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Zamany C, Ohrt-Nissen S, Udby PM. Preoperative risk factors for nonsatisfaction after lumbar interbody fusion. BRAIN & SPINE 2024; 4:102784. [PMID: 38571556 PMCID: PMC10987792 DOI: 10.1016/j.bas.2024.102784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Abstract
Introduction Low back pain (LBP) is a common cause of impaired quality of life and disability and studies regarding surgical management of patients with LBP show a high variation in patient-reported success rate. Research question To find valuable preoperative clinical risk factors and variables associated with a non-satisfactory patient-reported outcome following surgery. Materials and methods The Danish surgical spine database (DaneSpine) was used to collect eight years of pre- and postoperative data on patients undergoing single-level fusions with either posterior- (PLIF) or transforaminal lumbar interbody fusions (TLIF). The primary outcome was patient nonsatisfaction. We collected data on European Quality of Life-5 Dimensions (EQ-5D), visual analogue scale (VAS), Oswestry Disability Index (ODI) score, pain intensity, duration of back pain, previous discectomy, and expectations regarding return to work after surgery at 2-year follow-up. Results The cohort included 453 patients of which 19% reported treatment nonsatisfaction. The nonsatisfaction group demonstrated higher preoperative VAS scores for back pain (75 ± 19 vs. 68 ± 21, p = 0.006) and leg pain (65 ± 25 vs. 58 ± 28, p = 0.004). The preoperative EQ-5D score was significantly lower in the nonsatisfaction group (0.203 + 0.262 vs. 0.291 ± 0.312, p = 0.016). There was no statistical significance between patient nonsatisfaction and preoperative ODI score, age, body mass index, duration of back pain or expectations regarding return to work after surgery. Discussion and conclusion Low preoperative EQ-5D scores and high VAS leg and back pain scores were statistically significant with patient nonsatisfaction following surgery and may prove to be valuable tools in the preoperative screening and alignment of patient expectations.
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Affiliation(s)
- Cyrus Zamany
- Spine Unit, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
- Spine Unit, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Copenhagen University Hospital, Denmark
| | - Søren Ohrt-Nissen
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Peter Muhareb Udby
- Spine Unit, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
- Spine Surgery and Research, Spine Center of Southern Denmark, Lillebælt Hospital, Middelfart, Denmark
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Fary C, Cholewa J, Ren AN, Abshagen S, Anderson MB, Tripuraneni K. Multicenter, prospective cohort study: immediate postoperative gains in active range of motion following robotic-assisted total knee replacement compared to a propensity-matched control using manual instrumentation. ARTHROPLASTY 2023; 5:62. [PMID: 38044446 PMCID: PMC10694935 DOI: 10.1186/s42836-023-00216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/27/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Range of motion (ROM) following total knee replacement (TKR) has been associated with patient satisfaction and knee function, and is also an early indicator of a successful procedure. Robotic-assisted TKR (raTKR) is considered to reproduce more precise resections, and, as a result, may be associated with improved early patient satisfaction compared to manual TKR (mTKR). The purpose of this study was to evaluate the early postoperative active ROM (aROM) between raTKR and mTKR. METHODS A total of 216 mTKR patients were propensity-matched, in terms of age, gender, comorbidities, and BMI, to 216 raTKR cases. Intraoperative and immediate postoperative adverse events were collected. Knee flexion and extension aROM were measured preoperatively and at one- and three months after operation. RESULTS Changes in flexion aROM were significantly greater in raTKR vs. mTKR at one- (6.9°, 95% CI: 3.5, 10.4°) and three months (4.9°, 95% CI: 2.1, 7.7°). Flexion aROM was greater at three postoperative months compared to preoperative aROM only in the raTKR group, and raTKR patients had higher odds of achieving ≥ 90° of flexion at one month after operation (OR: 2.15, 95% CI: 1.16, 3.99). There were no significant differences between groups in intraoperative (P > 0.999) or postoperative adverse events. CONCLUSIONS Compared with mTKR, raTKR resulted in less loss of aROM immediately after operation and a faster recovery of aROM within three months after operation. TRIAL REGISTRATION Clinicaltrials.gov (NCT# 03737149).
