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Scott S, Brameier DT, Tryggedsson I, Suneja N, Stenquist DS, Weaver MJ, von Keudell A. Prevalence, resources, provider insights, and outcomes: a review of patient mental health in orthopaedic trauma. J Orthop Surg Res 2024; 19:538. [PMID: 39223649 PMCID: PMC11370264 DOI: 10.1186/s13018-024-04932-4] [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] [Received: 03/29/2024] [Accepted: 07/19/2024] [Indexed: 09/04/2024] Open
Abstract
This literature review examines the impact of orthopaedic trauma on patient mental health. It focuses on patient outcomes, available resources, and healthcare provider knowledge and education. Orthopaedic trauma represents a significant physical and psychological burden for patients, often resulting in long-term disability, pain, and functional limitations. Understanding the impact of orthopaedic trauma on patient mental health is crucial for improving patient care, and optimizing recovery and rehabilitation outcomes. In this review, we synthesize the findings of empirical studies over the past decade to explore the current understanding of mental health outcomes in patients with orthopaedic trauma. Through this analysis, we identify gaps in existing research, as well as potential avenues for improving patient care and mental health support for patients with severe orthopaedic injuries. Our review reveals the pressing need for collaboration between healthcare providers, mental health professionals, and social support systems to ensure comprehensive mental care for patients with traumatic orthopaedic injuries.
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Affiliation(s)
- Sophia Scott
- Human Evolutionary Biology, Harvard University, Cambridge, MA, 02138, USA.
- Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Devon T Brameier
- Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ida Tryggedsson
- Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nishant Suneja
- Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Michael J Weaver
- Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Steiner Q, Watson AM, Mosiman SJ, Spiker AM. Association Between Symptoms of Anxiety and Depression, Hip Pathology, and Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement. Am J Sports Med 2024; 52:1728-1734. [PMID: 38771945 DOI: 10.1177/03635465241252821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
BACKGROUND In patients with femoroacetabular impingement (FAI), mental health has been implicated in both symptom severity and postoperative outcomes. However, there are limited data regarding the independent influences of baseline mental health and hip pathology on patient-reported outcomes over time after hip arthroscopy. PURPOSE To evaluate the association between mental health and structural hip pathology with pain, hip function, and quality of life (QOL). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patient records from a single surgeon's hip outcomes registry were retrospectively reviewed. Mental health was evaluated using the Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores. Pain was evaluated with the Single Assessment Numeric Evaluation score for Activities of Daily Living (SANE-ADL), while hip-related QOL was evaluated with the 12-item International Hip Outcome Tool (iHOT-12). Hip function was assessed with the Hip Outcome Score (HOS) Sport-Specific (SS) and ADL subscales. Separate mixed models were used to predict pain, QOL, and hip function, including hip pathology measures (size of labral tear, grade of chondral damage, preoperative alpha angle), anxiety, depression, and time as fixed effects and individuals as a random effect. RESULTS A total of 312 patients were included in this study. The preoperative alpha angle, degree of intraoperative cartilage damage, and size of the labral tear were not associated with pain or QOL (P > .05 for all). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (estimate ± SE) (anxiety: -0.59 ± 0.07, P < .0001; depression: -0.64 ± 0.08, P < .0001), iHOT-12 scores (anxiety: -0.72 ± 0.07, P < .0001; depression: -0.72 ± 0.08, P < .0001), HOS-SS scores (anxiety: -0.68 ± 0.09, P < .0001; depression: -0.57 ± 0.10, P < .0001), and HOS-ADL scores (anxiety: -0.43 ± 0.05, P < .0001; depression: -0.43 ± 0.06, P < .0001). CONCLUSION Patients had similar improvements in pain scores, QOL, and hip function after hip arthroscopy for FAI irrespective of their degree of hip pathology. Additionally, preoperative symptoms of anxiety and depression symptoms were associated with greater pain, decreased QOL, and worse hip function both pre- and postoperatively, independent of the degree of hip pathology. This suggests that efforts to directly address symptoms of anxiety and depression may improve outcomes after hip arthroscopy.
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Affiliation(s)
- Quinn Steiner
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrew M Watson
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Samuel J Mosiman
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Hennekes ME, Li S, Bennie J, Makhni EC. What does routine depression screening in the ambulatory orthopedic clinic teach us? Results from nearly 60,000 patient encounters. J Orthop 2024; 51:81-86. [PMID: 38333047 PMCID: PMC10847749 DOI: 10.1016/j.jor.2024.01.015] [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: 11/28/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024] Open
Abstract
Background It remains unclear what role depression screening plays in routine ambulatory orthopedic care. The purpose of this study was to determine (1) the floor and ceiling effects of the Patient-Reported Outcomes Measurement Information System Depression (PROMIS-D) form, (2) the prevalence of positive PROMIS-D screening forms across an orthopedic service line, and (3) the prevalence of previously diagnosed depression and interventions among a representative sample of patients. Methods This retrospective study analyzed 58,227 patients who presented to ambulatory orthopedic clinics across an orthopedic service line between January 1, 2019 to December 31, 2021. All patients completed a self-administered PROMIS-D form as part of the ambulatory encounter. Scores were analyzed with respect to patient characteristics including age, gender, and presenting orthopedic complaint. A sample of 1000 patients was evaluated for prevalence of depressive symptoms and formal psychiatric diagnosis and interventions in the 5 years preceding the clinic visit. Results PROMIS-D displayed a negligible ceiling effect (<0.001 %) but a large floor effect (19.0 %). PROMIS-D scores indicating depressive symptoms were highest among patients presenting with spine complaints (42.8 %) and lowest among patients presenting to orthopedic pediatric clinics (28.6 %). Women and those in the lowest quartile median household income (MHI) were more likely to report depressive symptoms. Among the 1000 patient sample, 31.3 % exhibited depressive symptoms. Of these, 39 % had previously received some form of mental health treatment, including 33.2 % who were prescribed antidepressants. Conclusions PROMIS-D is a useful screening questionnaire for patients in the orthopedic clinic, although there is a consistent floor effect. There are a number of patients who present to the orthopedic clinic who have depressive symptoms but have had no interaction with behavioral health. Given the impact depression can have on outcomes, screening for depressive symptoms should be considered as part of routine orthopedic practice.
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Affiliation(s)
| | - Stanley Li
- Michigan State University College of Human Medicine, 15 E Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Justin Bennie
- Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI, 48201, USA
| | - Eric C. Makhni
- Henry Ford Health, 2799 W. Grand Blvd, Detroit, MI, 48202, USA
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Johnson AH, Levermore SB, Maley AD, Turcotte JJ, Petre BM. Effects of Preexisting Anxiety and Depression on Postoperative Outcomes in Patients Aged 30 Years and Younger Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome. HSS J 2024; 20:214-221. [PMID: 39281985 PMCID: PMC11393620 DOI: 10.1177/15563316231164614] [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: 11/14/2022] [Accepted: 12/16/2022] [Indexed: 09/18/2024]
Abstract
Background: Mental health influences postoperative outcomes in orthopedic procedures. Increasing attention is being paid to this effect. Purpose: We sought to evaluate the effect of diagnosed depression, anxiety, or both on postoperative outcomes in patients who have undergone hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods: We conducted a retrospective cohort study of 289 patients aged 30 years or younger who underwent hip arthroscopy for FAIS at a single institution from January 2014 to June 2021. Univariate statistics were used to assess differences between patients diagnosed with depression, anxiety, or both, and those without these diagnoses. Differences included demographics, operative characteristics, and postoperative outcomes: duration of postanesthesia care unit (PACU) stay, PACU pain scores, complications, reoperations, postoperative injections, 90-day emergency department (ED) visits, and patient-reported outcome measures (PROMs). Multivariate analysis was used to evaluate risk factors for postoperative complications, including wound infection, documented reinjury, postoperative intra-articular hip injection, and any reoperation. Results: Patients diagnosed with depression, anxiety, or both were more likely to be older, female, and have a higher comorbidity burden. At the time of surgery, they were more likely to undergo concomitant procedures, including bursectomy and iliotibial band release. Postoperatively, they had longer PACU stays (90.5 vs 75.1 minutes) and higher first PACU pain scores (5.9 vs 4.6), as well as higher rates of postoperative injection (18.1 vs 9.2%), any reoperation (13.9% vs 4.6%), and revision hip arthroscopy (11.1% vs. 3.7%). Diagnoses of depression, anxiety, or both were independently predictive of any reoperation (odds ratio [OR] = 2.841) and revision hip arthroscopy (OR = 3.401). Conclusion: This retrospective cohort study found that, in patients undergoing hip arthroscopy for FAIS, there was an association between a diagnosis of depression, anxiety, or both, and increased comorbidities, higher first PACU pain scores, longer PACU stays, and increased rates of postoperative injection, any reoperation, or revision hip arthroscopy. Targeted interventions may improve outcomes, but further study is warranted.
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Affiliation(s)
- Andrea H Johnson
- Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Sandra B Levermore
- Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Alyssa D Maley
- Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Justin J Turcotte
- Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
| | - Benjamin M Petre
- Orthopedics, Luminis Health Anne Arundel Medical Center, Annapolis, MD, USA
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Punnoose A, Claydon-Mueller L, Rushton A, Khanduja V. PREHAB FAI- Prehabilitation for patients undergoing arthroscopic hip surgery for Femoroacetabular Impingement Syndrome -Protocol for an assessor blinded randomised controlled feasibility study. PLoS One 2024; 19:e0301194. [PMID: 38603694 PMCID: PMC11008823 DOI: 10.1371/journal.pone.0301194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The past decade has seen an exponential growth of minimally invasive surgical procedures. Procedures such as hip arthroscopy have rapidly grown and become the standard of care for patients with Femoroacetabular Impingement Syndrome (FAIS). Although, the results of such procedures are encouraging, a large proportion of patients do not achieve optimal outcomes due to chronicity and deconditioning as a result of delay in diagnosis and increased waiting times amongst other factors. In a recent systematic review and meta-analysis of randomised control trials, moderate certainty evidence supported prehabilitation over standard care in optimising several domains including muscle strength, pain and health related quality of life in patients undergoing orthopaedic surgical interventions. However, the role of prehabilitation in patients with FAI syndrome undergoing hip arthroscopy has received little attention. AIM To evaluate the feasibility, suitability, acceptability and safety of a prehabilitation programme for FAI to inform a future definitive randomised control trial to assess effectiveness. METHODS A systematically developed prehabilitation intervention based on a literature review and international consensus will be utilised in this study. A mixed methodology encompassing a two-arm randomised parallel study alongside an embedded qualitative component will be used to answer the study objectives. Patients will be recruited from a tertiary referral NHS centre for young adult hip pathology in the UK. Patient reported outcomes such as iHOT-12, Brief Pain Inventory Scale (Short form), Hospital Anxiety and Depression Scale and Patient Global Impression of Change score will be obtained alongside objective measurements such as Muscle Strength and Star Excursion Balance Test at various time points. Outcome measures will be obtained at baseline (prior to prehabilitation intervention), after prehabilitation before surgery, and at 6 weeks+/- 4 weeks and 6 months +/- 4 weeks (planned primary endpoint for definitive RCT) postoperatively when participants attend the research site for clinical care and remotely at 12 months +/- 4 weeks postoperatively. Mean change and 95% CI, and effect size of outcome measures will be used to determine the sample size for a future RCT. For the qualitative component, in depth face-to-face semi-structured interviews with physiotherapists and focus groups with participants will be conducted to assess the feasibility, suitability, and acceptability of the prehabilitation intervention using a predetermined success criteria. All qualitative data will be recorded, transcribed verbatim and thematically analysed. DISCUSSION This study will be first of its kind to evaluate a systematically developed prehabilitation intervention for patients with FAIS undergoing hip arthroscopy. This study will provide important preliminary data to inform feasibility of a definitive RCT in the future to evaluate effectiveness of a prehabilitation intervention. TRIAL REGISTRATION ISRCTN 15371248, 09/03/2023. TRIAL PROTOCOL Version 2.3, 26th June 2023.
