidence indicates that viscosupplementation leads to a small reduction in knee osteoarthritis pain compared with placebo, but the difference is less than the minimal clinically important between group difference. Strong conclusive evidence indicates that viscosupplementation is also associated with an increased risk of serious adverse events compared with placebo. The findings do not support broad use of viscosupplementation for the treatment of knee osteoarthritis. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021236894.
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Affiliation(s)
- Tiago V Pereira
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Pakeezah Saadat
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Dan Xing
- Arthritis Clinic & Research Centre, Peking University People's Hospital, Beijing, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Pavlos Bobos
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Department of Health and Rehabilitation Sciences, School of Physical Therapy, Western University, London, ON, Canada
| | - Arnav Agarwal
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Cesar A Hincapié
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Bruno R da Costa
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Anderson PM, Vollmann P, Weißenberger M, Rudert M. Total hip arthroplasty in geriatric patients – a single-center experience. SICOT J 2022; 8:12. [PMID: 35380534 PMCID: PMC8982179 DOI: 10.1051/sicotj/2022011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background: As advanced age often leads to accumulating comorbidities, geriatric patients are endangered by serious events during total hip arthroplasty. This study was conducted to explore whether or not the benefit in terms of health-related quality of life (HRQoL) was comparable to younger patients. Methods: At a single academic center, 100 patients meeting the following inclusion criteria were retrospectively recruited: (1) primary arthritis of the hip leading to THA; (2) age 80 years or older at the time of surgery; (3) follow up of at least 12 months. For comparison, two further groups were recruited in the same manner, differing only in the age criterion: 100 patients aged 60–69 and 100 patients aged 70–79 at the time of hip replacement. The primary outcome was compared using the WOMAC and the EQ-5D score. The secondary outcome was determined by rates of orthopedic and non-orthopedic complications. Intragroup comparisons of the PROMS were performed by the non-parametric Wilcoxon test for paired samples. For intergroup comparisons of the PROMS, the Kruskal–Wallis-test was performed. Concerning categorial data, intergroup comparisons were performed by the Chi-Square test. The level of significance was set at 0.05. Results: Concerning the WOMAC score, neither the absolute values at 12 months after THA (p = 0.176) nor the amount of change relative to the values before surgery (p = 0.308) differed significantly between the 3 groups. Concerning the EQ-5D index the absolute values at 12 months after THA differed significantly (p = 0.008). Rates of orthopedic complications did not differ significantly (p = 0.631). Rates of non-orthopedic complications increased significantly with rising age (p = 0.033). Conclusions: Compared to younger patients, geriatric patients after THA have an equal improvement in hip-specific and general HRQoL. While rates of orthopedic complications are comparable too, non-orthopedic complications occur more frequently.
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Affiliation(s)
- Philip Mark Anderson
- University of Wuerzburg, Department of Orthopedics, Orthopädische Klinik König-Ludwig-Haus Brettreichstraße 11 97074 Würzburg Germany
- Corresponding author:
| | - Peter Vollmann
- University of Wuerzburg, Department of Orthopedics, Orthopädische Klinik König-Ludwig-Haus Brettreichstraße 11 97074 Würzburg Germany
| | - Manuel Weißenberger
- University of Wuerzburg, Department of Orthopedics, Orthopädische Klinik König-Ludwig-Haus Brettreichstraße 11 97074 Würzburg Germany
| | - Maximilian Rudert
- University of Wuerzburg, Department of Orthopedics, Orthopädische Klinik König-Ludwig-Haus Brettreichstraße 11 97074 Würzburg Germany
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18
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Zavala-González J, Martínez D, Gutiérrez-Espinoza H. Effectiveness of adding virtual reality to physiotherapeutic treatment in patients with total hip arthroplasty. A randomized controlled trial. Clin Rehabil 2022; 36:660-668. [PMID: 35166608 DOI: 10.1177/02692155221080546] [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: 11/16/2022]
Abstract
OBJECTIVE To determine the clinical effectiveness of adding virtual reality via the Nintendo Wii console and its Wii Balance Board to physiotherapy treatment in patients with total hip arthroplasty. DESIGN Randomized controlled trial. SETTING Clinical Hospital San Borja Arriaran, Santiago, Chile. PARTICIPANTS A total of 73 patients over 50 years of age with total hip arthroplasty were randomly allocated to two groups. INTERVENTIONS The control group (n = 37) received 6 weeks of physiotherapy treatment; the intervention group (n = 36) received the same treatment plus virtual reality exercises with the Nintendo Wii console. OUTCOME MEASURES The two groups were assessed at baseline and after the 6 weeks of treatment. The primary outcome assessed was the function with the WOMAC questionnaire. The secondary outcomes were the Berg Balance Scale, distance covered with the six-minute walk test, and difference in weight load on the lower extremities. RESULTS A total of 73 patients, 37 patients in the control group (20 women; mean age of 70.9 ± 9.16 years) and 36 patients in the intervention group (18 women; mean age of 70.39 ± 9.02 years) were analyzed. At the end of the treatment, the difference between groups for the total WOMAC score was -10.4 points (p = 0.00), 4.7 points (p = 0.00) for the Berg Balance Scale, and 45.2 mt (p = 0.00) for the six-minute walk test All differences were in favor of the intervention group. CONCLUSIONS In the short term, the addition of virtual reality via the Nintendo Wii and its Wii Balance Board platform showed statistically significant differences in the function of patients with total hip replacement, but these differences were not minimally clinically important.Trial registration: This research was registered in the Clinical Trials Registry of Australia and New Zealand, with reference ACTRN12618001252202.
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Affiliation(s)
- Jonathan Zavala-González
- Health Rehabilitation Research Center (CIRES), 28059University of the Americas, Santiago, Chile.,Kinesiology Service, 60765San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Diego Martínez
- Kinesiology Service, 60765San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Héctor Gutiérrez-Espinoza
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, 28087Universidad Andres Bello, Santiago, Chile
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Ângelo ACLPG, de Campos Azevedo CI. Donor-Site Morbidity After Autologous Fascia Lata Harvest for Arthroscopic Superior Capsular Reconstruction: A Midterm Follow-up Evaluation. Orthop J Sports Med 2022; 10:23259671211073133. [PMID: 35141340 PMCID: PMC8819761 DOI: 10.1177/23259671211073133] [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: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Autologous fascia lata (AFL) graft use in arthroscopic superior capsular reconstruction (ASCR) is effective for the treatment of irreparable rotator cuff tears (RCTs). Although donor-site morbidity (DSM) is a recurrent argument against AFL graft use, scientific evidence for this argument is lacking. Purpose: To report the midterm clinical follow-up evaluation of DSM in ASCR using minimally invasively harvested AFL grafts and compare thigh function and patient satisfaction with those of an unharvested control group. Study Design: Cohort study; Level of evidence, 3. Methods: Of 66 consecutive patients who underwent ASCR using a minimally invasively harvested AFL graft, 39 patients with a minimum follow-up of 24 months were retrospectively evaluated (ASCR group) and compared with 39 randomly selected patients who underwent arthroscopic RCT repair by the same surgeons (control group). The functional outcomes of both thighs were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patient satisfaction was evaluated using the Patient Scar Assessment Questionnaire (PSAQ) and a subjective questionnaire. Pain was quantified using a visual analog scale (VAS). Results: The ASCR group had a mean age of 65 years (range, 51-77 years) and a mean follow-up of 47 months (range, 24-66 months). The WOMAC score in the harvested thigh differed by 0.8% from that in the contralateral thigh ( P = .002). The mean PSAQ score differed by 6 points from the minimum PSAQ score ( P < .001). Overall, 95% of the patients indicated that they would undergo the same surgery again and that the shoulder outcome compensated for the thigh symptoms. There was no significant association between the presence of residual thigh symptoms and the willingness to undergo the same surgery again ( P = .354). The mean VAS score in the harvested thigh was 0.6 (range, 0-5). There was no significant difference in the average WOMAC score or VAS score between groups ( P = .684 and P = .148, respectively). Conclusion: Despite the proportion of residual symptoms, the associated functional effects were small and not clinically significant, and the vast majority of patients were accepting of the harvest symptoms given the improvement in shoulder function.