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Affiliation(s)
- Camdon Fary
- Epworth Foundation, Richmond, VIC, 3121, Australia
- Department of Orthopaedics, Western Hospital, Melbourne, 3011, Australia
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Buchan GBJ, Bernhard Z, Hecht CJ, Davis GA, Pickering T, Kamath AF. Improved perioperative narcotic usage patterns in patients undergoing robotic-assisted compared to manual total hip arthroplasty. ARTHROPLASTY 2023; 5:56. [PMID: 37924164 PMCID: PMC10625224 DOI: 10.1186/s42836-023-00211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/13/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Robot-assisted total hip arthroplasty (RA-THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA (mTHA), but optimal dosage for peri-RA-THA and mTHA pain relief remains unclear. This study aimed to compare pain control with opioids between patients undergoing direct anterior approach THA with the use of a novel, fluoroscopic-assisted RA-THA system compared to opioid consumption associated with fluoroscopic-assisted, manual technique. METHODS Retrospective cohort analysis was performed on a consecutive series of patients who received mTHA and fluoroscopy-based RA-THA. The average amount of postoperative narcotics in morphine milligram equivalents (MME) given to each cohort was compared, including during the in-hospital and post-discharge periods. Analyses were performed on the overall cohort, as well as stratified by opioid-naïve and opioid-tolerant patients. RESULTS The RA-THA cohort had significantly lower total postoperative narcotic use compared to the mTHA cohort (103.7 vs. 127.8 MME; P < 0.05). This difference was similarly seen amongst opioid-tolerant patients (123.6 vs. 181.3 MME; P < 0.05). The RA-THA cohort had lower total in-hospital narcotics use compared to the mTHA cohort (42.3 vs. 66.4 MME; P < 0.05), consistent across opioid-naïve and opioid-tolerant patients. No differences were seen in post-discharge opioid use between groups. CONCLUSIONS Fluoroscopy-based RA-THA is associated with lower postoperative opioid use, including during the immediate perioperative period, when compared to manual techniques. This may have importance in rapid recovery protocols and mitigating episode burden of care.
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Affiliation(s)
- Graham B J Buchan
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Zachary Bernhard
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Graeme A Davis
- Pinehaven Orthopaedic and Arthroplasty Institute, Krugersdorp, Johannesburg, 1739, South Africa
- Life Wilgeheuwel Hospital, Roodepoort, Johannesburg, 1724, South Africa
| | - Trevor Pickering
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, MS, 39202, USA
| | - Atul F Kamath
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Nie JW, Hartman TJ, Oyetayo OO, MacGregor KR, Zheng E, Federico VP, Massel DH, Sayari AJ, Singh K. Perioperative Predictors in Patients Undergoing Lateral Lumbar Interbody Fusion for Minimum Clinically Important Difference Achievement. World Neurosurg 2023; 175:e914-e924. [PMID: 37080454 DOI: 10.1016/j.wneu.2023.04.042] [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: 11/29/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To identify perioperative predictors of minimum clinically important difference (MCID) for patients undergoing lateral lumbar interbody fusion (LLIF) for the patient-reported outcome measures (PROMs) of Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) back, VAS leg, Oswestry Disability Index (ODI), and Patient Health Questionnaire-9 (PHQ-9). METHODS Patients undergoing LLIF were identified through retrospective review of a single-surgeon database. Overall MCID achievement was determined as the number of unique patients achieving ΔPROM thresholds of PROMIS-PF = 4.5, VAS back = 2.1, VAS leg = 2.8, ODI = 14.9, and PHQ-9 = 3.0 over a 2-year postoperative period. Univariate and multivariable logistic regression were used to determine perioperative predictors for MCID achievement. RESULTS Two-hundred and ninety patients were identified. For PROMIS-PF MCID achievement, increased preoperative PROMIS-PF and postoperative day (POD) 1 VAS pain were significant negative predictors. For VAS back, primary fusion with revision decompression was a negative predictor, whereas increased preoperative VAS back score was a positive predictor of MCID achievement. For VAS leg, increased preoperative VAS leg score was a positive predictor. For ODI, increased POD 0 VAS pain score was a negative predictor, whereas increased preoperative ODI was a positive predictor. For PHQ-9, increased preoperative PHQ-9 score was a positive predictor. CONCLUSIONS In patients undergoing LLIF, perioperative predictors for MCID achievement were highly dependent on PROM. Preoperative PROM was the most consistent perioperative predictor for achieving MCID. Increased acute postoperative pain and primary fusion after failed index decompression were significant predictors of failing to achieve MCID. Surgeons may use these findings in prognostication and management of postoperative expectations.