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Affiliation(s)
- Anuj Punnoose
- Young Adult Hip Service & Physiotherapy Department, Addenbrooke’s- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- School of Allied Health, Anglia Ruskin University, Cambridge, United Kingdom
| | | | - Alison Rushton
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Canada
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Young Adult Hip Service, Addenbrooke’s – Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
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Zacharias AJ, Dooley M, Mosiman S, Spiker AM. Depression Scores Decrease After Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2024; 6:100871. [PMID: 38495634 PMCID: PMC10944102 DOI: 10.1016/j.asmr.2023.100871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/18/2023] [Indexed: 03/19/2024] Open
Abstract
Purpose To evaluate clinical depression scores and functional outcomes following arthroscopic treatment of femoroacetabular impingement syndrome in patients with elevated preoperative depressive symptoms as defined by Patient-Reported Outcomes Measurement Information System for Depression (PROMIS-D). Methods Patients with femoroacetabular impingement syndrome completed the PROMIS-D Computer Adaptive Test and additional patient-reported outcome (PRO) measures preoperatively and at the time of postoperative visits. Patients were categorized into preoperative clinically depressed (CD) and nonclinically depressed (NCD) groups based on preoperative PROMIS-D scores. Scores ≥55 correlate to mild clinical depression, and this cutoff was used to determine preoperative depression status. PROMIS-D scores and functional outcome scores were assessed at 6 months and a minimum of 1-year postoperatively. Results In total, 100 patients were included with complete PROs at a minimum of 1-year follow-up. Of those included, 21 (21%) were categorized with preoperative CD. There were no differences in demographic or radiographic variables between the preoperative CD and NCD groups. At 6 months and 12 months postoperatively, the percentage of patients in the preoperative CD group with continued depression was 33.3% and 23.8%, respectively. Overall, 1-year change in PROMIS-D score for the CD group was -9.1 versus -0.8 in the NCD group (P = .001). There was no significant difference in rates of patients achieving patient acceptable symptom state between the preoperative CD and NCD groups. Conclusions Patients with symptoms of preoperative CD, as defined by the PROMIS-D score, demonstrated significant improvement in depressive symptoms following hip arthroscopy. In addition, patients with CD preoperatively did not show decreased rates of achieving minimum clinically important difference or patient acceptable symptom state on postoperative PROs compared with patients with NCD. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Anthony J. Zacharias
- Department of Orthopedic Surgery Froedtert South, Pleasant Prairie, Wisconsin, U.S.A
| | - Matthew Dooley
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Samuel Mosiman
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Andrea M. Spiker
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
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Greif DN, Shaikh HJ, Neumanitis J, Ramirez G, Maloney MD, Bronstein RD, Giordano B, Nicandri GT, Voloshin I, Mannava S. Arthroscopic subacromial decompression improved outcomes in situationally depressed patients compared to clinically depressed or nondepressed patients. JSES Int 2024; 8:304-309. [PMID: 38464455 PMCID: PMC10920123 DOI: 10.1016/j.jseint.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background The purpose of this study is to evaluate patient reported outcomes after arthroscopic extensive débridement of the shoulder with subacromial decompression (SAD) for subacromial impingement using the Patient-Reported Outcomes Measurement Information System (PROMIS) system and evaluate if depression (Dep) (clinical or situational) impacts patients achieving a Minimal Clinically Important Difference (MCID). Methods Preoperative PROMIS Physical function (PF), Mood, and Dep scores were obtained at the closest date prior to arthroscopic rotator cuff repair and postoperative scores were collected at every clinical visit thereafter. Final PROMIS score used for data analysis was determined by the patients final PROMIS value between 90 to 180 days. Clinical Dep was determined by patients having a formal diagnosis of "Depression or Major Depressive Disorder" at the time of their surgery. Situationally depressed patients, those without a formal diagnosis yet exhibited symptomatic depressive symptoms, were classified by having a PROMIS-Dep cutoff scores larger than 52.5. Results A total of 136 patients were included for final statistical analysis. 13 patients had a clinical but not situational diagnosis of Dep, 86 patients were identified who had no instance of clinical or situational Dep (nondepressed). 35 patients were situationally depressed. All three cohorts demonstrated a significant improvement in postoperative PROMIS Dep, PI, and PF score relative to their preoperative value (P = .001). Situationally depressed patients achieved greater delta PROMIS-Dep compared to patients with major depressive disorder. Depressed patients had a higher chance of achieving MCID for PROMIS-Dep compared to nondepressed patients (P = .01). Logistic regression analysis demonstrated that underlying Dep did not alter the odds of obtaining MCID compared to nondepressed patients. Nonsmoking patients had significantly greater odds of achieving MCID for PF (P = .02). Discussion Patients improved after undergoing SAD regardless of underlying Dep or depressive symptoms. Depressed patients exhibited greater change in PROMIS scores compared to nondepressed patients. Smoking remains a risk factor for postoperative outcomes in patients undergoing SAD for subacromial impingement. Identifying and counseling patients with underlying depressive symptoms without a formal major depressive disorder diagnosis may lead to improved outcomes. These findings may help guide clinicians in deciding who would benefit the most from this procedure.
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Affiliation(s)
- Dylan N. Greif
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Hashim J.F. Shaikh
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - James Neumanitis
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Gabriel Ramirez
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Michael D. Maloney
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Robert D. Bronstein
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Brian Giordano
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Gregg T. Nicandri
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Ilya Voloshin
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
| | - Sandeep Mannava
- University of Rochester Department of Orthopaedics and Physical Rehabilitation, Rochester, NY, USA
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Rana P, Brennan JC, Johnson AH, Turcotte JJ, Petre BM. Social Determinants of Health in Maryland Hip Arthroscopy Patients. Cureus 2024; 16:e52576. [PMID: 38371015 PMCID: PMC10874623 DOI: 10.7759/cureus.52576] [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] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Background Prior studies have demonstrated racial and socioeconomic disparities in patient-reported outcome measure (PROM) completion rates, and improvement exists across multiple orthopedic conditions. The purpose of this study was to assess whether these disparities are present in patients undergoing hip arthroscopy (HA) procedures. Methods A retrospective study of 306 patients undergoing HA from 2021 to 2023 was performed. Social determinants of health (SDOH) were compared between HA patients and the general Maryland population. Patients were then classified by whether they completed baseline and six-month PROMs (Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) instrument). Patients who completed PROMIS-PF were classified by whether or not they achieved minimal clinically important difference (MCID) at six months. Demographics and SDOH were compared using univariate analyses between patients who did and did not complete PROMs and between those who did and did not achieve MCID. SDOH were evaluated at the zip-code level using regional health information exchange measures. Results Compared to the Maryland population, HA patients resided in areas of lower social vulnerability. Preoperative and six-month PROMs were completed by 102 (33%) patients. No significant differences in demographics or any SDOH were found between patients who did and did not complete PROMs. Six-month MCID was achieved in 75 of 102 (74%) patients with complete PROMs; no significant differences in demographics or SDOH were observed between patients who did and did not achieve MCID. Conclusions For patients undergoing HA, disparities in patient-reported outcome completion rates and postoperative functional improvement do not appear to be present across demographics and SDOH, indicating equitable care is being delivered.
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Affiliation(s)
- Parimal Rana
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
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Nasir M, Scott EJ, Westermann RC. Pain Catastrophizing, Kinesiophobia, Stress, Depression, and Poor Resiliency Are Associated With Pain and Dysfunction in the Hip Preservation Population. THE IOWA ORTHOPAEDIC JOURNAL 2023; 43:125-132. [PMID: 38213857 PMCID: PMC10777701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background Psychiatric disorders are known to have a negative impact on outcomes attained from hip-preservation surgery. Psychosocial traits such as resiliency and pain avoidance likely also affect treatment outcomes, however these characteristics are less easily identified, and data is lacking supporting their presence and impact on related outcomes within the hip preservation population. We therefore evaluated hip preservation patients for a variety of maladaptive psychosocial traits and assessed patient-reported outcomes (PROs) in order to ascertain which specific traits were most associated with hip pain and dysfunction. Methods 62 subjects aged 15-49 years presenting for evaluation of a nonarthritic hip condition completed psychosocial questionnaires and patient reported outcome measures via electronic survey as listed in table one. Participants were tested again eight weeks later to evaluate the relationship between changes in physical function, pain, and mental health behaviors. Pearson correlation coefficients assessed association between hip PROs and psychosocial tests and analyses were corrected for multiple comparisons. Results Pain Catastrophizing (PCS), Kinesiophobia (TSK), Stress, and PROMIS-Global Mental Health (GMH) scores correlated with poor physical function and high pain scores at zero and eight weeks. Low resiliency (BRS) and depression were also associated with elevated pain on PRO tests as well as HOOS-Physical Function. There was a moderately strong correlation between improvement in PROMIS-Physical Function (PF) from zero to eight weeks and subjects initial scores for kinesiophobia, anxiety, and stress (r= -0.45, -0.41, -0.44, all p<0.05). Conclusion PCS, TSK, Stress, Depression, and low BRS are associated with pain and disability in hip preservation subjects. Elevated TSK, Anxiety and Stress may be predictors of failure to improve with nonoperative treatment. These psychosocial characteristics should be investigated further as predictors of clinical outcomes in the hip preservation population. Level of Evidence: II.
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Affiliation(s)
- Momin Nasir
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Elizabeth J. Scott
- Department of Orthopaedics and Rehabilitation, Duke University, Durham, North Carolina, USA
| | - Robert C. Westermann
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Gordon AM, Elali FR, Ton A, Schwartz JM, Miller C, Alluri RK. Preoperative Depression Screening in Primary Lumbar Fusion: An Evaluation of Its Modifiability on Outcomes in Patients with Diagnosed Depressive Disorder. World Neurosurg 2023; 176:e173-e180. [PMID: 37178911 DOI: 10.1016/j.wneu.2023.05.024] [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: 04/14/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Studies have reported the detrimental effects of depression following spine surgery; however, none have evaluated whether preoperative depression screening in patients with a history of depression is protective from adverse outcomes and lowers health care costs. We studied whether depression screenings/psychotherapy visits within 3 months before 1- to 2-level lumbar fusion were associated with lower medical complications, emergency department utilization, readmissions, and health care costs. METHODS The PearlDiver database from 2010 to 2020 was queried for depressive disorder (DD) patients undergoing primary 1- to 2-level lumbar fusion. Two cohorts were 1:5 ratio matched and included DD patients with (n = 2,622) and DD patients without (n = 13,058) a preoperative depression screen/psychotherapy visit within 3 months of lumbar fusion. A 90-day surveillance period was used to compare outcomes. Logistic regression models computed odds ratio (OR) of complications and readmissions. P value < 0.003 was significant. RESULTS DD patients without depression screening had significantly greater incidence and odds of experiencing medical complications (40.57% vs. 16.00%; OR 2.71, P < 0.0001). Rates of emergency department utilization were increased in patients without screening versus screening (15.78% vs. 4.23%; OR 4.25, P < 0.0001), despite no difference in readmissions (9.31% vs. 9.53%; OR 0.97, P = 0.721). Finally, 90-day reimbursements ($51,160 vs. $54,731) were significantly lower in the screened cohort (all P < 0.0001). CONCLUSIONS Patients who underwent a preoperative depression screening within 3 months of lumbar fusion had decreased medical complications, emergency department utilization, and health care costs. Spine surgeons may use these data to counsel their patients with depression before surgical intervention.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA; Questrom School of Business, Boston University, Boston, Massachusetts, USA.
| | - Faisal R Elali
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA; College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Andy Ton
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jake M Schwartz
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Chaim Miller
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ram K Alluri
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Gruskay JA, Martin MB, Shelton TJ, Comfort SM, Day HK, Philippon MJ. Improved Mental Health Status and Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement. Am J Sports Med 2023; 51:1525-1530. [PMID: 36942740 DOI: 10.1177/03635465231160289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is often a chronic problem, which can lead to a decrease in mental well-being. PURPOSE/HYPOTHESIS The purpose of this study was to determine patient mental health improvement after hip arthroscopy and if this improvement correlated with improved outcomes. It was hypothesized that patients with low mental health (LMH) status would improve after hip arthroscopy for FAI and that their patient-reported outcomes (PROs) would significantly improve after surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent hip arthroscopy with labral repair between 2008 and 2015 were included. The minimum follow-up was 2 years. PROs included the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sports (HOS-Sports), and 12-Item Short Form Health Survey (SF-12). The minimal clinically important difference and Patient Acceptable Symptom State (PASS) were determined for HOS-ADL, HOS-Sports, and the mHHS based on previously published studies. Patients who scored <46.5 on the SF-12 Mental Component Summary (MCS) were in the LMH group, and those who scored ≥46.5 were in the high mental health (HMH) group. RESULTS In total, 120 (21%) of the 566 patients were in the LMH group and 446 (79%) patients were in the HMH group preoperatively. There was no difference in age or sex between groups. Patients in the LMH group had lower mHHS, HOS-ADL, and HOS-Sports at the mean 4-year follow-up and were less likely to reach PASS for the scores. Postoperatively, 84% (478/566) of the entire group was in the HMH group. A total of 88 (73%) of the LMH group improved to HMH. A multiple linear regression model for change in MCS identified independent predictors of changes in preoperative MCS to be LMH group preoperatively, change in HOS-Sports, and change in mHHS (r2 = 0.4; P < .001). CONCLUSION HMH was achieved in 84% of the patients after hip arthroscopy for FAI. Improvement in MCS was correlated with function and activity, as indicated by a significant correlation with HOS-ADL and HOS-Sports. A small percentage of patients did see a decline in their MCS score. This study showed that patients with LMH scores before hip arthroscopy for FAI can improve to normal/high mental health, and this correlated with higher PROs.