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Affiliation(s)
| | - Clara Isabel de Campos Azevedo
- Hospital dos SAMS de Lisboa, Lisbon, Portugal
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Hospital CUF Tejo, Lisbon, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B’s–Instituto de Investigação em Ciências da Vida e Saúde/Biomaterials, Biodegradables and Biomimetics PT Government Associate Laboratory, Braga/Guimarães, Portugal
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20
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Dodd A, Pinsker E, Younger ASE, Penner MJ, Wing KJ, Dryden PJ, Glazebrook M, Daniels TR. Sex Differences in End-Stage Ankle Arthritis and Following Total Ankle Replacement or Ankle Arthrodesis. J Bone Joint Surg Am 2022; 104:221-228. [PMID: 35007215 DOI: 10.2106/jbjs.21.00287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated the influence of sex on patient-reported outcomes preoperatively and following total ankle replacement and ankle arthrodesis. METHODS Patients who had undergone total ankle replacement or ankle arthrodesis for the treatment of end-stage ankle arthritis and who had ≥2 years of follow-up were identified from the Canadian Orthopaedic Foot and Ankle Society Prospective Ankle Reconstruction Database. Standard surgical techniques and implantation methods were followed, and STAR, Hintegra, Mobility, and Agility prostheses were used. Data were collected on patient demographics, revisions, secondary procedures, complications, Ankle Osteoarthritis Scale (AOS) scores, Short Form-36 (SF-36) scores, and expectations and satisfaction. Statistical analyses included 3-way repeated-measures analysis of variance (ANOVA) and multiple linear regression models controlling for inflammatory arthritis, age, preoperative scores, and surgery type. RESULTS The study included 872 patients: 629 who had undergone total ankle replacement (316 men, 313 women) and 243 who had undergone ankle arthrodesis (154 men, 89 women). The mean duration of follow-up (and standard deviation) was 4.9 ± 2.4 and 4.0 ± 1.9 years for the total ankle replacement and ankle arthrodesis groups, respectively. Men were older than women (p ≤ 0.001). In both the total ankle replacement and ankle arthrodesis groups, women had higher AOS pain scores (i.e., more pain) than men preoperatively (p < 0.05). Pain was reduced significantly in both sexes postoperatively (p < 0.05), with no significant difference between sexes. In both the total ankle replacement and ankle arthrodesis groups, women had higher AOS disability scores (i.e., more disability) and lower SF-36 Physical Component Summary (PCS) scores (i.e., worse function) than men both preoperatively and postoperatively (p < 0.001). Postoperatively, AOS disability and SF-36 PCS scores improved significantly from baseline in both sexes (p < 0.001). After controlling for covariates, sex was not a significant predictor of postoperative SF-36 MCS (Mental Component Summary), AOS pain, or AOS disability scores (p > 0.05) but explained 0.5% of variance in SF-36 PCS scores (p = 0.03). Sex did not significantly influence preoperative expectations or postoperative satisfaction. When patients with inflammatory arthritis were excluded, preoperative and postoperative outcome measures, expectations, and satisfaction were similar. CONCLUSIONS Men and women with end-stage ankle arthritis benefited from total ankle replacement and ankle arthrodesis with similar magnitudes of improvement. Small differences in pain and function between men and women undergoing total ankle replacement and ankle arthrodesis mostly disappeared when controlling for potential confounding variables. Both total ankle replacement and ankle arthrodesis remain good options for men and women with end-stage ankle arthritis. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew Dodd
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Ellie Pinsker
- Division of Orthopaedic Surgery, Unity Health Network-St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alastair S E Younger
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Clinic for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada
| | - Murray J Penner
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Clinic for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada
| | - Kevin J Wing
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Clinic for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada
| | - Peter J Dryden
- Rebalance MD, Island Health Authority, Victoria, British Columbia, Canada
| | - Mark Glazebrook
- Dalhousie University, Halifax, Nova Scotia, Canada.,Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Timothy R Daniels
- Division of Orthopaedic Surgery, Unity Health Network-St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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21
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Griffin DR, Dickenson EJ, Achana F, Griffin J, Smith J, Wall PD, Realpe A, Parsons N, Hobson R, Fry J, Jepson M, Petrou S, Hutchinson C, Foster N, Donovan J. Arthroscopic hip surgery compared with personalised hip therapy in people over 16 years old with femoroacetabular impingement syndrome: UK FASHIoN RCT. Health Technol Assess 2022; 26:1-236. [PMID: 35229713 PMCID: PMC8919110 DOI: 10.3310/fxii0508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery or with physiotherapist-led conservative care. OBJECTIVE To compare the clinical effectiveness and cost-effectiveness of hip arthroscopy with best conservative care. DESIGN The UK FASHIoN (full trial of arthroscopic surgery for hip impingement compared with non-operative care) trial was a pragmatic, multicentre, randomised controlled trial that was carried out at 23 NHS hospitals. PARTICIPANTS Participants were included if they had femoroacetabular impingement, were aged ≥ 16 years old, had hip pain with radiographic features of cam or pincer morphology (but no osteoarthritis) and were believed to be likely to benefit from hip arthroscopy. INTERVENTION Participants were randomly allocated (1 : 1) to receive hip arthroscopy followed by postoperative physiotherapy, or personalised hip therapy (i.e. an individualised physiotherapist-led programme of conservative care). Randomisation was stratified by impingement type and recruiting centre using a central telephone randomisation service. Outcome assessment and analysis were masked. MAIN OUTCOME MEASURE The primary outcome was hip-related quality of life, measured by the patient-reported International Hip Outcome Tool (iHOT-33) 12 months after randomisation, and analysed by intention to treat. RESULTS Between July 2012 and July 2016, 648 eligible patients were identified and 348 participants were recruited. In total, 171 participants were allocated to receive hip arthroscopy and 177 participants were allocated to receive personalised hip therapy. Three further patients were excluded from the trial after randomisation because they did not meet the eligibility criteria. Follow-up at the primary outcome assessment was 92% (N = 319; hip arthroscopy, n = 157; personalised hip therapy, n = 162). At 12 months, mean International Hip Outcome Tool (iHOT-33) score had improved from 39.2 (standard deviation 20.9) points to 58.8 (standard deviation 27.2) points for participants in the hip arthroscopy group, and from 35.6 (standard deviation 18.2) points to 49.7 (standard deviation 25.5) points for participants in personalised hip therapy group. In the primary analysis, the mean difference in International Hip Outcome Tool scores, adjusted for impingement type, sex, baseline International Hip Outcome Tool score and centre, was 6.8 (95% confidence interval 1.7 to 12.0) points in favour of hip arthroscopy (p = 0.0093). This estimate of treatment effect exceeded the minimum clinically important difference (6.1 points). Five (83%) of six serious adverse events in the hip arthroscopy group were related to treatment and one serious adverse event in the personalised hip therapy group was not. Thirty-eight (24%) personalised hip therapy patients chose to have hip arthroscopy between 1 and 3 years after randomisation. Nineteen (12%) hip arthroscopy patients had a revision arthroscopy. Eleven (7%) personalised hip therapy patients and three (2%) hip arthroscopy patients had a hip replacement within 3 years. LIMITATIONS Study participants and treating clinicians were not blinded to the intervention arm. Delays were encountered in participants accessing treatment, particularly surgery. Follow-up lasted for 3 years. CONCLUSION Hip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome. Hip arthroscopy led to a greater improvement in quality of life than personalised hip therapy, and this difference was clinically significant at 12 months. This study does not demonstrate cost-effectiveness of hip arthroscopy compared with personalised hip therapy within the first 12 months. Further follow-up will reveal whether or not the clinical benefits of hip arthroscopy are maintained and whether or not it is cost-effective in the long term. TRIAL REGISTRATION Current Controlled Trials ISRCTN64081839. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Damian R Griffin
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Edward J Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Felix Achana
- Warwick Medical School, University of Warwick, Coventry, UK
| | - James Griffin
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Joanna Smith
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Peter Dh Wall
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Alba Realpe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Nick Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Hobson
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Marcus Jepson
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Charles Hutchinson
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Nadine Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences NIHR, Keele University, Keele, UK
| | - Jenny Donovan
- Bristol Medical School, University of Bristol, Bristol, UK
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22
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Dust P, Corban J, Sampalis J, Antoniou J, Bergeron SG. Patient Functional Status as an Indication for Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2022; 37:390-397. [PMID: 34538682 DOI: 10.1016/j.arth.2021.08.016] [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: 05/16/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The number of total hip arthroplasties performed per year is increasing for reasons not fully explained by a growing and aging population. The purpose of this study was to determine the role of patient functional status as an indication for surgery and determine if patients are undergoing surgery at a better functional status than in the past. METHODS A systematic review and meta-analysis of the MEDLINE, EMBASE, and Cochrane databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Functional status was assessed using the 36-Item Short-Form Health Survey's Physical Component Summary score. Only primary procedures were included; revisions were excluded. Articles were screened by 2 independent reviewers with conflicts resolved with a third reviewer. Meta-regression analysis was performed to determine the effect of time, patient age, and gender. Subgroup analysis was performed to compare geographic regions. RESULTS A total of 1504 articles were identified. Data from 172 groups representing 18,644 patients recruited from 1990 to 2013 and identified from 107 articles were included. The mean preoperative Physical Component Summary score was 31.2 (95% confidence interval 30.5-31.9) with a 95% prediction interval of 22.6-39.8. The variance across studies was statistically significant (P = .000) with 97.25% true variance. Year of enrollment, age, and the percentage of females were not found to have any significant effect. There were no differences between countries. CONCLUSION Patients are undergoing total hip arthroplasty at a similar preoperative physical functional status as in the past. Patient age, gender, and location do not influence the functional status at which patients are indicated for surgery.
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Affiliation(s)
- Peter Dust
- Jewish General Hospital, Department of Orthopaedic Surgery, McGill University, Montréal, Québec, Canada; Department of Experimental Surgery, McGill University, JSS Medical Research, Montréal, Québec, Canada
| | - Jason Corban
- Jewish General Hospital, Department of Orthopaedic Surgery, McGill University, Montréal, Québec, Canada
| | - John Sampalis
- Department of Experimental Surgery, McGill University, JSS Medical Research, Montréal, Québec, Canada
| | - John Antoniou
- Jewish General Hospital, Department of Orthopaedic Surgery, McGill University, Montréal, Québec, Canada; Department of Experimental Surgery, McGill University, JSS Medical Research, Montréal, Québec, Canada
| | - Stephane G Bergeron
- Jewish General Hospital, Department of Orthopaedic Surgery, McGill University, Montréal, Québec, Canada; Department of Experimental Surgery, McGill University, JSS Medical Research, Montréal, Québec, Canada
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23
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Kuklinski D, Marques CJ, Bohlen K, Westphal KC, Lampe F, Geissler A. Thresholds for meaningful improvement in WOMAC scores need to be adjusted to patient characteristics after hip and knee replacement. J Orthop 2022; 29:50-59. [PMID: 35125779 PMCID: PMC8803617 DOI: 10.1016/j.jor.2022.01.002] [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: 12/04/2021] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To calculate unstratified and patient-specific meaningful improvement (MI) and patient acceptable symptom states (PASS) for the WOMAC total score in patients after total hip (THR) or total knee replacement (TKR). METHODS A retrospective observational cohort study. Anchor-based receiver operator characteristics curves were used to estimate MI and PASS thresholds. RESULTS Recovery paths were specific to individual characteristics of patients. An unstratified 12-months MI threshold of 28.1 (PASS: 13.3) and 17.8 (PASS: 15.8) for patients after THR and TKR, respectively, would unfairly detect critical recovery paths. CONCLUSIONS Thresholds for treatment success need to be as patient-specific as possible.
