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Andriollo L, Montagna A, Mazzella GG, Sangaletti R, Benazzo F, Rossi SMP. Navigated versus conventional medial unicompartmental knee arthroplasty: Minimum 18 years clinical outcomes and survivorship of the original Cartier design. Knee 2024; 49:183-191. [PMID: 39043013 DOI: 10.1016/j.knee.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 06/21/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) is a viable option of treatment in case of osteoarthritis (OA) or avascular osteonecrosis (AVN) isolated to either the medial or the lateral compartment of the knee. The aim of this study was to retrospectively present clinical outcomes and survivorship at minimum 18 years follow up of a fixed bearing (FB) UKA comparing the results of conventional technique and navigation. METHODS Patients treated with a medial FB UKA between June 2003 and December 2006 were retrospectively evaluated. From March 2005 all UKAs were performed using a computer navigation system. Patients were divided into two groups: UKAs assisted by navigation (n-UKAs) versus standard UKAs (s-UKAs). For all patients, at final follow up, patient-reported outcome measures (PROMs) were collected: Western Ontario and McMaster Universities (WOMAC) score, Oxford Knee Score (OKS) and Forgotten Joint Score (FJS-12). Survival rate and outcomes were compared between groups. RESULTS Fifty-two patients were analyzed in this retrospective evaluation. All UKAs were medial and the tibial component was all polyethylene (AP) in 26 cases and metal backed (MB) in 26. Twenty-six UKAs were implanted with standard technique (AP 10, MB 16) and 26 assisted by a navigation system (AP 16, MB 10). Three patients (5.7%) underwent revision; the average time to revision was 140.7 months (standard deviation 81.2). Average follow up was 216.4 months (standard deviation 10.6). The survivorship of the implant was 94.4% at final follow up. Survivorship and PROMs were not different between groups. CONCLUSIONS This study showed excellent survivorship and outcomes at long term follow up of the original fixed bearing Cartier designed implant in both groups with equivalent survivorship and PROMs.
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Affiliation(s)
- Luca Andriollo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alice Montagna
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy; Università degli Studi di Pavia, Pavia, Italy
| | - Giovan Giuseppe Mazzella
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy; IUSS Istituto Universitario di Studi Superiori, Pavia, Italy
| | - Stefano Marco Paolo Rossi
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia Fondazione Poliambulanza, Brescia, Italy.
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Longo UG, Papalia R, Mazzola A, Campi S, De Salvatore S, Candela V, Vaiano A, Piergentili I, Denaro V. Bilateral simultaneous hip and knee replacement: an epidemiological nationwide study from 2001 to 2016. BMC Surg 2024; 24:172. [PMID: 38822306 PMCID: PMC11141036 DOI: 10.1186/s12893-024-02450-y] [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: 02/14/2023] [Accepted: 05/09/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Several studies have compared the pros and cons of simultaneous bilateral versus staged bilateral hip and knee replacement but the outcomes of these two surgical options remains a matter of controversy. This study aimed to evaluate demographic features, incidence and hospitalization rates of bilateral one stage total hip and knee arthroplasty in Italy. METHODS The Italian Ministry of Health's National Hospital Discharge Reports (SDO) were used to gather data. This study referred to the adult population (+ 20 years of age) from 2001 to 2015 for hip arthroplasty and from 2001 to 2016 for knee arthroplasty. RESULTS Overall, 1,544 bilateral simultaneous hip replacement were carried out. The incidence rate was 0.21 cases per 100,000 adult Italian residents. Male/female ratio was 1.1. The average days of hospital stay was 11.7 ± 11.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, pelvic region and thigh (ICD code: 715.15). 2,851 bilateral simultaneous knee replacement were carried out. The incidence rate was 0.37 cases per 100,000 adult Italian residents. Male/female ratio was 0.6. The average days of hospital stay was 7.7 ± 5.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, lower leg (ICD code: 715.16). CONCLUSIONS The burden of hip and knee osteoarthrosis as a leading cause of bilateral joint replacement is significant in Italy. The national registers' longitudinal analysis may provide data for establishing international guidelines regarding the appropriate indications for one stage bilateral simultaneous hip or knee replacement versus two stage.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy.