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Affiliation(s)
- Jordan A Gruskay
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | | | - Trevor J Shelton
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | | | - Hannah K Day
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Patient-Reported Outcomes Measurement Information System Is Not as Responsive as Legacy Scores in Detecting Patient Outcomes in Hip Preservation: A Systematic Review. Arthroscopy 2023; 39:838-850. [PMID: 35817373 DOI: 10.1016/j.arthro.2022.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate publication trends of Patient-Reported Outcomes Measurement Information System (PROMIS) in hip preservation literature, assess the usage of PROMIS as an outcome measure, and evaluate correlations of all available published PROMIS domains with legacy patient-reported outcomes (PROs). METHODS The PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Google Scholar databases were queried for articles evaluating PROMIS scores among hip preservation populations. Inclusion criteria consisted of studies with Level IV evidence or above (per the Sackett et al. levels of evidence), such as case series and cohort studies, reporting on perioperative use of hip PROMIS scores. Exclusion criteria consisted of arthroplasty and trauma studies. Patient demographics, PROMIS usage, and PROMIS Pearson or Spearman correlation coefficients to historic PROs were recorded for each study. RESULTS Fifteen articles published between 2017 and 2021 were included in the analysis, with the majority (75%) published between 2020 and 2021. Studies assessing postoperative outcomes had follow-up periods ranging from 6 months to 5 years. The most common PROMIS domain reported was Physical Function (PF), and there was varying usage of other domains including Pain Intensity, Anxiety, and Depression. PROMIS validity was most often assessed in comparison to the modified Harris Hip Score (mHHS) by calculating the Pearson coefficient, which assumes normal data distribution, or Spearman coefficient, which is rank-based and does not require normal data distribution. Studies comparing PROMIS-PF with mHHS reported Pearson coefficients ranging from 0.49 to 0.72 and Spearman coefficients ranging from 0.67 to 0.71. CONCLUSIONS There has been a chronologic increase in PROMIS usage in hip preservation literature. PROMIS demonstrates moderate-to-strong correlations with legacy PROs, but there is substantial heterogeneity in follow-up periods, PROMIS domains used, and statistical methodology. The current data show that PROMIS is not as responsive as historically used, validated PROs in quantitatively assessing function and pain in hip preservation patients. CLINICAL RELEVANCE Surgeons using PROMIS solely should be aware that the score may not be as responsive as legacy PROs in closely assessing improvements or deterioration in patient performance after hip preservation surgery. Rather than being used alone, PROMIS may be useful as a replacement for a group of legacy PROs. Thus, when used alongside select legacy PROs, overall questionnaire burden can be reduced while maintaining a high level of accuracy in assessing health status.
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Lindsey C, Dornan GJ, McKelvey K. Integration of collaborative care model ameliorates population level COVID-19 Pandemic-related depressive symptoms among orthopaedic clinic patient population in US major metropolitan area. CURRENT ORTHOPAEDIC PRACTICE 2023. [DOI: 10.1097/bco.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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14
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Muacevic A, Adler JR, Tarpada S, Kahn MD. Treatment of an Infected Tibial Shaft Non-Union Using a Novel 3D-Printed Titanium Mesh Cage: A Case Report. Cureus 2023; 15:e34212. [PMID: 36852371 PMCID: PMC9957684 DOI: 10.7759/cureus.34212] [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] [Accepted: 01/25/2023] [Indexed: 01/27/2023] Open
Abstract
Treating large bone defects resulting from trauma, tumors, or infection can be challenging, as current methods such as external fixation with bone transport, bone grafting, or amputation often come with high costs, high failure rates, high requirements for follow-up, and potential complications. In this case report, we present the successful treatment of a complicated, infected tibial shaft non-union by using a personalized three-dimensional (3D)-printed titanium mesh cage. This case adds to the existing body of literature by demonstrating successful integration of bone into a titanium implant and a demonstration of immediate postoperative weight bearing in the setting of suboptimal operative and psychosocial conditions. Futhermore, this report highlights the flexibility of 3D-printing technology and its ability to allow for continued limb salvage, even after a planned bone transport procedure has been interrupted. The use of 3D-printed implants customized to the patient's specific needs offers a promising new avenue for treating complex tibial pathologies, and the technology's versatility and ability to be tailored to individual patients makes it a promising tool for addressing a wide range of bone defects.
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Bernstein DN, Ramirez G, Thirukumaran CP, Samuel Flemister A, Oh IC, Ketz JP, Baumhauer JF. Clinical Improvement Following Operative Management of Ankle Fractures Among Patients With and Without Moderate to High Depressive Symptoms: An Analysis Using PROMIS. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221151077. [PMID: 36741681 PMCID: PMC9893091 DOI: 10.1177/24730114221151077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Understanding the recovery trajectory following operative management of ankle fractures can help surgeons guide patient expectations. Further, it is beneficial to consider the impact of mental health on the recovery trajectory. Our study aimed to address the paucity of literature focused on understanding the recovery trajectory following surgery for ankle fractures, including in patients with depressive symptoms. Methods From February 2015 to March 2020, patients with isolated ankle fractures were asked to complete Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression questionnaires as part of routine care at presentation and follow-up time points. Linear mixed effects regression models were used to evaluate the patient recovery pattern, comparing the preoperative time point to <3 months, 3-6 months, and >6 months across all patients. Additional models that included the presence of depression symptoms as a covariate were then used. Results A total of 153 patients met inclusion criteria. By 3-6 months, PROMIS PF (β: 9.95, 95% CI: 7.97-11.94, P < .001), PI (β: -10.30, 95% CI: -11.87 to -8.72, P < .001), and Depression (β: -5.60, 95% CI: -7.01 to -4.20, P < .001) improved relative to the preoperative time point. This level of recovery was sustained thereafter. When incorporating depressive symptoms into our model as a covariate, the moderate to high depressive symptoms were associated with significantly and clinically important worse PROMIS PF (β: -4.00, 95% CI: -7.00 to -1.00, P = .01) and PI (β: 3.16, 95% CI: -0.55 to 5.76, P = .02) scores. Conclusion Following ankle fracture surgery, all patients tend to clinically improve by 3-6 months postoperatively and then continue to appreciate this clinical improvement. Although patients with moderate to high depressive symptoms also clinically improve following the same trajectory, they tend to do so to a lesser level than those who have low depressive symptoms. Level of Evidence Level III, case-control study.
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Affiliation(s)
- David N. Bernstein
- Harvard Combined Orthopaedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
| | - Gabriel Ramirez
- Harvard Combined Orthopaedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Caroline P. Thirukumaran
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - A. Samuel Flemister
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Irvin C. Oh
- Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - John P. Ketz
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Judith F. Baumhauer
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Hall A, Dandu N, Sonnier JH, Rao S, Holston K, Liu J, Freedman K, Tjoumakaris F. The Influence of Psychosocial Factors on Hip Surgical Disorders and Outcomes After Hip Arthroscopy: A Systematic Review. Arthroscopy 2022; 38:3194-3206. [PMID: 35660519 DOI: 10.1016/j.arthro.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the associations between mental health and preoperative or postoperative outcomes of hip arthroscopy for femoroacetabular impingement. METHODS The literature search was conducted using the PubMed, EMBASE and PsychINFO databases following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. RESULTS Nine studies were identified that met the inclusion and exclusion criteria. All studies assessing patient-reported outcomes found significantly lower patient-reported outcomes (modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports-Specific Subscale, and International Hip Outcome Tool scores) related to worse mental health functioning before surgery. Specifically, preoperative Hip Outcome Score-Activities of Daily Living and Hip Outcome Score-Sports-Specific Subscale were significantly greater in control patients than patients in the mental health group by 11.6 points (mean difference; 95% confidence interval 7.58-15.79, P < .001) and 10 points (95% confidence interval 5.14-14.87, P < .001), without significant heterogeneity between studies (I2 = 28.59, P = .25; I2 = 0, P = .93), respectively. Patients with lower mental health status also had lower rates of achieving a minimal clinically important difference in 5 studies included in this review. CONCLUSIONS This systematic review finds consistent evidence supporting the association between negative psychological function and worse preoperative and postoperative outcomes for patients with hip disorders. Understanding both the effect of mental health on surgical outcomes and the potential benefits of psychological intervention may represent an opportunity to improve patient outcomes following hip arthroscopy. LEVEL OF EVIDENCE IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Anya Hall
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Navya Dandu
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | | | - Somnath Rao
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kayla Holston
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - James Liu
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
| | - Kevin Freedman
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, U.S.A
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Shaw DB, Carreira DS. The Impacts of Anxiety and Depression on Outcomes in Foot and Ankle Surgery. Foot Ankle Int 2022; 43:1606-1613. [PMID: 36367127 DOI: 10.1177/10711007221132277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Kaveeshwar S, Rocca MP, Oster BA, Schneider MB, Tran A, Kolevar MP, Adib F, Henn RF, Meredith SJ. Depression and anxiety are associated with worse baseline function in hip arthroscopy patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:3563-3569. [PMID: 35416491 DOI: 10.1007/s00167-022-06963-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to analyze the correlation between baseline depression and anxiety and preoperative functional status in hip arthroscopy patients. METHODS A prospective, institutional review board-approved orthopaedic registry was used to retrospectively study 104 patients undergoing hip arthroscopy. Enrolled patients were administered baseline questionnaires for Patient-Reported Outcomes Measurement Information System (PROMIS) domains, Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) preoperative expectations, and Numeric Pain Scale (NPS). RESULTS The average baseline PROMIS Depression and Anxiety scores were 49.9 ± 9.8 and 55.5 ± 9.3, respectively. Bivariate analysis demonstrated that greater baseline PROMIS Anxiety correlated with worse preoperative PROMIS PI (p < 0.001), Fatigue (p < 0.001), Social Satisfaction (p < 0.001), and NPS score (p = 0.013). Bivariate analysis showed that greater PROMIS Depression correlated with worse preoperative PROMIS PF (p = 0.001), PI (p < 0.001), Fatigue (p < 0.001), SS (p < 0.001), and NPS score (p = 0.004). After controlling for confounders, multivariable analysis confirmed increased PROMIS Depression as an independent predictor of worse preoperative PROMIS PF (p = 0.009), MODEMS Expectations (p = 0.025), and NPS score (p = 0.002). Increased PROMIS Anxiety was predictive of worse baseline PROMIS PI (p < 0.001), Fatigue (p < 0.001), and Social Satisfaction (p < 0.001). A previous clinical diagnosis of depression or anxiety was only an independent predictor of worse baseline PROMIS Fatigue (p = 0.002) and was insignificant in all other models. CONCLUSION Increasing severity of depression and anxiety correlated with and predicted worse functional status at baseline in hip arthroscopy patients. As compared to clinical diagnosis of anxiety and depression, PROMIS metrics have superior utility in recognizing potentially modifiable mental health concerns that predict worse preoperative status. Ultimately, the study identifies an at-risk population undergoing hip arthroscopy that requires particular attention and potential mental health intervention in the preoperative setting. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Michael P Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Brittany A Oster
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Andrew Tran
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matthew P Kolevar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Farshad Adib
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Stoica CI, Nedelea G, Cotor DC, Gherghe M, Georgescu DE, Dragosloveanu C, Dragosloveanu S. The Outcome of Total Knee Arthroplasty for Patients with Psychiatric Disorders: A Single-Center Retrospective Study. Medicina (B Aires) 2022; 58:medicina58091277. [PMID: 36143953 PMCID: PMC9502460 DOI: 10.3390/medicina58091277] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: For some years, psychiatric illness has been a major factor in evaluating the results of total knee arthroplasty. As with other patient-related items, patients diagnosed with mental illness have higher costs of medical treatment, longer recovery, and longer hospital stays. The aim of this paper is to evaluate the role of mental diseases on the surgical outcome compared with the normal population. Materials and Methods: At our hospital, we undertook a retrospective study between June 2020 and January 2022. The experimental group consisted of patients with mental diseases including schizophrenia, bipolar disease, depression, substance uses, or other psychiatric disorders. The control group consisted of patients who underwent total knee arthroplasty and did not have a mental disease. Postoperative complications and length of stay were also recorded during the study. We used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Score (KSS) as outcome measures. Results: Between June 2020 and January 2022, a total of 634 patients underwent total knee arthroplasty in our clinic, of which 239 had a mental disease. The majority of patients were female (61%), and the average length of stay was significantly longer for patients with mental illness (6.8 vs. 2.8 days). Preoperative WOMAC and KS function scores demonstrated statistically significant differences between groups (67.83 ± 17.8 vs. 62.75 ± 15.7 and 29.31 ± 19.8 vs. 34.98 ± 21.3). KS knee score did not show any significant differences preoperatively. All postoperative functional scores showed significantly better results for the control group compared to the mental illness group. Conclusions: Mental illness appears to be linked with lower TKA scores before and after the surgical procedure.
