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Roussel T, Dartus J, Pasquier G, Duhamel A, Preda C, Migaud H, Putman S. Can the minimal clinically important difference (MCID) for the Oxford score, KOOS and its derivatives be identified in a French sample of total knee arthroplasties? Orthop Traumatol Surg Res 2024:103965. [PMID: 39089421 DOI: 10.1016/j.otsr.2024.103965] [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: 03/17/2024] [Revised: 06/28/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
CONTEXT To assess the effect of a surgical procedure on a patient, it is conventional to use clinical scores before and after the procedure, but it is increasingly common and recommended to weight the results of these scores with the notion of minimal clinically important difference ("MCID"). This MCID should be determined using either the data distribution method based on score variation, or the anchor method, which uses an external question to categorize the results. MCIDs vary from one population to another, and to our knowledge there has been no investigation in France for total knee arthroplasties (TKAs). We therefore conducted a prospective study on a population of TKAs in order to: 1) Define MCID in France on a population of TKAs for the Oxford score, KOOS (Knee injury and Osteoarthritis Outcome Score) and its derivatives, 2) Determine whether MCID for these scores in France is comparable to results in the literature. HYPOTHESIS Is the MCID for total knee arthroplasty in France comparable to other results in the literature? MATERIAL AND METHOD This was a prospective observational study in which 218 patients (85 men, 133 women) with a mean age of 72 years [27-90] who had undergone a primary TKA out of 300 initially included responded, before and after surgery, to the Oxford-12, KOOS and Forgotten Joint Score (FJS) questions (mean follow-up 24 months). MCID was calculated using the distribution method as well as the anchor method ("improvement 1 to 5" and "improvement yes or no"). RESULTS At a mean follow-up of 24 months [18-36], the Oxford-12 score increased from 16 ± 8 [0-41] to 34 ± 11 [6-48] (p < 0.001), all components of the KOOS score were improved and the FJS at follow-up was 47 ± 32 [0-100]. For the anchor "improvement 1 to 5", there were 14 unimproved patients, 23 patients in identical condition and 179 patients improved by surgery. For the anchor "are you improved yes/no", there were 8 unimproved patients, 22 in identical condition and 187 surgically-improved patients. The mean MCID for all methods (anchor method and distribution) was 10 [7-13] for Oxford-12, 12 [12-12] for KOOS Symptom, 14 [12-17] for KOOS Pain, 12 [11-14] for KOOS Function, 14 [12-16] for KOOS Sport, 15 [15-16] for KOOS Quality of Life (QOL), 11 [10-12] for KOOS 12, 15 [12-18] for KOOS 12 Pa in. 12 [12-13] for KOOS 12 Function, 15 [15-15] for KOOS 12 QOL, 14 [13-14] for KOOS Physical Function Short-form (PS) and 14 [13-16] for KOOS Joint Replacement (JR). DISCUSSION The MCID for the Oxford-12, KOOS and its derivatives scores in a French population is comparable to that observed in other populations in the literature. LEVEL OF EVIDENCE IV; prospective study without control group.
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Affiliation(s)
- Tom Roussel
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France.
| | - Julien Dartus
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France
| | - Gilles Pasquier
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France
| | - Alain Duhamel
- Lille University, 59000, France; Univ. Lille, CHU Lille, ULR2694-METRICS : évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; CHU Lille, Department of Biostatistics, F-59000 Lille, France
| | - Cristian Preda
- Lille University, 59000, France; Laboratory of Mathematics Paul Painlevé, UMR CNRS 8524, University of Lille, France; Lille Catholics Hospitals, Biostatistics Department Delegation for Clinical Research and Innovation, Lille Catholic University, Lille, France
| | - Henri Migaud
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France
| | - Sophie Putman
- CHU Lille, Service d'Orthopédie, Place de Verdun, Hôpital Salengro, F-59000 Lille, France; Lille University, 59000, France; Univ. Lille, CHU Lille, ULR2694-METRICS : évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; CHU Lille, Department of Biostatistics, F-59000 Lille, France
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Addi A, Duguay T, Valentin E, Anract P, Hardy A. Simple Hip Value: a simple score to evaluate Hip function. Orthop Traumatol Surg Res 2024:103952. [PMID: 39032864 DOI: 10.1016/j.otsr.2024.103952] [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: 06/26/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 07/23/2024]
Abstract
BACKGROUND Several self-administered questionnaires are available for assessing hip function in clinical practice (HOOS-12, Oxford-12). These questionnaires can be used to assess and monitor patients with hip pathology. However, they are sometimes difficult to deploy in clinical practice. Recent studies on the shoulder and knee have shown that a single-question assessment provides a relevant evaluation of joint function, and correlates with more complex scores. However, this has not yet been evaluated for the hip. We set out to develop a single-question test that would enable patients to assess their hip function between 0 and 100. Therefore, we did a prospective study aiming to assess: (1) the relevance of the SHV (Simple Hip Value) test by comparing it with the Oxford-12 and HOOS-12 scores, (2) the discriminatory capacity and reproducibility of this test. HYPOTHESIS The hypothesis of this study was that the assessment of hip function by a single-question patient-completed questionnaire (PROM) would be reliable and useful in clinical practice. PATIENTS AND METHODS We conducted a prospective study including 74 patients operated on for total hip arthroplasty from February 2020 to April 2021 in a high-volume center and 20 healthy subjects. The SHV questionnaire, as well as HOOS-12 and OXFORD-12 were submitted on average 18 months after surgery, with values scaled to 100 points. A second test containing the 3 questionnaires was resubmitted to 20 patients randomly chosen from hip arthroplasty group to evaluate the reproducibility of the test. To evaluate the discrimination capacity of our test, 20 controls were selected to respond to the three questionnaires. RESULTS Test results were median SHV, Oxford-12 and HOOS-12 scores of 90/100 (Interquartile Range [IQR]: 80-95), 88.5 (IQR: 77.1-95.8) and 79.1 (IQR: 65.1-93.2), respectively. The SHV was strongly correlated with the Oxford-12 (Spearman coefficient: 0.63 [IQR: 0.45-0.76]) and the HOOS-12 (Spearman coefficient: 0.66 [IQR: 0.46-0.79]). The SHV differed significantly from the control group (90.0 vs 100.0 in the control group [p < 0.001]) and had excellent reproducibility (Interclass Correlation Coefficient [ICC]: ICC: 0.82 [CI95%, 0.59-0.93]). DISCUSSION The SHV test seems to be a reliable, reproducible and discriminating tool for assessing hip function after total hip arthroplasty, thus offering a simplified and practical approach for practitioners. Further testing in different populations would be useful to validate this test. LEVEL OF EVIDENCE III; prospective comparative diagnostic study.
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Affiliation(s)
- Alix Addi
- Service de Chirurgie Orthopédique, AP-HP Centre-Université de Paris, Hôpital Cochin, Paris, France.
| | - Tristan Duguay
- Service de Chirurgie Orthopédique, AP-HP Centre-Université de Paris, Hôpital Cochin, Paris, France
| | - Eugenie Valentin
- Clinique du Sport Paris 5, 36 Boulevard Saint-Marcel, 75005, Paris, France
| | - Philippe Anract
- Service de Chirurgie Orthopédique, AP-HP Centre-Université de Paris, Hôpital Cochin, Paris, France
| | - Alexandre Hardy
- Clinique du Sport Paris 5, 36 Boulevard Saint-Marcel, 75005, Paris, France
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Anwar A, Zhang Y, Zhang Z, Li J. Artificial intelligence technology improves the accuracy of preoperative planning in primary total hip arthroplasty. Asian J Surg 2024; 47:2999-3006. [PMID: 38342724 DOI: 10.1016/j.asjsur.2024.01.133] [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: 10/02/2023] [Revised: 12/27/2023] [Accepted: 01/26/2024] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVE Successful total hip arthroplasty relies on accurate preoperative planning. However, the conventional preoperative planning, a two-dimensional method using X-ray template, has shown poor reliability of predicting component size. To our knowledge, artificial intelligence technology assisted three-dimensional preoperative planning is promising to improve the accuracy of preoperative planning but there is a dearth of clinical evidence. Therefore, in this study we compared the prediction accuracy of these two maneuvers. METHODS We conducted a prospective study consisting of 117 consecutive patients who underwent a primary cementless total hip arthroplasty to compare the prediction accuracy of these two methods. The two-dimensional and artificial intelligence assisted three-dimensional planning results of the same patient were compared with the definitive implant size respectively. RESULTS The prediction accuracy of artificial intelligence assisted three-dimensional planning for cup and the stem sizes were 66.67% (78/117) and 65.81% (77/117), two-dimensional planning was 30.77% (36/117) and 37.61% (44/117) (p < 0.05). There were poor prediction results of two-dimensional planning in patients with hip dysplasia (p = 0.004, OR = 7.143) and excessive femoral anteversion (p = 0.012, OR = 1.052), meanwhile the failure risk of stem side two-dimensional planning increased as patients got older (p = 0.003, OR = 1.118). The accuracy of artificial intelligence assisted three-dimensional planning cannot be affected by above factors. CONCLUSIONS We confirmed that artificial intelligence assisted three-dimensional preoperative planning showed higher accuracy and stability than two-dimensional preoperative planning in primary cementless total hip arthroplasty. We believe artificial intelligence assisted three-dimensional preoperative planning technology provides surgeons a new reliable choice and offers advantages whether in simple or complicated cases.
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Affiliation(s)
- Adeel Anwar
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, PR China.
| | - Yufang Zhang
- Zhengzhou Railway Vocational and Technical College, No.56, Pengcheng Avenue, Zhengdong New District, Zhengzhou, Henan, PR China.
| | - Zhen Zhang
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, PR China.
| | - Jie Li
- Department of Orthopedics, The First Affiliated Hospital of Dalian Medical University, Dalian, 116021, PR China.