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Affiliation(s)
- David Kuklinski
- Technical University Berlin, Department of Health Care Management, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Carlos J. Marques
- Science Office of the Orthopaedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany
| | - Karina Bohlen
- Orthopedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany
| | - Karl C. Westphal
- Orthopedic and Joint Replacement Department, Schoen Clinic Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany
| | - Frank Lampe
- Orthopedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany
- Faculty of Life Sciences at the Hamburg University of Applied Sciences, Lohbrügger Kirchstraße 65, 21033, Hamburg, Germany
| | - Alexander Geissler
- School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, 9000, St. Gallen, Switzerland
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24
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Smolle MA, Fischerauer SF, Maier M, Reinbacher P, Friesenbichler J, Ruckenstuhl P, Grandesso M, Leithner A, Maurer-Ertl W. Leg length measures appear inaccurate in the early phase following total hip arthroplasty. Sci Rep 2021; 11:23262. [PMID: 34853409 PMCID: PMC8636479 DOI: 10.1038/s41598-021-02684-3] [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: 08/11/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022] Open
Abstract
The aims of this study were to (1) assess reliability of leg length discrepancy (LLD) measurements at different anatomical landmarks, (2) longitudinally investigate LLD in patients within the first year following total hip arthroplasty (THA) and to (3) correlate changes in LLD with functional outcome. Ninety-nine patients with short stem THA (53.3% males, mean age: 61.0 ± 8.1 years) were prospectively included. Upright pelvic anteroposterior (a.p.) radiographs taken at 6 timepoints (preoperatively, discharge, 6, 12, 24, 52 weeks postoperatively) were used to assess LLD at 5 anatomical landmarks (iliac crest, upper sacroiliac joint, lower sacroiliac joint, tear drop figure, greater trochanter). WOMAC and Harris Hip Score (HHS) were obtained preoperatively and at 6 and 52 weeks. LLD measures significantly increased in the initial phase following THA, from discharge to 6 weeks postoperatively and remained constant thereafter. Documentation of LLDs is dependent on measurement site: LLDs varied significantly between trochanter and iliac crest to tear drop figure (p < 0.001). Functional assessments did not correlate with the occurrence of LLDs [WOMAC (p = 0.252); HHS (p = 0.798)]. Radiographic assessment of LLD following THA may not be performed early postoperatively, as measurements appear to inaccurately reflect actual LLDs at this time, potentially due incomplete leg extension and/or inhibited weight-bearing.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Stefan Franz Fischerauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Michael Maier
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Jörg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Paul Ruckenstuhl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Grandesso
- Dipartimento Universitario Clinico Di Scienze Mediche, Chirurgiche E Della Salute, Universitá Degli Studi Di Trieste, Strada Di Fiume, 447, Trieste, Italy
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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25
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Wright-Chisem JI, Cohn MR, Kunze KN, Wright-Chisem A, Warner T, Hicks JJ, Williams RJ. Do Self-Reported Drug Allergies Influence Clinically Significant Outcome Improvement Following Osteochondral Allograft Transplantation? A Nested Cohort Study. Cartilage 2021; 13:868S-872S. [PMID: 33246361 PMCID: PMC8808784 DOI: 10.1177/1947603520976770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare clinical outcomes for patients who underwent osteochondral allograft transplantation (OCA) based on the presence or absence of one or more self-reported drug allergies. DESIGN Prospective data were collected from 245 consecutive patients after OCA of the knee from one large academic institution. Patient-reported allergies were obtained via chart review. Patient-reported outcome measures, including activities of daily living of the Knee Outcome Survey (KOS-ADL), Marx Activity Scale, International Knee Documentation Committee (IKDC), and visual analogue scale (VAS) pain were all collected. The minimal clinically important difference (MCID) for each outcome was quantified using a distribution-based method. Independent t tests were used to compare patient-reported outcome measures between those with and without self-reported allergies, while chi-square analysis of association was used to compare rates of MCID achievement. RESULTS Of 245 patients included, 83 (33.9%) reported having at least one drug allergy at the time of OCA. There were no statistically significant differences with regard to patient demographics, including age, body mass index, gender, or sports participation between those with and without a reported allergy. Similarly, there were no significant differences found between baseline preoperative patient-reported outcomes. Overall, both cohorts demonstrated a significant improvement from baseline scores at 2 years postoperatively. There were no differences found between any patient-reported outcome at 2 years postoperatively. The presence of at least one self-reported drug allergy was not a significant risk factor for failing to achieve the MCID in any specific outcome measure. CONCLUSIONS The presence of one or more drug allergy was not associated with worse patient-reported outcomes or lower rates of clinically significant outcome improvement after OCA.
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Affiliation(s)
- Joshua I. Wright-Chisem
- Hospital for Special Surgery, New York,
NY, USA,Joshua I. Wright-Chisem, Hospital for
Special Surgery, 535 East 70th Street, New York, NY 10021-4898, USA.
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26
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Single item self-rated general health: SF-36 based observations from 16,910 spine surgery procedures. Qual Life Res 2021; 31:1819-1828. [PMID: 34825299 DOI: 10.1007/s11136-021-03048-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In spine surgery single item patient-reported outcome assessment has been used for many years. Items 1 and 2 of SF-36 are used for assessment of general health. We used these items to explore single item, self-rated, general health assessment after spine surgery. METHODS Patients operated for lumbar disc herniation or lumbar spinal stenosis between 2007 and 2017, were recruited from the national Swedish spine register. A total of 16,910 procedures were eligible for analysis. The responsiveness of the SF-36 general health assessment items to surgical treatment was evaluated with the standardized response mean (SRM). Improvement in self-rated general health was used to dichotomize SF-36 profiles and EQ VAS distributions. RESULTS For disc herniation, 5852 (83%) patients reported improvement in general health 1 year after surgery. For spinal stenosis, the corresponding numbers were 6,482 (66%). The additional improvement after year 1 was small. The responsiveness of the SF-36 item 2 (the health transition item) to surgical treatment of disc herniation or spinal stenosis was substantial. There was a clear association between improvement in SF-36 item 2 and improvements in all domains of SF-36. CONCLUSIONS Surgery for disc herniation or spinal stenosis improve patients' perception of general health 1 year after surgery. The improvement in general health after year 1 is limited. The SF-36 item 2 is a responsive measure of self-rated general health that may be used for dichotomization of SF-36 and EQ VAS data when evaluating surgical outcome in spine surgery.
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27
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Haunschild ED, Condron NB, Gilat R, Fu MC, Wolfson T, Garrigues GE, Nicholson G, Forsythe B, Verma N, Cole BJ. Establishing clinically significant outcomes of the Patient-Reported Outcomes Measurement Information System Upper Extremity questionnaire after primary reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2231-2239. [PMID: 33878484 DOI: 10.1016/j.jse.2021.03.147] [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: 10/27/2020] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Since its introduction, the Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) assessment has been increasingly used in shoulder arthroplasty outcome measurement. However, determination of clinically significant outcomes using the PROMIS UE has yet to be investigated following reverse total shoulder arthroplasty (RTSA). We hypothesized that we could establish clinically significant outcomes of the PROMIS UE outcome assessment in patients undergoing primary RTSA and identify significant baseline patient factors associated with achievement of these measures. METHODS Consecutive patients undergoing primary RTSA between 2018 and 2019 who received preoperative baseline and follow-up PROMIS UE assessments at 12 months after surgery were retrospectively reviewed. Domain-specific anchor questions pertaining to pain and function assessed at 12 months after surgery were used to determine minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) values for the PROMIS UE using receiver operating characteristic curve and area-under-the-curve (AUC) analysis. Univariate logistic regression analysis was then performed to identify significant patient factors associated with achieving the MCID, SCB, or PASS. RESULTS A total of 95 patients met all inclusion criteria and were included in the analysis. By use of an anchor-based method, the PASS value was 36.68 (sensitivity, 0.795; specificity, 0.765; AUC, 0.793) and the SCB value was 11.62 (sensitivity, 0.597; specificity, 1.00; AUC, 0.806). By use of a distribution-based method, the MCID value was calculated to be 4.27. Higher preoperative PROMIS UE scores were a positive predictor in achievement of the PASS (odds ratio [OR], 1.107; P = .05), whereas lower preoperative PROMIS UE scores were associated with obtaining SCB (OR, 0.787; P < .001). Greater baseline forward flexion was negatively associated with achievement of the PASS (OR, 0.986; P = .033) and MCID (OR, 0.976, P = .013). Of the patients, 83.2%, 69.5%, and 47.4% achieved the MCID, PASS, and SCB, respectively. CONCLUSION This study defines the MCID, SCB, and PASS for the PROMIS UE outcome assessment in patients undergoing primary RTSA, of whom the majority achieved meaningful outcome improvement at 12 months after surgery. These values may be used in assessing the outcomes and extent of functional improvement following RTSA.