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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McKee ED, Clement ND. Does an Adductor Canal Block Influence Patient-Reported Outcomes at One Year Following Total Knee Arthroplasty? Cureus 2023; 15:e41123. [PMID: 37519521 PMCID: PMC10382907 DOI: 10.7759/cureus.41123] [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: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Total knee arthroplasty (TKA) for osteoarthritis is performed to improve knee function and quality of life. Adductor canal block (ACB) (with posterior capsule local anaesthetic) and periarticular local anaesthetic infiltration (LA) alone are common methods used for post-operative pain control following TKA. The primary aim of this study was to investigate the influence of ACB compared to LA alone on knee function at one year in patients undergoing primary TKA. The secondary aims were to investigate the influence on health-related quality of life (HRQoL), patient satisfaction at one year, and length of stay (LOS) in hospital following TKA. Methods During a three-year period, 1396 patients who underwent TKA at the study centre completed pre-operative and one-year post-operative questionnaires. Data collected included patient demographics, co-morbidities, LOS, Oxford Knee Score (OKS), EuroQol 5-Dimension (EQ-5D) and satisfaction scores. Patients who had a spinal anaesthetic (n=1096) with either ACB (with posterior capsule local anaesthetic) (n=224) and LA infiltration alone (n=872) were compared. Results There was a significant improvement in pre-operative to one-year post-operative knee function as measured by OKS overall (15.1, p<0.001), however there was no significant difference between ACB and LA groups (p=0.37). There was no significant difference in change (p=0.43) or one-year post-operative (p=0.70) HRQoL, as measured by EQ-5D. There was also no significant difference in one-year patient satisfaction between groups (p=0.57). There was no significant difference in median LOS between groups (four days with ACB, four days with LA), although patients younger than 55 years undergoing ACB had a statistically significant median of one day reduced LOS compared with the LA group (p=0.01). Conclusions ACB when compared with LA alone was not associated with a difference in change in knee function, HRQoL, or patient satisfaction at one year following TKA. There was also no difference between groups in length of stay post-operatively. However, ACB was associated with a shorter length of stay in patients younger than 55, and this may be a group that would benefit from this intervention.
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Affiliation(s)
| | - Nick D Clement
- Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, GBR
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Yokochi M, Nakamura M, Iwata A, Kaneko R, Watanabe S, Konrad A, Yamada N. A 1-Week Comprehensive Foam Rolling Intervention Program Can Improve Knee Pain but Not Muscle Function and Range of Motion in Patients with Total Knee Arthroplasty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3351. [PMID: 36834043 PMCID: PMC9961826 DOI: 10.3390/ijerph20043351] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
We investigate the effect of a 1-week comprehensive foam rolling (FR) intervention program on knee pain, range of motion (ROM), and muscle function in patients with TKA.Thirty patients with TKA were randomly allocated to FR (n = 15) or control (n = 15) groups. The control group received only regular physical therapy. Patients in the FR group performed the FR intervention in addition to their regular physical therapy twice daily from postoperative weeks two to three (60 s × 3 repetitions × 2 times/day × 6 days: total = 2160 s). Pain score, knee flexion and extension ROM, muscle strength, walking function, and balance function were measured before and after the FR intervention. From the second to third postoperative weeks, there were significant improvements in all variables, and the reduction in pain score at stretching was significantly greater in the FR group (-26.0 ± 1.4; p < 0.05) than in the control group (-12.5 ± 1.9). However, there was no significant difference in changes in the other variables except for the pain score at stretching between FR and control groups. A 1-week comprehensive FR intervention program in patients with TKA could reduce pain scores at stretching without a synergistic effect on physical function, i.e., walking speed, balance function, and muscle strength of the knee extensors muscles.