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Khatri C, Harrison CJ, Clement ND, Scott CEH, MacDonald D, Metcalfe AJ, Rodrigues JN. Item Response Theory Validation of the Forgotten Joint Score for Persons Undergoing Total Knee Replacement. J Bone Joint Surg Am 2024; 106:1091-1099. [PMID: 38502741 DOI: 10.2106/jbjs.23.00814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND The Forgotten Joint Score (FJS), a commonly used patient-reported outcome measure, was developed without fully confirming assumptions such as unidimensionality (all items reflect 1 underlying factor), appropriate weighting of each item in scoring, absence of differential item functioning (in which different groups, e.g., men and women, respond differently), local dependence (pairs of items are measuring only 1 underlying factor), and monotonicity (persons with higher function have a higher score). We applied item response theory (IRT) to perform validation of the FJS according to contemporary standards, and thus support its ongoing use. We aimed to confirm that the FJS reflects a single latent trait. In addition, we aimed to determine whether an IRT model could be fitted to the FJS. METHODS Participants undergoing primary total knee replacement provided responses to the FJS items preoperatively and at 6 and 12 months postoperatively. An exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Mokken analysis were conducted. A graded response model (GRM) was fitted to the data. RESULTS A total of 1,774 patient responses were analyzed. EFA indicated a 1-factor model (all 12 items reflecting 1 underlying trait). CFA demonstrated an excellent model fit. Items did not have equal weighting. The FJS demonstrated good monotonicity and no differential item functioning by sex, age, or body mass index. GRM parameters are reported in this paper. CONCLUSIONS The FJS meets key validity assumptions, supporting its use in clinical practice and research. The IRT-adapted FJS has potential advantages over the traditional FJS: it provides continuous measurements with finer granularity between health states, includes individual measurement error, and can compute scores despite more missing data (with only 1 response required to estimate a score). It can be applied retrospectively to existing data sets or used to deliver individualized computerized adaptive tests. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chetan Khatri
- Clinical Trials Unit, University of Warwick, Coventry, England, United Kingdom
| | - Conrad J Harrison
- Surgical Intervention Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom
| | - Nick D Clement
- Department of Orthopaedics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Chloe E H Scott
- Department of Orthopaedics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Deborah MacDonald
- Department of Orthopaedics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Andrew J Metcalfe
- Clinical Trials Unit, University of Warwick, Coventry, England, United Kingdom
| | - Jeremy N Rodrigues
- Clinical Trials Unit, University of Warwick, Coventry, England, United Kingdom
- Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, England, United Kingdom
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Foissey C, Pineda T, Servien E, Fontalis A, Batailler C, Lustig S. Adapting hip arthroplasty practices during the COVID-19 pandemic: Assessing the impact of outpatient care sudden increase on early complications and clinical outcomes. SICOT J 2024; 10:1. [PMID: 38193980 PMCID: PMC10775906 DOI: 10.1051/sicotj/2023037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has significantly affected access to timely care for patients with hip osteoarthritis requiring total hip replacement (THR). This study aimed to assess the changes in surgical activity, outpatient treatment, length of stay (LOS), discharge destinations, readmission rates, clinical outcomes, and patient satisfaction before and after the pandemic at our institution. MATERIALS AND METHODS This retrospective study encompassed patients undergoing primary THR through the direct anterior approach at a single university hospital. Data on demographic characteristics, surgical technique, perioperative management, LOS, discharge destinations, complications, and clinical outcomes were collected. Furthermore, a comparative analysis between the pre-pandemic (2019) and post-pandemic (2022) periods was conducted. RESULTS There was a 14% increase in surgical activity post-pandemic, with 214 patients undergoing surgery in 2019 versus 284 in 2022. The percentage of patients managed as outpatients significantly increased from 0.5% in 2019 to 29.6% in 2022 (p < 0.001). LOS decreased from 2.7 ± 1 [0-8] days to 1.4 ± 1.1 [0-12] days (p < 0.001), and the rate of discharge to rehabilitation centres declined from 21.5% to 8.8% (p < 0.001). No significant increase in the readmission rates was observed (1.4% in both periods). At two months postoperatively, the mean HHS and satisfaction rates were comparable between the two groups (p = 1 and p = 0.73, respectively). DISCUSSION Despite the challenges posed by the COVID-19 pandemic, surgical activity at our institution demonstrated an increase compared to the pre-pandemic levels by expanding outpatient care, reducing LOS, and increasing rates of home discharges. Importantly, these changes did not adversely affect rehospitalization rates or early clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Constant Foissey
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
| | - Tomas Pineda
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
- LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility Claude Bernard Lyon 1 University Lyon France
| | - Andreas Fontalis
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust 235 Euston Rd. London NW1 2BU UK
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Centre of Excellence, Croix-Rousse Hospital, Lyon University Hospital Lyon France
- Division of Surgery and Interventional Science, University College London Gower Street London WC1E 6BT UK
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Angelliaume A, Harper L, Bouty A, Bouteiller C, Deleplanque B, Ravel M, Le Hanneur M, Narayanan UG, Ferdynus C, Pfirrmann C. Validation of the French version of the Caregivers' Priorities and Child Health Index of Life with Disabilities questionnaire. Orthop Traumatol Surg Res 2023:103753. [PMID: 37979675 DOI: 10.1016/j.otsr.2023.103753] [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: 04/16/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The Caregivers' Priorities and Child Health Index of Life with Disabilities (CPCHILD) is a questionnaire that measures the health-related quality of life (HRQL) of children with cerebral palsy (CP). Though measuring HRQL is challenging in these children, it is a valuable help for medical decision-making. There is no questionnaire to assess HRQL in French-speaking children with severe CP. OBJECTIVE To translate and adapt transculturally the CPCHILD questionnaire into French (CPCHILD-FV). MATERIAL AND METHODS The CPCHILD was translated from English into French by forward and backward translation by independents translators. The questionnaire was then tested on 32 caregivers of patients with CP classified as GMFCS IV or V, remarks of caregivers were analyzed by an expert committee and, if necessary, modifications were performed. Internal consistency of the CPCHILD-FV was assessed using a sample of 32 parents or caregivers and test-retest reliability was assessed on a random sample of 10 patients. RESULTS The translation and transcultural process resulted in a French version of the CPCHILD. Some items of the CPCHILD required careful discussion to ensure that items had the same meaning as in the original. Internal consistencies were over 0.70 for each domain except for health, and 0.97 for the total scores. The ICC for the test-retest reliability of the CHILD-FV total score was 0.98 (95% CI: 0.93-0.99) and ranged from 0.59 to 0.99 for the domains. CONCLUSION The translation and cross-cultural adaptation of the CPCHILD questionnaire provides a French version than can measure the HRQL of children with severe CP. LEVEL OF EVIDENCE IV; prospective study without control group.
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Affiliation(s)
- Audrey Angelliaume
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Luke Harper
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Aurore Bouty
- Department of Pediatric Surgery, The Royal Children's Hospital, 50, Flemington Road, Parkville, Victoria 3052, Australia
| | - Cécile Bouteiller
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Brigitte Deleplanque
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Magaly Ravel
- Department of Children Physical and Rehabilitation Medicine, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Malo Le Hanneur
- Department of Pediatric Orthopaedics, Trousseau University Hospital, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - Unni G Narayanan
- Department of Orthopaedic Surgery and Child Health Evaluative Science, Hospital of Sick Children, Toronto, Canada
| | - Cyril Ferdynus
- Methodological Support Unit, University Hospital, allée des Topazes, 97400 Saint-Denis, Reunion Island, France
| | - Clémence Pfirrmann
- Department of Pediatric Surgery, Pellegrin University Hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Masson JB, Foissey C, Bertani A, Pibarot V, Rongieras F. Transverse subtrochanteric shortening osteotomy with double tension-band fixation during THA for Crowe III-IV developmental dysplasia: 12-year outcomes. Orthop Traumatol Surg Res 2023; 109:103684. [PMID: 37704103 DOI: 10.1016/j.otsr.2023.103684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND When performing total hip arthroplasty in patients with severe developmental dysplasia, shortening the femur facilitates reduction while also preventing sciatic or crural nerve injury and excessive length of the operated limb. No consensus exists about the optimal type of implant and best internal fixation procedure, two parameters that directly govern the risk of the most common intraoperative and postoperative complications (diaphyseal fractures, dislocation, non-union). To minimise these risks, we developed a technique combining a transverse subtrochanteric shortening osteotomy, a long ovoid-profiled, cementless stem anchored in the metaphysis, and double tension-band wiring for internal fixation. The primary objective of this study was to evaluate the outcomes of this technique with emphasis on (i) complications and femoral implant survival, (ii) clinical outcomes (functional scores and lower-limb length inequality [LLLI]), and time to healing. HYPOTHESIS Our technique is associated with low rates of intraoperative and postoperative complications. MATERIAL AND METHODS This single-centre retrospective cohort study included patients who underwent THA with a transverse subtrochanteric shortening osteotomy and fixation using double tension-band wiring to treat severe (Crowe III or IV) developmental hip dysplasia. The femoral implant was a long, ovoid, cementless stem fully coated with hydroxyapatite. We collected the intraoperative and postoperative complications, survival, LLLI, functional scores (Harris Hip Score [HHS] and Forgotten Joint Score [FJS]), patient satisfaction, and radiographic outcomes. RESULTS The study included 31 hips in 25 patients. Two patients (2/31 hips, 6.5%) were lost to follow-up, leaving 29 hips for the analysis of postoperative outcomes. Mean follow-up was 13.7±4.2 years (range, 5.8-18.3 years). The four intraoperative complications (4/31, 12.9%) consisted fracture of the diaphysis (2/31, 6.5%), fracture of the greater trochanter (1/31, 3.2%), and sciatic nerve injury followed by a full recovery (1/29, 3.4%). The 8 (8/29, 27.5%) postoperative complications consisted of dislocation (2/29, 6.9%), stem subsidence (2/29, 6.9%), and non-union (4/29, 13.8%). Femoral implant survival at last follow-up was 87.1% (95% CI, 76.1-99.7). The mean HHS increased from 39.6±12.0 (range, 14-61) before surgery to 81.7±13.2 (range, 48-100) at last follow-up (p<0.01). The FJS at last follow-up indicated that the joint was forgotten in 14/29 (48.2%) cases and caused only acceptable symptoms in 9/29 (31.0%) of cases. Clinically significant (≥ 1cm) LLLI was present in 8/29 (27.6%) patients postoperatively compared to 19/29 (65.5%) preoperatively. The mean LLLI decreased from 20.8±19.7mm (range, 0-60mm) to 5.0±7.3mm (range, 0-30mm). Mean time to healing was 4.3±2.4 months (range, 2-11 months). CONCLUSION Regarding these complex procedures, this technique was associated with low rates of intraoperative fractures and early postoperative complications. However, femoral stem survival was shorter than in earlier studies and the non-union rate was high, despite satisfactory functional and clinical outcomes. LEVEL OF EVIDENCE IV
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Affiliation(s)
| | - Constant Foissey
- Hôpital de la Croix Rousse, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Antoine Bertani
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69008 Lyon, France
| | - Vincent Pibarot
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69008 Lyon, France
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Massardier E, Bauwens PH, Masson JB, Rongieras F, Bertani A. Survival and complications at a minimum 5years' follow-up of the modular Mark-2 Extreme™ cementless femoral stem: Does the reduced modularity resolve the mechanical issues of the Mark-I stem? Orthop Traumatol Surg Res 2023; 109:103613. [PMID: 37004733 DOI: 10.1016/j.otsr.2023.103613] [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: 06/28/2021] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION The Extreme™ modular stem was developed for implant revision with metaphyseal-diaphyseal defect. Due to the high breakage rate, a new "reduced modularity" design has been introduced, but without reported results. We therefore conducted a retrospective assessment of (1) overall stem survival, (2) functional results, (3) osseointegration, and (4) the rate of complications, and notably of mechanical failure. HYPOTHESIS Reduced modularity reduces the risk of revision surgery for mechanical failure. MATERIAL AND METHODS Forty-five prostheses were implanted between January 2007 and December 2010 in 42 patients with severe bone defect (Paprosky≥III) or periprosthetic shaft fracture. Mean age was 69.6years (range: 44-91years). Minimum follow-up was 5years, for a mean 115.4months (range: 60-156months). The main study endpoint was femoral stem survival, counting all-cause explantation as event. Functional assessment comprised subjective rating of satisfaction, Postel Merle d'Aubigné (PMA) and Harris Hip scores, and Forgotten Joint Score (FJS). Whether the revision assembly was carried out in situ, in the patient's hip, or outside, on the operating table, was not known in 2 cases; in the other 43, assembly was in situ in 15 cases (35%) and on the operating table in 28 (65%). RESULTS Five-year stem survival was 75.7% (95% CI: 61.9-89.5%), taking all causes of change together. Seventeen patients (45.9%) had complications, 13 (35.1%) requiring revision surgery, including 10 (27.0%) for stem replacement. Five patients (13.5%) had steam breakage at the junction between the metaphysis and the diaphyseal stem, 4 of which occurred within 2 years of implantation or of fixation of a periprosthetic fracture. Mean preoperative Harris score was 48.4 [IQR (25-75% interquartile range): 37-58] and PMA score 11.1 (IQR: 10-12), compared to respectively 74 (IQR: 67-89) and 13.6 (IQR: 12.5-16) at follow-up. Mean FJS at follow-up was 71.5 (IQR: 61-94.5). In the 15 in situ assemblies, there were 3 breakages (20%), compared to 2 (7.1%) in the 28 table assemblies (p=0.21). DISCUSSION The stem breakage rate was high despite the reduced modularity, which concentrated all stress on a single junction but without reducing the risk of mechanical failure. Surgical technique was faulty in some cases, with in situ assembly of the metaphysis after implanting the diaphyseal stem, which does not respect the manufacturer's recommendations. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Etienne Massardier
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France.