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Affiliation(s)
| | | | - Ron Gilat
- Midwest Orthopaedics at Rush, Chicago, IL, USA
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28
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Nwachukwu BU, Sullivan SW, Rauck RC, James EW, Burger JA, Altchek DW, Allen AA, Williams RJ. Patient-Reported Outcomes and Factors Associated with Achieving the Minimal Clinically Important Difference After ACL Reconstruction: Results at a Mean 7.7-Year Follow-up. JB JS Open Access 2021; 6:e21.00056. [PMID: 34841188 PMCID: PMC8613365 DOI: 10.2106/jbjs.oa.21.00056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Analyzing outcomes and the minimal clinically important difference (MCID) after anterior cruciate ligament reconstruction (ACLR) is of increased interest in the orthopaedic literature. The purposes of this study were to report outcomes after ACLR at medium to long-term follow-up, identify the threshold preoperative outcome values that would be predictive of achieving the MCID postoperatively, and analyze outcome maintenance at medium to long-term follow-up after ACLR. Methods Active athletes who underwent ACLR were identified in an institutional ACL registry. Patient-reported outcome measures (PROMs) were administered preoperatively and at the 2-year and >5-year postoperative follow-up; measures included the International Knee Documentation Committee (IKDC) form, the 12-item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS), and Lysholm scale. We calculated the MCID from baseline to each of the 2 follow-up periods (2-year and mean 7.7-year). Logistic regression was performed to investigate factors associated with achievement of the MCID. Results A total of 142 patients (mean follow-up, 7.7 years [range, 6.6 to 9.1 years]) underwent ACLR. The mean age and body mass index at the time of surgery were 27.2 ± 13.0 years and 23.2 ± 3.0 kg/m2, respectively. Final postoperative outcome scores improved significantly from baseline for the IKDC (50.9 ± 14.7 to 87.9 ± 11.2), SF-12 PCS (41.6 ± 8.9 to 55.6 ± 3.2), and Lysholm scale (62.2 ± 17.6 to 90.5 ± 10.3) (p < 0.0001), while the SF-12 MCS did not improve significantly (54.2 ± 8.0 to 54.4 ± 6.0) (p = 0.763). Between 2- and >5-year follow-up, the SF-12 PCS showed significant improvement (54.6 ± 4.5 to 55.6 ± 3.2; p = 0.036), while no change was noted in the IKDC (87.6 ± 11.1 to 87.9 ± 11.2), SF-12 MCS (55.5 ± 5.3 to 54.4 ± 6.0), and Lysholm scale (89.8 ± 10.6 to 90.5 ± 10.3) (p ≥ 0.09). At the time of final follow-up, the MCID was achieved by 94.7% of patients for the IKDC, 80.8% for the Lysholm, 79.0% for the SF-12 PCS, and 28.2% for the SF-12 MCS. At 2-year follow-up, 95.3% of patients were either "very" or "somewhat" satisfied with their surgery, compared with 88.6% at the time of final follow-up. Conclusions We found a high level of maintained function following ACLR. The IKDC, SF-12 PCS, and Lysholm scores improved significantly after ACLR at the time of final follow-up and were not significantly different between follow-up periods. Approximately 95% and 89% of patients reported being satisfied with the outcome of surgery at the 2-year and final follow-up, respectively. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | - Ryan C. Rauck
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Evan W. James
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY
| | - Joost A. Burger
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY
| | - David W. Altchek
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY
| | - Answorth A. Allen
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY
| | - Riley J. Williams
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY
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Abu-Amer W, Lawrie CM, Thapa S, Nepple JJ, Clohisy JC. Does the Patient-Reported Outcomes Measurement Information System Correlate to Legacy Scores in Measuring Physical Health in Young Total Hip Arthroplasty Patients? J Arthroplasty 2021; 36:3478-3484. [PMID: 34332792 DOI: 10.1016/j.arth.2021.06.003] [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: 01/28/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed by the National Institutes of Health to collect outcome data in rapid dynamic fashion on electronic platforms. The potential role of PROMIS in monitoring pain and function in young total hip arthroplasty (THA) patients has been under-investigated. The purpose of this study is to investigate correlation between PROMIS Physical Function (PF) and PROMIS Pain Interference (PI) and legacy scores with similar considerations. METHODS We identified 298 hips who underwent primary THA over 40 months. Patients without preoperative PROMIS or legacy scores, or >50 years were excluded. Demographic data included age, gender, and body mass index. Outcome data included PF, PI, modified Harris Hip Score (mHHS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) domains, and Short Form 12 components. Floor/ceiling effects were considered to be significant if ≥15% of patients responded with the lowest or highest possible score. Spearman correlation (R) was performed to investigate correlation between legacy scores and PROMIS domains. RESULTS Mean age was 40 years, mean body mass index was 30.1 kg/m2, and 55% were female. None of the patient-reported outcome measures showed any floor/ceiling effects. PI showed moderate correlation to mHHS (R = -0.60), WOMAC Pain (R = -0.62), and WOMAC PF (R = -0.60). PF showed moderate correlation to mHHS (R = 0.66) and WOMAC PF (R = 0.55). Mean PF and PI scores differed significantly from the general population mean of 50 (36.7, 65.4, respectively; both P < .001). CONCLUSION PROMIS is an attractive alternative to legacy scoring measures, showing moderate correlations between PROMIS physical domains and legacy PROMs of WOMAC and mHHS in young patients undergoing THA.
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Affiliation(s)
- Wahid Abu-Amer
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Charles M Lawrie
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Susan Thapa
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
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30
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Scholes C, Ebrahimi M, Field C, Farah S, Kerr D, Kohan L. Minimally Invasive Inlay Prosthesis Unicompartmental Knee Arthroplasty for the Treatment of Unicompartmental Osteoarthritis: A Prospective Observational Cohort Study with Minimum 2-Year Outcomes and up to 14-Year Survival. J Knee Surg 2021; 34:793-800. [PMID: 31887766 DOI: 10.1055/s-0039-3400536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are limited medium-term outcome data available for the Repicci II device in unicompartmental knee arthroplasty (UKA). The purpose of this study was to report the medium-term (minimum 2 years) patient-reported outcomes and long-term (up to 14 years) procedure survival in a consecutive series of patients undergoing an inlay prosthesis UKA (Repicci II) at an independent orthopaedic clinic. Patients presenting with medially localized unicompartmental knee osteoarthritis and meeting the criteria appropriate for UKA were recruited to a clinical patient registry at the time of presentation. A cemented unicompartmental prosthesis (Repicci II) was implanted using minimally invasive techniques with rapid postoperative mobilization. Patients were asked to complete patient-reported outcomes preoperatively and annually postoperatively. A procedure list was cross-matched with the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and an analysis of procedure survival was performed with comparison to the national data for UKA. Data from a cohort of 661 primary medial compartment UKA procedures performed in 551 patients over a 15-year period were extracted from the clinical patient registry. Significant improvements were maintained in general health, disease symptoms, pain, and function at an average follow-up of 9 years compared with preoperative data. Threshold analysis revealed that >65% of patients exceeded Patient Acceptable Symptom State at the latest follow-up, with >80% within or exceeding age-matched norms for general health. Cumulative revision rate was significantly lower than that reported for UKA in the AOANJRR at up to 13 years follow-up. This series represents a lower cumulative revision rate than previously reported, with >65% of patients reporting satisfactory functional outcomes at an average of 9 years from surgery. Surgical options for treating unicompartmental knee osteoarthritis could include UKA as a viable alternative; however, clear definitions of procedure success and its overall cost-benefit ratio in the context of ongoing management of knee osteoarthritis remain to be elucidated.
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Affiliation(s)
- Corey Scholes
- EBM Analytics, Crows Nest, Sydney, New South Wales, Australia
| | - Milad Ebrahimi
- EBM Analytics, Crows Nest, Sydney, New South Wales, Australia
| | - Clarice Field
- Joint Orthopaedic Centre, Sydney, New South Wales, Australia
| | - Sami Farah
- Joint Orthopaedic Centre, Sydney, New South Wales, Australia.,AM Orthopaedics, Sydney, New South Wales, Australia
| | - Dennis Kerr
- Joint Orthopaedic Centre, Sydney, New South Wales, Australia
| | - Lawrence Kohan
- Joint Orthopaedic Centre, Sydney, New South Wales, Australia
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31
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Joelson A, Sigmundsson FG, Karlsson J. Responsiveness of the SF-36 general health domain: observations from 14883 spine surgery procedures. Qual Life Res 2021; 31:589-596. [PMID: 34145526 DOI: 10.1007/s11136-021-02913-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The study evaluated perceptions of general health (GH) after surgical treatment of spinal stenosis and disk herniation. We used a large longitudinally collected data set to explore differences in responsiveness between the SF-36 GH domain, EQ VAS, EQ-5D index, and SF-6D index. METHODS Patients, surgically treated for lumbar spinal stenosis or lumbar disk herniation between 2007 and 2017, were recruited from the national Swedish spine register. A total of 14,883 procedures were eligible for analysis. The responsiveness of the SF-36 GH domain to surgical treatment was evaluated with the standardized response mean (SRM) and effect size (ES). The internal consistency of the GH domain was evaluated, ceiling and floor effects were assessed, and the correlation between GH domain and EQ VAS was analyzed. RESULTS The SF-36 GH domain did not respond to surgical treatment of spinal stenosis and disk herniation. In contrast, EQ VAS, EQ-5D index, and SF-6D showed moderate to large responsiveness. There were pronounced ceiling effects in items 11a-c of the SF-36 GH domain. There was a negative effect size of change for item 11c. The internal consistency of the GH domain was satisfactory. There were marked differences in the correlations between EQ VAS and the GH domain preoperatively and postoperatively. CONCLUSIONS The SF-36 GH domain should be used with caution when evaluating effects on GH perceptions after spine surgery procedures. The lack of responsiveness is most probably explained by ceiling effects for items 11a-c and a negative effect size of change for item 11c.