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Affiliation(s)
- Masanobu Yokochi
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamagamachi, Aizuwakamatsu 965-8585, Fukushima, Japan
- Department of Rehabilitation, Fukushima Medical University, 1 Hikarigaoka, Fukushima City 960-1295, Fukushima, Japan
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, 4490-9 Ozaki, Kanzaki 842-8585, Saga, Japan
| | - Ayaka Iwata
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamagamachi, Aizuwakamatsu 965-8585, Fukushima, Japan
| | - Ryota Kaneko
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamagamachi, Aizuwakamatsu 965-8585, Fukushima, Japan
| | - Shiho Watanabe
- Department of Rehabilitation, Takeda General Hospital, 3-27 Yamagamachi, Aizuwakamatsu 965-8585, Fukushima, Japan
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, Mozartgasse 14, 8010 Graz, Austria
| | - Noboru Yamada
- Department of Orthopaedic Surgery, Takeda General Hospital, 3-27 Yamagamachi, Aizuwakamatsu 965-8585, Fukushima, Japan
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Plancher KD, Matheny LM, Briggs KK, Petterson SC. Reliability and Validity of the Knee Injury and Osteoarthritis Outcome Score in Patients Undergoing Unicompartmental Knee Arthroplasty. J Arthroplasty 2022; 37:1998-2003.e1. [PMID: 35487406 DOI: 10.1016/j.arth.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Knee Injury and Osteoarthritis Outcome Score (KOOS) was developed to document outcomes from knee injury, including the impact of osteoarthritis on knee function. The purpose of this study is to determine the reliability and validity of the KOOS subscales for evaluating outcomes following unicompartmental knee arthroplasty (UKA). METHODS KOOS Pain, Activities of Daily Living (ADL), Sport, Symptoms, and Quality of Life (QoL) scores collected from 172 patients who underwent UKA were used in the analysis. KOOS subscales were tested for reliability and validity of scores through a Rasch model analysis. RESULTS KOOS Sport, KOOS ADL, and KOOS QoL had good evidence of reliability with acceptable person reliability, person separation, and item reliability. For overall scale functioning, KOOS Pain, Symptoms, and ADL all had 1 question that did not have an acceptable value for infit or outfit mean square value. Questions in KOOS Sport and QoL all had acceptable values. There was a positive, linear relationship between the Short-Form 12 Physical Component Summary and the KOOS subscales which indicated good evidence of convergent validity. These associations were also seen when the cohort was separated in medial and lateral UKA. CONCLUSION Two of the 5 KOOS subscales (KOOS Sport and KOOS QoL) were considered adequate in measuring outcomes, as well as reliability. The KOOS ADL had borderline values; however, it had adequate infit and outfit values. The KOOS Pain and Symptom score performed poorly in this analysis. For documenting outcomes following UKA, this study supports the use of KOOS ADL, Sport, and QoL.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York; Plancher Orthopaedics & Sports Medicine, New York, New York; Orthopaedic Foundation, Stamford, Connecticut
| | - Lauren M Matheny
- School of Data Science and Analytics, Kennesaw State University, Atlanta, Georgia
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Zhang Y, Li Z, Su Q, Ge H, Cheng B, Tian M. The duration of postoperative analgesic use after total knee arthroplasty and nomogram for predicting prolonged analgesic use. Front Surg 2022; 9:911864. [PMID: 35959127 PMCID: PMC9360610 DOI: 10.3389/fsurg.2022.911864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Total knee arthroplasty is currently a reliable treatment for end-stage knee osteoarthritis. However, chronic postsurgical pain (CPSP) is substantially thought to reduce patient satisfaction. NSAID-based oral analgesics were used to manage CPSP, but research on the duration of postoperative analgesic use (DAU) and prolonged analgesic use (PAU) are presently scarce. Methods Preoperative, perioperative, and one-year or above postoperative follow-up data were collected from 162 patients who underwent total knee arthroplasty between 1 June 2018 and 1 March 2019, and the DAU and the discontinuation time of each patient after discharge were recorded. Observational statistical analysis, diagnostic test, and predictive nomogram construction were performed on the collected data. Results The 3-month DAU has good diagnostic utility for poor outcome of postoperative months twelve (POM12). The constructed nomogram shows that gender, preoperative Numeric Rating Scale (NRS) movement pain scores, duration of surgery, postoperative days three (POD3) moderate to severe movement pain, and POD3 pain rescue medication were significant prognostic predictors of PAU after discharge. The area under the curve (AUC) of the 3-month, 6-month, and 12-month nomogram receiver operating characteristic (ROC) curves were calculated to be 0.741, 0.736, and 0.781. Conclusion PAU was defined as more than three months of NSAID-based oral analgesic use after TKA. Prognostic predictors of PAU after TKA were identified, and visualized nomogram was plotted and evaluated. The evaluation indicated that the prediction model had the good predictive ability and was a valuable tool for predicting PAU after discharge.
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Affiliation(s)
- Yi Zhang
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Orthopaedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zihua Li
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qihang Su
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Heng’an Ge
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Biao Cheng
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Correspondence: Biao Cheng Meimei Tian
| | - Meimei Tian
- Department of Orthopaedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Correspondence: Biao Cheng Meimei Tian
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