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Kamp T, Stevens M, Vlieland TPMV, Nelissen RGHH, Brouwer S, Gademan MGJ. Three out of four working-age patients have fulfilled expectations towards paid employment six months after total hip or knee arthroplasty: a multicentre cohort study. Rheumatol Int 2024; 44:339-347. [PMID: 37642700 PMCID: PMC10796735 DOI: 10.1007/s00296-023-05437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
To investigate factors associated with fulfilment of expectations towards paid employment after total hip/knee arthroplasty (THA/TKA). Cohort study including preoperatively employed patients aged 18-64 scheduled for THA/TKA. Expectations were collected preoperatively, and 6 and 12 months postoperatively with the paid employment item of the Hospital-for-Special-Surgery Expectations Surveys (back-to-normal = 1; large improvement = 2; moderate improvement = 3; slight improvement = 4; not applicable = 5). Patients scoring not applicable were excluded. Fulfilment was calculated by subtracting preoperative from postoperative scores (< 0: unfulfilled; ≥ 0: fulfilled). Multivariable logistic regression analyses were conducted separately for THA/TKA at 6 and 12 months postoperatively. Six months postoperatively, 75% of THA patients (n = 237/n = 316) and 72% of TKA patients (n = 211/n = 294) had fulfilled expectations. Older age (TKA:OR 1.08, 95% CI 1.01-1.15) and better postoperative physical functioning (THA:OR 1.10, 95% CI 1.06-1.14; TKA:OR 1.03, 95% CI 1.01-1.06) increased the likelihood of fulfilment. Physical work tasks (THA:OR 0.12, 95% CI 0.03-0.44), preoperative sick leave (TKA:OR 0.33, 95% CI 0.17-0.65), and difficulties at work (THA:OR 0.10, 95% CI 0.03-0.35; TKA:OR 0.41, 95% CI 0.17-0.98) decreased the likelihood of fulfilment. Twelve months postoperatively similar risk factors were found. Three out of four working-age THA/TKA patients had fulfilled expectations towards paid employment at 6 months postoperatively. Preoperative factors associated with fulfilment were older age, mental work tasks, no sick leave, postoperative factors were better physical functioning, and no perceived difficulties at work.
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Affiliation(s)
- Tamara Kamp
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Martin Stevens
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | | | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Madden K. CORR Insights®: How Much Perioperative Pain and Dysfunction Underlie the HOOS JR and KOOS JR? Clin Orthop Relat Res 2023; 481:1811-1812. [PMID: 37083518 PMCID: PMC10427031 DOI: 10.1097/corr.0000000000002666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Kim Madden
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joseph's Healthcare, Hamilton, ON, Canada
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Blomquist MB, Blank JL, Schmitz DG, Thelen DG, Roth JD. Shear wave tensiometry tracks reductions in collateral ligament tension due to incremental releases. J Orthop Res 2023; 41:524-533. [PMID: 35716160 PMCID: PMC9759618 DOI: 10.1002/jor.25400] [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: 10/04/2021] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Surgeons routinely perform incremental releases on overly tight ligaments during total knee arthroplasty (TKA) to reduce ligament tension and achieve their desired implant alignment. However, current methods to assess whether the surgeon achieved their desired reduction in the tension of a released ligament are subjective and/or do not provide a quantitative metric of tension in an individual ligament. Accordingly, the purpose of this study was to determine whether shear wave tensiometry, a novel method to assess tension in individual ligaments based on the speed of shear wave propagation, can detect changes in ligament tension following incremental releases. In seven medial and eight lateral collateral porcine ligaments (MCL and LCL, respectively), we measured shear wave speeds and ligament tensions before and after incremental releases consisting of punctures with an 18-gauge needle. We found that shear wave speed squared decreased linearly with decreasing tension in both the MCL (average coefficient of determination (R2 avg ) = 0.76) and LCL (R2 avg = 0.94). We determined that errors in predicting tension following incremental releases were 26.2 and 14.2 N in the MCL and LCL, respectively, using ligament-specific calibrations. These results suggest shear wave tensiometry is a promising method to objectively measure the tension reduction in released structures. Clinical Significance: Direct, objective measurements of the tension changes in individual ligaments following release could enhance surgical precision during soft tissue balancing in total knee arthroplasty. Thus, shear wave tensiometry could help surgeons reduce the risk of poor outcomes associated with overly tight ligaments, including residual knee pain and stiffness.