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Affiliation(s)
- Anders Joelson
- Department of Orthopedics, Orebro University School of Medical Sciences and Orebro University Hospital, 70185, Orebro, Sweden.
| | - Freyr Gauti Sigmundsson
- Department of Orthopedics, Orebro University School of Medical Sciences and Orebro University Hospital, 70185, Orebro, Sweden
| | - Jan Karlsson
- Faculty of Medicine and Health, University Health Care Research Center, Orebro University, 70182, Orebro, Sweden
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32
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Forlenza EM, Lu Y, Cohn MR, Baker J, Lavoie-Gagne O, Yanke AB, Cole BJ, Verma NN, Forsythe B. Establishing Clinically Significant Outcomes for Patient-Reported Outcomes Measurement Information System After Biceps Tenodesis. Arthroscopy 2021; 37:1731-1739. [PMID: 33450409 DOI: 10.1016/j.arthro.2020.12.236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish thresholds for improvement in patient-reported outcome scores that correspond with clinically significant outcomes (CSOs) including the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive testing (CAT) and pain interference (PIF) CAT after biceps tenodesis (BT) and to assess patient variables that are associated with achieving these outcomes. METHODS After institutional review board approval was obtained, a prospectively maintained institutional database was queried for patients undergoing BT between December 2017 and August 2019. Patients undergoing BT in isolation or BT in conjunction with rotator cuff debridement, SLAP repair, subacromial decompression, or distal clavicle excision were included in the analysis. Anchor- and distribution-based methods were used to calculate the MCID whereas an anchor-based method was used to calculate SCB and the PASS for PROMIS UE CAT and PIF CAT. RESULTS A total of 112 patients (86.8% follow-up) who underwent BT were included for analysis. The MCID, net SCB, absolute SCB, and PASS for PROMIS UE CAT were 4.02, 9.25, 43.4, and 41.1, respectively. The MCID, net SCB, absolute SCB, and PASS for PROMIS PIF CAT were -4.12, -10.7, 52.4, and 52.4, respectively. Higher preoperative UE CAT and PIF CAT scores, preoperative opioid use, depression, and living alone were negative predictors of CSO achievement. Male sex and regular participation in exercise were positive predictors of CSO achievement. CONCLUSIONS Patients with higher preoperative UE scores were less likely to achieve the MCID (odds ratio [OR], 0.84), whereas patients with higher preoperative PIF scores were less likely to achieve absolute SCB and the PASS (OR, 0.83-0.89). Most patients achieved the MCID for PIF CAT (70.5%) and UE CAT (62.5%) at final follow-up. Male sex (OR, 4.38-9.15) and regular exercise participation (OR, 6.45-18.94) positively predicted CSO achievement, whereas preoperative opioid use (OR, 0.06), depression (OR, 0.23), and living alone (OR, 0.90) were negative predictors of CSO achievement. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Yining Lu
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew R Cohn
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - James Baker
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Adam B Yanke
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Rush University Medical Center, Chicago, Illinois, U.S.A..
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Liu J, Wong MCM, Lo ECM. The use of Oral Health Impact on Daily Living (OHIDL) transition scale in measuring the change in oral health-related quality of life among older adults. BMC Oral Health 2021; 21:230. [PMID: 33941160 PMCID: PMC8094480 DOI: 10.1186/s12903-021-01593-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background This longitudinal study aimed to evaluate the longitudinal validity and reliability of the Oral Health Impact on Daily Living (OHIDL) transition scale and measure the perceived change in oral health-related quality of life (OHRQoL) after dental treatments among older adults.
Methods OHIDL was administered to older adults who sought dental treatments. Participants were asked to assess changes in impact for each OHIDL item retrospectively compared with that before the treatment. The responsiveness, minimal clinically important difference (MCID), internal consistency and test–retest reliability of the OHIDL transition scale were evaluated. Multiple linear regression was employed to predict the change in oral health impacts after dental treatment. Beta coefficients (β) and 95% confidence intervals (CI) were reported. Results One hundred and seventy-six participants were followed-up with upon completing their dental treatments. The follow-up rate was 70.4% (176/250). The OHIDL transition score strongly correlated with the global rating of change (rs = 0.76, P < 0.01). MCID was determined by participants who reported “a little improved” in the perceived oral health impacts, and their mean transition score was 3.3. Cronbach’s alpha of the transition scale was 0.87, and many items had a test–retest correlation of at least 0.60. Patients who perceived more oral health impacts at baseline as measured by the total intensity score (β = 0.32, 95% CI: 0.20, 0.44, P < 0.001) and those who had received endodontic treatment (β = 8.04, 95% CI: 4.36, 11.71, P < 0.001) would have more improvement in perceived oral health impacts. Conclusions The OHIDL transition scale has good psychometric properties and is sensitive to change over time. After receiving dental treatment, most of the study’s older adults perceived a lower intensity of OHIDL. Clinical relevance The OHIDL transition scale is a valid and reliable instrument to measure the change in OHRQoL after dental treatments.
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Affiliation(s)
- Jian Liu
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.,Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - May Chun Mei Wong
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | - Edward Chin Man Lo
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Lizaur-Utrilla A, Miralles-Muñoz FA, Ruiz-Lozano M, González-Parreño S, Alonso-Montero C, Lopez-Prats FA. Better clinical outcomes and overall higher survival with hybrid versus cemented primary total knee arthroplasty: a minimum 15 years follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:832-837. [PMID: 32347345 DOI: 10.1007/s00167-020-06028-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare the clinical outcomes and survival at long-term between hybrid and cemented primary total knee arthroplasty (TKA). A better clinical outcome and survival following a follow-up as long as 15 years with the use of hybrid fixation as compared with cemented fixation was hypothesized. METHODS Case-control study of 126 patients with a mean age of 62.4 years who underwent hybrid TKA matched with 126 patients underwent cemented TKA. Clinical outcome was assessed by the Knee Society scores (KSS) and reduced Western Ontario and MacMaster Universities questionnaire (WOMAC). Radiological assessment was made by the Knee Society method. RESULTS The mean follow-up was 15.7 (range 15-17) years. At the final follow-up, clinical scores were significantly better in the hybrid group, although the differences were not clinically relevant. Revisions for all reasons were performed in five knees in the hybrid group and 15 knees in the cemented group (p = 0.033). In the hybrid group, there was one aseptic femoral loosening and no aseptic tibial loosening. In the cemented group, the main reasons for aseptic revisions were polyethylene wear (six knees) and tibial loosening (four knees). Cemented fixation was a significant risk factor for aseptic revision (hazard ratio 2.3; 95% CI 1.3-3.7%; p = 0.004). Survival at 15 years for aseptic reasons was 96.5% (95% CI 93.4-98.7%) in hybrid groups and 90.3% (95% CI 88.7-93.9%) in cemented group (p = 0.020). CONCLUSION After a minimum follow-up of 15 years, hybrid fixation of primary TKA for osteoarthritis provide significantly higher clinical benefits compared with cemented fixation, but the differences were not clinically relevant. Hybrid fixation provides longer overall survival, although the femoral component survival was similar between groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain.
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain.
| | - Fancisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Matias Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Santiago González-Parreño
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Carolina Alonso-Montero
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain
| | - Fernando A Lopez-Prats
- Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain
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Gould D, Thuraisingam S, Shadbolt C, Knight J, Young J, Schilling C, Choong PF, Dowsey MM. Cohort profile: the St Vincent's Melbourne Arthroplasty Outcomes (SMART) Registry, a pragmatic prospective database defining outcomes in total hip and knee replacement patients. BMJ Open 2021; 11:e040408. [PMID: 33483441 PMCID: PMC7825265 DOI: 10.1136/bmjopen-2020-040408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The St Vincent's Melbourne Arthroplasty Outcomes (SMART) Registry is an institutional clinical registry housed at a tertiary referral hospital in Australia. The SMART Registry is a pragmatic prospective database, which was established to capture a broad range of longitudinal clinical and patient-reported outcome data to facilitate collaborative research that will improve policy and practice relevant to arthroplasty surgery for people with advanced arthritis of the hip or knee. The purpose of this cohort profile paper is to describe the rationale for the SMART Registry's creation, its methods, baseline data and future plans for the Registry. A full compilation of the data is provided as a reference point for future collaborators. PARTICIPANTS The SMART Registry cohort comprises over 13 000 consecutive arthroplasty procedures in more than 10 000 patients who underwent their procedure at St Vincent's Hospital Melbourne, since January 1998. Participant recruitment, data collection and follow-up is ongoing and currently includes up to 20 years follow-up data. FINDINGS TO DATE SMART Registry data are used for clinical audit and feedback, as well as for a broad range of research including epidemiological studies, predictive statistical modelling and health economic evaluations. At the time of writing, there were 46 publications from SMART Registry data, with contributions from more than 67 coauthors. FUTURE PLANS With the recent linking of the SMART Registry with Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data through the Australian Institute of Health and Welfare, research into prescribing patterns and health system utilisation is currently underway. The SMART Registry is also being updated with the Clavien-Dindo classification of surgical complications.
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Affiliation(s)
- Daniel Gould
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
| | - Sharmala Thuraisingam
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
| | - Josh Knight
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse Young
- Melbourne School of Population and Global Health, The University of Melbourne Centre for Health Equity, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne St Vincent's, Fitzroy, Victoria, Australia
- Department of Orthopaedics, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
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Harold RE, Butler BA, Delagrammaticas D, Sullivan R, Stover M, Manning DW. Patient-Reported Outcomes Measurement Information System Correlates With Modified Harris Hip Score in Total Hip Arthroplasty. Orthopedics 2021; 44:e19-e25. [PMID: 33284982 DOI: 10.3928/01477447-20201202-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/31/2019] [Indexed: 02/03/2023]
Abstract
The modified Harris Hip Score (mHHS) is a validated and disease-specific instrument commonly used to assess outcomes in total hip arthroplasty (THA). The Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated, computer adaptive testing (CAT)-based global health assessment tool. The authors' goal was to examine the correlation between PROMIS Pain Interference and Physical Function CATs and the mHHS in patients undergoing primary THA. All THAs were performed by 1 of 2 fellowship-trained dedicated total joint surgeons at 1 academic institution. Patients completed PROMIS and mHHS assessments preoperatively and at 3, 6, 12, and 52 weeks postoperatively. Descriptive statistics and Pearson correlation values were determined. A total of 48 patients were prospectively enrolled in the study. Preoperatively, mean total PROMIS score (Pain Interference and Physical Function) was 74.2 and mHHS was 50.8. Preoperatively, mean total PROMIS score showed a moderate correlation (r=0.56; P<.0001) with total mHHS. Postoperatively, mean total PROMIS score at 3, 6, 12, and 52 weeks was 82.4, 93.4, 100, and 100, respectively (all P<.01 vs baseline), and mHHS was 68.2, 81.1, 85.9, and 88.6, respectively (all P<.01). At 3, 6, 12, and 52 weeks postoperatively, a strong and consistent correlation was observed between the total PROMIS score and mHHS (r=0.74, 0.74, 0.73, and 0.80, respectively; all P<.0001). The PROMIS Pain Interference and Physical Function CATs accurately assessed preoperative pain and dysfunction, as well as clinical improvement following THA. Combined PROMIS Pain Interference and Physical Function is comparable to the mHHS when assessing outcome following THA for osteoarthritis. [Orthopedics. 2021;44(1):e19-e25.].