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Affiliation(s)
- Cristian Ioan Stoica
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
- “Carol Davila” Faculty of Medicine, University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Georgiana Nedelea
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
| | - Dragos C. Cotor
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
- Correspondence:
| | - Mihai Gherghe
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
| | - Dragos Eugen Georgescu
- “Carol Davila” Faculty of Medicine, University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of General Surgery, “Dr. Ion Cantacuzino” Clinical Hospital, 022904 Bucharest, Romania
| | - Christiana Dragosloveanu
- “Carol Davila” Faculty of Medicine, University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Serban Dragosloveanu
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
- “Carol Davila” Faculty of Medicine, University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Tian K, Gao G, Dong H, Zhang W, Wang J, Xu Y. Arthroscopic Synovectomy of the Hip Joint: The Regional Surgical Technique. Arthrosc Tech 2022; 11:e1181-e1187. [PMID: 35936843 PMCID: PMC9353157 DOI: 10.1016/j.eats.2022.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/11/2022] [Indexed: 02/03/2023] Open
Abstract
Synovial disease is a common reason for hip joint dysfunction. Although traditionally treated with open synovectomy, with the popularization and development of arthroscopic techniques, arthroscopic synovectomy has become the main surgical treatment for synovial diseases. Given the long soft tissue channel and learning curve, arthroscopic synovectomy of the hip joint has high surgical requirements for surgeons. However, there is currently no standardized surgical protocol for arthroscopic synovectomy of the hip joint to guide the surgeon to perform hip synovectomy in an orderly manner. During the past 3 years, we have employed a novel technique, wherein we divided the synovium of the hip into seven regions based on the anatomical structure and the operating range of the arthroscopic portals. With the assistance of flexion, extension, and traction of the hip joint, synovectomy was sequentially performed under arthroscopic guidance. This regional surgical technique can be popularized and likely has the potential to become a standardized arthroscopic synovectomy protocol of the hip joint.
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Affiliation(s)
- Kang Tian
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China,Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Guanying Gao
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Hanmei Dong
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Weiguo Zhang
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jianquan Wang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yan Xu
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Beijing, China,Address correspondence to Yan Xu, M.D., Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, No.49 Huayuan North Rd., Beijing 100191, China.
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Lippold B, Tarkunde YR, Cheng AL, Hannon CP, Adelani MA, Calfee RP. Depression and Anxiety Screening Identifies Patients That may Benefit From Treatment Regardless of Existing Diagnoses. Arthroplast Today 2022; 15:215-219.e1. [PMID: 35774874 PMCID: PMC9237258 DOI: 10.1016/j.artd.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background This study investigated the utility of depression and anxiety symptom screening in patients scheduled for total knee arthroplasty to examine differences in active symptoms according to patients' mental health diagnoses and associated prescription medications. Material and methods This cross-sectional study analyzed 594 patients scheduled for total knee arthroplasty at a tertiary practice between June 2018 and December 2018. Patients completed Patient-Reported Outcomes Measurements Information System (PROMIS) Depression and Anxiety Computerized Adaptive Tests in clinic quantifying active symptoms. Mental health diagnoses and associated medications were extracted from health records. Statistical analysis assessed between-group differences in mean PROMIS scores and the prevalence of heightened depressive and anxiety symptoms. Results Multivariable linear regression modeling demonstrated that being diagnosed with depression without medication (β 7.1; P < .001) and with medication (β 8.6; P < .001) were each associated with higher PROMIS Depression scores. Similar modeling demonstrated that patients diagnosed with anxiety and prescribed an anxiolytic (β 8.4; P < .001) were associated with higher PROMIS Anxiety scores than undiagnosed patients. Eighty-six (15%) patients experienced heightened anxiety and/or depressive symptoms. Heightened depressive symptoms were more prevalent among those diagnosed with depression (19% without medication, 24% with antidepressant vs 5% undiagnosed: P < .001). Heightened anxiety symptoms were most prevalent among those diagnosed with anxiety and on anxiolytic medication (25% vs 7% diagnosed with anxiety without medication, 8% undiagnosed: P < .001). Conclusion One in seven arthroplasty patients screened reported heightened depressive and/or anxiety symptoms. Despite the majority of arthroplasty patients on antidepressants and anxiolytics having symptoms controlled, these patients remain at increased risk of heightened active symptoms.
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Affiliation(s)
- Brandon Lippold
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Yash R. Tarkunde
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Abby L. Cheng
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Charles P. Hannon
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Muyibat A. Adelani
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Ryan P. Calfee
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Kearney SP. Low Back Pain, Psychiatric Disorders, and a Combination of Both Negatively Affect Hip Arthroscopy Outcomes in Servicemembers. Am J Sports Med 2022; 50:1888-1899. [PMID: 35503098 DOI: 10.1177/03635465221092144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy for femoroacetabular impingement (FAI) in athletes, including military servicemembers, has resulted in variable outcomes. The prevalence of low back pain (LBP) and psychiatric disorders (PSYs) is high among patients undergoing hip arthroscopy. PURPOSE To determine the effect of LBP, PSYs, and the combination of both on outcomes in servicemembers treated arthroscopically for FAI. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Between April 2016 and June 2020, a total of 108 consecutive active-duty servicemembers underwent hip arthroscopy by a single surgeon at a single military medical center. Servicemembers were grouped according to the presence of preoperative LBP (Group LBP), a PSY (Group PSY), or both (Group Both), and outcomes were compared with those of servicemembers without these comorbidities (Group None). The minimum follow-up was 6 months. The primary outcome measure was return to duty (RTD). Secondary outcomes included the Nonarthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) subscale, and Hip Outcome Score-Sports (HOS-S) subscale. RESULTS All servicemembers' final duty status was confirmed, with a mean follow-up of 2 years (range, 6 months-4.3 years). The prevalence of preoperative LBP and PSY was 27% and 39%, respectively. RTD was 59% (10/17) in Group LBP, 10% (3/30) in Group PSY, 0% (0/12) in Group Both, and 47% (23/49) in Group None. Compared with Group None, the risk of discontinuing military service was statistically higher in Group PSY (relative risk [RR], 1.70 [95% CI, 1.41-1.99]) and Group Both (RR, 1.88 [95% CI, 1.62-2.15]) but not in Group LBP (RR, 0.78 [95% CI, 0.15-1.40]). The mean preoperative secondary outcomes all significantly improved postoperatively in Group None (NAHS, 58 to 75 [P < .001]; HOS-ADL, 63 to 74 [P < .001]; HOS-S, 44 to 57 [P < .001]). Among the comorbid groups, the mean HOS-S did not significantly improve (Group LBP, 45 to 48 [P = .71]; Group PSY, 36 to 44 [P = .22]; Group Both 43 to 45 [P = .75]), and <50% of these servicemembers achieved HOS-S meaningful clinical benefit metrics. CONCLUSION Preoperative LBP, PSY, and a combination of both negatively affected outcomes after hip arthroscopy. Preoperative counseling is crucial in setting realistic outcome expectations.
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Affiliation(s)
- Sean P Kearney
- Department of Orthopaedics and Rehabilitation, Womack Army Medical Center, Fort Bragg, North Carolina, USA
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Yoo JI, Cha Y, Kim JT, Park CH, Choy W, Koo KH. Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions. Clin Orthop Surg 2022; 14:155-161. [PMID: 35685973 PMCID: PMC9152889 DOI: 10.4055/cios21156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/28/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
Because of the increasing global trend of patients with mental disorders, orthopedic surgeons are more likely to encounter orthopedic patients with mental disorders in clinical settings. Identifying the characteristics of these patients and implementing psychiatric management can affect the clinical outcome of orthopedic treatment. Thus, orthopedic surgeons need to assess the psychiatric medical history of orthopedic patients with mental disorders before surgery and understand the psychological and behavioral patterns of patients with mental disorders. In addition, appropriate psychiatric consultations and evaluations are necessary to prevent worsening of mental disorders before and after surgery.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Yonghan Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Wonsik Choy
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Kazarian GS, Haddad FS, Donaldson MJ, Wignadasan W, Nunley RM, Barrack RL. Implant Malalignment may be a Risk Factor for Poor Patient-Reported Outcomes Measures (PROMs) Following Total Knee Arthroplasty (TKA). J Arthroplasty 2022; 37:S129-S133. [PMID: 35248754 DOI: 10.1016/j.arth.2022.02.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Implant malalignment may be a risk factor for poor patient-reported outcomes measures (PROMs) following total knee arthroplasty (TKA). METHODS Postoperative surveys were administered to assess PROMs regarding satisfaction, pain, and function in 262 patients who underwent surgery at 4 centers in the U.S. and U.K (average age, 67.2) at a mean 5.5 years after primary TKA. Postoperative distal femoral angle (DFA), proximal tibial angle (PTA), and posterior tibial slope angle (PSA) were radiographically measured, and outliers were recorded. PROMs were compared between patients with aligned versus malaligned knees using univariate analysis. RESULTS Patients with DFA, PTA, and PSA outliers were more likely to experience similar or decreased activity levels postoperatively than patients with no alignment outliers, as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA, PTA, and PSA outliers were significantly more likely to be dissatisfied with their ability to perform activities of daily living (ADLs), as were patients with 1 or 2 outliers of any kind (P < .05). Patients with DFA and PSA outliers were more likely to be dissatisfied with their degree of pain relief, as were patients with 2 outliers of any kind (P < .05). Finally, patients with DFA and PSA outliers, as well as those with 1 outlier of any kind, were more likely to be dissatisfied with their overall knee function (P < .05). CONCLUSION DFA, PTA, and PSA outliers represent a significant risk factor for decreased satisfaction with activities of daily living(ADLs), pain relief, and knee function, as well as decreased activity levels. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Fares S Haddad
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Matthew J Donaldson
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Warran Wignadasan
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
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25
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Holt M, Swalwell CL, Silveira GH, Tippett V, Walsh TP, Platt SR. Pain catastrophising, body mass index and depressive symptoms are associated with pain severity in tertiary referral orthopaedic foot/ankle patients. J Foot Ankle Res 2022; 15:32. [PMID: 35524334 PMCID: PMC9074220 DOI: 10.1186/s13047-022-00536-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients with chronic foot/ankle pain are often referred for orthopaedic assessment. Psychological vulnerabilities influence pain states (including foot and ankle), therefore this study aimed to establish the prevalence and relative importance of compromised psychological health to perceived foot/ankle pain severity in people referred to an orthopaedic foot and ankle clinic with non-urgent presentations. Methods Patients with triaged non-urgent foot/ankle referrals to the Department of Orthopaedics at Gold Coast University Hospital were recruited over a 12-month period and completed the Manchester-Oxford Foot and Ankle Questionnaire which was the primary measure. Participants also completed questionnaires assessing their anthropometric, demographic and health characteristics (Self-Administered Comorbidity Questionnaire) as well as measures of health-related quality of life (EuroQol-5-Dimensions-5-Level Questionnaire and EQ Visual Analogue Scale) and psychological health (Center for Epidemiological Studies-Depression scale, Pain Catastrophizing Scale and Central Sensitization Inventory). Descriptive statistics were used to summarise participant characteristics and a hierarchical multiple linear regression was employed to establish the extent to which psychological variables explain additional variance in foot/ankle pain severity beyond the effects of participant characteristics (age, sex, body mass index (BMI)). Results One hundred and seventy-two adults were recruited ((64.0% female), median (IQR) age 60.9 (17.7) years and BMI 27.6 (7.5) kg/m2). Specific psychological comorbidities were prevalent including depressive symptoms (48%), central sensitisation (38%) and pain catastrophising (24%). Age, sex and BMI accounted for 11.7% of the variance in MOXFQ-index and psychological variables accounted for an additional 28.2%. Pain catastrophising was the most significant independent predictor of foot/ankle pain severity (accounting for 14.4% of variance), followed by BMI (10.7%) and depressive symptoms (2.3%). Conclusions This study demonstrated that specific psychological comorbidities and increased BMI are common in this cohort and that these factors are associated with the symptoms for which patients are seeking orthopaedic assessment. This knowledge should prompt clinicians to routinely consider the psychosocial components of patient presentations and develop non-operative and pre-operative treatment strategies which consider these factors with the goal of improving overall patient outcomes.
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Affiliation(s)
- Matthew Holt
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, 4215, Australia.,Griffith University, School of Medicine, Southport, Queensland, 4215, Australia
| | - Caitlin L Swalwell
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, 4215, Australia.,Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Kelvin Grove, Queensland, 4059, Australia
| | - Gayle H Silveira
- Department of Orthopaedics & Trauma, Northern Adelaide Local Health Network, South Australia, 5112, Australia
| | - Vivienne Tippett
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Kelvin Grove, Queensland, 4059, Australia
| | - Tom P Walsh
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, 4215, Australia. .,Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Kelvin Grove, Queensland, 4059, Australia.
| | - Simon R Platt
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, 4215, Australia.,Griffith University, School of Medicine, Southport, Queensland, 4215, Australia
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26
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Lansdown DA. Editorial Commentary: It's "90% Mental": Mental Distress Influences Symptom Perception in Hip Arthroscopy. Arthroscopy 2022; 38:783-785. [PMID: 35248229 DOI: 10.1016/j.arthro.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
There is a well-established relationship between mental distress, mental health disorders, and the perception of pain and physical dysfunction. While determining the root cause is often challenging, increasing levels of mental distress are associated with increasingly disruptive manifestation of physical symptoms and vice versa. In femoroacetabular impingement syndrome, patients with preoperative mental distress exhibit more impactful levels of symptoms. Patients do show symptomatic improvement with appropriate surgical management, even in the presence of mental distress. Patients and surgeons should recognize both the physical and mental contributions to pain perception when developing a treatment plan for musculoskeletal pathologies and incorporate this as part of the postoperative rehabilitation process.