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Affiliation(s)
- Matthew B. Blomquist
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jonathon L. Blank
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Dylan G. Schmitz
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Darryl G. Thelen
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Joshua D. Roth
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
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Latijnhouwers DAJM, Vlieland TPMV, Marijnissen WJ, Damen PJ, Nelissen RGHH, Gademan MGJ. Sex differences in perceived expectations of the outcome of total hip and knee arthroplasties and their fulfillment: an observational cohort study. Rheumatol Int 2022; 43:911-922. [PMID: 36437310 PMCID: PMC10073060 DOI: 10.1007/s00296-022-05240-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/22/2022] [Indexed: 11/29/2022]
Abstract
AbstractThe influence of sex on preoperative expectations and their fulfillment following total hip and knee arthroplasty (THA/TKA) remains unexplored. We investigated differences between men and women in perceived preoperative expectations on the outcome of THA/TKA and their fulfillment 1 year postoperatively. We performed a cohort study. Expectations were collected preoperatively and 1 year postoperatively using the Hospital for Special Surgery Hip/Knee Replacement Expectations Surveys (HSS-HRES/KRES; not applicable = 0, applicable: back to normal = 1, much = 2/moderate = 3/slight improvement = 4). Fulfillment of expectations was calculated by subtracting preoperative from postoperative scores (score < 0:unfulfilled; score ≥ 0:fulfilled). We included patients with “applicable” expectations. Chi-square and ordinal regression were used to compare expectations and fulfillment regarding sex. 2333 THA (62% women) and 2398 TKA (65% women) patients were included. 77% of THA and 76% of TKA patients completed the HSS-HRES/HSS-KRES both preoperatively and 1 year postoperatively. Men more often perceived items as “applicable”, with differences in 9/20 (HSS-HRES) and 9/19 (HSS-KRES) preoperative items and, respectively, 12/20 (HSS-HRES) and 10/19 (HSS-KRES) postoperative items. The largest differences (> 10%) were found in sexual activity and working ability. 16/20 (HSS-HRES) and 14/19 (HSS-KRES) items showed an increased probability of having higher preoperative expectations of ≥ 10%, in favor of men. In all items, 60% of the respondents indicated that their expectation was fulfilled. Differences were observed in 16/20 (HSS-HRES) and 6/19 (HSS-KRES) items in favor of men. Sex differences were present in expectations and fulfillment, with higher applicability of items, preoperative expectations and fulfillment in men, especially on items related to functional activities.Trial registration: Trial-ID NTR3348.
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Affiliation(s)
| | - Thea P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Orthopedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Pieter-Jan Damen
- Department of Orthopaedics, Dijklander Hospital, Purmerend, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Grünwald L, Schröter S, Dickschas J, Harrer J, Minzlaff P, Hinterwimmer S, Saier T, Pattappa G, Angele P. Patient response to osteotomy around the knee joint at one year post-operation-fulfilment of expectations and current health status. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04660-6. [PMID: 36344785 DOI: 10.1007/s00402-022-04660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The aim of this study was to investigate patient satisfaction and fulfilment of expectations after osteotomy around the knee at one year postoperatively, using patient-related outcome measures. MATERIALS AND METHODS From the initial sample of 264 patients, a total of 132 patients (age 48y ± 11) were enrolled in this prospective study (response rate 49.3%). Data were collected using the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES), items for satisfaction and the Knee injury and Osteoarthritis Outcome Score (KOOS) measures. At one year postoperative follow-up, an individualized questionnaire asked whether the specific person-related expectations had been fulfilled. RESULTS Satisfaction was high with 83.2% of all participants at one year after surgery. A total of 78% of patients stated they would decide to do the surgery again. This decision was significantly associated with satisfaction, younger age and better KOOS scores scales before surgery for pain, activity and sports. We found high correlations between satisfaction and fulfilment of expectations for the HFES-KSES. Fulfilment of expectations one year after surgery was significantly associated with significant improvements in KOOS scales at one year post-operation. Expectations (1) "to get the knee back to normal status", (2) "improve ability to squat", (3) "improve ability to run", (4) "improve ability to kneel" had been fulfilled worst. A multiple linear regression model for satisfaction had an R2 = 0.797 of the variance. The most influential was the variable fulfilment of "maintain health" that had 70.7% of variance. CONCLUSIONS The fulfilled expectation concerning an improvement of the ability to maintain health was the most influential parameter for satisfaction at one year post-osteotomy. Patients with better health status of the knee and younger age rated the surgery to be more positive and were also more likely to do the surgery again. This provides an indication for an earlier intervention, before the knee and overall health status becomes more detrimental. LEVEL OF EVIDENCE Level II (Therapeutic study).
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Affiliation(s)
- Leonard Grünwald
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, University of Tübingen, Tübingen, Germany.
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany.
| | - Steffen Schröter
- Department of Orthopedics and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany
| | - Jörg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany
- Klinik für Unfallchirugie und Orthopädische Chirurgie, Universitätsklinikum Erlangen, Friedrich Alexander Universität Erlange, Maximilianspl. 2, 91054, Erlangen, Germany
| | - Jörg Harrer
- Department of Orthopedics and Traumatology, Helmut-G.-Walther Klinikum, Prof.-Arneth-Straße 2B, 96215, Lichtenfels, Germany
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany
| | - Philipp Minzlaff
- Orthoclinic Agatharied, Krankenhaus Agatharied GmbH, Norbert-Kerkel-Platz, 83734, Hausham, Germany
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
| | | | - Tim Saier
- Berufsgenossenschaftliche Unfallklinik Murnau, Prof-Küntscher-Str. 8, 82418, Murnau, Germany
| | - Girish Pattappa
- Department of Experimental Trauma Surgery, University of Regensburg Medical Centre, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Peter Angele
- Department of Experimental Trauma Surgery, University of Regensburg Medical Centre, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Sporthopaedicum Regensburg, Hildegard-Von Bingen-Str. 1, 93053, Regensburg, Germany
- Klinik für Trauma und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Franz Josef Strauss Allee 11, 93042, Regensburg, Germany
- Osteotomy Committee of the German Knee Society (DKG), Ismaninger Str. 22, 81675, München, Germany
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Chai XM, Shi HY, Zhang JJ, Wang L, Gao HX, Dai YL, Gao LL, Yu JQ, Li YX, Wang CC. Analgesic effect of auricular point acupressure for acute pain in patients with dementia: study protocol for a randomized controlled trial. Trials 2022; 23:404. [PMID: 35568917 PMCID: PMC9107136 DOI: 10.1186/s13063-022-06326-5] [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: 07/27/2021] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background Common and frequent as acute pain is, it is often underestimated and undertreated in older people with dementia in nursing homes and inadequate pain management remains an issue. Methods The study is designed to be a randomized, sham-controlled trial and is underway in nursing homes located in China. A total of 206 dementia patients are being recruited from nursing homes in Yinchuan, China. They are randomly allocated to an intervention or a controlled group in a 1:1 ratio. The intervention group will be treated with true APP therapy, while the other group will receive APP at sham point stimulation therapy. The patients will be assessed at baseline (T0), at 5 min during performing the intervention (T1), and at 5 min after completion of the intervention (T2). The primary outcome is the level of pain relief at T1 and T2. Physiological parameters, side effects and additional use of analgesics during the procedure, satisfaction from caregivers, and acceptance of patients are evaluated as secondary outcomes. Discussion The results of this study are expected to verify the analgesic effect of APP for acute pain in patients with mild dementia in nursing homes. It has the potential to prompt APP therapy to be implemented widely in dementia patients with acute pain in nursing homes. Trial registration Chinese Clinical Trial Registry ChiCTR2100047932. Registered on 27 June 2021. Currently, patient recruitment is ongoing. Recruitment is expected to take place from December 2020 to December 2021.