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Haunschild ED, Gilat R, Fu MC, Tauro T, Huddleston HP, Yanke AB, Forsythe B, Verma NN, Cole BJ. Establishing the Minimal Clinically Important Difference, Patient Acceptable Symptomatic State, and Substantial Clinical Benefit of the PROMIS Upper Extremity Questionnaire After Rotator Cuff Repair. Am J Sports Med 2020; 48:3439-3446. [PMID: 33104397 DOI: 10.1177/0363546520964957] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Patient-Reported Outcome Measurement Information System Upper Extremity (PROMIS UE) questionnaire has been validated as an effective and efficient outcome measure after rotator cuff repair (RCR). However, definitions of clinically significant outcomes used in interpreting this outcome measure have yet to be defined. PURPOSE To define clinically significant outcomes of the PROMIS UE questionnaire in patients undergoing arthroscopic RCR. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS We reviewed charts of consecutive patients undergoing RCR in our institution between 2017 and 2018 and included patients who were administered the PROMIS UE before surgery and 12 months after surgery. At 12 months postoperatively, patients were asked domain-specific anchor questions regarding their function and satisfaction after surgery, which were then used to determine the minimal clinically important difference (MCID), Patient Acceptable Symptomatic State (PASS), and substantial clinical benefit (SCB) using receiver operating characteristic and area under the curve (AUC) analysis. Univariate and multivariate logistic regression analysis was utilized to identify patient factors associated with clinically significant outcomes. RESULTS A total of 105 patients with RCR and minimum 12-month postoperative PROMIS UE were included in the analysis. The defined clinically significant outcomes were 4.87 for the MCID using a distribution-based method, 7.95 for the SCB (sensitivity, 0.708; specificity, 0.833; AUC, 0.760), and 39.00 for the PASS (sensitivity, 0.789; specificity, 0.720; AUC, 0.815). Among respondents, 79.0%, 62.9%, and 64.8% achieved the MCID, SCB, and PASS score thresholds, respectively. Workers' compensation was negatively associated with achievement of the PASS. Lower preoperative PROMIS UE scores were associated with obtaining the MCID (odds ratio [OR], 0.871; P = .001) and the SCB (OR, 0.900; P = .040), whereas higher preoperative scores were predictive of achieving the PASS (OR, 1.111; P = .020). CONCLUSION This study defines the clinically significant outcomes for the PROMIS UE after RCR, of which the majority of patients achieved the MCID, PASS, and SCB at 12 months after surgery. These thresholds should be considered in future study design and interpretation of PROMIS UE in patients with RCR.
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Affiliation(s)
- Eric D Haunschild
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ron Gilat
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Fu
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Tracy Tauro
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hailey P Huddleston
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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38
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Weick JW, Bullard J, Green JH, Gagnier JJ. Measures of Hip Function and Symptoms. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:200-218. [PMID: 33091262 DOI: 10.1002/acr.24231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/21/2020] [Indexed: 12/28/2022]
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Busija L, Ackerman IN, Haas R, Wallis J, Nolte S, Bentley S, Miura D, Hawkins M, Buchbinder R. Adult Measures of General Health and Health‐Related Quality of Life. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:522-564. [DOI: 10.1002/acr.24216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022]
Affiliation(s)
| | | | - Romi Haas
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
| | - Jason Wallis
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
| | - Sandra Nolte
- Charité – Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany, ICON GmbH, Munich, Germany, and Deakin University Burwood Victoria Australia
| | - Sharon Bentley
- Queensland University of Technology Kelvin Grove Queensland Australia
| | | | - Melanie Hawkins
- Deakin University, Burwood, Victoria, Australia, and Swinburne University of Technology Melbourne Victoria Australia
| | - Rachelle Buchbinder
- Cabrini Institute, Malvern, Victoria, Australia, and Monash University Melbourne Victoria Australia
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Marques CJ, Pinnschmidt HO, Bohlen K, Lorenz J, Lampe F. TKA patients experience less improvement than THA patients at 3 and 12 months after surgery. A retrospective observational cohort study. J Orthop 2020; 21:517-522. [PMID: 33013084 PMCID: PMC7511647 DOI: 10.1016/j.jor.2020.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/13/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate whether WOMAC scores changes after THA or TKA are gender and joint specific. METHODS Retrospective cohort study. The data of 855 THA and 684 TKA patients were analyzed. RESULTS Follow-up time (p < 0.001), gender (p < 0.001), joint (p < 0.001), and interaction FU by joint (p < 0.001) had significant effects on WOMAC total and sub-scores. Patients after TKA perceived less improvement in all dimensions in comparison to THA patients (p < 0.001). CONCLUSION WOMAC score changes after THA or TKA are joint-specific. Patients after TKA perceived less improvement. These results can be used to adjust patients' expectations.
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Affiliation(s)
- Carlos J. Marques
- Science Office of the Orthopaedic and Joint Replacement Department at the Schoen Clinic Hamburg Eilbek, Dehnhaide 120, D-22081, Hamburg, Germany
| | - Hans O. Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karina Bohlen
- Orthopaedic and Joint Replacement Department at the Schoen Clinic Hamburg Eilbek, Dehnhaide 120, D-22081, Hamburg, Germany
| | - Juergen Lorenz
- Faculty of Life Sciences at the Hamburg University of Applied Sciences, Ulmenliet 20, D-21033, Hamburg, Germany
| | - Frank Lampe
- Orthopaedic and Joint Replacement Department at the Schoen Clinic Hamburg Eilbek, Dehnhaide 120, D-22081, Hamburg, Germany
- Faculty of Life Sciences at the Hamburg University of Applied Sciences, Ulmenliet 20, D-21033, Hamburg, Germany
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Gong L, Zhang YY, Yang N, Qian HJ, Zhang LK, Tan MS. Raloxifene Prevents Early Periprosthetic Bone Loss for Postmenopausal Women after Uncemented Total Hip Arthroplasty: A Randomized Placebo-Controlled Clinical Trial. Orthop Surg 2020; 12:1074-1083. [PMID: 32686337 PMCID: PMC7454213 DOI: 10.1111/os.12696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To examine the results of raloxifene for prevention of periprosthetic bone loss around the femoral stem in patients undergoing total hip arthroplasty (THA). METHODS Between January 2015 and May 2017, 240 female patients between 55 and 80 years underwent primary THA and were randomly allocated to receive 60 mg raloxifene hydrochloride per day (treatment group, TG, n = 120) or placebo (control group, CG, n = 120) orally at bedtime using computer-generated randomization sequence generation. Baseline data, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), women's quality of life (QoL) score, bone mineral density (BMD) around the prosthesis, and adverse events were compared between the two groups. The measuring range of BMD around the prosthesis was divided into seven regions of interest (ROI). The sample size was calculated to detect a mean difference in BMD of 0.15 g/cm2 with a standard deviation (SD) of 0.3. The error was set at 0.05 and the power level at 90% with additional compensation for a possible dropout rate of 20%. RESULTS A total of 240 participants in the study up to 24 months after THA. There were no significant differences in the mean BMD of all the zones between groups before surgery (all P > 0.05). However, there were significant differences in the BMD of Gruen zones 4 and 7 between groups at 6 months postoperatively (both P < 0.05); there were significant differences in Gruen zones 1, 4, 6, and 7 at 12 months postoperatively (all P < 0.01); there were significant differences in Gruen zones 1, 2, 4, 6, and 7 at 24 months postoperatively (all P < 0.001). Patients taking raloxifene reported higher QoL scores, with better improvement in BMD in all areas except in zones 3 and 5 compared with the control group. There were no significant differences in WOMAC pain (P = 0.4045), WOMAC function (P = 0.4456) and women's QoL scores (P = 0.5983) between groups before surgery. However, WOMAC pain, WOMAC function and women's QoL score in the treatment group were significantly better at all time points (all P < 0.05). Patients in the treatment group showed no increased adverse events, including cardiac events, stroke, venous thromboembolism, and gynecological cancer (all P > 0.05), but did show decreased odds of breast cancer in comparison with those using a placebo (P = 0.0437). CONCLUSION Raloxifene can help inhibit bone loss around the prosthesis and improve the QoL of postmenopausal women after THA with no increased adverse events, and can even decrease the odds of breast cancer.