| | - Paul-Henri Bauwens
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Jean-Baptiste Masson
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Frédéric Rongieras
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
| | - Antoine Bertani
- Service de Chirurgie Orthopédique et Traumatologique Pavillon E, Hôpital Édouard-Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69008 Lyon, France
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Ge H, Huang Y, Yan H, Zeng Y, Zeng J. What is the difference in proprioception between single condylar arthroplasty and high tibial osteotomy? a comparative study on both knees of the same patient. J Orthop Surg Res 2023; 18:486. [PMID: 37415243 DOI: 10.1186/s13018-023-03965-5] [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: 05/08/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE This study aims to investigate the efficacy and outcomes of different surgical procedures, namely unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO), for the treatment of bilateral medial compartment knee osteoarthritis in the same patient. The joint awareness and function of these two surgical methods were evaluated. METHODS A total of 15 patients with bilateral medial compartment knee osteoarthritis who underwent either UKA or HTO between 2012 and 2020 were included in the study. Patient data, including age, gender, body mass index and length of hospital stay, were collected. Pre- and post-operative measurements were conducted, including tibiofemoral angle, tibial plateau posterior inclination angle, proximal tibial medial angle, distance from mechanical axis to knee joint center, hip-knee-ankle angle, pre- and post-operative knee joint scores, knee joint range of motion, and FIS-12 scores at 3, 6, 12, and 24 months postoperatively. The latest follow-up was used for evaluating the outcomes of osteoarthritis treatment. Normality of continuous variables was assessed using the Shapiro-Wilk test. Between-group comparisons were performed using the paired sample t-test or Wilcoxon rank-sum test. Repeated measures analysis of variance was utilized to analyze FJS-12 measurements at different time points, and the correlation between FJS-12 and postoperative clinical results was examined using Pearson's correlation coefficient. Statistical significance was set at P < 0.05. RESULTS Significant differences were observed in FJS between the UKA and HTO groups at 3 and 6 months postoperatively, but no significant difference was found at 1 and 2 years postoperatively. FJS in the UKA group demonstrated a significant increase from 3 to 6 months postoperatively, but no significant difference was observed from 6 to 24 months postoperatively. In contrast, FJS in the HTO group showed a significant increase from 3 to 24 months postoperatively. CONCLUSIONS Patients who underwent UKA exhibited superior joint awareness compared to those who underwent HTO during the early postoperative period. Furthermore, the rate of joint awareness in UKA patients was faster than in HTO patients.
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Affiliation(s)
- Hao Ge
- Guangzhou University of Chinese Medicine, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yiwei Huang
- Guangzhou University of Chinese Medicine, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Hongsong Yan
- Guangzhou University of Chinese Medicine, The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District 22 Baiyun, Guangzhou, 510405, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District 22 Baiyun, Guangzhou, 510405, Guangdong, China.
- Baiyun Hospital, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Longqi Road 2#, Renhe Town, Baiyun, Guangzhou, 510405, Guangdong, China.
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Foissey C, Batailler C, Shatrov J, Servien E, Lustig S. Is combined robotically assisted unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction a good solution for the young arthritic knee? INTERNATIONAL ORTHOPAEDICS 2023; 47:963-971. [PMID: 35962232 DOI: 10.1007/s00264-022-05544-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Anterior cruciate ligament (ACL) deficiency can be a consequence or a cause of femoro-tibial osteoarthritis (OA). Several studies have published satisfactory outcomes of unicompartimental knee arthroplasty (UKA) and combined ACL reconstruction despite its absence classically being considered a contraindication. A major challenge in the ACL deficient knee is obtaining appropriate gap balancing and limb axis. Robotically assisted UKA allows for precise control of these factors; however, it's utilisation as a tool with combined ACL reconstruction and UKA has not been described. The purpose of this study was to evaluate the clinical and radiological outcomes of robotically assisted UKA with combined ACL reconstruction. METHODS This was a retrospective single-centre study of ten patients operated by a single surgeon from 2016 to 2020. All surgery was performed using a cemented fixed bearing UKA prosthesis (Journey uni, Smith and Nephew®) (8 medial, 2 lateral) inserted with the assistance of an image-free robotic-assisted system (BlueBelt, Navio, Smith and Nephew®). All ACL reconstructions were performed using hamstring autograft. Clinical assessment included International Knee Score (IKS) score, Tegner score and patient satisfaction. Radiological assessment was performed to assess radiolucent lines, progression of OA in the other compartments, Hip-Knee-Ankle angle and Posterior Tibial Slope. RESULTS There were eight females (80%), mean age was 57 ± 7 [48-70], mean BMI was 26 ± 3 [22-31]. The mean follow-up was 45 months ± 13 months [24-66]. Mean post-operative IKS knee and function score were respectively 96 ± 4.5 [88-100] and 93 ± 8.2 [74-100], mean Tegner score was 4.5 ± 1.4 [3-6]. Nine patients (90%) returned to sport; one patient (10%) was dissatisfied because of residual pain preventing a return to a desired level of sport. 100% of the radiological objectives were achieved. No radiolucent lines were seen at the last follow-up. There were two re-operations (20%) for stiffness requiring arthroscopic arthrolysis at two and three months respectively following surgery, with full recovery of the flexion at the last follow-up in both cases. No other complications were observed. CONCLUSION Robotic UKA associated with ACL reconstruction provides satisfactory early patient outcomes and accurate implant positioning. The first results in terms of return to sports were promising.
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Affiliation(s)
- Constant Foissey
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France.
| | - Cécile Batailler
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
| | - Jobe Shatrov
- Sydney Orthopaedic Research Institute (SORI), St. Leonards, Sydney, Australia
| | - Elvire Servien
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
- LIBM - EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, Lyon, France
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France
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Khalifé M, Marie-Hardy L, Vafadar S, Pietton R, Duray C, Guigui P, Ferrero E. Validation of the Total Disability Index (TDI) in French Version. Orthop Traumatol Surg Res 2023; 109:103311. [PMID: 35523373 DOI: 10.1016/j.otsr.2022.103311] [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: 05/13/2021] [Revised: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Total Disability Index (TDI) questionnaire has been developed to provide a more complete assessment of low back and neck pain, as they frequently co-occur. This study aimed at validating the TDI questionnaire in French, to determine if it could be used in France. HYPOTHESIS The TDI French version is valid, reproducible and comparable to the English version. METHODS This multicentric study prospectively included French-speaking volunteers, both patients admitted for spine surgery in two specialized spine centers and healthy individuals. Healthy subjects were recruited among students of an engineering school and medical staff. A booklet was given to the participants containing a Lumbar and Cervical Visual Analog Scale (respectively LVAS and CVAS), and the French versions of Oswestry Disability Index (ODI), Neck Disability Index (NDI) and TDI questionnaires. Statistical analysis included Cronbach's α calculation for internal consistency assessment, correlation analysis with ODI and NDI items for convergent validity, principal component analyses and factor analysis. Discriminant validity was assessed by comparing healthy subjects and patients using Student's t tests, and floor and ceiling effects search. RESULTS 71 participants were included, with 34 (48%) healthy volunteers and 37 (52%) patients. Mean age was 45.2±19.6 years and 57% of the cohort were males. Internal consistency was good: Cronbach's α was calculated at 0.96 (95%CI: [0.95-0.98]). For each TDI item, a high correlation was found with ODI corresponding items, between 0.81 and 0.97 (p<0.001), and good correlation with NDI items, ranging from 0.65 to 0.96 (p<0.001). TDI correlated also with LVAS and CVAS (respectively 0.70 and 0.65, p<0.001). Principal component analyses indicated good correlation between the TDI items and between each item and TDI total score. Factor analysis indicated two main factors explaining 77% of TDI variance, constituted by all TDI items. Regarding discriminative validity, healthy subjects and patients presented significantly different TDI scores (p-values ≤0.01 for each item). Barplot representations of each TDI item revealed no major floor nor ceiling effects. CONCLUSION This study confirms the reliability, feasibility and validity of the Total Disability Index questionnaire in its French version. Its validation allows its use in France. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Marc Khalifé
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université de Paris, Paris, France.