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Affiliation(s)
- Xiao-Min Chai
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China
| | - Hong-Yan Shi
- Department of Geriatric Medicine and Special Medical, Ningxia Medical University General Hospital, 804 Sheng Li South Street, Yinchuan, 750004, China
| | - Jun-Jun Zhang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China.,Department of Hematology and Oncology, International Cancer Center, Shenzhen Key Laboratory, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen University Health Science Center, Xueyuan AVE 1098, Shenzhen, 518000, China
| | - Lei Wang
- The Third Middle school of Yinchuan, Yinchuan, 750001, China
| | - Hai-Xiang Gao
- Department of Emergency, Yinchuan Second People's Hospital, 684 Beijing Road, Yinchuan, 750000, China
| | - Ya-Liang Dai
- Department of Surgical, The First People's Hospital of Yinchuan, 2 Li Qun West Street, Yinchuan, 750001, China
| | - Lu-Lu Gao
- School of Public Health, Xinxiang Medical University, 601 Jinsui Avenue, Xinxiang, 453003, China
| | - Jian-Qiang Yu
- Department of Pharmacology, Pharmaceutical Institute of Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, China
| | - Yu-Xiang Li
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China.
| | - Carol Chunfeng Wang
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA, 6027, Australia.
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Capin JJ, Bade MJ, Jennings JM, Snyder-Mackler L, Stevens-Lapsley JE. Total Knee Arthroplasty Assessments Should Include Strength and Performance-Based Functional Tests to Complement Range-of-Motion and Patient-Reported Outcome Measures. Phys Ther 2022; 102:6556168. [PMID: 35358318 PMCID: PMC9393064 DOI: 10.1093/ptj/pzac033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/29/2021] [Accepted: 02/02/2022] [Indexed: 11/14/2022]
Abstract
Range of motion (ROM) and pain often define successful recovery after total knee arthroplasty (TKA), but these routine clinical outcomes correlate poorly or not at all to functional capacity after TKA. The purpose of this Perspective is to underscore the importance of muscle strength and performance-based functional tests in addition to knee ROM and patient-reported outcome (PRO) measures to evaluate outcomes after TKA. Specifically: (1) muscle strength is the rate-limiting step for recovery of function after TKA; (2) progressive rehabilitation targeting early quadriceps muscle strengthening improves outcomes and does not compromise ROM after TKA; (3) ROM and PROs fail to fully capture functional limitations after TKA; and (4) performance-based functional tests are critical to evaluate function objectively after TKA. This Perspective also addresses studies that question the need for or benefit of physical therapy after TKA because their conclusions focus only on ROM and PRO measures. Future research is needed to determine the optimal timing, delivery, intensity, and content of physical therapy.
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Affiliation(s)
- Jacob J Capin
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA,Eastern Colorado Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA,Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA
| | - Michael J Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA,Eastern Colorado Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado, USA,Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, Department of Biomedical Engineering, and Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA,Eastern Colorado Veterans Affairs Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA,Address all correspondence to Dr. Stevens-Lapsley at ; Follow the author(s): @JacobCapin, @PhysioBade, @DocLSmack, @JSLapsley
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Geng J, Chen X, Shi J, Bao H, Chen Q, Yu H. Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach. BMC Public Health 2021; 21:1886. [PMID: 34663271 PMCID: PMC8524814 DOI: 10.1186/s12889-021-11947-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China's public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap. METHODS We established a hypothetical model that comprised patients' awareness of insurance policies, the fulfillment of patients' expectations of insurance benefits, patients' perceived value of health insurance coverage, patients' satisfaction with health insurance programs, patients' complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases. RESULTS The SEM model, with good fit indices, showed that patients' awareness of health insurance policies, insurance program's fulfillment of expectations, and patients' perceived value of insurance coverage, positively predicted patient satisfaction (P < 0.01). The fulfillment of patients' expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P < 0.001), while the patients' perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average (P < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis. CONCLUSIONS Our findings highlight the importance of incorporating patients' perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients' expectations.