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Affiliation(s)
- Long Gong
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
| | - Yao-Yao Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Chengdu, China
| | - Na Yang
- Bao Ding Maternal and Children Hospital, Baoding, China
| | - Huan-Juan Qian
- Department of Orthopedics Surgery, 81 Group Military Hospital of Chinese PLA, Baoding, China
| | - Ling-Kun Zhang
- Department of Orthopedics Surgery, 81 Group Military Hospital of Chinese PLA, Baoding, China
| | - Ming-Sheng Tan
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, China
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Joly DA, Ludwig T, Mahdavi S, Khong H, Piroozfar SG, Sharma R. Does Age Influence Patient-Reported Outcomes in Unilateral Primary Total Hip and Knee Arthroplasty? J Arthroplasty 2020; 35:1800-1805. [PMID: 32241648 DOI: 10.1016/j.arth.2020.02.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are used to treat patients with end-stage arthritis. Previous studies have not demonstrated a consistent relationship between age and patient-reported outcomes. The purpose of this study is to assess the impact of age on patient-reported outcomes after unilateral primary THA or TKA. METHODS A retrospective review of available data in Alberta Bone and Joint Health Institute (ABJHI) Data Repository was performed. We identified 53,498 unilateral primary THA and TKA between April 2011 and 2017. Patients were divided by age into 3 categories: <55, 55-70, and >70. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and EuroQoL 5-dimension (EQ-5D) Canada scores were obtained at presurgery, 3 and 12 months postoperatively. RESULTS For TKA, younger patients had larger improvements in WOMAC scores at 3 and 12 months (P = <.001-.033), and in EQ-5D scores at 3 months (P < .001). When adjusted, patients <55 had lower WOMAC and EQ-5D scores at 3 months postoperatively compared to those 55-70 or >70 (all P < .01). Outcomes at 12 months did not differ between age-groups. For THA, younger patients had larger improvements in WOMAC at 3 months (P = .03). When adjusted, patients <55 had higher WOMAC scores at 12 months postoperatively compared to those 55-70 or >70, and higher EQ-5D scores compared to those 55-70 (all P < .05). CONCLUSION While a multitude of factors go in to quantifying successful THA or TKA, this study suggests that patient age should not be a deterrent when considering the impact of age on patient-reported outcomes.
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Affiliation(s)
- Denis A Joly
- Department of Surgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Taryn Ludwig
- Department of Surgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Saboura Mahdavi
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Alberta Hip and Knee Clinic, Calgary, Alberta, Canada
| | - Hoa Khong
- Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Sophie Gh Piroozfar
- Alberta Hip and Knee Clinic, Calgary, Alberta, Canada; Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Rajrishi Sharma
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Alberta Hip and Knee Clinic, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
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43
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Pintér D, Janszky J, Kovács N. Minimal Clinically Important Differences for
Burke‐Fahn‐Marsden
Dystonia Rating Scale and
36‐Item Short‐Form
Health Survey. Mov Disord 2020; 35:1218-1223. [DOI: 10.1002/mds.28057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 12/27/2022] Open
Affiliation(s)
- Dávid Pintér
- Department of Neurology, Medical SchoolUniversity of Pécs Pécs Hungary
| | - József Janszky
- Department of Neurology, Medical SchoolUniversity of Pécs Pécs Hungary
- MTA‐PTE Clinical Neuroscience MR Research Group Pécs Hungary
| | - Norbert Kovács
- Department of Neurology, Medical SchoolUniversity of Pécs Pécs Hungary
- MTA‐PTE Clinical Neuroscience MR Research Group Pécs Hungary
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44
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Lawrie CM, Abu-Amer W, Barrack RL, Clohisy JC. Is the Patient-Reported Outcome Measurement Information System Feasible in Bundled Payment for Care Improvement in Total Hip Arthroplasty Patients? J Arthroplasty 2020; 35:1179-1185. [PMID: 31932103 DOI: 10.1016/j.arth.2019.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) is increasingly used to assess patient health. The Bundled Payment for Care Improvement (BPCI) initiative for total hip arthroplasty (THA) was introduced to decrease costs and improve clinical care. We investigated differences between BPCI and non-BPCI THA patients and their PROMIS scores, along with its feasibility and responsiveness in these populations. METHODS We included all consecutive patients receiving unilateral primary THA who also had preoperative and one-year postoperative PROMIS physical function (PF), PROMIS pain interference (PI), and PROMIS depression (DEP) scores. Demographics and PROMIS scores were compared. Test burden was assessed using the number of questions and time required for PROMIS completion. The minimum clinically important difference was defined as 5. Floor and ceiling effects were noted if more than 15% of patients responded with the lowest or highest possible score, respectively. Wilcoxon rank-sum test was used to compare categorical data. ANOVA was used for PROMIS comparisons. RESULTS 290 hips (86 BPCI, 30%) were included. The BPCI cohort was older (P < .001) with a higher American Society of Anesthesiologists physical status classification system (P = .0045). There were significant differences in baseline scores of PF and DEP between BPCI and non-BPCI (P = .046 and P = .048, respectively). Both groups showed significant improvement at follow-up in all scores (all P < .001). Significantly more non-BPCI patients achieved minimum clinically important difference at follow-up in PI and PF (P = .047 and P = .023, respectively). Floor effects were identified for DEP at baseline and follow-up and for PI at follow-up only. CONCLUSION PROMIS is feasible and time-efficient in BPCI patients undergoing primary THA. There were significant differences between BPCI and non-BPCI hips. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Charles M Lawrie
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Wahid Abu-Amer
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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45
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An update on joint-specific outcome measures in total hip replacement. Reumatologia 2020; 58:107-115. [PMID: 32476684 PMCID: PMC7249528 DOI: 10.5114/reum.2020.95366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/18/2020] [Indexed: 12/15/2022] Open
Abstract
This is the latest review of joint-specific tools used to evaluate patients undergoing total hip replacement (THR) surgery, which is an effective treatment for end-stage osteoarthritis. Due to the large number and multitude of scales and their variants used, a critical assessment of the available tools is necessary. In the article, we briefly describe six different clinical tools: the Western Ontario and McMaster Universities Osteoarthritis Index, the Hip Disability and Osteoarthritis Outcome Score, the Harris Hip Score, the Oxford Hip Score, the Mayo Hip Score, and the Rheumatoid and Arthritis Outcome Score. We present the advantages and constraints of the different outcome measures, providing a helpful resource of information for clinical trials and for everyday routine evaluation.
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46
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Galmiche R, Poitras S, Dobransky J, Kim PR, Feibel RJ, Gofton W, Abdelbary H, Beaulé PE. Does surgical approach influence mid- to long-term patient-reported outcomes after primary total hip replacement? A comparison of the 3 main surgical approaches. Can J Surg 2020; 63:E181-E189. [PMID: 32302085 DOI: 10.1503/cjs.008919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The most effective surgical approach to total hip replacement (THR) remains controversial. Most studies that have compared approaches have reported only short-term outcome data. It is therefore unclear in the literature if a particular surgical approach offers long-term advantages. The aim of this study was to determine the effect of the 3 main surgical approaches to THR on patient-reported outcomes 5 years after surgery. Methods All patients who underwent a THR for osteoarthritis or osteonecrosis between 2008 and 2012 by an anterior, posterior or lateral approach at The Ottawa Hospital in Ontario, Canada, were included in the study. All preoperative and postoperative scores for the Hip Disability and Osteoarthritis Outcome Score (HOOS) and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) questionnaires were recorded. Analysis of covariance was used to study the relationship between the amount of change in scores on the HOOS and WOMAC subscales (dependent variables) and the surgical approach. The confounding factors of age, sex, American Society of Anesthesiologists (ASA) class, Charnley classification and body mass index were included in the analysis. Results There were 138 patients (37.6%) in the posterior approach group, 104 (28.3%) in the lateral approach group and 125 (34.1%) in the anterior approach group. There were no significant differences among the 3 groups in terms of Charnley classification, body mass index, sex, ASA class, surgical side and preoperative functional scores. We did not observe any significant differences in the amount of change in the scores for HOOS and WOMAC subscales among the 3 groups. There were also no differences in the final postoperative scores. Conclusion Our findings suggest that the choice of surgical approach in primary THR surgery without revision has no influence on functional outcomes and quality of life after 5 years. Further studies are needed to assess how patient age and sex may influence the functional outcome of individual surgical approaches.
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Affiliation(s)
- Romain Galmiche
- From the Ottawa, Hospital, Ottawa, Ont. (Galmiche, Dobransky, Kim, Feibel, Gofton, Abdelbary, Beaulé); and the School of Rehabilitation, University of Ottawa, Ottawa, Ont. (Poitras)
| | - Stéphane Poitras
- From the Ottawa, Hospital, Ottawa, Ont. (Galmiche, Dobransky, Kim, Feibel, Gofton, Abdelbary, Beaulé); and the School of Rehabilitation, University of Ottawa, Ottawa, Ont. (Poitras)
| | - Johanna Dobransky
- From the Ottawa, Hospital, Ottawa, Ont. (Galmiche, Dobransky, Kim, Feibel, Gofton, Abdelbary, Beaulé); and the School of Rehabilitation, University of Ottawa, Ottawa, Ont. (Poitras)
| | - Paul R Kim
- From the Ottawa, Hospital, Ottawa, Ont. (Galmiche, Dobransky, Kim, Feibel, Gofton, Abdelbary, Beaulé); and the School of Rehabilitation, University of Ottawa, Ottawa, Ont. (Poitras)
| | - Robert J Feibel
- From the Ottawa, Hospital, Ottawa, Ont. (Galmiche, Dobransky, Kim, Feibel, Gofton, Abdelbary, Beaulé); and the School of Rehabilitation, University of Ottawa, Ottawa, Ont. (Poitras)
| | - Wade Gofton
- From the Ottawa, Hospital, Ottawa, Ont. (Galmiche, Dobransky, Kim, Feibel, Gofton, Abdelbary, Beaulé); and the School of Rehabilitation, University of Ottawa, Ottawa, Ont. (Poitras)
| | - Hesham Abdelbary
- From the Ottawa, Hospital, Ottawa, Ont. (Galmiche, Dobransky, Kim, Feibel, Gofton, Abdelbary, Beaulé); and the School of Rehabilitation, University of Ottawa, Ottawa, Ont. (Poitras)
| | - Paul E Beaulé
- From the Ottawa, Hospital, Ottawa, Ont. (Galmiche, Dobransky, Kim, Feibel, Gofton, Abdelbary, Beaulé); and the School of Rehabilitation, University of Ottawa, Ottawa, Ont. (Poitras)
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Melchiorri G, Viero V, Triossi T, Bianchi D, Tancredi V. Use of the pedometer in the evaluation of the effects of rehabilitation treatment on deambulatory autonomy in patients with lower limb arthroplasty during hospital rehabilitation: long-term postoperative outcomes. J Phys Ther Sci 2020; 32:243-250. [PMID: 32184541 PMCID: PMC7064351 DOI: 10.1589/jpts.32.243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022] Open
Abstract
[Purpose] To provide data on the applicability of pedometers in the evaluation of the
results of rehabilitative treatment on total daily walking activity after total knee
arthroplasty (TKA) and total hip arthroplasty (THA). [Participants and Methods] One
hundred fifty six hospitalized patients (age 63.9 ± 12.2 years) involved. On the day of
hospitalization and at the end of the rehabilitation treatment the following were
performed: clinical examination, X-ray examination and weight. On the same day the
pedometer was applied and removed after 48 hours. Only on 30 participants, the same
evaluation was carried out 5 days before the hospitalization to measure reliability and
responsiveness. Compliance was measured by a face-to-face interview. Visual analogic scale
(VAS), Barthel Index (BI) and Ambulation Index (AI) were used to better describe the
analyzed sample. [Results] VAS, BI and AI improved by 29.8%, 19.4 and 60.6% respectively.