| | - Laura Marie-Hardy
- Orthopaedic Surgery Unit, Pitié-Salpêtrière University Hospital, Assistance Publique - Hôpitaux de Paris, 47, Boulevard de l'hôpital, 75013 Paris, France; Faculté de Médecine, Sorbonne Université, Paris, France
| | - Saman Vafadar
- Institut de Biomécanique Humaine Georges Charpak Arts et Métiers Institute of Technology, Paris, France
| | - Raphael Pietton
- Orthopaedic Surgery Unit, Pitié-Salpêtrière University Hospital, Assistance Publique - Hôpitaux de Paris, 47, Boulevard de l'hôpital, 75013 Paris, France; Faculté de Médecine, Sorbonne Université, Paris, France
| | - Cédric Duray
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université de Paris, Paris, France
| | - Pierre Guigui
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université de Paris, Paris, France
| | - Emmanuelle Ferrero
- Orthopaedic Surgery Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; Université de Paris, Paris, France
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Longo UG, De Salvatore S, Santamaria G, Indiveri A, Piergentili I, Salvatore G, De Marinis MG, Bandini B, Denaro V. Total Hip Replacement: Psychometric Validation of the Italian Version of Forgotten Joint Score (FJS-12). J Clin Med 2023; 12:jcm12041525. [PMID: 36836060 PMCID: PMC9966760 DOI: 10.3390/jcm12041525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND One million Total Hip Replacements (THA) are thought to be performed annually. To measure prosthesis awareness throughout daily activities, the FJS-12 patient-reported outcome scale was developed. This article's goal is to undertake a psychometric validation of the Italian FJS-12 among a sample of related THA patients. METHODS Between January and July 2019, data from 44 patients were retrieved. The participants were required to complete the Italian version of FJS-12 and of the WOMAC at preoperative follow-up, after two weeks, 1, 3, and 6 months postoperatively. RESULTS The Pearson correlation coefficient between the FJS-12 and WOMAC was 0.287 (p = 0.002) at preoperative follow-up, r = 0.702 (p < 0.001) at 1 month, r = 0.516 (p < 0.001) at 3 months and r = 0.585 (p < 0.001) at 6 months. The ceiling effect surpassed the acceptable range (15%) for FJS-12 in 1 month (25.5%) and WOMAC in 6 months follow-up (27.3%). CONCLUSIONS The psychometric validation of the Italian version of this score for THA was executed with acceptable results. FJS-12 and WOMAC reported no ceiling and floor effects. Therefore, to distinguish between patients who had good or exceptional results following UKA, the FJS-12 could be a reliable score. Under the first four months, FJS-12 had a smaller ceiling effect than WOMAC. It is recommended to use this score in clinical research concerning the outcomes of THA.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
- Correspondence: ; Tel.: +39-06-225411613; Fax: +39-06-225411638
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giulia Santamaria
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy
| | - Anna Indiveri
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giuseppe Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | | | - Benedetta Bandini
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
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Does acetabular robotic-assisted total hip arthroplasty with femoral navigation improve clinical outcomes at 1-year post-operative? A case-matched propensity score study comparing 98 robotic-assisted versus 98 manual implantation hip arthroplasties. Orthop Traumatol Surg Res 2023; 109:103477. [PMID: 36375721 DOI: 10.1016/j.otsr.2022.103477] [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: 07/24/2021] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Despite the optimization of implant positioning, the clinical benefit of the use of robotic assistance during THA remains uncertain. In this case-control study (robotic versus manual technique) we made a retrospective short-term comparison of: (1) the functional results, (2) the complications, (3) and the influence of radiological symmetrization of the hips on the functional result. HYPOTHESIS The use of a robotic arm improved the functional results of a THA. MATERIALS AND METHOD A retrospective case-control study was performed, including patients with unilateral hip osteoarthritis who underwent a robotic arm-assisted THA (THA-R). The controls (THA-C) were matched according to age, sex, body mass index and surgical approach. The Harris (HHS), Oxford (OHS) and Forgotten Joint (FJS) scores were collected preoperatively and 1 year postoperatively. At each review, complications were categorized into minor events, revision surgery with and without implant change. Radiographic analysis was performed on weight-bearing images of the pelvis 3 months postoperatively. The objective of the surgery was symmetrization of the THA in the contralateral healthy hip. For each measured parameter of the hip joint center of rotation (COR), global offset (GO) and articular leg length discrepancy (aLLD), the difference between the two sides corresponding to the delta symmetrization was compared. RESULTS Ninety-eight patients were included in the THA-R group and matched to 98 controls in the THA-C group. At 1 year postoperatively, the FJS and OHS scores were statistically higher in the THA-R group, respectively 82.1±22.3 [8.3; 100] and 40.8±8.8 [6; 48] vs. 71.2±27.8 [0; 100] and 38.1±9.7 [12; 48] in the THA-C group (p=0.004 and p=0.043). There was no difference in HHS (THA-R: 85.9±15.8 [31; 100] vs. THA-C: 85.8±13.3 [49-100] (p=0.962)). The implant revision rate at 1 year was significantly higher in the THA-C group (0% vs. 5.1% (p=0.025)). There was no difference in the reoperation without component exchange despite 3 dislocations (3.1%) in the THA-R group (5 (5.1%) vs. 9 (9.2%) (p=0.273)). The rate of abarticular pathologies (ilio-psoas irritation and greater trochanteric bursitis) was higher in the THA-C group (10 (10.8%) vs. 2 (2%) (p=0.016). Robotic acetabular assistance allowed a significantly better restitution of the horizontal position (THA-R: 1mm±4.8 [-11.7; 12.6] vs. THA-C: 4.1mm±7 [-29.6; 28] (p=0.0005)) and vertical COR (THA-R: 0.5mm±3.1 [-6; 8.3] vs. THA-C: 2mm±4.1 [-6; 14.6] (p=0.0068)). Navigated assistance of the femur did not significantly optimize the restitution of the Global Offset (THA-R: +2mm±6.4 [-16.4; 27.6] vs. THA-C: +0.5mm±7 .7 [-34; 30.2] (p=0.145)), or lower limb length (THA-R: +1.1mm±5 [-8.2; 13.5] vs. THA-C: +0.3mm±6 [-14.1; 22.5] (p=0.344). The FJS was statistically correlated with the restoration of the symmetry of the COR and the aLLD. A post-hoc power analysis confirmed sufficient potency (1-β=0.85). CONCLUSION Robotic acetabular assistance combined with femoral navigation improves clinical outcomes of THAs with fewer short-term complications. The precision of the positioning of the implants, optimized by the computer-assisted surgery system, is correlated with the missed joint score. LEVEL OF EVIDENCE III, retrospective case-control study.
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Gabrion M, Rattier S, Blondin E, Michaud A, Mertl P, Gabrion A. Survival and radioclinical evaluation of the Optimys™ short stem at more than 6years' mean follow-up: A retrospective study of 108 cases. Orthop Traumatol Surg Res 2023; 109:103470. [PMID: 36336294 DOI: 10.1016/j.otsr.2022.103470] [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: 01/08/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The short stems developed in recent years offer an interesting alternative to standard long stems. The Optimys™ short stem has been widely studied, but not according to the National Institute for Health and Care Excellence (NICE) criteria. We therefore conducted a retrospective study of Optimys™ at a minimum 5years' follow-up, to assess: (1) survival on NICE criteria, (2) complications, (3) functional results, and (4) subsidence, restoration of offset and bone remodeling. HYPOTHESIS Optimys™ shows survival comparable to that of other non-cemented standard and short stems, with a<0.5% per year revision rate or<2.5% at 5years on NICE criteria. MATERIAL AND METHODS A single-center retrospective study included 108 Optimys™ stems at a mean 76.5months' follow-up (range: 60-112months). Clinical [Harris, Oxford-12 and forgotten hip (French version: SHO-12) scores] and radiologic data were collected pre- and postoperatively. Analysis focused on implant survival, complications, functional results and radiological results (restoration of offset, bone remodeling, subsidence and osseointegration) and risk factors for stem migration. RESULTS At a mean 76.5months' follow-up (range: 60-112months), Optimys™ survival was 97.7% (95% CI: 0.945-1). Oxford and Harris scores improved significantly: respectively, 16.1 vs. 44.7 [Δ=28.598; 95% CI: 27.410-29.785 (p<0.001)] and 45.3 vs. 95 [Δ=49.662; 95% CI: 47.442-51.882 (p<0.001)]. Mean forgotten hip score (SHO-12) at last follow-up was 82.7±19.6 (range: 35.4-100.0). There was 1 case of aseptic revision at 11months for femoral osseointegration defect. Mean subsidence was 1.64mm (range: 0-20.63mm); no predisposing factors could be identified. Femoral offset increased by a mean 2.41±4.53mm (range: -10.10 to 14.70mm). CONCLUSION The present study reports good survival for the Optimys™ stem, which meets NICE criteria. Radiologic and clinical results were encouraging, with a low rate of subsidence, comparable to other series, but with increased femoral offset. LEVEL OF EVIDENCE IV; retrospective cohort study.
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Affiliation(s)
- Matthieu Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France.
| | - Simon Rattier
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Emile Blondin
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Audrey Michaud
- Direction de la recherche clinique et de l'innovation, site Sud - Hall 1 - 1(er) étage zone administrative, 1, rond-point du Professeur-Christian-Cabrol, 80054 Amiens, France
| | - Patrice Mertl
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
| | - Antoine Gabrion
- Service de chirurgie orthopédique et traumatologie, CHU Amiens-Picardie, 1, rue du Professeur-Christian-Cabrol, 80054 Amiens, France; UFR de médecine, pôle santé, 3, rue des Louvels, CS 13036, 80036 Amiens, France
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Angilecchia D, Stano F, Signorelli M, Giovannico G, Pournajaf S, Pellicciari L. Psychometric properties of the Italian version of the Forgotten Joint Score in patients with total hip arthroplasty. Int J Rehabil Res 2022; 45:343-349. [PMID: 36197448 DOI: 10.1097/mrr.0000000000000549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Total hip arthroplasty (THA) surgeries are increasing; to assess quality of life after THA, an instrument that considers patient's perspective on surgical outcomes is necessary. The objective of this study is to assess the psychometric properties of the Italian version of the Forgotten Joint Score (FJS-I) in patients with THA. The FJS-I was administered to 111 patients with THA, as well as the Western Ontario and McMaster Universities (WOMAC), Numerical Pain Rating Scale (NPRS), and the EuroQol 5D-5L (EQ-5D-5L). Structural validity [confirmatory factor analysis (CFA)], internal consistency (Cronbach's alpha), test-retest reliability [intraclass correlation coefficient (ICC 2,1 )], measurement error [standard error of the measurement (SEM)], and construct validity (hypothesis testing with correlation of the WOMAC, NPRS, and EQ-5D-5L) were assessed. In addition, the minimal detectable change (MDC) was computed. The result of CFA confirmed the one-factor structure. Internal consistency was supported (α = 0.944). A high test-retest reliability (ICC = 0.958; 95% confidence interval, 0.914-0.980) was found with an SEM and an MDC of 5.3 and 16.6 points, respectively. The a-priori hypotheses were fully met, determining the construct validity to be satisfactory. Psychometric properties of the FJS-I were confirmed, and it can be used for single-person assessment. Further research is suggested to refine its structural validity.