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Affiliation(s)
- Jinsong Geng
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China.
| | - Xiaowei Chen
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China.,Library and Reference Department, The First Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, 310003, Hangzhou, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Haini Bao
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Qian Chen
- Department of Ophthalmology, The Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
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Evaluation of Patient Expectations before Carpal Tunnel Release. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3823. [PMID: 34584826 PMCID: PMC8460224 DOI: 10.1097/gox.0000000000003823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 01/29/2023]
Abstract
Background: Carpal tunnel release (CTR) is common, yet patient treatment expectations remain unclear. The primary purpose was to describe patient expectations before CTR. Secondarily, we aimed to identify factors influencing expectations. Methods: Included patients underwent unilateral or bilateral CTR between 2015 and 2017 at a single academic center. Expectations regarding the level of relief/improvement were queried. Area deprivation index (ADI) was used to measure social deprivation. Univariate and multivariable logistic regression identified factors associated with expecting great relief/improvement. Results: Of 307 included patients, mean age was 54 ± 16 years and 63% were women. Patients most commonly expected great (58%) or some (23%) relief/improvement. Few patients expected little (3%) or no (4%) relief/improvement, and 13% had no expectations. In the multivariable analysis, male sex, lower social deprivation, and lower BMI were associated with expecting great relief/improvement. Age, surgical technique (open versus endoscopic), use of the operating room versus procedure room, and preoperative factors (constant numbness, weakness/atrophy, duration of symptoms, and QuickDASH) were not associated with expectations. Conclusions: Most patients expect some to great improvement after CTR. This was independent of several factors with a known association with worse outcomes (advanced age, atrophy/weakness, and constant numbness). Male sex was associated with the expectation of great improvement, in which superior outcomes relative to females have not been borne out in the literature. These findings highlight patient counseling opportunities. The observed association between social deprivation and expectations warrants further investigation, as the socioeconomically disadvantaged experience worse healthcare outcomes in general.
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10
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Schwartz AM, Wilson JM, Farley KX, Bradbury TL, Guild GN. New-Onset Depression After Total Knee Arthroplasty: Consideration of the At-Risk Patient. J Arthroplasty 2021; 36:3131-3136. [PMID: 33934951 DOI: 10.1016/j.arth.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Postoperative new-onset depression (NOD) has gained recent attention as a previously unrecognized complication which may put patients at risk for poor outcomes after elective total hip arthroplasty. We aimed to investigate risk factors for the development of NOD after total knee arthroplasty (TKA) and assess its association with postoperative complications. METHODS This is a retrospective, population-level investigation of elective TKA patients. Patients with a preoperative diagnosis of depression were excluded from this study. Two groups were compared: patients who were diagnosed with depression within one year after TKA (NOD) and those who did not (control). The association of both preoperative patient factors and postoperative surgical and medical complications with NOD was then determined using multivariate and univariate analyses. RESULTS Of 196,728 unique TKA patients in our cohort, 5351 (2.72%) were diagnosed with NOD within one year of TKA. Age <54 year old, female gender, preoperative anxiety disorder, drug, alcohol, and/or tobacco use, multiple comorbidities, and opioid use before TKA were all associated with a diagnosis of NOD postoperatively (all P < .001). Postoperative NOD was associated with periprosthetic fracture (OR 2.11; 95% CI 1.29-3.52; P = .033), aseptic failure (OR 1.61; 95% CI 1.24-2.07; P = .020), prosthetic joint infection (OR 1.55, 95% CI 1.30-1.85; P < .001), stroke (OR 1.24; 95% CI 1.09-1.42; P = .006), and venous thromboembolism (OR 1.24; 95% CI 1.12-1.37; P < .001). CONCLUSION Post-TKA NOD is common and is associated with poor outcomes. This may aid surgeons in developing both anticipatory measures and institute preventative measures for patients at risk for developing NOD.
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11
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Rodriguez-Merchan EC. Patient Satisfaction Following Primary Total Knee Arthroplasty: Contributing Factors. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:379-386. [PMID: 34423084 DOI: 10.22038/abjs.2020.46395.2274] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/14/2020] [Indexed: 11/06/2022]
Abstract
The reported dissatisfaction rate after primary total knee arthroplasty (TKA) ranges between 15% and 25%. The purpose of this article is to perform a narrative review of the literature with the aim of answering the following question: What are the main factors contributing to patient dissatisfaction after TKA? A review of the literature was performed on patient satisfaction after TKA. The search engines used were MedLine (PubMed) and the Cochrane Library. The keywords used were "TKA" and "satisfaction". The main reported preoperative factors positively contributing to patient satisfaction were the following: fulfilment of preoperative expectations, preoperative complete joint space collapse, increasing patellar and lateral compartment osteophyte size, and TKA communication checklist. The principal preoperative factors negatively contributing to patient satisfaction included female sex, comorbidities, and Hispanic race. The chief perioperative factor positively contributing to patient satisfaction was cosmetic closure, whereas the fundamental perioperative factors negatively contributing to patient satisfaction included joint laxity, anterior tibial component slope, and greater femoral component valgus angle. The principal postoperative factors positively contributing to patient satisfaction were the following: ameliorated walking distance, improved range of motion, and improvements in pain. The most important postoperative factors negatively contributing to patient satisfaction included poor postoperative knee stability and soft-tissue balance, functional limitation, surgical complication and reoperation, staff or quality of care issues, and increased stiffness.