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27
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Saks BR, Glein RM, Jimenez AE, Ankem HK, Sabetian PW, Maldonado DR, Lall AC, Domb BG. Patients Obtain Meaningful Clinical Benefit After Hip Arthroscopy Despite Preoperative Psychological Distress: A Propensity-Matched Analysis of Mid-Term Outcomes. Arthroscopy 2022; 38:773-782. [PMID: 34019982 DOI: 10.1016/j.arthro.2021.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the influence of baseline psychological distress on patient-reported outcomes (PROs) after arthroscopic hip surgery for femoroacetabular impingement at a minimum of 5 years. METHODS Demographic and intraoperative data were prospectively collected from patients who underwent primary arthroscopic hip surgery for femoroacetabular impingement and labral tears after failure of conservative management between June 2012 and December 2014. Included patients had preoperative and minimum 5-year postoperative PROs and visual analog scale scores for pain and satisfaction. The 12-item Short Form Health Survey (SF-12) Mental Component Summary (MCS) score was used to stratify patients into 2 cohorts: Patients with an average or above-average score (SF-12 MCS score ≥ 50) were considered psychologically non-distressed, whereas those who scored below average (SF-12 MCS score < 50) were considered to have psychological distress. Distressed patients were propensity matched by age, sex, and body mass index to an equal number of non-distressed patients. RESULTS Of the 153 hips that met the inclusion criteria, 117 (76.5%) had minimum 5-year follow-up. Eighty-two hips were included in the final analysis after propensity matching, with 41 in both the distressed and non-distressed cohorts. Preoperatively, patients in the distressed cohort reported inferior scores for all PROs. There was a significant difference in the SF-12 MCS score between groups at 2 years, but similar scores were observed for all other PROs. At minimum 5-year follow-up, there were no differences between groups for any PRO. There were no differences in the rates of achieving the minimal clinically important difference for all PROs or in achieving the patient acceptable symptomatic state for the modified Harris Hip Score. CONCLUSIONS Patients with baseline psychological distress may have a lower functional status at the time of presentation but still gain meaningful clinical benefit and pain improvement from arthroscopic hip surgery, with mid-term outcomes comparable to those obtained by patients without preoperative psychological distress. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A..
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28
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Efficacy of automated electronic medical records (EMR) notification to promote provider intervention for severe depression. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Kazarian GS, Anthony CA, Lawrie CM, Barrack RL. The Impact of Psychological Factors and Their Treatment on the Results of Total Knee Arthroplasty. J Bone Joint Surg Am 2021; 103:1744-1756. [PMID: 34252068 DOI: 10.2106/jbjs.20.01479] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ There is a growing body of evidence implicating psychosocial factors, including anxiety, depression, kinesiophobia, central sensitization, and pain catastrophizing, as negative prognostic factors following total knee arthroplasty (TKA). ➤ Symptoms of anxiety and depression likely represent risk factors for negative outcomes in patients undergoing TKA. However, few studies have assessed the impact of preoperative interventions for these conditions on postoperative outcomes. ➤ The Tampa Scale of Kinesiophobia and the Central Sensitization Inventory have demonstrated value in the diagnosis of kinesiophobia and central sensitization. Higher preoperative indices of kinesiophobia and central sensitization predict worse patient-reported outcomes postoperatively. ➤ Although evidence is limited, cognitive-behavioral therapy for kinesiophobia and duloxetine for central sensitization may help to diminish the negative impact of these preoperative comorbidities. It is important to note, however, that outside the realm of TKA, cognitive-behavioral therapy has been recognized as a more effective treatment for central sensitization than medical treatment. ➤ Awareness of these issues will allow surgeons to better prepare patients regarding postoperative expectations in the setting of a comorbid psychosocial risk factor. Further research into the role of preoperative assessment and possible treatment of these conditions in patients undergoing TKA is warranted.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Christopher A Anthony
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.,Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles M Lawrie
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
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30
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Freshman RD, Salesky M, Cogan CJ, Lansdown DA, Zhang AL. Association Between Comorbid Depression and Rates of Postoperative Complications, Readmissions, and Revision Arthroscopic Procedures After Elective Hip Arthroscopy. Orthop J Sports Med 2021; 9:23259671211036493. [PMID: 34514010 PMCID: PMC8427924 DOI: 10.1177/23259671211036493] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Depression and related psychiatric diagnoses are common in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The effects of depression on postoperative complications, readmissions, and additional ipsilateral hip surgery are not well studied. Hypothesis: Patients with preoperative depression who undergo hip arthroscopy for FAIS would experience higher rates of 90-day postoperative complications and readmissions, with an increased risk of additional ipsilateral hip procedures, as compared with patients without depression. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study between 2010 and 2019 was performed using the Mariner/PearlDiver database. Current Procedural Terminology and International Classification of Diseases codes were used to compare patients with and without preexisting depression who underwent hip arthroscopy for FAIS. Patients were matched at a 1:1 ratio based on age, sex, Charlson Comorbidity Index, body mass index, and tobacco use. Patients undergoing shoulder or knee arthroscopy were also identified to compare lifetime preoperative depression prevalence amongst groups. Results: The lifetime preoperative depression prevalence was significantly higher in patients undergoing hip arthroscopy as compared with patients undergoing shoulder or knee arthroscopy (25.4% vs 22.2% vs 19.8%; P < .001). When compared with the patients without depression, patients with preoperative depression had higher rates of 90-day readmissions (2.4% vs 1.5%) and complications, including urinary tract infection (36.2% vs 28.9%), pneumonia (12.9% vs 9.1%), hematoma formation (3.1% vs 1.9%), acute kidney injury (4.0% vs 2.6%), deep venous thrombosis/pulmonary embolism (2.6% vs 1.7%), and superficial infection (4.9% vs 2.8%; P < .01 for all comparisons). Preoperative depression was associated with significantly higher odds of undergoing revision hip arthroscopy within 2 years (6.3% vs 2.4%; P < .001). Conclusion: Patients with preexisting depression experienced higher rates of 90-day postoperative complications and hospital readmissions after elective hip arthroscopy for FAIS and were more likely to undergo revision hip arthroscopy within 2 years of the index procedure.
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Affiliation(s)
- Ryan D Freshman
- Department of Orthopedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Madeleine Salesky
- Department of Orthopedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Charles J Cogan
- Department of Orthopedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopedic Surgery, University of California-San Francisco, San Francisco, California, USA
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31
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Lynch TS, Oak SR, Cossell C, Strnad G, Zajichek A, Goodwin R, Jones MH, Spindler KP, Rosneck J. Effect of Baseline Mental Health on 1-Year Outcomes After Hip Arthroscopy: A Prospective Cohort Study. Orthop J Sports Med 2021; 9:23259671211025526. [PMID: 34485585 PMCID: PMC8414618 DOI: 10.1177/23259671211025526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Patient factors, including mental health, sex, and smoking, have been found
to be more predictive of preoperative hip pain and function than
intra-articular findings during hip arthroscopy for femoroacetabular
impingement (FAI); however, little is known about how these factors may
influence patients’ postoperative outcomes. Hypothesis: We hypothesized that lower patient-reported mental health scores would be
significant risk factors for worse patient-reported outcomes (PROs) 1 year
after arthroscopic hip surgery for FAI and that baseline intra-articular
pathology would fail to demonstrate an association with outcomes 1 year
after FAI surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients undergoing hip arthroscopy for FAI were
electronically enrolled. Baseline and 1-year follow-up PROs were collected,
including Hip disability and Osteoarthritis Outcome Score for pain
(HOOS-Pain), HOOS–Physical Function Short Form (HOOS-PS), and Veterans RAND
12-Item Health Survey–Mental Component Score (VR-12 MCS). Intra-articular
operative findings and treatment were documented at the time of surgery.
Proportional odds logistic regression models were built for 1-year outcomes
(HOOS-Pain, HOOS-PS, and VR-12 MCS). Risk factors included patient
characteristics and intraoperative anatomic and pathologic findings. Results: Overall, 494 patients underwent hip arthroscopy for FAI, and 385 (78%) were
evaluated at 1 year with at least 1 PRO. The median patient age was 33
years, mean body mass index was 25.5 kg/m2, and 72% were female.
Multivariable analysis demonstrated that better baseline HOOS-Pain, HOOS-PS,
and VR-12 MCS were significantly associated with improvement in the 1-year
scores for each PRO. Higher VR-12 MCS was significantly associated with
better 1-year HOOS-Pain and HOOS-PS, while current and former smokers had
worse 1-year outcomes than those who never smoked. In ranking each
variable’s relative importance, baseline HOOS-Pain and HOOS-PS and baseline
VR-12 MCS were identified as the strongest predictors of 1-year HOOS-Pain
and HOOS-PS in our multivariable model. Conclusion: During hip arthroscopy for FAI, patient factors, including baseline hip pain
and function, mental health, and smoking, were independently associated with
1-year PROs of hip pain and function, while intra-articular pathology such
as the presence of labral tear and its treatment, tear size, tear location,
and anchors placed were not independently associated.
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Affiliation(s)
- T Sean Lynch
- Columbia University Irving Medical Center, New York, New York, USA
| | - Sameer R Oak
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | | | - Alexander Zajichek
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA
| | - Ryan Goodwin
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
| | | | | | - James Rosneck
- Cleveland Clinic Sports Medicine, Cleveland, Ohio, USA
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Kazarian GS, Lieberman EG, Hansen EJ, Nunley RM, Barrack RL. Clinical impact of component placement in manually instrumented total knee arthroplasty : a systematic review. Bone Joint J 2021; 103-B:1449-1456. [PMID: 34465158 DOI: 10.1302/0301-620x.103b9.bjj-2020-1639.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The goal of the current systematic review was to assess the impact of implant placement accuracy on outcomes following total knee arthroplasty (TKA). METHODS A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Ovid Medline, Embase, Cochrane Central, and Web of Science databases in order to assess the impact of the patient-reported outcomes measures (PROMs) and implant placement accuracy on outcomes following TKA. Studies assessing the impact of implant alignment, rotation, size, overhang, or condylar offset were included. Study quality was assessed, evidence was graded (one-star: no evidence, two-star: limited evidence, three-star: moderate evidence, four-star: strong evidence), and recommendations were made based on the available evidence. RESULTS A total of 49 studies were identified for inclusion. With respect to PROMs, there was two-star evidence in support of mechanical axis alignment (MAA), femorotibial angle (FTA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), femoral rotation, tibial and combined rotation/mismatch, and implant size/overhang or offset on PROMs, and one-star evidence in support of tibial sagittal angle (TSA), impacting PROMs. With respect to survival, there was three- to four-star evidence in support FTA, FCA, TCA, and TSA, moderate evidence in support of femoral rotation, tibial and combined rotation/mismatch, and limited evidence in support of MAA, FSA, and implant size/overhang or offset impacting survival. CONCLUSION Overall, there is limited evidence to suggest that PROMs are impacted by the accuracy of implant placement, and malalignment does not appear to be a significant driver of the observed high rates of patient dissatisfaction following TKA. However, FTA, FCA, TCA, TSA, and implant rotation demonstrate a moderate-strong relationship with implant survival. Efforts should be made to improve the accuracy of these parameters in order to improve TKA survival. Cite this article: Bone Joint J 2021;103-B(9):1449-1456.
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Affiliation(s)
- Gregory S Kazarian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Elizabeth G Lieberman
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Erik J Hansen
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Missouri, USA
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33
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Browning RB, Clapp IM, Alter TD, Nwachukwu BU, Nho SJ. Pain Catastrophizing and Kinesiophobia Affect Return to Sport in Patients Undergoing Hip Arthroscopy for the Treatment of Femoroacetabular Impingement. Arthrosc Sports Med Rehabil 2021; 3:e1087-e1095. [PMID: 34430888 PMCID: PMC8365207 DOI: 10.1016/j.asmr.2021.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess whether pain catastrophizing and kinesiophobia affect return to sport (RTS) or clinically significant outcome (CSO) achievement in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI). Methods Patients undergoing primary hip arthroscopy at a single institution between January 2017 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophobia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Patients also received the Hip Outcome Score Sport-Specific (HOS-SS) questionnaire preoperatively and 1 year and 2 years' postoperatively. An RTS questionnaire was completed at final follow-up. Bivariate correlations were conducted between PCS and TSK-11 scores and RTS status and achievement of CSOs of HOS-SS, based on patient acceptable symptom state (PASS) and substantial clinical benefit (SCB). Results Fifty-eight patients with an average age of 31.9 ± 12.2 and body mass index of 24.0 ± 3.8 participated in sport prior to surgery and were included in the study. Forty-two (72.4%) patients returned to sport at 10.5 ± 7.1 months following surgery. There was a significant reduction in TSK-11 and PCS scores at 1-year follow-up (TSK-11, 26.1 ± 6.0 vs 18.6 ± 6.1, P < .001; PCS, 17.7 ± 10.5 vs 4.3 ± 6.8, P < .001) as well as a significant improvement in HOS-SS (P < .001). At 1 year, fair correlations were demonstrated between PCS (r = -0.446, P = .010) and TSK (r = -0.330, P = .029) scores and RTS. Patient who returned to sport had lower PCS (8.5 ± 11.7 vs 3.0 ± 3.7, P = .010) and TSK-11 (21.8 ± 8.5 vs 17.6 ± 4.8, P = .029) scores at 1 year. At 1-year follow-up, PCS (r = -0.572, P = .001) and TSK-11 (r = -0.441, P = .012) scores demonstrated fair correlations with achieving PASS for HOS-SS at 2-year follow-up. Conclusions Patient kinesiophobia and pain catastrophizing at 1-year follow-up were negatively correlated with RTS and achievement of a CSO in sport-related activities at 2-year follow-up. Level of Evidence III, prospective cohort study.