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Affiliation(s)
- Domenico Angilecchia
- Department of Medicine and Health Scienze "Vincenzo Tiberio", University of Molise, Campobasso
- Rehabilitation service - ASL, Bari
| | - Flavia Stano
- Department of Medicine and Health Scienze "Vincenzo Tiberio", University of Molise, Campobasso
| | | | - Giuseppe Giovannico
- Department of Medicine and Health Scienze "Vincenzo Tiberio", University of Molise, Campobasso
| | - Sanaz Pournajaf
- Neurorehabilitation Research Lab, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele, Rome
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Batailler C, Foissey C, Fary C, Naaim A, Servien E, Lustig S. Similar kinematic patterns between revision total stabilized (TS) and primary posterior stabilized (PS) knee prostheses: a prospective case-controlled study with gait assessment. Knee Surg Sports Traumatol Arthrosc 2022; 30:2714-2722. [PMID: 33948674 DOI: 10.1007/s00167-021-06591-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE There are increased surgical considerations when revising total knee arthroplasty (TKA) in active patients. Few studies have assessed if a semi-constrained [Total Stabilized (TS)] prostheses has similar knee biomechanics to a primary posterior stabilized (PS) prosthesis. The aim was to compare the gait parameters in patients with PS or TS TKA and normal controls. METHODS 32 patients with TKA were prospectively included with either a primary PS (n = 15) or a revision TS (n = 17) prosthesis. Gait analysis was performed at 6 months postoperatively for each patient, with an optoelectronic knee assessment device (KneeKG®) assessing the displacement of the tibia relative to the femur during the different gait phases (flexion/extension, anterior/posterior translation, adduction/abduction, internal/external rotation). A control group (n = 12) of healthy knees was compared with the TKA groups. RESULTS There were no significant kinematic differences between PS and TS groups. The maximum knee flexion during gait was 53° ± 8.1° in the PS group vs 52° ± 8.7° in the TS group. The antero-posterior translation was similar in both group (2.3 ± 0.5 mm vs 2.6 ± 0.9 mm, respectively). Peak varus angle during loading and swing phase was slightly higher in the TS group (2.7° ± 0.7° and 5.2° ± 0.9°) than in the PS group (2.9° ± 0.6° and 5.6° ± 1.2°), without significant difference. The ranges in internal/external rotation were similar between PS and TS TKA (3.7° ± 0.5° vs 3.3° ± 0.6°, respectively). Both designs approached closely the normal gait patterns of the control group except in the frontal plane. CONCLUSION Single radius TS TKA has gait parameters similar to single radius PS TKA. Use of a single radius TS TKA in revision TKA is not detrimental to a patient's gait pattern. Both designs approached closely the normal gait patterns of the control group. LEVEL OF EVIDENCE Prospective, case-control study; Level III.
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Affiliation(s)
- Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Constant Foissey
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Camdon Fary
- Orthopaedic Department, Western Health, Melbourne, Australia
| | - Alexandre Naaim
- Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
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Foissey C, Abid H, Martinot P, Cazor A, Thaunat M. Predictive radiological parameters of failure following surgical management of femoroacetabular impingement associated with borderline acetabular dysplasia. Orthop Traumatol Surg Res 2022; 109:103349. [PMID: 35688380 DOI: 10.1016/j.otsr.2022.103349] [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: 09/04/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The role of arthroscopic treatment of femoroacetabular impingement (FAI) in mild or borderline hip dysplasia (lateral center edge angle=18-25) is controversial. It is recommended to combine capsular plication with femoral neck osteoplasty and suture repair of the labrum. Few studies have investigated which radiological parameters are associated with failure of this procedure. HYPOTHESIS A larger number of radiological signs of mild or borderline hip dysplasia than radiological signs of FAI negatively influence the outcomes of arthroscopic treatment. METHODS This was a retrospective study done with data collected prospectively after a minimum of 2 years' follow-up in patients who underwent arthroscopic treatment of FAI due to cam impingement combined with mild to moderate hip dysplasia. Patients with hip osteoarthritis graded as ≥ Tönnis 2 were excluded. Functional outcome scores (mHHS and NAHS) were determined along with the need for reoperation. Three groups were defined based on the outcomes: success (mHHS ≥ Patient Acceptable Symptomatic State [PASS]); moderate improvement (improvement in mHHS + mHHS<PASS) and failure (worsening of the mHHS). Demographic data, radiographic parameters (LCEA, Tönnis angle, alpha angle, offset, FEAR index, Shenton's line, Cliff sign, anterior wall index [AWI], posterior wall index [PWI]) and intraoperative findings were compared between these three groups. The area under the curve (AUC) for the most relevant data identified during the univariate analysis were then modeled to define which factors were the best at predicting failed arthroscopic treatment a posteriori. RESULTS The study analyzed 39 patients. The mean mHHS was 76±15 [40-92]. The "success" group consisted of 21 patients (56%, 21/39), the "moderate improvement" group of 12 patients (31%, 12/39) and the failure group of 6 patients (13%, 6/39) (2 subsequently underwent total hip replacement, 4 underwent shelf acetabuloplasty). The FEAR index was significantly higher and the AWI and VCE were significantly lower in the "failure" group. The FEAR index was the best predictive factor; an index ≥ 4° detected 100% of failures with 96% specificity. The patients in the "moderate improvement" group were significantly older (37 years±8 [18-45]<p= 0.04) with a significantly higher offset (2mm±3 [-5-5]<p=0.004); an offset ≥ 2mm could detect 73% of them with a specificity of 72%. CONCLUSION A FEAR index ≥ 4° and offset ≥ 2mm is best able to detect patients at risk of failure and unsatisfactory results, respectively, in the mild clinical cam-type impingement in a population of FAI patients. LEVEL OF EVIDENCE IV, retrospective series.
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Affiliation(s)
- Constant Foissey
- Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
| | - Hichem Abid
- Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Pierre Martinot
- Service d'orthopédie, Hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France
| | - Antoine Cazor
- Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France-Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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Mirghaderi SP, Raeini AG, Gholamshahi H, Mortazavi SMJ, Shafiei SH, Sheikhvatan M. Content Validity and Reliability of the Persian Version of the Forgotten Joint Score Questionnaire in Patients Undergoing Total Hip Arthroplasty. Arthroplast Today 2022; 15:40-42. [PMID: 35399989 PMCID: PMC8990039 DOI: 10.1016/j.artd.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Forgotten Joint Score (FJS) is a patient-reported outcome measurement that evaluates patients' ability to forget the replaced joint (knee or hip) in everyday activity. This study aimed to evaluate the validity and reliability of the Persian version of this questionnaire in Iranian patients who underwent total hip arthroplasty. Methods A team of specialists reviewed this questionnaire and voted for its clarity and content validity. Then, the FJS was filled out by 100 randomly selected total hip arthroplasty patients between 2019 and 2021 with at least 6 months of follow-up. The reliability coefficient (Cronbach's alpha) was calculated. Results A total of 95 patients who met the inclusion criteria, with the mean age 59.9 ± 11.6 years and 26.6% being female, participated in the study. Patients had no difficulty with the content and linguistic format of the Persian FJS-12. The mean FJS for these patients was 50.8 ± 4.6. The Cronbach's alpha was measured at 0.87. The mean content validity index was 0.93. Conclusion FJS-12 can discriminate even patients with eximious pain and functional outcomes after joint reconstruction surgery. The Persian format of FJS-12 showed acceptable internal consistency using Cronbach's alpha and acceptable content validity. Therefore, it can be utilized in the Iranian population for future research studies.
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Singh V, Bieganowski T, Huang S, Karia R, Davidovitch RI, Schwarzkopf R. The Forgotten Joint Score patient-acceptable symptom state following primary total hip arthroplasty. Bone Jt Open 2022; 3:307-313. [PMID: 35387474 PMCID: PMC9044089 DOI: 10.1302/2633-1462.34.bjo-2022-0010.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The Forgotten Joint Score-12 (FJS-12) is a validated patient-reported outcome measure (PROM) tool designed to assess artificial prosthesis awareness during daily activities following total hip arthroplasty (THA). The patient-acceptable symptom state (PASS) is the minimum cut-off value that corresponds to a patient's satisfactory state-of-health. Despite the validity and reliability of the FJS-12 having been previously demonstrated, the PASS has yet to be clearly defined. This study aims to define the PASS of the FJS-12 following primary THA. METHODS We retrospectively reviewed all patients who underwent primary elective THA from 2019 to 2020, and answered both the FJS-12 and the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) questionnaires one-year postoperatively. HOOS, JR score was used as the anchor to estimate the PASS of FJS-12. Two statistical methods were employed: the receiver operating characteristic (ROC) curve point, which maximized the Youden index; and 75th percentile of the cumulative percentage curve of patients who had the HOOS, JR score difference larger than the cut-off value. RESULTS This study included 780 patients. The mean one-year FJS-12 score was 65.42 (SD 28.59). The mean one-year HOOS, JR score was 82.70 (SD 16.57). A high positive correlation between FJS-12 and HOOS, JR was found (r = 0.74; p<0.001), making the HOOS, JR a valid external anchor. The threshold score of the FJS-12 that maximized the sensitivity and specificity for detecting a PASS was 66.68 (area under the curve = 0.8). The cut-off score value computed with the 75th percentile approach was 92.20. CONCLUSION The PASS threshold for the FJS-12 at one year following primary THA was 66.68 and 92.20 using the ROC curve and 75th percentile approaches, respectively. These values can be used to achieve consensus about meaningful postoperative improvement to maximize the utility of the FJS-12 to evaluate and counsel patients undergoing THA. Cite this article: Bone Jt Open 2022;3(4):307-313.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Shengnan Huang
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Raj Karia
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Roy I. Davidovitch
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Robinson PG, MacDonald DJ, Macpherson GJ, Patton JT, Clement ND. Changes and thresholds in the Forgotten Joint Score after total hip arthroplasty : minimal clinically important difference, minimal important and detectable changes, and patient-acceptable symptom state. Bone Joint J 2021; 103-B:1759-1765. [PMID: 34847716 DOI: 10.1302/0301-620x.103b12.bjj-2021-0384.r1] [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] [Indexed: 01/23/2023]
Abstract
AIMS The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) in the Forgotten Joint Score (FJS) according to patient satisfaction six months following total hip arthroplasty (THA) in a UK population. METHODS During a one-year period, 461 patients underwent a primary THA and completed preoperative and six-month FJS, with a mean age of 67.2 years (22 to 93). At six months, patient satisfaction was recorded as very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. The difference between patients recording neutral (n = 31) and satisfied (n = 101) was used to define the MCID. MIC for a cohort was defined as the change in the FJS for those patients declaring their outcome as satisfied, whereas receiver operating characteristic curve analysis was used to determine the MIC for an individual and the PASS. Distribution-based methodology was used to calculate the MDC. RESULTS Using satisfaction as the anchor, the MCID for the FJS was 8.1 (95% confidence interval (CI) 3.7 to 15.9; p = 0.040), which was affirmed when adjusting for confounding. The MIC for the FJS for a cohort of patients was 17.7 (95% CI 13.7 to 21.7) and for an individual patient was 18. The MDC90 for the FJS was eight, meaning that 90% of patients scoring more than this will have experienced a real change that is beyond measurement error. The PASS threshold for the FJS was defined as 29. CONCLUSION The MCID and MIC can be used respectively to assess whether there is a clinical difference between two groups, or whether a cohort or patient has had a meaningful change in their FJS. Both values were greater than measurement error (MDC90), suggesting a real change. The PASS threshold for the postoperative FJS can be used as a marker of achieving patient satisfaction following THA. Cite this article: Bone Joint J 2021;103-B(12):1759-1765.