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Clement ND, Weir DJ, Holland J, Deehan DJ. Is there a Threshold Preoperative WOMAC Score That Predicts Patient Satisfaction after Total Knee Arthroplasty? J Knee Surg 2021; 34:846-852. [PMID: 31830763 DOI: 10.1055/s-0039-3401826] [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
The aim of this study was to identify threshold preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores that were predictive of patient dissatisfaction 1 year after total knee arthroplasty (TKA). A retrospective cohort of 3,324 patients undergoing a primary TKA was identified from an established arthroplasty database. Patient demographics, comorbidities, and the WOMAC score were collected preoperatively. Patient satisfaction was assessed at 1 year using four questions that focused on: overall outcome, activity, work, and pain. Receiver operating characteristic (ROC) curve analysis was used to identify threshold values predictive of dissatisfaction. The overall satisfaction rate at 1 year was 89.7% (n = 2982). Patients who were satisfied had a significantly greater preoperative pain (3.6, 95% confidence interval [CI] 1.6-5.6, p < 0.001) and functional (4.5, 95% CI 2.6-6.5, p < 0.001) component and total (4.2, 95% CI 2.3-6.0, p < 0.001) WOMAC scores compared with those who were dissatisfied. ROC curve analysis demonstrated the preoperative pain (p = 0.001) and functional (p < 0.001) components and total (p < 0.001) WOMAC scores were significant predictors of satisfaction. Patients scoring < 36 for the pain and function components and < 35 for the total WOMAC score were more likely to be dissatisfied with their overall outcome, but the area under the curves (AUCs) for these predictive threshold values were 0.56, 0.54, and 0.60, respectively, indicating poor prognostic value. A similar finding was observed for satisfaction with pain relief and ability to work and recreational activities; however, in addition the stiffness component was also a significant (p < 0.001) predictor with a threshold value of < 43. Again, these thresholds were of poor prognostic value with an AUC of less than 0.57 for all these satisfaction questions. Threshold values in the preoperative component and total WOMAC scores were not reliable prognostic indicators of overall patient satisfaction or for satisfaction with pain relief, ability to do work, or recreational activities after TKA.
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Affiliation(s)
- Nicholas D Clement
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne, United Kingdom
| | - David J Weir
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne, United Kingdom
| | - James Holland
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne, United Kingdom
| | - David J Deehan
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne, United Kingdom
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Kung JE, Zhang T, Aneizi A, Koenig S, Shasti K, Wahl AJ, Packer JD, Meredith SJ, Henn RF. Predictors of two-year patient satisfaction following elective knee surgery. J Clin Orthop Trauma 2021; 20:101486. [PMID: 34277340 PMCID: PMC8267497 DOI: 10.1016/j.jcot.2021.101486] [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: 02/19/2021] [Revised: 05/16/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Patient satisfaction metrics are increasingly being utilized as tools to evaluate the quality of healthcare and affect reimbursements. The objectives of this study were to (1) identify factors associated with two-year patient satisfaction after elective knee surgery, (2) compare the Surgical Satisfaction Questionnaire-8 (SSQ-8) and a numeric satisfaction scale (NSS), and (3) determine if two-year patient satisfaction can be predicted based on preoperative factors. METHODS A total of 365 patients undergoing elective knee surgery at a single center were administered questionnaires to assess demographics, medical history, and various patient-reported outcomes preoperatively and at two years postoperatively. Patient satisfaction was measured at two years postoperatively with SSQ-8 and NSS. Bivariate and multivariate statistical analyses were performed to identify significant associations and independent predictors of satisfaction. RESULTS SSQ-8 and NSS scores were significantly correlated (rs = 0.68, P < 0.0001). Lower SSQ-8 and NSS scores were associated with black race, higher BMI, more comorbidities, unemployment, smoking, higher ASA score, and greater Met Expectations (P < 0.05). Better scores on patient-based outcome measures and better improvement from baseline were significantly correlated with higher satisfaction on both SSQ-8 and NSS. Multivariable analysis identified greater Met Expectations and higher two-year Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scores as independent predictors of greater SSQ-8 scores (adjusted r2 = .52). Greater Met Expectations and better two-year PROMIS Social Satisfaction scores were independent predictors of NSS score (adjusted r2 = .41). In contrast, when only preoperative variables were considered, the multivariable regression model accounted for only 14% of the variance in SSQ-8 and 6% of the variance in NSS. CONCLUSION While there are multiple preoperative factors that are associated with two-year patient satisfaction after knee surgery, those factors contribute relatively little to satisfaction. Meeting expectations and better patient-based outcomes at two years are more important.
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Affiliation(s)
| | | | | | | | | | | | | | | | - R. Frank Henn
- Corresponding author. Chief of Sports Medicine University of Maryland School of Medicine 2200 Kernan Drive Baltimore, MD 21207, USA.
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Ashraf Y, Iqbal HJ, Senevirathana S, Ashraf T. Has the modern design of Attune total knee replacement improved outcome in patients with isolated patellofemoral arthritis? J Orthop Surg (Hong Kong) 2021; 28:2309499020975553. [PMID: 33272080 DOI: 10.1177/2309499020975553] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND AIM Modern knee replacements aim to improve patient function in arthritis affecting different compartments of the knee. This study evaluates the Patient Reported Outcome Measure (PROM) and functional outcome of a modern total knee replacement (Attune, DePuy) in patients with isolated patellofemoral arthritis. METHODS A total of 50 consecutive patients with isolated unilateral patellofemoral arthritis having had Attune total knee replacements at a single institution between 2010 and 2016 were prospectively studied. Five patients who developed symptoms on the opposite side during the study and two patients lost to follow-up were excluded. One patient needed early revision for loosening, leaving a total of 42 patients to be followed up over a period of 4 years. The Oxford Knee score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) recorded pre-operatively and at follow-up was compared. A Functional assessment at around 8 months after operation was undertaken. RESULTS At average follow-up of 24 months the mean OKS score improved by 15 points and the KOOS score improved by 20 points. Final KOOS sub-score for Pain was 80, Symptom 80, and ADL 82, Sports & Recreation 32 and QOL 60. Functional assessment at mean 8 months showed that a significant number of patients were able to Kneel (50%); Sit cross legged (23%); sit on their heel (23%) and were able do a single leg dip test (86%). CONCLUSION This unique study of a modern design total knee replacement (Attune) in patients with isolated unilateral patellofemoral arthritis shows good PROM scores at 2 years and good functional assessment results at 8 months. The PROM scores are marginally better than the published results with Attune's predecessor, in a similar cohort of patients, but falls short of the published results of patellofemoral replacement implants. Large randomised comparative studies between traditional and the modern implant design is recommended to answer the question if design modification has influenced clinical outcome in patients with patellofemoral arthritis.