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Affiliation(s)
- Robert B Browning
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ian M Clapp
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
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Zacharias AJ, Lemaster NG, Hawk GS, Duncan ST, Thompson KL, Jochimsen KN, Stone AV, Jacobs CA. Psychological Healthcare Burden Lessens After Hip Arthroscopy for Those With Comorbid Depression or Anxiety. Arthrosc Sports Med Rehabil 2021; 3:e1171-e1175. [PMID: 34430898 PMCID: PMC8365206 DOI: 10.1016/j.asmr.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/14/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose In this study, we investigated whether patients undergoing arthroscopic treatment of femoral acetabular impingement syndrome (FAIS) seek health care for treatment of comorbid depression and anxiety in the year following hip arthroscopy. Methods Using the Truven Health Marketscan database, FAIS patients who underwent hip arthroscopy between January 2009 and December 2016 were identified. Claims related to depression or anxiety filed during the year before surgery were required for inclusion. Using claims for pharmaceutical and psychological therapy treatments for mental health disorders, four groups of patients were analyzed on the basis of preoperative anxiety/depression treatment: medication only, therapy only, medication + therapy, and no treatment. Number of opioid pain prescriptions within 180 days prior to surgery and >90 days after hip arthroscopy were also compared. Results Depression and anxiety claims were identified in 5,208/14,830 (35.1%) patients. Preoperative treatment for depression and anxiety included medication only (n = 648, 12.4%), therapy only (n = 899, 17.3%), medication + therapy (n = 252, 4.8%), and no treatment (n = 3,409, 65.5%). Of the 900 patients who filled an anxiety/depression-related prescription prior to surgery, 422 (46.9%) patients did not fill a similar prescription in the postoperative year. Of the 1,151 patients receiving anxiety/depression-related therapy prior to surgery, 549 (47.7%) did not receive therapy in the postoperative year. Preoperative opioid prescriptions were filled for 393 patients (60.6%) in medication-only group, 275 (30.6%) in therapy-only group, 156 (61.9%) in medication + therapy group, and 1,059 (31.1%) in the group receiving no treatment. Opioid prescriptions >90 days postoperatively were filled for 330 (50.9%), 225 (25.0%), 120 (47.6%), and 861 (25.3%) patients, respectively. Conclusion Hip arthroscopy for FAIS is associated with a decreased postoperative use of health care resources for the treatment of depression and anxiety. Clinicians should also be aware of the potential interplay between preoperative psychotropic medication use and prolonged opioid use when counseling patients. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
- Anthony J Zacharias
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Nicole G Lemaster
- Department of Rehabilitation Science, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Gregory S Hawk
- Department of Statistics, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Stephen T Duncan
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | | | - Kate N Jochimsen
- Division of Athletic Training, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Austin V Stone
- Division of Sports Medicine, Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Cale A Jacobs
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
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Wang TY, Than KD. Commentary: Patterns and Impact of Electronic Health Records-Defined Depression Phenotypes in Spine Surgery. Neurosurgery 2021; 89:E33-E34. [PMID: 33862630 DOI: 10.1093/neuros/nyab116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Timothy Y Wang
- Department of Neurological Surgery, Duke University, Durham, North Carolina, USA
| | - Khoi D Than
- Department of Neurological Surgery, Duke University, Durham, North Carolina, USA
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Kamalapathy P, Kurker KP, Althoff AD, Browne JA, Werner BC. The Impact of Mental Illness on Postoperative Adverse Outcomes After Outpatient Joint Surgery. J Arthroplasty 2021; 36:2734-2741. [PMID: 33896669 DOI: 10.1016/j.arth.2021.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/15/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The effect of pre-existing mental illness on outpatient surgical outcomes is not well characterized. The objective of this study was to evaluate the association between pre-existing mental illness diagnosis and postoperative complications after outpatient total knee (TKA) and total hip arthroplasty (THA) and 2) compare with inpatient total joint arthroplasty (TJA). METHODS The Mariner Claims Database was used to capture patients undergoing outpatient TJA from 2010 to 2017. Patients were grouped into three categories: those with an existing history of anxiety and/or depression, those with severe mental illness, and those without history of mental illness. Additional subgroup analysis compared those with severe mental illness undergoing outpatient vs inpatient TJA. Outcomes were analyzed using multivariable logistic regression (P < .05). RESULTS Patients undergoing outpatient TJA with prior history of anxiety and/or depression or severe mental illness had an increased risk of emergency department (ED) visits (TKA, P < .001; THA, P = .014) within 90 days compared with those without history of mental illness. Severe mental illness was also associated with increased risk of medical complications at 90 days (TKA, P < .001; THA, P = .006). When compared with those undergoing inpatient surgery, patients undergoing outpatient TKA with severe mental illness were at increased risk of periprosthetic infection (P = .005) and ED visit (P = .003) within 90 days of surgery. CONCLUSION Anxiety/depression and severe mental illness are associated with higher rates of ED visits after outpatient TJA. Patients with severe mental illness also experienced more adverse events, whereas those with anxiety and/or depression had similar rates compared with control. A higher rate of adverse outcomes was seen after TKA in patients with severe mental illness when surgery was performed in the outpatient setting vs those that had surgery as an inpatient. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Kristina P Kurker
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Alyssa D Althoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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Au Yong PSA, Sim EYL, Ho CYX, He Y, Kwa CXW, Teo LM, Abdullah HR. Association of Multimorbidity With Frailty in Older Adults for Elective Non-Cardiac Surgery. Cureus 2021; 13:e15033. [PMID: 34150384 PMCID: PMC8200322 DOI: 10.7759/cureus.15033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Frailty is associated with adverse surgical outcomes. While existing studies describe the prevalence of multimorbidity and frailty in the community, the surgical population may have more severe disease and significant surgical stress. This study aims to describe the distribution of frailty and multimorbidity in the older surgical population and examine if specific comorbidities are more strongly associated with frailty. Methods This is a single-centre retrospective cohort study using an electronic database in the preoperative evaluation clinic, conducted in Singapore General Hospital, Singapore. All patients above 70 years old going for elective non-cardiac surgery were included. Demographics and comorbidities were analysed for their association with frailty according to the Edmonton Frail Scale. Results A total of 1396 out of 1398 patients were analyzed. The overall incidence of frailty was 27.8% and multimorbidity was 63.4%. Factors independently associated with frailty were age (adjusted Odds Ratio [aOR] = 1.07), female gender (aOR = 1.67), type 2 diabetes mellitus (aOR = 1.69), chronic kidney disease (aOR = 1.47), end-stage renal failure (aOR = 3.58), history of cerebrovascular accident or transient ischemic attack (aOR = 1.87), moderate anaemia (aOR = 2.11), dementia (aOR = 6.38), depression (aOR = 3.82), and peptic ulcer disease (aOR = 1.98). The presence of multi-morbidity was significantly associated with frailty, with overall increasing strength of association. Conclusion As the number of comorbidities increases, the odds of frailty increase. Only a small proportion of those with multimorbidity accumulate enough biological deficits to develop frailty, putting them at higher risk than with solely multimorbidity or frailty. Dementia and depression are comorbidities with strong associations that have yet to see coordinated interventional efforts in the preoperative setting.
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Affiliation(s)
- Phui Sze Angie Au Yong
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Eileen Yi Lin Sim
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Collin Yih Xian Ho
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Yingke He
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Charlene Xian Wen Kwa
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Li Ming Teo
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Hairil Rizal Abdullah
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
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Filan D, Carton P. Chronic Hip Injury Has a Negative Emotional Impact on the Male Athlete With Femoroacetabular Impingement. Arthroscopy 2021; 37:566-576. [PMID: 33239184 DOI: 10.1016/j.arthro.2020.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the impact of hip arthroscopy for femoroacetabular impingement (FAI) on both the physical and mental components of the 36-Item Short Form (SF-36) and assess how changes in health status compare with improvements in physical function and ability to continue to play (CTP) 2 years after surgery. METHOD Data collected prospectively from male athletes undergoing primary arthroscopic correction of FAI between November 2008 and October 2016 were analyzed. Physical (PCS) and mental (MCS) component scores of the SF-36 were assessed preoperatively and 2 years postoperatively. The minimal clinical important difference (MCID) was calculated using an anchor-based percentage of possible improvement technique, and the proportion of athletes achieving MCID was established. Logistic regression analysis was used to identify predictors of achieving MCID. CTP was assessed at 2-year follow-up. RESULTS 486 cases were included, age 25.9 ± 5.6 years. Median PCS improved from baseline 69.4 (51.9 to 85.0) to 91.9 (81.9 to 97.5) at 2 years (P < .001). Median MCS remained unchanged-preoperative, 88 (76 to 92); postoperative, 88 (80 to 96)-although the difference in the distribution of scores was statistically significant (P < .001). Calculated MCID was 60.1% (PCS) and 58.1% (MCS). Mean improvement was significantly higher for PCS compared with MCS (17.4 versus 3.7, P < .001) The proportion of cases achieving MCID was 56.9% and 28.7% for PCS and MCS, respectively, and the difference was statistically significant (P < .001). Lower Tonnis grade (odds ratio [OR] 0.601, 95% confidence interval [CI] 0.377 to 0.958; P = .032) and symptom duration <2 years (OR 0.624, 95% CI 0.406 to 0.960; P = .032) were predictive of achieving PCS MCID. Higher preoperative scores decreased the odds of achieving MCID (OR 0.965, 95% CI 0.955 to 0.975; P < .001; OR 0.972, 95% CI 0.958 to 0.986; P < .001 for PCS and MCS, respectively). 77.3% continued to play their main preinjury sport. Where CTP was not achieved, a significantly higher proportion of cases failed to meet MCID for the MCS compared with PCS (85% versus 60%, P < .001). CONCLUSION Arthroscopic management of sports-related FAI results in excellent overall clinical outcome and high levels of satisfaction and CTP at 2 years. Chronic hip injury has a significant negative effect on the physical and mental well-being of athletes; corrective surgery may restore physical function but is more limited in its ability to improve mental health status in this athletic cohort. LEVEL OF EVIDENCE IV, therapeutic case series.
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Affiliation(s)
- David Filan
- Hip and Groin Clinic, University of Pittsburgh Medical Center Whitfield, Waterford, Ireland.
| | - Patrick Carton
- Hip and Groin Clinic, University of Pittsburgh Medical Center Whitfield, Waterford, Ireland
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Cochrane S, Dale AM, Buckner-Petty S, Sobel AD, Lippold B, Calfee RP. Relevance of Diagnosed Depression and Antidepressants to PROMIS Depression Scores Among Hand Surgical Patients. J Hand Surg Am 2021; 46:99-105. [PMID: 33277101 DOI: 10.1016/j.jhsa.2020.10.012] [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: 11/15/2019] [Revised: 07/31/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE We aimed to test the utility of screening for depressive symptoms in the hand surgical office focusing on chances of heightened depressive symptoms in patients with no history of diagnosed depression and by quantifying ongoing depressive symptoms among patients diagnosed with depression accounting for antidepressant use. The clinical importance of this study was predicated on the documented negative association between depressive symptoms and hand surgical outcomes. METHODS This cross-sectional study analyzed 351 patients presenting to a tertiary hand center between April 21, 2016, and November 22, 2017. Adult patients completed self-administered Patient-Reported Outcomes Measurement Information System (PROMIS) Depression computer adaptive tests at registration. Health records were examined for a past medical history of diagnosed depression and whether patients reported current use of prescription antidepressants. Mean PROMIS Depression scores were compared by analysis of variance (groups: no diagnosed depression, depression without medication, depression with medication). Four points represented a clinically relevant difference in PROMIS Depression scores between groups and Depression scores greater than 59.9 were categorized as having heightened depressive symptoms. RESULTS Sixty-two patients (18%) had been diagnosed with depression. Thirty-four of these patients (55%) reported taking antidepressant medications. The PROMIS Depression scores indicated greater current depressive symptoms among patients with a history of diagnosed depression when not taking antidepressants (11 points worse than unaffected) and also among patients taking antidepressants (7 points worse than unaffected). Heightened depressive symptoms were detected in all groups but were more prevalent among those diagnosed with depression (36% with no medication, 29% with antidepressant medication) compared with unaffected patients (7%). CONCLUSIONS Depression screening for heightened depressive symptoms identifies 1 in 14 patients without diagnosed depression and 1 in 3 patients diagnosed with depression as having currently heightened depressive symptoms. Hand surgeons can use PROMIS Depression screening in all patients and using this to guide referrals for depression treatment to ameliorate one confounder of hand surgical outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Symptom prevalence study II.