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Affiliation(s)
| | - Deborah J MacDonald
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Edinburgh Orthopaedics, University of Edinburgh, Edinburgh, UK
| | | | - James T Patton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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From statistical significance to clinical relevance: The contribution of new assessment instruments. Orthop Traumatol Surg Res 2021; 107:102879. [PMID: 33677128 DOI: 10.1016/j.otsr.2021.102879] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/25/2021] [Indexed: 02/03/2023]
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Dion MO, Faure PA, May O, Bonin N, Beaulé P, Carsen S, Nault ML, Pelet S, Simonyan D, Belzile EL. Validation of the French version of the self-administered international hip outcome tool-33 questionnaire. Orthop Traumatol Surg Res 2021; 107:102858. [PMID: 33588091 DOI: 10.1016/j.otsr.2021.102858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION To evaluate the effectiveness of new treatments, whether conservative or surgical, a self-administered questionnaire for hip pain targeted at physically active patients 18 to 60 years of age, named the international Hip Outcome Tool-33 (iHOT-33), was developed and validated in 2012. Since there is no French version available and we are acutely aware of transcultural variations, we conducted a prospective study to: 1) translate, and then 2) validate this questionnaire into international French. HYPOTHESIS The iHOT-33-Fr questionnaire is a valid and reliable tool for evaluating hip pain in a young, francophone population. MATERIALS AND METHODS Translation of the questionnaire was done according to the standardized method described by Beaton and the final version of the iHOT-33-Fr was validated using the COSMIN methodology. The data were collected prospectively at multiple sites. The reliability of the iHOT-33-Fr questionnaire was evaluated using the intraclass correlation coefficient (ICC) and its internal consistency using Cronbach's alpha. The standard error of measurement and minimum detectable change were calculated. The construct validity was evaluated using Pearson's correlation coefficient by comparing the iHOT-33-Fr with the Hip disability and Osteoarthritis Outcome Score (HOOS-Fr) and Nonarthritic Hip Score (NAHS-Fr). RESULTS In all, 101 patients filled out the questionnaires. The ICC was 0.87. The Cronbach alpha was 0.95. The standard error of measurement was 6.4 and the minimum detectable change was 1.8. The correlation between the iHOT-33-Fr and the HOOS-Fr was 0.86, while the correlation between the iHOT-33-Fr and the NAHS-Fr was 0.75. DISCUSSION Our results show that the metrological qualities of the iHOT-33-Fr are comparable to those of the original version and the versions translated into other languages. This study demonstrates that the iHOT-33-Fr is valid, reproducible and comparable to the original iHOT-33. It can be used by francophone surgeons treating symptomatic hip disease in young, active patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marc-Olivier Dion
- Département de Chirurgie Orthopédique, CHU de Québec-Hôpital de l'Enfant-Jésus, 1401 18e Rue, G1J 1Z4 Québec, Québec Canada.
| | - Philippe-Alexandre Faure
- Département de Chirurgie Orthopédique, CHU de Québec-Hôpital de l'Enfant-Jésus, 1401 18e Rue, G1J 1Z4 Québec, Québec Canada
| | - Olivier May
- Médipôle Garonne, Clinique du Sport, 45, Rue de Gironis, 31036 Toulouse, France
| | - Nicolas Bonin
- Lyon Ortho Clinic, Lyon, 29B, avenue des sources, 69009 Lyon, France
| | - Paul Beaulé
- Département de Chirurgie Orthopédique, L'Hôpital d'Ottawa, 1053, avenue Carling, K1Y 4E9 Ottawa, Ontario, Canada
| | - Sasha Carsen
- Département de Chirurgie Orthopédique, Centre Hospitalier pour enfants de l'est de l'Ontario, 401, Smyth Rd, K1H 8L1 Ottawa, Ontario, Canada
| | - Marie-Lyne Nault
- Département de Chirurgie Orthopédique, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, Québec, Canada
| | - Stephane Pelet
- Département de Chirurgie Orthopédique, CHU de Québec-Hôpital de l'Enfant-Jésus, 1401 18e Rue, G1J 1Z4 Québec, Québec Canada
| | - David Simonyan
- Centre de recherche clinique et évaluative, CHU de Québec, 2705, Boulevard Laurier, G1V 4G2 Québec, Québec, Canada
| | - Etienne L Belzile
- Département de Chirurgie Orthopédique, CHU de Québec-Hôpital de l'Enfant-Jésus, 1401 18e Rue, G1J 1Z4 Québec, Québec Canada
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Does change in language change the properties of a shortened score previously validated in its complete version? Validation of the French versions of the HOOS-12 and KOOS-12 scores in primary knee and hip arthroplasties. Orthop Traumatol Surg Res 2021; 107:102824. [PMID: 33493653 DOI: 10.1016/j.otsr.2021.102824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The HOOS and KOOS scoring questionnaires comprise respectively 40 and 42 items; a shorter 12-item version was recently developed, but remains to be validated in a French-speaking population. We therefore conducted a prospective study: 1) to determine whether the new 12-item versions in French are equivalent to the longer HOOS and KOOS versions, and 2) to validate the French-language HOOS-12 and KOOS-12 patient-reported outcome measures in a population of primary total hip and knee arthroplasty: validity, reliability, and responsiveness. HYPOTHESIS The change in language in a score already validated in its long version does not alter its properties in the short version. MATERIAL AND METHODS One hundred patients (59 males, 41 females) undergoing primary total hip arthroplasty and 100 patients (43 males, 57 females) undergoing primary total knee arthroplasty were prospectively included. They filled out the original HOOS or KOOS questionnaires, their simplified versions (PS: Physical function Short form; JR: Joint Replacement) and the short HOOS-12 and KOOS-12 versions, and also the Oxford-12 score assessing the affected joint, preoperatively, then at 6-12 months. RESULTS The 100% response rate confirmed ease of use. There were no redundant items. There were strong correlations between the 12-item and longer versions (>0.9). The HOOS-12 and KOOS-12 scores were reliable and valid: 1) there were no ceiling or floor effects for pre- or postoperative KOOS-12 scores, although a ceiling effect was found for HOOS-12 postoperatively (20% of patients having maximum scores of 100); 2) internal consistency was confirmed, with Cronbach alpha>0.8; 3) external consistency between Oxford-12 and HOOS-12/KOOS-12 was excellent, with Pearson correlation coefficient>0.8. Sensitivity to pre-/postoperative change was confirmed, with effect size>0.8. DISCUSSION The present study confirmed the usefulness of this new 12-item form for HOOS and KOOS. Properties were identical between the French- and English-language versions, authorising everyday use of these simpler versions. LEVEL OF EVIDENCE IV; prospective study without control group.
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Putman S, Dartus J, Migaud H, Pasquier G, Girard J, Preda C, Duhamel A. Can the minimal clinically important difference be determined in a French-speaking population with primary hip replacement using one PROM item and the Anchor strategy? Orthop Traumatol Surg Res 2021; 107:102830. [PMID: 33524632 DOI: 10.1016/j.otsr.2021.102830] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/18/2020] [Accepted: 07/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The impact of surgery on the patient is classically assessed on pre- and post-treatment scores. However, it is increasingly recommended to rank these results according to the minimal clinically important difference (MCID), using either the data distribution method or the anchor method, latter consisting in an extra question specifically targeting the patient's improvement. MCIDs vary between populations and, to the best of our knowledge; there have been no investigations in France regarding this in the context of total hip replacement (THR). Therefore, we conducted a prospective study in a population with THR to determine: 1) whether MCID scores in France were comparable to those reported in the data from the international literature; 2) whether a general item taken from a different score could serve as an anchor; and 3) whether an item from the actual questionnaire itself could serve as an anchor. HYPOTHESIS When pre- and post-treatment scores are available, an item from the questionnaire itself can serve as an anchor for MCID. MATERIAL AND METHODS In a prospective observational study, 123 primary THR patients (69 male, 54 female), out of 150 initially included, completed the 5 domains of the HOOS hip disability and osteoarthritis outcome score and the Oxford-12 questionnaire, preoperatively and at 6-12 months. The MCID was calculated via the distribution-based and the anchor-based methods. Two Oxford items (questions 1 and 2) and 2 HOOS items (questions S1 and Q4) were used as anchors, as well as a supplementary question on improvement and the Forgotten Joint Score (FJS). RESULTS At a mean 10.12±1.2 months' follow-up [range, 6.5-11.9 months], the Oxford-12 score increased from 19±8 [3-35] to 40±10 [8-48] (p<0.001), all HOOS components demonstrated improvement, and the FJS at the final follow-up was 71±29 [0-100]. The general items (Oxford question 1 and HOOS question Q4) were more discriminating than the joint-specific items (Oxford question 2 and HOOS question S1). Based on results from the 3 anchors (improvement rated 1 to 5, Oxford question 1 and HOOS question Q4), 3 to 5 patients showed deterioration, 5 to 6 were unchanged, 30 to 40 were slightly improved, and 73 to 80 were improved by THR. The mean MCID on both distribution and anchor methods was 9 [5.5-12] for Oxford-12, 20 [12-27] for HOOS symptoms, 26 [10-36] for HOOS pain, 22 [11.5-28] for HOOS function, 26 [13-34] for HOOS sport and 22 [14-28] for HOOS quality of life. DISCUSSION The MCID for the Oxford-12 and HOOS scores in a French population was comparable to data from the past literature. Using a score item as an anchor to define improvement is possible, but only if a general item is used. LEVEL OF EVIDENCE IV; prospective study without control group. CLINICAL TRIALS REGISTRATION NCT04057651.