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Abstract
AIMS Neither a surgeon's intraoperative impression nor the parameters of computer navigation have been shown to be predictive of the outcomes following total knee arthroplasty (TKA). The aim of this study was to determine whether a surgeon, with robotic assistance, can predict the outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain (KPS), one year postoperatively, and establish what factors correlate with poor KOOS scores in a well-aligned and balanced TKA. METHODS A total of 134 consecutive patients who underwent TKA using a dynamic ligament tensioning robotic system with a tibia first resection technique and a cruciate sacrificing ultracongruent TKA system were enrolled into a prospective study. Each TKA was graded based on the final mediolateral ligament balance at 10° and 90° of flexion: 1) < 1 mm difference in the thickness of the tibial insert and that which was planned (n = 75); 2) < 1 mm difference (n = 26); 3) between 1 mm to 2 mm difference (n = 26); and 4) > 2 mm difference (n = 7). The mean one-year KPS score for each grade of TKA was compared and the likelihood of achieving an KPS score of > 90 was calculated. Finally, the factors associated with lower KPS despite achieving a high-grade TKA (grade A and B) were analyzed. RESULTS Patients with a grade of A or B TKA had significantly higher mean one-year KPS scores compared with those with C or D grades (p = 0.031). There was no difference in KPS scores in grade A or B TKAs, but 33% of these patients did not have a KPS score of > 90. While there was no correlation with age, sex, preoperative deformity, and preoperative KOOS and Patient-Reported Outcomes Measurement Information System (PROMIS) physical scores, patients with a KPS score of < 90, despite a grade A or B TKA, had lower PROMIS mental health scores compared with those with KPS scores of > 90 (54.1 vs 50.8; p = 0.043). Patients with grade A and B TKAs with KPS > 90 were significantly more likely to respond with "my expectations were too low", and with "the knee is performing better than expected" compared with patients with these grades of TKA who had a KPS score of < 90 (40% vs 22%; p = 0.004). CONCLUSION A TKA balanced with robotic assistance to within 1 mm of difference between the medial and lateral sides in both flexion and extension had a higher KPS score one year postoperatively. Despite accurate ligament balance information, a robotic system could not guarantee excellent pain relief. Patient expectations and mental status also significantly affected the perceived success of TKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):67-73.
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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Vajapey SP, McKeon JF, Krueger CA, Spitzer AI. Outcomes of total joint arthroplasty in patients with depression: A systematic review. J Clin Orthop Trauma 2021; 18:187-198. [PMID: 34026486 PMCID: PMC8121979 DOI: 10.1016/j.jcot.2021.04.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Depression has been implicated as a poor predictor of outcomes after total joint arthroplasty (TJA) of the lower extremity in some studies. We aimed to determine whether depression as a comorbidity affects the TJA outcomes and whether pain reduction associated with successful TJA alters depressive symptoms. METHODS A search of PUBMED was performed using keywords "depression", "arthroplasty", "depressive disorder", and "outcomes." All English studies published over the last ten years were considered for inclusion. Quantitative and qualitative analysis was then performed on the data. RESULTS Thirty articles met inclusion criteria (16 retrospective, 14 prospective). Three showed that depressed patients were at higher risk for readmission. Two reported that depressed patients had higher likelihood of non-home discharge after TJA compared to non-depressed patients. Four noted that depressed patients incur higher hospitalization costs than non-depressed patients. Ten suggest depression is a predictor of poor patient-reported outcome measures, pain, and satisfaction after TJA. Five suggested the gains depressed patients experience in functional outcome scores after TJA are similar to gains experienced by patients without depression. Another eight suggested that TJA improves not only function and pain but also depressive symptoms in patients with depression. CONCLUSION The results of this review show that depression increases the risk of persistent pain, dissatisfaction, and complications after TJA. Additionally, depressed patients may incur higher costs than non-depressed patients undergoing TJA and may have worse preoperative and postoperative patient reported outcome measures (PROMs). However, the gains in function that depressed patients experience after TJA are equivalent to gains experienced by non-depressed patients and depressed patients may experience improvement in their depressive symptoms after TJA. Patient selection for TJA is critical and counseling regarding increased risk for complications is crucial in depressed patients undergoing TJA.