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Alessandro Mazzola
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Vincenzo Candela
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Andrea Vaiano
- Department of Statistical Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, Roma, 00185, RM, Italy
| | - Ilaria Piergentili
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, 200 - 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio- Medico di Roma, Via Alvaro del Portillo, Roma, 21 - 00128, Italy
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Kwon SC, Jung HJ, Lee JH, Hyun JT, Hwang JH, Kim JI. Robotic-assisted medial unicompartmental knee arthroplasty restored prearthritic alignment and led to superior functional outcomes compared with conventional techniques. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38796719 DOI: 10.1002/ksa.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE Robotic-assisted medial unicompartmental knee arthroplasty (UKA) can ensure precise preoperative planning, minimise soft tissue damage and restore native coronal alignment. However, few studies have investigated how these advantages translate into differences in early postoperative outcomes. This study aimed to compare differences in early outcomes between conventional UKA (C-UKA) and robotic-assisted UKA (R-UKA). METHODS This retrospective study investigated two groups of patients who underwent medial UKA: C-UKA group (n = 35) and R-UKA group (n = 35). We assessed (1) serum indicators (hemoglobin, creatine kinase and C-reactive protein) and pain visual analogue scale (VAS) at postoperative days (PODs) 1, 2, 4 and 6; (2) radiologic parameters including joint line height change and arithmetic and mechanical hip-knee-ankle angle (aHKA and mHKA); (3) patient-reported outcomes including Knee Society Scores, Western Ontario and Mcmaster Universities Arthritis Index (WOMAC) and Forgotten Joint Score-12 (FJS-12) at 1-year follow-up. RESULTS Despite similar serum indicator results, pain VAS was lower in the R-UKA group than in the C-UKA group at PODs 2 (2.5 ± 1.3 vs. 3.6 ± 1.2, p = 0.02), 4 (2.4 ± 0.9 vs. 3.3 ± 1.0, p = 0.03) and 6 (1.9 ± 1.1 vs. 3.1 ± 1.1, p < 0.01). The joint line height change was significantly lower in the R-UKA group than in the C-UKA group (0.9 mm ± 0.6 mm vs. 2.0 mm ± 1.3 mm, p = 0.02). The equivalence test for preoperative aHKA and postoperative mHKA revealed equivalence in only the R-UKA group (p < 0.01). The R-UKA group showed better WOMAC and FJS-12 compared to C-UKA group at 1-year follow-up. CONCLUSION R-UKA led to lower pain VAS in the early postoperative period compared with C-UKA. Additionally, R-UKA effectively restored the joint line and prearthritic lower limb alignment, resulting in superior functional outcomes at 1-year follow-up compared with C-UKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Seung Cheol Kwon
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ho Jung Jung
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jong Hwa Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin Tak Hyun
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ji Hyo Hwang
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Piovan G, De Berardinis L, Screpis D, Senarighi M, Povegliano L, Natali S, Gigante AP, Zorzi C. Metal-backed or all-poly tibial components: which are better for medial unicompartmental knee arthroplasty? A propensity-score-matching retrospective study at the 5-year follow-up. J Orthop Traumatol 2024; 25:24. [PMID: 38704499 PMCID: PMC11069491 DOI: 10.1186/s10195-024-00765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/04/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND This retrospective medium-term follow-up study compares the outcomes of medial fixed-bearing unicompartmental knee arthroplasty (mUKA) using a cemented metal-backed (MB) or an all-polyethylene (AP) tibial component. MATERIALS AND METHODS The database of our institution was mined for primary mUKA patients implanted with an MB or an AP tibial component (the MB-UKA and AP-UKA groups, respectively) from 2015 to 2018. We compared patient demographics, patient-reported outcome measures (PROMs), and motion analysis data obtained with the Riablo™ system (CoRehab, Trento, Italy). We conducted propensity-score-matching (PSM) analysis (1:1) using multiple variables. RESULTS PSM analysis yielded 77 pairs of MB-UKA and AP-UKA patients. At 5 years, the physical component summary (PCS) score was 52.4 ± 8.3 in MB-UKA and 48.2 ± 8.3 in AP-UKA patients (p < 0.001). The Forgotten Joint Score (FJS-12) was 82.9 ± 18.8 in MB-UKAs and 73.4 ± 22.5 in AP-UKAs (p = 0.015). Tibial pain was reported by 7.8% of the MB-UKA and 35.1% of the AP-UKA patients (p < 0.001). Static postural sway was, respectively, 3.9 ± 2.1 cm and 5.4 ± 2.3 (p = 0.0002), and gait symmetry was, respectively, 92.7% ± 3.7 cm and 90.4% ± 5.4 cm (p = 0.006). Patient satisfaction was 9.2 ± 0.8 in the MB-UKA and 8.3 ± 2.0 in the AP-UKA group (p < 0.003). CONCLUSIONS MB-UKA patients experienced significantly better 5-year static sway and gait symmetry outcomes than AP-UKA patients. Although the PROMs of the two groups overlapped, MB-UKA patients had a lower incidence of tibial pain, better FJS-12 and PCS scores, and were more satisfied.