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Affiliation(s)
- Sophie Putman
- Service d'orthopédie, CHU Lille, Hôpital Salengro, place de Verdun, 59000 Lille, France; Université de Lille, 59000 Lille, France; University of Lille, CHU of Lille, ULR2694-METRICS: évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France; Department of biostatistics, CHU Lille, 59000 Lille, France.
| | - Julien Dartus
- Service d'orthopédie, CHU Lille, Hôpital Salengro, place de Verdun, 59000 Lille, France; Université de Lille, 59000 Lille, France
| | - Henri Migaud
- Service d'orthopédie, CHU Lille, Hôpital Salengro, place de Verdun, 59000 Lille, France; Université de Lille, 59000 Lille, France
| | - Gilles Pasquier
- Service d'orthopédie, CHU Lille, Hôpital Salengro, place de Verdun, 59000 Lille, France; Université de Lille, 59000 Lille, France
| | - Julien Girard
- Service d'orthopédie, CHU Lille, Hôpital Salengro, place de Verdun, 59000 Lille, France; Université de Lille, 59000 Lille, France
| | - Cristian Preda
- Université de Lille, 59000 Lille, France; Laboratory of mathematics Paul-Painlevé, UMR CNRS 8524, University of Lille, Lille, France; Biostatistics department, delegation for clinical research and innovation, Lille catholic hospitals, Lille catholic university, Lille, France
| | - Alain Duhamel
- Université de Lille, 59000 Lille, France; University of Lille, CHU of Lille, ULR2694-METRICS: évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France; Department of biostatistics, CHU Lille, 59000 Lille, France
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Goyal T, Sethy SS, Paul S, Choudhury AK, Das SL. Good validity and reliability of forgotten joint score-12 in total knee arthroplasty in Hindi language for Indian population. Knee Surg Sports Traumatol Arthrosc 2021; 29:1150-1156. [PMID: 32602037 DOI: 10.1007/s00167-020-06124-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Commonly used patient-reported outcome measurement (PROM) tools for knee joint have a ceiling effect and may not be able to differentiate between patients achieving outcomes better than the upper limit of the score. Forgotten joint score-12 (FJS-12) is said to be free of this limitation. FJS-12 has been translated and validated in different languages. This study aims to translate and validate FJS-12 in Hindi (Hindi FJS-12). METHODS Hindi FJS-12 was tested for comprehensibility in a pilot study in 20 patients. This was followed by a prospective cohort study including 140 patients of bilateral total knee arthroplasty, with a minimum follow-up of 12 months. The mean age of the patients was 62.0 ± 14.5 years. There were 77 (55.2%) males and remaining were females. All patients were asked to fill up questionnaires of Hindi FJS-12, WOMAC, KSS and OKS. Hindi FJS-12 was tested for validity, reliability, responsiveness, floor effect and ceiling effect. Construct validity was expressed as the Pearson correlation coefficient. Internal consistency was expressed as Cronbach's alpha and test-retest reliability as the intra-class correlation coefficient (ICC). RESULTS In the pilot study, it was seen that all the questions were well answered by most of the participants. The main study showed good construct validity with Hindi FJS-12 showing moderate correlation with WOMAC, KSS and OKS (Pearson coefficients 0.45, 0.32, 0.37, respectively). Hindi FJS-12 had excellent internal consistency with Cronbach's alpha of 0.93 (95% CI 0.90, 0.97). ICC was 0.95 (95% CI 0.90, 0.99). No floor or ceiling effect was observed. CONCLUSION Hindi FJS-12 has high validity, reliability and reproducibility for knee function after TKA. It is devoid of floor or ceiling effect. Thus, it can be successfully used for studying knee function in the Indian population. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Siddharth S Sethy
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - S Lakshmana Das
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Translation and Validation of Forgotten Joint Score for Total Hip Arthroplasty for Indian Population. Indian J Orthop 2020; 54:892-900. [PMID: 33133413 PMCID: PMC7573040 DOI: 10.1007/s43465-020-00228-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The ultimate success of a total hip replacement lies in patients forgetting about their artificial joints during routine activities. "Forgotten Joint Score (FJS)" is emerging as an important tool in assessing outcomes of total hip arthroplasty. There has been no version of this score available in commonly spoken vernaculars in India. This study aims to formulate and validate the Hindi version of FJS in Indian population. METHODS A total of 136 patients with a minimum follow-up of 6 months and a maximum follow-up of 18 months after total hip arthroplasty were asked to fill the translated and adapted version of FJS questionnaire, at two points of time 2 weeks apart. The Hindi version of FJS (I-FJS) was tested for reliability and responsiveness, floor and ceiling effect and validity against modified Harris Hip Score (mHHS). Construct validity was expressed as the Pearson correlation coefficient. Internal consistency was expressed as Cronbach's alpha and test-retest reliability as the intra-class correlation coefficient (ICC). RESULTS I-FJS showed excellent internal consistency with Cronbach's alpha of 0.88. Intra-class correlation coefficient (ICC) was 0.94. I-FJS showed good correlation with m-HHS (r = 0.8, p = 0.001). The standard error of measurement was 3.6 and the smallest detectable change was 9.97. There was no floor or ceiling effect observed with I-FJS. Data from this study were insufficient to establish adequate responsiveness of I-FJS. CONCLUSION I-FJS is a valid, reliable and reproducible score for hip function in post-THA patients. It is devoid of any floor or ceiling effect. Hindi version of FJS could be an effective tool for studying hip function in the Indian population.
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Galea VP, Ingelsrud LH, Florissi I, Shin D, Bragdon CR, Malchau H, Gromov K, Troelsen A. Patient-acceptable symptom state for the Oxford Hip Score and Forgotten Joint Score at 3 months, 1 year, and 2 years following total hip arthroplasty: a registry-based study of 597 cases. Acta Orthop 2020; 91:372-377. [PMID: 32316804 PMCID: PMC8023959 DOI: 10.1080/17453674.2020.1750877] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patient-acceptable symptom states (PASS) represent the level on a patient-reported outcome measure (PROM) at which patients are satisfied with postoperative outcomes. We defined the PASS for the Oxford Hip Score (OHS) and Forgotten Joint Score (FJS-12) at 3-month, 1-year, and 2-year intervals after primary total hip arthroplasty (THA).Patients and methods - Between July 2018 and April 2019, primary THA patients in an academic medical center's registry completed the OHS, FJS-12, and a satisfaction anchor question at 3-month (n = 230), 1-year (n = 180), or 2-year (n = 187) postoperative intervals. PASS thresholds were derived with receiver operating characteristic analysis using the 80% specificity method. 95% confidence intervals (CI) were calculated using 1,000 non-parametric bootstrap replications.Results - 74%, 85%, and 86% of patients reported having a satisfactory symptom state at 3 months, 1, and 2 years after surgery, respectively. At 3-month, 1-year, and 2-year intervals, PASS thresholds were 34 (CI 31-36), 40 (CI 36-44), and 39 (CI 35-42) points for the OHS and 59 (CI 54-64), 68 (CI 61-75), and 69 (CI 62-75) points for the FJS-12.Interpretation - PASS thresholds varied with time for both the OHS and the FJS-12, with lower 3-month compared with 1-year and 2-year thresholds. These PASS thresholds represent OHS and FJS-12 levels at which the average patient is satisfied with THA outcomes, helping to interpret PROMs and serving as clinically significant benchmarks and patient-centered outcomes for research.
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Affiliation(s)
- Vincent P Galea
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Lina Holm Ingelsrud
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Isabella Florissi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - David Shin
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Charles R Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Pre-operative bone mineral density is a predictive factor for excellent early patient-reported outcome measures in cementless total hip arthroplasty using a proximally fixed anatomic stem. A prospective study at two year minimum follow-up. INTERNATIONAL ORTHOPAEDICS 2020; 44:2253-2259. [PMID: 32594225 DOI: 10.1007/s00264-020-04683-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The goal of the study was to analyze the impact of the pre-operative bone mineral density on the patients' reported outcomes at two year minimum follow-up of cementless THA using a proximally fixed anatomic stem. METHODS A prospective study included all patients who underwent a cementless THA using a specific proximally fixed anatomic stem and a 3D preoperative CT scan-based planning. The bone mineral density (BMD) of the metaphyseal cancellous bone was computed in a volume (of 1 mm thick and of 1 cm2 surface) at the level of the calcar 10 mm above the top of the lesser trochanter. Patients were assessed at two year follow-up using self-administered auto-questionnaires corresponding to the modified Harris (mHHS), the Oxford (OHS), and the Forgotten Hip (FHS) scores. A multiple linear regression statistical analysis was performed to assess the link between the mHHS, the age, body mass index (BMI), BMD, gender, and ASA grade. RESULTS Fifty patients were included (29 men, 21 women), with an average age of 62 ± 12 years and an average BMI of 27 ± 5 kg/m2. At two year follow-up, on multivariate analysis, excellent mHHS (≥ 90%) was significantly associated with only two parameters: a BMI ≤ 25 kg /m2 with an odd ratio OR = 10 (CI95% [2.1-48.3], p = 0.004) and a BMD ≥ 72 mg/cm3 with an odd ratio OR = 4.87 (CI95% [1.2-18.6], p = 0.02). CONCLUSION The short-term PROMs after cementless THA are impacted by pre-operative cancellous bone density. However, the BMI remains the most influential parameter on the clinical outcomes.
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Adriani M, Malahias MA, Gu A, Kahlenberg CA, Ast MP, Sculco PK. Determining the Validity, Reliability, and Utility of the Forgotten Joint Score: A Systematic Review. J Arthroplasty 2020; 35:1137-1144. [PMID: 31806559 DOI: 10.1016/j.arth.2019.10.058] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/11/2019] [Accepted: 10/28/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With improving patient outcome after total hip and total knee arthroplasty, patient-reported outcome measures (PROMs) have seen a parallel rise in average scores and ceiling effects. The Forgotten Joint Score (FJS) is a PROM that has been previously proposed to reduce this observed ceiling effect. However, the validity and reliability of the FJS has not been well analyzed. METHODS The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried using keywords pertinent to FJS, validity, reliability, measurement properties, and PROM. The methodological quality of measurement properties was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS In total, 13 articles met the inclusion criteria and were included in this analysis. Internal consistency was consistently high (Cronbach alpha >0.9). Test-retest reliability was good or excellent (interclass correlation coefficient ≥0.8) in all studies. As for construct validity, all the articles reported a positive rating. Floor and ceiling effects overall were low (<15%). Conflicting results were found for responsiveness and measurement error. CONCLUSION There is a strong evidence of good construct validity and test-retest reliability regarding the FJS, with moderate evidence of good internal consistency. Ceiling and floor effects were very low, showing a very promising discriminatory power between patients with a good outcome and patients with an excellent outcome. Therefore, especially in patients expected to achieve high levels of function after total joint replacement, we highly recommend the use of FJS for the long-term assessment of their treatment.