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Affiliation(s)
- Shannon Cochrane
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Ann Marie Dale
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Skye Buckner-Petty
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Andrew D Sobel
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Brandon Lippold
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ryan P Calfee
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
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Amar E, Martin RL, Tudor A, Factor S, Atzmon R, Rath E. Midterm Outcomes and Satisfaction After Hip Arthroscopy Are Associated With Postoperative Rehabilitation Factors. Orthop J Sports Med 2021; 9:2325967120981888. [PMID: 33614802 PMCID: PMC7869163 DOI: 10.1177/2325967120981888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Arthroscopic hip-preservation surgery is commonly performed to address
nonarthritic sources of hip pain in young, active individuals. However,
there is little evidence to support postoperative rehabilitation protocols,
including the most appropriate frequency and length of individual formal
physical therapy sessions. There is also a lack of information to look at
patients’ perceived value of their home program/self-practice in relation to
outcomes. Purpose: To investigate postoperative rehabilitation factors after hip arthroscopy
related to formal physical therapy and home program/self-practice and their
correlation with patient outcomes and satisfaction. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 125 patients who underwent hip arthroscopy for femoroacetabular
impingement syndrome and a labral tear (75 men) were included. The mean age
was 34.6 ± 14.4 years, and the mean follow-up time was 4.9 ± 1.6 years. Hip
Outcome Score–Activities of Daily Living subscale (HOS-ADL) scores, overall
satisfaction scores, and factors related to supervised physical therapy and
home program/self-practice were collected. Correlations between continuous
variables and differences in the length of individual formal physical
therapy and patients’ rating of the importance of their home
program/self-practice between those who would and those who would not
undergo surgery again were assessed. Results: The frequency and length of individual formal physical therapy sessions were
significantly correlated with postoperative HOS-ADL scores
(r = 0.22, P = .014; and
r = 0.24, P = .007, respectively) and
level of satisfaction (r = 0.24, P = .007;
and r = 0.21, P = .02, respectively). The
length of individual formal physical therapy sessions was significantly
greater in those who noted they would undergo surgery again (35.3 vs 26.3;
P = .033). A significant correlation was identified
between the rating of the importance of their home program/self-practice and
postoperative HOS-ADL scores (r = 0.29; P
= .001) and their level of satisfaction (r = 0.23;
P = .009). There was a significant difference in the
rating of the importance of their home program/self-practice between those
who would undergo surgery again and those who would not (8.9 vs 7.8;
P = .007). Conclusion: Surgeons and physical therapists should emphasize the value of home
program/self-practice when it comes to outcomes and may want to encourage
their patients to participate in more frequent, longer, formal physical
therapy sessions.
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Affiliation(s)
- Eyal Amar
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - RobRoy L Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Adrian Tudor
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Atzmon
- Department of Orthopaedic Surgery, Assuta Medical Center, Ashdod, Israel, Affiliated to Faculty of Health and Science, Ben Gurion University, Beer-Sheva, Israel
| | - Ehud Rath
- Division of Orthopedic Surgery, Tel Aviv Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Reynolds AW, McGovern RP, Nickel B, Christoforetti JJ. Pre-operative comparisons for a return to running protocol in recreational athletes following hip arthroscopy. J Hip Preserv Surg 2020; 7:262-271. [PMID: 33163211 PMCID: PMC7605782 DOI: 10.1093/jhps/hnaa030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/08/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023] Open
Abstract
The purpose of the current study was to present pre-operative comparisons for recreational athletes attempting a return to running following hip arthroscopy, and the return to running progression protocol used to guide them. A prospective, non-randomized cohort study was conducted to evaluate recreational athletes that returned to running following hip arthroscopy. Return to running was the primary outcome measure and defined as the ability to run at least one mile three times weekly while maintaining patient-reported relief of pre-operative symptoms. Patients included were correlated with the following pre-operative patient-reported outcome measures: hip outcome score (HOS), 12-item international outcome tool (iHOT-12), visual analog scale for pain (VAS) and the Short-Form Health Survey (SF-12). Of the 99 included patients, 94 (95%) returned to running successfully with an average return of 4.8 months. There was no statistical difference in pre-operative comparisons between patients that returned to running and did not return to running (P ≥ 0.154). Evaluation of pre-operative clinical outcomes demonstrated no statistical difference between individuals that returned and did not return to running (P ≥ 0.177), but a large difference between the two groups was identified for HOS-ADL (64.8 versus 53.7, returned versus did not return), iHOT-12 (33.8 versus 25.4) and VAS (58.6 versus 69.3). Patients who returned to running demonstrated similar intraoperative procedures as those that did not return to running (P ≥ 0.214). The current study successfully establishes a management plan and progression protocol for patients identifying a return to recreational running following hip arthroscopy. Level of evidence: 3.
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Affiliation(s)
- Alan W Reynolds
- Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - Ryan P McGovern
- Department of Orthopaedic Surgery, Texas Health Sports Medicine, Allegheny Health Network, 5858 Main Street, Suite 210, Frisco, Texas 75034, USA
| | - Beth Nickel
- Department of Orthopaedic Surgery, Allegheny Health Network, Pittsburgh, PA 15224, USA
| | - John J Christoforetti
- Department of Orthopaedic Surgery, Texas Health Sports Medicine, Allegheny Health Network, 5858 Main Street, Suite 210, Frisco, Texas 75034, USA
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Agarwalla A, Lu Y, Chang E, Patel BH, Cancienne JM, Cole BJ, Verma N, Forsythe B. Influence of mental health on postoperative outcomes in patients following biceps tenodesis. J Shoulder Elbow Surg 2020; 29:2248-2256. [PMID: 32684282 DOI: 10.1016/j.jse.2020.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the relationship between preoperative mental health measured by the Short-Form 12 health survey mental component score and outcomes after isolated biceps tenodesis. METHODS The American Shoulder and Elbow Surgeons form (ASES), Single Assessment Numeric Evaluation (SANE), Constant-Murley score (CMS), and visual analog scale (VAS) for pain were administered preoperatively and at 6 and 12 months postoperatively to consecutive patients undergoing isolated biceps tenodesis between 2014 and 2018. Minimal clinically important difference, substantial clinical benefit (SCB), patient-acceptable symptom state (PASS), and rates of achievement were calculated. Patients were stratified by mental health status based on preoperative scores on the Short-Form 12 health survey mental component score. Multivariate logistic regression was performed to evaluate preoperative mental health status on achievement of minimal clinically important difference, SCB, and PASS. RESULTS Patients demonstrated significant improvements in all outcome measures (P < .001). Patients with depression reported inferior postoperative scores on all patient-reported outcome measures. Low preoperative mental health score significantly predicted reduced likelihood to achieve SCB (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.17-0.81, P = .01) and PASS (OR: 0.28, 95% CI: 0.12-0.65, P = .003) on the ASES form, SANE (OR: 0.24, 95% CI: 0.10-0.61, P = .003), CMS (OR: 0.25, 95% CI: 0.08-0.77, P = .016), and VAS pain (OR: 0.01, 95% CI: 0.00-0.31, P = .008). CONCLUSION Patients with depression reported inferior scores on all postoperative patient-reported outcome measures and demonstrated lower odds of achieving the SCB and PASS on the ASES form and PASS on the SANE, CMS, and VAS pain, compared with nondepressed patients.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Chang
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Bhavik H Patel
- Department of Orthopaedic Surgery, University of Illinois, Chicago, IL, USA
| | | | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Cheng AL, Schwabe M, Doering MM, Colditz GA, Prather H. The Effect of Psychological Impairment on Outcomes in Patients With Prearthritic Hip Disorders: A Systematic Review and Meta-analysis. Am J Sports Med 2020; 48:2563-2571. [PMID: 31829034 DOI: 10.1177/0363546519883246] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies have suggested that mental health disorders negatively affect postoperative outcomes in patients with femoroacetabular impingement (FAI). However, the outcome measures reported and the effect sizes have varied. Furthermore, it is unknown whether similar effects are present in young adults with other hip disorders such as acetabular dysplasia. PURPOSE To synthesize current evidence regarding the effect of baseline psychological impairment on postintervention outcomes in patients with prearthritic hip disorders. STUDY DESIGN Systematic review and meta-analysis. METHODS In February 2019, the Ovid Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov databases were searched for longitudinal studies that evaluated the effect of baseline psychological impairment (such as depression or anxiety) on a postintervention clinical outcome in patients with prearthritic hip disorders including FAI, acetabular dysplasia, and/or acetabular labral tears. Descriptive measures of study quality and bias were recorded, and studies that reported statistically comparable outcomes were analyzed in meta-analyses through use of random effects models. RESULTS We identified 12 eligible studies, all of which specifically evaluated patients with FAI after hip arthroscopy. No eligible studies described patients with acetabular dysplasia. Of the included studies, 8 studies reported odds ratios (ORs). The other 4 studies reported mean postoperative scores on patient-reported outcome measures (PROMs), all of which were scored from 0 to 100, with higher numbers being favorable. Patients with psychological impairment were less likely to achieve a favorable outcome after arthroscopy (OR, 0.74; 95% CI, 0.62 to 0.88; P < .001), and they reported worse postoperative PROM scores compared with nonimpaired patients (weighted mean difference, -20.2 points; 95% CI, -32.9 to -7.5; P < .001). CONCLUSION Baseline psychological impairment is associated with clinically significantly worse outcomes in patients with femoroacetabular impingement who undergo hip arthroscopy. More standardized reporting would facilitate improved understanding of this important, potentially modifiable risk factor. REGISTRATION CRD42019124836 (PROSPERO).
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Affiliation(s)
- Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Maria Schwabe
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Michelle M Doering
- Bernard Becker Medical Library, Washington University School of Medicine, St Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Heidi Prather
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Kuroda Y, Saito M, Çınar EN, Norrish A, Khanduja V. Patient-related risk factors associated with less favourable outcomes following hip arthroscopy. Bone Joint J 2020; 102-B:822-831. [PMID: 32600150 DOI: 10.1302/0301-620x.102b7.bjj-2020-0031.r1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This paper aims to review the evidence for patient-related factors associated with less favourable outcomes following hip arthroscopy. METHODS Literature reporting on preoperative patient-related risk factors and outcomes following hip arthroscopy were systematically identified from a computer-assisted literature search of Pubmed (Medline), Embase, and Cochrane Library using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and a scoping review. RESULTS Assessment of these texts yielded 101 final articles involving 90,315 hips for qualitative analysis. The most frequently reported risk factor related to a less favourable outcome after hip arthroscopy was older age and preoperative osteoarthritis of the hip. This was followed by female sex and patients who have low preoperative clinical scores, severe hip dysplasia, altered hip morphology (excess acetabular retroversion or excess femoral anteversion or retroversion), or a large cam deformity. Patients receiving workers' compensation or with rheumatoid arthritis were also more likely to have a less favourable outcome after hip arthroscopy. There is evidence that obesity, smoking, drinking alcohol, and a history of mental illness may be associated with marginally less favourable outcomes after hip arthroscopy. Athletes (except for ice hockey players) enjoy a more rapid recovery after hip arthroscopy than non-athletes. Finally, patients who have a favourable response to local anaesthetic are more likely to have a favourable outcome after hip arthroscopy. CONCLUSION Certain patient-related risk factors are associated with less favourable outcomes following hip arthroscopy. Understanding these risk factors will allow the appropriate surgical indications for hip arthroscopy to be further refined and help patients to comprehend their individual risk profile. Cite this article: Bone Joint J 2020;102-B(7):822-831.
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Affiliation(s)
- Yuichi Kuroda
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Masayoshi Saito
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Ece Nur Çınar
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
| | - Alan Norrish
- Department of Academic Orthopaedics, Trauma and Sports Medicine, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Mobius Hip and Knee Clinic, Cambridge Nuffield Hospital, Cambridge, UK
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45
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Dick AG, Smith C, Bankes MJK, George M. The impact of mental health disorders on outcomes following hip arthroscopy for femoroacetabular impingement syndrome: a systematic review. J Hip Preserv Surg 2020; 7:195-204. [PMID: 33163204 PMCID: PMC7605775 DOI: 10.1093/jhps/hnaa016] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/15/2020] [Accepted: 02/24/2020] [Indexed: 01/11/2023] Open
Abstract
Hip arthroscopy for femoroacetabular impingement syndrome (FAI) has been shown to be beneficial in the short- to medium-term though outcomes vary between individuals. Multiple factors have been suggested to affect outcomes including pre-operative mental health disorders. We undertook a systematic review to assess the evidence relating to the effect of pre-existing mental health disorders on the outcomes following hip arthroscopy for FAI. Following PRISMA guidelines, a multi-database search was undertaken using three key concepts: 'mental health', 'FAI' and 'hip arthroscopy'. Results were screened and data extracted from relevant studies. A total of six studies met the inclusion criteria including 2248 hips, all published between 2017 and 2019. All studies were of evidence level III or IV with reasonable methodological quality. One study demonstrated pre-operative depression to be related to altered pain reduction in the short-term following surgery. Three studies reported inferior outcomes in the medium-term (1-2 years) in those with worse mental health. One study demonstrated an increased risk of persistent pain 2 years following surgery and one a reduced chance of returning to active military service following surgery in those with worse mental health. Despite inferior outcomes individuals with mental health disorders did still benefit from surgery in general. In conclusion, the presence of pre-existing poor mental health is associated with inferior outcomes in the medium-term following arthroscopic surgery for FAI. Surgeons should consider screening patients for mental health disorders before surgery and counselling them appropriately as to the potential for less satisfactory surgical outcomes.