The data obtained on testing-retesting showed a good reliability and a mean Total Error of
7.3% for steps and 15.8% for distance. A good response in the test-retest was detected.
The deambulatory autonomy of patients passed from 2,070 ± 740 m to 3,100 ± 810 m. Average
improvement in the number of daily steps is 25%. [Conclusion] The data showed a good
applicability of pedometer. The results on responsiveness can be used to better interpret
the results of rehabilitative treatment on total daily walking activity after THA and
TKA.
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Affiliation(s)
- Giovanni Melchiorri
- School of Sport and Exercise Sciences, Department of Systems Medicine, Faculty of Medicine and Surgery, University of Roma Tor Vergata, Italy.,Don Gnocchi Foundation IRCS, Italy
| | - Valerio Viero
- School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Roma Tor Vergata: Via Montpellier 1 Roma 00133, Italy
| | - Tamara Triossi
- School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Roma Tor Vergata: Via Montpellier 1 Roma 00133, Italy
| | - Daniele Bianchi
- School of Sport and Exercise Sciences, Faculty of Medicine and Surgery, University of Roma Tor Vergata: Via Montpellier 1 Roma 00133, Italy
| | - Virginia Tancredi
- Department of Systems Medicine and Centre of Space BioMedicine, University of Rome Tor Vergata, Italy
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Bilbao A, Martín-Fernández J, García-Pérez L, Arenaza JC, Ariza-Cardiel G, Ramallo-Fariña Y, Ansola L. Mapping WOMAC Onto the EQ-5D-5L Utility Index in Patients With Hip or Knee Osteoarthritis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:379-387. [PMID: 32197734 DOI: 10.1016/j.jval.2019.09.2755] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/05/2019] [Accepted: 09/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To map the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) onto the EQ-5D-5L in patients with hip or knee osteoarthritis (OA). METHODS A prospective observational study was conducted on 758 patients with hip or knee OA who completed the EQ-5D-5L and WOMAC questionnaires, of whom 644 completed them both again 6 months later. Baseline data were used to derive mapping functions. Generalized additive models were used to identify to which powers the WOMAC subscales should be raised to achieve a linear relationship with the response. For the modeling, general linear models (GLM), Tobit models, and beta regression models were used. Age, sex, and affected joints were also considered. Preferred models were selected based on Akaike and Bayesian information criteria, adjusted R2, mean absolute error (MAE), and root mean squared error (RMSE). The functions were validated with the follow-up data using MAE, RMSE, and the intraclass correlation coefficient. RESULTS The preferred models were a GLM with Pain2+Pain3+Function+Pain·Function as covariates and a beta model with Pain3+Function+Function2+Function3 as covariates. The adjusted R2 were similar (0.6190 and 0.6136, respectively). The predictive performance of these models in the validation sample was similar and both models showed an overprediction for health states worse than death. CONCLUSION To our knowledge, these are the first functions mapping the WOMAC onto the EQ-5D-5L in patients with hip or knee OA. They showed an acceptable fit and precision and could be very useful for clinicians and researchers when cost-effectiveness studies are needed and generic preference-based health-related quality of life instruments to derive utilities are not available.
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Affiliation(s)
- Amaia Bilbao
- Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain; Health Service Research Network on Chronic Diseases, Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain.
| | - Jesús Martín-Fernández
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Oeste Multiprofessional Teaching Unit of Primary and Community Care, Primary Healthcare Management, Madrid Health Service, Madrid, Spain; Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Lidia García-Pérez
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Fundación Canaria de Investigación Sanitaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Juan Carlos Arenaza
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Osakidetza Basque Health Service, Basurto University Hospital, Traumatology and Orthopedic Surgery Service, Bilbao, Spain
| | - Gloria Ariza-Cardiel
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Oeste Multiprofessional Teaching Unit of Primary and Community Care, Primary Healthcare Management, Madrid Health Service, Madrid, Spain
| | - Yolanda Ramallo-Fariña
- Health Service Research Network on Chronic Diseases, Bilbao, Spain; Fundación Canaria de Investigación Sanitaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Laura Ansola
- Osakidetza Basque Health Service, Basurto University Hospital, Research Unit, Bilbao, Spain
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Stauber A, Schüßler N, Palmdorf S, Schürholz N, Bruns D, Osterbrink J, Nestler N. RECOVER-E - a mobile app for patients undergoing total knee or hip replacement: study protocol. BMC Musculoskelet Disord 2020; 21:71. [PMID: 32019529 PMCID: PMC7001367 DOI: 10.1186/s12891-020-3090-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/23/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Total knee replacement (TKR) or total hip replacement (THR) are common and effective procedures in patients with osteoarthritis (OA) to restore physical function and reduce joint related pain. Patient education plays an important role in the treatment process aiming to develop necessary self-management skills to facilitate recovery and ensure long-term success. We have developed a mobile app (RECOVER-E) for iOS and Android smartphones which provides important information on the preoperative phase, surgery and recovery. The concomitant study will determine the efficacy of RECOVER-E on patients' surgical outcomes. METHODS/DESIGN This study is a non-randomized, multi-centre (4 sites), double-arm, controlled trial with 1:1 assignment. 160 patients undergoing primary TKR or THR will be recruited from January until October 2019 in 4 German hospitals. Both groups will receive standard care. Additionally, the intervention group will use the app RECOVER-E. Measurements will be taken 4-6 weeks before surgery, on the day of admission to the hospital, on the first and 7th postoperative day and 3 months post-surgery. Primary outcome will be self-reported physical function measured on the activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Hip disability and Osteoarthritis Outcome Score (HOOS) for patients with knee and hip osteoarthritis, respectively. Secondary outcomes include the subscales for pain, symptoms, function in sport and recreation and knee/hip-related quality of life of the HOOS and KOOS, preoperative anxiety, measured by the Hospital Anxiety and Depression Scale (HADS), as well as, pain at rest and pain during activity measured by a numerical rating scale (NRS). Primary endpoint is 3 months post-surgery. DISCUSSION Mobile Health (mHealth) has become increasingly important in patient-centred health care aiming to enhance patient involvement and self-management capabilities. To our knowledge this is the first study to investigate the effect of an evidence-based mobile app on patient reported outcomes after joint replacement. This study should provide evidence supporting the use of mHealth to facilitate recovery and open up new possibilities for patient care in joint replacement. TRIAL REGISTRATION DRKS Data Management retrospectively registered. DRKS-ID DRKS00012744.
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Affiliation(s)
- Anja Stauber
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria.
| | - Nadine Schüßler
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Sarah Palmdorf
- Faculty of Health Sciences, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Nina Schürholz
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - David Bruns
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Nadja Nestler
- Institute of Nursing Science and Practice, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
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50
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Canfield M, Savoy L, Cote MP, Halawi MJ. Patient-reported outcome measures in total joint arthroplasty: defining the optimal collection window. Arthroplast Today 2019; 6:62-67. [PMID: 32211477 PMCID: PMC7083724 DOI: 10.1016/j.artd.2019.10.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to determine the optimal window for collection of patient-reported outcome measures (PROMs) after total joint arthroplasty (TJA). Methods Our prospectively collected institutional joint registry was queried for patients who underwent primary, unilateral TJAs. The primary outcomes were the net changes in WOMAC, SF-12 MCS, SF-12 PCS, OHS, KSCRS, and UCLA activity rating system at 6, 12, and 24 months postoperatively. Secondary outcomes were data acquisition costs and follow-up attrition rates. Results Eight hundred sixty-six procedures (450 total hip arthroplasties, 416 TKAs) were analyzed. A consistent plateau in all PROMs was noted by 6 months postoperatively–except for SF-12 MCS which showed no significant changes at any time interval. For TKA, the percentage of overall improvement achieved by 6 months was 88.7%, 84.5%, 100%, and 90.5% for the WOMAC, SF-12 PCS, UCLA, and KSCRS, respectively. For total hip arthroplasty, these values were 92.7%, 83.5%, 88.0%, and 89.8% for WOMAC, SF-12 PCS, UCLA, and OHS, respectively. There were marginal improvements from 6 to 12 months and no improvement from 12 to 24 months. Follow-up rates at 6, 12, and 24 months were 85%, 69%, and 40%, respectively. Our institutional costs for collecting a complete data set per patient were $128, $158, and $272 for 6, 12, and 24 months, respectively. Conclusions Most of the improvement in PROMs after primary TJA occurs within the first 6 months. In addition, limiting PROMs collection to 6 months appears to be cost-efficient owing to increased attrition rates beyond this time interval.
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Affiliation(s)
- Michael Canfield
- Department of Orthopaedic Surgery, University Connecticut Health Center, Farmington, CT, USA
| | - Lawrence Savoy
- Department of Orthopaedic Surgery, University Connecticut Health Center, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University Connecticut Health Center, Farmington, CT, USA
| | - Mohamad J Halawi
- Department of Orthopaedic Surgery, University Connecticut Health Center, Farmington, CT, USA
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