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Affiliation(s)
- Marco Adriani
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Cynthia A Kahlenberg
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
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Can We Help Patients Forget Their Joint? Determining a Threshold for Successful Outcome for the Forgotten Joint Score. J Arthroplasty 2020; 35:153-159. [PMID: 31506184 DOI: 10.1016/j.arth.2019.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/08/2019] [Accepted: 08/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Clinically important thresholds improve interpretability of patient-reported outcomes. A threshold for a successful outcome does not exist for the Forgotten Joint Score (FJS). The purpose of this study is to determine a threshold score for the FJS, 1 and 2 years after total hip arthroplasty (THA). METHODS A retrospective analysis of 247 primary THA recipients between December 2012 and April 2017 was performed. A binary "successful treatment" was defined as achieving a composite criterion of pain, function, and satisfaction. Receiver operator characteristic analysis determined thresholds for successful outcome at 1 and 2 years postoperatively, subanalyzed by demographics. Results were validated by a 75th centile comparison. The ceiling effect of FJS was also assessed. RESULTS The average FJS was 70.06 ± 29.39 and 75.05 ± 28.73 at 1 and 2 years, respectively (P < .001). The proportion of patients meeting the composite criteria for success was 66.8% at 1 year and 76.5% at 2 years (P = .017). The receiver operator characteristic analysis for FJS at 1 and 2 years yielded excellent accuracy as defined by area under the curve (0.91 and 0.92, respectively). The threshold values were 73.96 and 69.79 at the respective time points. A mild ceiling effect was found with 16% and 23% of cases achieving a score of 100 at 1 and 2 years, respectively. CONCLUSION The FJS has excellent accuracy in demonstrating successful outcome following THA. The FJS threshold for success at 1 and 2 years postoperatively is 73.96 and 69.79, respectively. The higher rates of success at 2 years, along with a rise in the mean FJS, may indicate continued clinical improvement up to 2 years after THA.
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Richard MA, Aractingi S, Joly P, Mahé E, Auquier P, Le Guen S, Acquadro C, Boucher F, Chalmers RJG. [French adaptation of a new score for global assessment of psoriasis severity: The Simplified Psoriasis Index (SPI)]. Ann Dermatol Venereol 2019; 146:783-792. [PMID: 31623858 DOI: 10.1016/j.annder.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/18/2019] [Accepted: 08/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although several scores exist to assess psoriasis severity, most have marked limitations that rule out their use in routine clinical practice. A new score, the Simplified Psoriasis Index (SPI), has recently been developed and validated in adults in Britain for such use. It has separate components for current severity (SPI-s), psychosocial impact (SPI-p) and past history and interventions (SPI-p), and it is suitable for either professional assessment or patient self-assessment. The aim of this work was to produce a validated translation of SPI into French (as spoken in France). METHODS The index was translated and validated using a strict methodology comprising respectively five and eight phases for the professional (proSPI) and self-administered instruments (saSPI). Translation of the saSPI instrument also involved a cognitive debriefing with five psoriasis patients. RESULTS Linguistic discrepancies and subtle differences of meaning arising during the process were closely examined. The developer of the instrument ensured conceptual accuracy. A panel of health experts guaranteed that medical terms were correctly translated. Five patients with plaque psoriasis (two female and three male of median age 45 years [range: 31-78]) tested the SPI-p version during cognitive interviews and found the questionnaire clear and easy to understand. CONCLUSION Validated French translations of both SPI instruments are now available for use in routine clinical practice. Further investigations are currently underway to validate the psychometric properties of the instrument.
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Affiliation(s)
- M A Richard
- EA 3279, département de dermatologie, centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix-Marseille université, hôpital de La Timone, Assistance publique-hôpitaux de Marseille, 13385 Marseille, France.
| | - S Aractingi
- Dermatologie, hôpital Cochin-Tarnier, 89, rue d'Assas, 75006 Paris, France
| | - P Joly
- Service de dermatologie, CHU de Charles Nicolle, université de Normandie, 76000 Rouen, France
| | - E Mahé
- Dermatologie, hôpital Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - P Auquier
- EA 3279, centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix-Marseille université, 13385 Marseille, France
| | - S Le Guen
- R&D, Novartis pharma SAS, 92506 Rueil-Malmaison, France
| | - C Acquadro
- Languages services, Mapi, an ICON plc Company, 69000 Lyon, France
| | - F Boucher
- Languages services, Mapi, an ICON plc Company, 69000 Lyon, France
| | - R J G Chalmers
- Centre for Dermatology, University of Manchester, Manchester, Royaume-Uni
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Bourlez J, Canovas F, Duflos C, Dagneaux L. Are modern knee outcomes scores appropriate for evaluating patellofemoral degeneration in osteoarthritis? Evaluation of the ceiling and floor effects in knee outcomes scores. Orthop Traumatol Surg Res 2019; 105:599-603. [PMID: 30935814 DOI: 10.1016/j.otsr.2019.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/31/2018] [Accepted: 01/08/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patellofemoral (PF) degeneration plays an important role in knee function in the context of osteoarthritis. A specific evaluation of PF symptoms is needed to better understand the initial functional status of the knee before surgery. The aim of this study was to assess the validity of patient-related outcome measures (PROMs) for knee scores and PF scores in knee osteoarthritis. HYPOTHESIS PF scores are more reliable for evaluating anterior knee pain than global knee scores in the context of PF degeneration in osteoarthritis. MATERIAL AND METHODS We performed a prospective single-center study of continuous patients included between January 2017 and January 2018 in our surgical department for total knee arthroplasty (TKA) for primary knee osteoarthritis. The analysis used global knee PROMs (KOOS and new IKS) and PF-specific PROMs (HSS Patella score, Kujala score and Lille score). Floor and ceiling effects were determined for each score based on tibiofemoral and PF degeneration on radiographic views; it was considered significant when greater than 15%. RESULTS We included 114 TKA procedures in 113 consecutive patients. According to the Iwano classification, no significant floor or ceiling effect was found for the PF preoperative scores (0-12%). The KOOS ADL and QOL scores were particularly affected by the ceiling and floor effects, whatever the patellofemoral degeneration (23-88%). In cases of severe PF degeneration (Iwano grade 3 and 4), no significant differences in the distribution of the functional scores were found. DISCUSSION Modern knee outcome scores used to evaluate knee function do not monitor PF degeneration and related symptoms in the context of knee osteoarthritis according to the Iwano classification. PF scores do not have a floor and ceiling effects even if the severity of the PF degeneration is difficult to identify preoperatively. Physicians should be aware of this effect on the preoperative functional evaluation before TKA. LEVEL OF EVIDENCE III, comparative prospective study.
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Affiliation(s)
- Julien Bourlez
- Département de chirurgie orthopédique et traumatologie, Unité de chirurgie du membre inférieur, hôpital Lapeyronie, CHRU Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - François Canovas
- Département de chirurgie orthopédique et traumatologie, Unité de chirurgie du membre inférieur, hôpital Lapeyronie, CHRU Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Claire Duflos
- DIM, unité de recherche clinique et épidémiologique, hôpital Lapeyronie, CHRU Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - Louis Dagneaux
- Département de chirurgie orthopédique et traumatologie, Unité de chirurgie du membre inférieur, hôpital Lapeyronie, CHRU Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Erivan R, Villatte G, Chaput T, Mulliez A, Ollivier M, Descamps S, Boisgard S. French translation and cultural adaptation of a questionnaire for patients with hip or knee prosthesis. Orthop Traumatol Surg Res 2019; 105:435-440. [PMID: 30858043 DOI: 10.1016/j.otsr.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Kingsbury questionnaire offers the possibility of follow-up by means of an X-ray and a simple questionnaire sent to the home address of the patient, who will not need to come in consultation if there are no problems. The questionnaire detects any anomaly in follow-up. In case of anomaly in the questionnaire or radiograph, the patient is contacted and/or seen again, as appropriate. The Kingsbury questionnaire has had no transcultural validation, and we therefore conducted a prospective study in order to 1) translate into French the questionnaire, previously validated in English; 2) adapt it for good understanding according to cultural habits; and 3) assess the translated version on a test-retest procedure. HYPOTHESIS The study hypothesis was that the translated questionnaire would show good test-retest reproducibility. MATERIAL AND METHODS The exact English version of the questionnaire was obtained directly from the authors of the index publication. A methodology of translation, back-translation and test-retest enabled assessment of the translation and of the reproducibility of the French version. The reference method of cultural adaptation of self-administered questionnaires and patient information documents was used. The questionnaire was tested prospectively. RESULTS One hundred patients were contacted, providing 73 clinical tests with radiographic validation and 48 complete test-retests in a representative population of total hip and total knee arthroplasty (THA, TKA). Internal coherence showed a KR-20 coefficient of 0.71 and Cronbach alpha of 0.76: e.g., good internal coherence. Item difficulty, requiring renewed contact, was low for all questions. Mean variance was low on the first 7 questions: 0.08 (range, 0.02-0.16). Correlation was close to 0.5 for each question. Analysis of reproducibility found excellent agreement (>90%) for the first 7 questions, which were binary; for question 8, agreement was good (83.3%) considering that there were 5 possible responses. For 19 of the 73 respondents, the questionnaire results indicated a need for further contact. After analysis of their radiographs, 4 needed to be seen in consultation again. The other 15 had unfavorable responses but without deterioration since the last classical consultation or any radiologic abnormality consultation, and were not called back for consultation. CONCLUSION The French version of the Kingsbury questionnaire provided reproducible assessment, avoiding the need to call the patient back for consultation unnecessarily. The questionnaire needs validating in a larger sample before being widely used: the present study was just a first step. LEVEL OF EVIDENCE IV, Prospective without control group.
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Affiliation(s)
- Roger Erivan
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | - Guillaume Villatte
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Thibault Chaput
- Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation à la Recherche Clinique et aux Innovations (DRCI) - CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, 13288, Marseille cedex 09, France Institute for Locomotion, Department of Orthopedics and Traumatology, St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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