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Affiliation(s)
- Alastair G Dick
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Christian Smith
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Marcus J K Bankes
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Marc George
- Department of Young Adult Hip Surgery, Guy’s & St Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, United Kingdom
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Rahman R, Ibaseta A, Reidler JS, Andrade NS, Skolasky RL, Riley LH, Cohen DB, Sciubba DM, Kebaish KM, Neuman BJ. Changes in patients' depression and anxiety associated with changes in patient-reported outcomes after spine surgery. J Neurosurg Spine 2020; 32:871-890. [PMID: 32005017 DOI: 10.3171/2019.11.spine19586] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a study to analyze associations between changes in depression/anxiety before and 12 months after spine surgery, as well as changes in scores using the Patient-Reported Outcomes Measurement Information System (PROMIS) at the same time points. METHODS Preoperatively and 12 months postoperatively, the authors assessed PROMIS scores for depression, anxiety, pain, physical function, sleep disturbance, and satisfaction with participation in social roles among 206 patients undergoing spine surgery for deformity correction or degenerative disease. Patients were stratified according to preoperative/postoperative changes in depression and anxiety, which were categorized as persistent, improved, newly developed postoperatively, or absent. Multivariate regression was used to control for confounders and to compare changes in patient-reported outcomes (PROs). RESULTS Fifty patients (24%) had preoperative depression, which improved in 26 (52%). Ninety-four patients (46%) had preoperative anxiety, which improved in 70 (74%). Household income was the only preoperative characteristic that differed significantly between patients whose depression persisted and those whose depression improved. Compared with the no-depression group, patients with persistent depression had less improvement in all 4 domains, and patients with postoperatively developed depression had less improvement in pain, physical function, and satisfaction with social roles. Compared with the group of patients with postoperatively improved depression, patients with persistent depression had less improvement in pain and physical function, and patients with postoperatively developed depression had less improvement in pain. Compared with patients with no anxiety, those with persistent anxiety had less improvement in physical function, sleep disturbance, and satisfaction with social roles, and patients with postoperatively developed anxiety had less improvement in pain, physical function, and satisfaction with social roles. Compared with patients with postoperatively improved anxiety, patients with persistent anxiety had less improvement in pain, physical function, and satisfaction with social roles, and those with postoperatively developed anxiety had less improvement in pain, physical function, and satisfaction with social roles. All reported differences were significant at p < 0.05. CONCLUSIONS Many spine surgery patients experienced postoperative improvements in depression/anxiety. Improvements in 12-month PROs were smaller among patients with persistent or postoperatively developed depression/anxiety compared with patients who had no depression or anxiety before or after surgery and those whose depression/anxiety improved after surgery. Postoperative changes in depression/anxiety may have a greater effect than preoperative depression/anxiety on changes in PROs after spine surgery. Addressing the mental health of spine surgery patients may improve postoperative PROs.■ CLASSIFICATION OF EVIDENCE Type of question: causation; study design: prospective cohort study; evidence: class III.
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Affiliation(s)
| | | | | | | | | | | | | | - Daniel M Sciubba
- 2Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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47
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Martin RL, Kivlan BR, Christoforetti JJ, Wolff AB, Nho SJ, Salvo JP, Van Thiel G, Matsuda D, Carreira DS. Defining Variations in Outcomes of Hip Arthroscopy for Femoroacetabular Impingement Using the 12-Item International Hip Outcome Tool (iHOT-12). Am J Sports Med 2020; 48:1175-1180. [PMID: 32130022 DOI: 10.1177/0363546520906408] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND As health care moves toward a value-based payment system, it will be important that patient-reported outcome measures (PROMs) define variations in outcome over a follow-up period that allows a patient to achieve maximal improvement. Although there is evidence to support the use of PROMs to assess postoperative outcomes after hip arthroscopy, there is limited information available to assess for variations in outcome at a 2-year follow-up interval. PURPOSE To identify substantial clinical benefit (SCB) and patient acceptable symptom state (PASS) cutoff scores for the 12-item International Hip Outcome Tool (iHOT-12) that define patient status across a spectrum of potential outcomes after hip arthroscopy at a 2-year follow-up interval. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS These data were collected from a research registry of patients having hip arthroscopy for femoroacetabular impingement and/or chondrolabral pathology. On initial assessment and 2 years (±2 months) postoperatively, patients completed the iHOT-12, and categorical self-rating of function. They also completed a visual analog scale of postoperative satisfaction. Receiver operator characteristic analysis was performed to determine absolute SCB iHOT-12 scores associated with an "abnormal,""nearly normal," or "normal" self-report of function, and PASS scores for those reporting at least 50%, at least 75%, or 100% satisfaction with their surgery. RESULTS Out of 723 eligible patients, 658 (91%) met the inclusion criteria. The patients consisted of 462 (70%) women and 196 (30%) men, with a mean age of 35.3 years (SD, 13 years) and mean follow-up of 722 days (SD, 69 days). Absolute SCB and PASS iHOT-12 scores ranging from 38 to 86 were accurate in identifying those who had abnormal, nearly normal, and normal self-reported function and were at least 50%, at least 75%, and 100% satisfied with surgery. The areas under the curve were >0.70, with sensitivity and specificity values ranging from 0.78 to 0.92. CONCLUSION This study provides absolute SCB and PASS iHOT-12 cutoff scores that can be used to define variations in 2-year (±2 months) outcomes in patients after hip arthroscopy for femoroacetabular impingement and chondrolabral pathology. iHOT-12 scores of 38, 60, and 86 were associated with abnormal, nearly normal, and normal reports of function respectively, with scores of 60, 71, and 86 associated with at least 50%, at least 75%, and 100% satisfaction after surgery, respectively.
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Affiliation(s)
- RobRoy L Martin
- Rangos School of Health Sciences, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA.,UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA
| | - Benjamin R Kivlan
- Rangos School of Health Sciences, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | | | - Andrew B Wolff
- Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington, DC, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Division of Sports Medicine, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, USA
| | - John P Salvo
- The Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Hip Arthroscopy Program, Rothman Institute, Philadelphia, Pennsylvania, USA
| | - Geoff Van Thiel
- OrthoIllinois, Rush University Medical Center, Team Physician, US National Soccer Teams, Team Physician, Chicago Blackhawks Medical Network, Chicago, Illinois, USA
| | - Dean Matsuda
- ISC Sports and Spine Center, Marina del Rey, California, USA
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48
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Martin RL, Kivlan BR, Christoforetti JJ, Wolff AB, Nho SJ, Salvo JP, Van Thiel G, Matsuda D, Carreira DS. A tiered system using substantial clinical benefit and patient acceptable symptomatic state scores to evaluate 2-year outcomes of hip arthroscopy with the Hip Outcome Score. J Hip Preserv Surg 2020; 7:62-69. [PMID: 32382431 PMCID: PMC7195928 DOI: 10.1093/jhps/hnz074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 11/30/2022] Open
Abstract
There is no information to define variations in hip arthroscopy outcomes at 2-year follow-up using the Hip Outcome Score (HOS). To offer a tiered system using HOS absolute substantial clinical benefit (SCB) and patient acceptable symptomatic state (PASS) scores for 2-year hip arthroscopy outcome assessment. This was a retrospective review of patients having hip arthroscopy for femoroacetabular impingement and/or chondrolabral pathology. On initial assessment and 2 years (±2 months) post-operatively, subjects completed the HOS activity of daily living (ADL) and Sports subscales, categorical self-rating of function and visual analog scale for satisfaction with surgery. Receiver operator characteristic analysis identified absolute SCB and PASS HOS ADL and Sports subscale scores. Subjects consisted of 462 (70%) females and 196 (30%) males with a mean age of 35.3 years [standard deviation (SD) 13] and mean follow-up of 722 days (SD 29). SCB and PASS scores for the HOS ADL and Sports subscales were accurate in identifying those at a ‘nearly normal’ and ‘normal’ self- report of function and at least 75% and 100% levels of satisfaction (area under the curve >0.70). This study provides tiered SCB and PASS HOS scores to define variations in 2-year (±2 months) outcome after hip arthroscopy. HOS ADL subscale scores of 84 and 94 and Sports subscale scores of 61 and 87 were associated with a ‘nearly normal’ and ‘normal’ self-report of function, respectively. HOS ADL subscale scores of 86 and 94 and Sports subscale score of 74 and 87 were associated with being at least 75% and 100% satisfied with surgery, respectively. Level of evidence: III, retrospective comparative study.
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Affiliation(s)
- RobRoy L Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15219, USA.,UPMC Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA 15203, USA
| | - Benjamin R Kivlan
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15219, USA
| | - John J Christoforetti
- Texas Health Sports Medicine, Department of Orthopaedic Surgery, 1120 Raintree Circle Allen, TX 75013, USA
| | - Andrew B Wolff
- Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Department of Orthopaedic Surgery, 2021 K Street, NW Washington, DC 20006, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, 1653 W. Congress Parkway Chicago, IL 60612, USA
| | - John P Salvo
- Orthopaedic Surgery, Hip Arthroscopy Program, The Sydney Kimmel Medical College, Rothman Institute, Thomas Jefferson University Hospital, 111 S 11th St, Philadelphia, PA 19107, USA
| | - Geoff Van Thiel
- Rush University Medical Center, Department of Orthopaedic Surgery, US National Soccer Teams, Chicago Blackhawks Medical Network, 1653 W Congress Pkwy, Chicago, IL 60612, USA
| | - Dean Matsuda
- Hip Arthroscopy DISC Sports and Spine Center, Department of Orthopaedic Surgery, 3501 Jamboree Rd #1250, Newport Beach, CA 92660, USA
| | - Dominic S Carreira
- Peachtree Orthopedics, Department of Orthopaedic Surgery, 3200 Downwood Cir NW Office - Suite 700, Atlanta, GA 30327, USA
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49
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Arakgi ME, Han F, Degen R. Role of Arthroscopy for Hip Osteoarthritis with Impingement. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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50
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Clapp IM, Nwachukwu BU, Beck EC, Rasio JP, Alter T, Allison B, Nho SJ. What is the Role of Kinesiophobia and Pain Catastrophizing in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? Arthrosc Sports Med Rehabil 2020; 2:e97-e104. [PMID: 32368745 PMCID: PMC7190542 DOI: 10.1016/j.asmr.2019.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose To (1) investigate trends in kinesiophobia and pain catastrophizing after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and (2) determine whether kinesiophobia and pain catastrophizing scores are associated with achieving minimal clinically important difference (MCID) for any of the hip-specific patient-reported outcome questionnaires. Methods Patients undergoing primary hip arthroscopy for treatment of FAIS between December 2016 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophoibia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 6 months, and 1 year postoperatively. They also received the hip-specific patient-reported outcome questionnaires (Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, modified Harris Hip Score, and International Hip Outcome Tool-12), as well as visual analog scale for satisfaction and pain preoperatively and 1-year postoperatively. The threshold for achieving MCID was determined for each hip outcome tool, and patients achieving MCID were compared with those who did not. Results A total of 85 (80.2%) patients (mean age: 33.7 ± 12.4 years; female: 75.3%) were included in the final analysis. At 1-year follow-up, there was a significant reduction in TSK-11 scores (26.22 ± 5.99 to 18.70 ± 6.49; P < .001) and PCS scores (17.81 ± 10.13 to 4.77 ± 7.57; P < .001) when compared with preoperative scores. 1-year PCS scores were significantly lower in patients achieving MCID compared with patients failing to achieve MCID (3.2 ± 4.4 vs 10.8 ± 15.2; P = .006). There were no significant differences in TSK-11 scores between those achieving and not achieving MCID. Conclusions Patient kinesiophobia and pain catastrophizing both show significant improvements 1 year after undergoing hip arthroscopy for FAIS. However, pain catastrophizing scores at 1 year are significantly greater in patients not achieving MCID, whereas no association was identified between kinesiophobia and likelihood for MCID achievement. This suggests PCS may be a more useful tool than TSK-11 during postoperative rehabilitation for identifying patients at risk for not achieving MCID. Level of Evidence Level II, prospective case series.
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Affiliation(s)
- Ian M Clapp
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Jonathan P Rasio
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas Alter
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bradley Allison
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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