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Affiliation(s)
- Sravya P. Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, USA,Corresponding author. 725 Prior Hall, Columbus, OH, 43210, USA.
| | - John F. McKeon
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, USA
| | - Chad A. Krueger
- Department of Orthopaedic Surgery, The Rothman Institute, USA
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Lin BJ, Zhang T, Aneizi A, Henry LE, Mixa P, Wahl AJ, Shasti K, Meredith SJ, Henn RF. Predictors of met expectations two years after knee surgery. J Orthop 2021; 25:10-15. [PMID: 33897134 DOI: 10.1016/j.jor.2021.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/28/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The purpose of this study is to determine which patient factors predict two-year postoperative met expectations in a cohort of patients undergoing knee surgery. Additionally, this study aims to measure the association between met expectations and postoperative outcomes. Methods 319 patients undergoing knee surgery at one institution were studied. Patients completed patient-reported outcome questionnaires prior to surgery and again two years postoperatively. Preoperative Expectations and postoperative Met Expectations were measured using the Musculoskeletal Outcomes and Data Evaluation Management System (MODEMS) Expectations domain. Results The mean Met Expectations score was significantly lower than the preoperative Expectations Score. Worse two-year Met Expectations were associated with older age, higher BMI, greater comorbidities, more previous surgeries, black race, unemployment, lower income, government insurance, Worker's Compensation, smoking, and no injury prior to surgery. Greater Met Expectations were correlated with better scores on all two-year outcome measures as well as greater improvement on most outcome measures. Race, insurance status, function, mental health, and knee pain were found to be independent predictors of Met Expectations. Conclusion This study identified multiple patient factors and outcome measures that were associated with Met Expectations two years after knee surgery.
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Affiliation(s)
- Brian J Lin
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Leah E Henry
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick Mixa
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexander J Wahl
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Keyan Shasti
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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McLendon PB, Christmas KN, Simon P, Plummer OR, Hunt A, Ahmed AS, Mighell MA, Frankle MA. Machine Learning Can Predict Level of Improvement in Shoulder Arthroplasty. JB JS Open Access 2021; 6:JBJSOA-D-20-00128. [PMID: 34386682 PMCID: PMC8352606 DOI: 10.2106/jbjs.oa.20.00128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The ability to accurately predict postoperative outcomes is of considerable interest in the field of orthopaedic surgery. Machine learning has been used as a form of predictive modeling in multiple health-care settings. The purpose of the current study was to determine whether machine learning algorithms using preoperative data can predict improvement in American Shoulder and Elbow Surgeons (ASES) scores for patients with glenohumeral osteoarthritis (OA) at a minimum of 2 years after shoulder arthroplasty.
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Affiliation(s)
- Paul B McLendon
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, Florida
| | - Kaitlyn N Christmas
- Translational Research, Foundation for Orthopaedic Research and Education (F.O.R.E.), Tampa, Florida
| | - Peter Simon
- Translational Research, Foundation for Orthopaedic Research and Education (F.O.R.E.), Tampa, Florida
| | | | - Audrey Hunt
- Universal Research Solutions, LLC, Columbia, Missouri
| | - Adil S Ahmed
- Department of Orthopaedic Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Mark A Mighell
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, Florida
| | - Mark A Frankle
- Shoulder and Elbow Service, Florida Orthopaedic Institute, Tampa, Florida
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Espinosa A, Jiménez M, Zorrilla P, López A, Salido J, Amo M. Influence of fulfilment patient expectations in outcomes after total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bhimani SJ, Bhimani R, Smith A, Eccles C, Smith L, Malkani A. Robotic-assisted total knee arthroplasty demonstrates decreased postoperative pain and opioid usage compared to conventional total knee arthroplasty. Bone Jt Open 2020; 1:8-12. [PMID: 33215101 PMCID: PMC7659658 DOI: 10.1302/2633-1462.12.bjo-2019-0004.r1] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims Robotic-assisted total knee arthroplasty (RA-TKA) has been introduced to provide accurate bone cuts and help achieve the target knee alignment, along with symmetric gap balancing. The purpose of this study was to determine if any early clinical benefits could be realized following TKA using robotic-assisted technology. Methods In all, 140 consecutive patients undergoing RA-TKA and 127 consecutive patients undergoing conventional TKA with minimum six-week follow-up were reviewed. Differences in visual analogue scores (VAS) for pain at rest and with activity, postoperative opiate usage, and length of stay (LOS) between the RA-TKA and conventional TKA groups were compared. Results Patients undergoing RA-TKA had lower average VAS pain scores at rest (p = 0.001) and with activity (p = 0.03) at two weeks following the index procedure. At the six-week interval, the RA-TKA group had lower VAS pain scores with rest (p = 0.03) and with activity (p = 0.02), and required 3.2 mg less morphine equivalents per day relative to the conventional group (p < 0.001). At six weeks, a significantly greater number of patients in the RA-TKA group were free of opioid use compared to the conventional TKA group; 70.7% vs 57.0% (p = 0.02). Patients in the RA-TKA group had a shorter LOS; 1.9 days versus 2.3 days (p < 0.001), and also had a greater percentage of patient discharged on postoperative day one; 41.3% vs 20.5% (p < 0.001). Conclusion Patients undergoing RA-TKA had lower pain levels at both rest and with activity, required less opioid medication, and had a shorter LOS.
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Affiliation(s)
- Samrath J Bhimani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Rohat Bhimani
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Austin Smith
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Christian Eccles
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Langan Smith
- U of L Health, UL Physicians - Orthopedic Group, Louisville, Kentucky, USA
| | - Arthur Malkani
- University of Louisville, Department of Orthopaedic Surgery, Louisville, Kentucky, USA
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Stumpff K, Hadley M, Corn K, Templeton K. Sex-Based Reporting of Common Musculoskeletal Conditions. J Womens Health (Larchmt) 2020; 30:689-693. [PMID: 33090896 DOI: 10.1089/jwh.2020.8628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: Sex- and gender-based differences affect all aspects of health and disease, including musculoskeletal conditions. However, it is unknown how often authors publish outcomes of common conditions based on sex. We reviewed the frequency with which articles in orthopedic journals published sex-specific outcomes with regard to a condition with known sex-based differences and one in which differences are less known. Materials and Methods: Articles that reported original clinical studies from four high-impact orthopedic journals were reviewed: Journal of Bone and Joint Surgery (JBJS), Clinical Orthopedics and Related Research (CORR), American Journal of Sports Medicine (AJSM), and Journal of Arthroplasty (JOA). JBJS and CORR were reviewed as journals intended for a general audience, while AJSM and JOA were included as subspecialty journals. Analysis of data based on sex beyond the statement of how many men and women were included was designated as successfully reporting sex-specific outcomes. The gender of authors was assessed for impact on reporting. Results: Sex-specific outcomes were reported in 24%-29% of articles regarding rotator cuff pathology and in 32%-40% of publications concerning knee osteoarthritis. There was a trend toward more publications with sex-specific outcomes in knee osteoarthritis (p = 0.0562). No significant changes in rates of reporting were noted over time. Articles listing a woman as the first or last author were significantly more likely to report results based on sex. Conclusions: While there was a trend for sex-specific outcomes to be reported more often in knee osteoarthritis, the level of reporting was still low. Reporting based on sex was higher if a woman was the first or last author. To improve care for all patients, sex-specific outcomes should be reported across all orthopedic conditions by all researchers.
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Affiliation(s)
- Kelly Stumpff
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Morgan Hadley
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Karsen Corn
- Department of Orthopaedic Surgery, St. Louis University, St. Louis, Missouri, USA
| | - Kim Templeton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Influence of fulfilment patient expectations in outcomes after total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:428-433. [PMID: 32451242 DOI: 10.1016/j.recot.2020.03.002] [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: 02/03/2020] [Revised: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Compliance with preoperative expectations of patients undergoing total knee arthroplasty (TKA) is related to the degree of satisfaction, but its effect on other outcomes has not been studied. The aim of this study is to determine whether meeting expectations influences clinical, functional and quality of life outcomes at one year after surgery. MATERIAL AND METHODS The expectations of 183 patients were evaluated through the Hospital for Special Surgery Knee Replacement Expectations Survey. The Visual Analog Scale, Knee Society Score, WOMAC and SF-36 questionnaires were administered preoperatively and at the annual review. Comparisons were made between compliance with expectations and socio-demographic variables, postoperative complications, improvement in the questionnaires and degree of satisfaction. RESULTS Patients without postoperative complications were significantly (P<.005) in the group that had fulfilled all their expectations. A statistically significant relationship (P<.001) was also observed between this group and a higher degree of satisfaction. Finally, the fulfillment of all expectations was associated with a greater improvement (P<.001) in the KSS-Function and SF-36 questionnaires. CONCLUSIONS Compliance with preoperative expectations is related to a greater improvement in functionality and quality of life at one year of the RTA and significantly affects satisfaction. These findings will allow us to adjust expectations to what is really expected from the surgery, in order to avoid poor results and dissatisfaction.
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Mahdi A, Hälleberg-Nyman M, Wretenberg P. Preoperative psychological distress no reason to delay total knee arthroplasty: a register-based prospective cohort study of 458 patients. Arch Orthop Trauma Surg 2020; 140:1809-1818. [PMID: 32720002 PMCID: PMC7560918 DOI: 10.1007/s00402-020-03537-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is effective in alleviating pain and improving function in patients with knee arthritis. Psychological factors are known to affect patient satisfaction after TKA. It is important to determine the effectiveness of TKA in patients with presurgical anxiety and/or depression to avoid excluding them from surgery. MATERIALS AND METHODS A prospective cohort study was conducted on all patients who underwent TKA during 2016-2018. Patients were divided into four groups: with anxiety, without anxiety, with depression, and without depression. Outcome measures comprised both generic and knee-specific instruments. Each patient group was compared regarding changes in outcome measures one year after surgery. Between-group comparison was also performed. RESULTS Of the 458 patients with complete data, 15.3% and 9.6% had experienced presurgical anxiety and depression, respectively. All patient groups displayed statistical (P < 0.001) and clinical improvement in all outcome measures. Patients with presurgical anxiety and/or depression generally displayed less improvement, though the only significant mean differences concerned the Knee Injury and Osteoarthritis Outcome Score (KOOS)-sport score in the non-anxiety and non-depression groups (P = 0.006 and 0.03, respectively), a higher proportion of clinically improved KOOS pain in the non-anxiety group (P = 0.03), and the general health state in the anxiety and depression groups (P = 0.004 and 0.04, respectively). CONCLUSIONS All patients improved in outcome measures 1 year after TKA, regardless of presurgical psychological state. Patients with presurgical anxiety and/or depression benefit greatly from surgery and should not be discriminated against based on presurgical psychological distress, though this fact should not eliminate the preoperative psychological assessment of patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Aamir Mahdi
- grid.451792.c0000 0000 8699 6304Department of Orthopaedics, Örebro County Council, Örebro, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden ,grid.15895.300000 0001 0738 8966Department of Orthopaedics, Faculty of Health and Medicine, Örebro University, SE-701 82 Örebro, Sweden
| | - Maria Hälleberg-Nyman
- grid.15895.300000 0001 0738 8966School of Health Sciences, Örebro University, Örebro, Sweden
| | - Per Wretenberg
- grid.451792.c0000 0000 8699 6304Department of Orthopaedics, Örebro County Council, Örebro, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
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