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Affiliation(s)
- Gianluca Piovan
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
| | - Luca De Berardinis
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica Delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy.
| | - Daniele Screpis
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
| | - Marco Senarighi
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica Delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Lorenzo Povegliano
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
| | - Simone Natali
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
| | - Antonio Pompilio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica Delle Marche, Via Tronto, 10/a, 60126, Ancona, AN, Italy
| | - Claudio Zorzi
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Italy
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Bensa A, Sangiorgio A, Deabate L, Illuminati A, Pompa B, Filardo G. Robotic-assisted unicompartmental knee arthroplasty improves functional outcomes, complications, and revisions. Bone Jt Open 2024; 5:374-384. [PMID: 38690670 PMCID: PMC11061807 DOI: 10.1302/2633-1462.55.bjo-2024-0030.r1] [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: 05/02/2024] Open
Abstract
Aims Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions. Methods The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 20 February 2024 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were comparative studies, written in the English language, with no time limitations, on the comparison of R-UKA and C-UKA. The quality of each article was assessed using the Downs and Black Checklist for Measuring Quality. Results Among the 3,669 articles retrieved, 21 studies on 19 series of patients were included. A total of 3,074 patients (59.5% female and 40.5% male; mean age 65.2 years (SD 3.9); mean BMI 27.4 kg/m2 (SD 2.2)) were analyzed. R-UKA obtained a superior Knee Society Score improvement compared to C-UKA (mean difference (MD) 4.9; p < 0.001) and better Forgotten Joint Score postoperative values (MD 5.5; p = 0.032). The analysis of radiological outcomes did not find a statistically significant difference between the two approaches. R-UKA showed longer operating time (MD 15.6; p < 0.001), but reduced complication and revision rates compared to C-UKA (5.2% vs 10.1% and 4.1% vs 7.2%, respectively). Conclusion This meta-analysis showed that the robotic approach for UKA provided a significant improvement in functional outcomes compared to the conventional manual technique. R-UKA showed similar radiological results and longer operating time, but reduced complication and revision rates compared to C-UKA. Overall, R-UKA seems to provide relevant benefits over C-UKA in the management of patients undergoing UKA.
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Affiliation(s)
- Alessandro Bensa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland
| | - Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Luca Deabate
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | | | - Benedetta Pompa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland
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Pasqualini I, Mariorenzi M, Klika AK, Rullán PJ, Zhang C, Murray TG, Molloy RM, Piuzzi NS. Establishing patient-centered metrics for the knee injury and osteoarthritis outcome score following medial unicompartmental knee arthropalsty. Knee 2024; 46:1-7. [PMID: 37972421 DOI: 10.1016/j.knee.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND This study aimed to determine the minimal clinically important difference (MCID) and the patient acceptable symptoms state (PASS) threshold for the knee injury and osteoarthritis outcome score (KOOS) pain subscore, KOOS physical short form (PS), and KOOS joint replacement (JR) following medial unicompartmental knee arthroplasty (mUKA). METHODS Prospectively collected data from 743 patients undergoing mUKA from a single academic institution from April 2015 through March 2020 were analyzed. Patient-reported outcome measures (PROMs) were collected both pre-operatively and 1-year post-operatively. Distribution-based and anchored-based approaches were used to estimate MCIDs and PASS, respectively. The optimal cut-off point and the percentage of patients who achieved PASS were also calculated. RESULTS MCID for KOOS-pain, KOOS-PS, and KOOS-JR following mUKA were calculated to be 7.6, 7.3, and 6.2, respectively. The PASS threshold for KOOS pain, PS, and JR were 77.8, 70.3, and 70.7, with 68%, 66%, and 64% of patients achieving satisfactory outcomes, respectively. Cut-off values for delta KOOS pain, PS, and JR were found to be 25.7, 14.3, and 20.7 with 73%, 69%, and 68% of patients achieving satisfactory outcomes, respectively. CONCLUSION The current study identified useful values for the MCID and PASS thresholds at 1 year following medial UKA of KOOS pain, KOOS PS, and KOOS JR scores. These values may be used as targets for surgeons when evaluating PROMS using KOOS to determine whether patients have achieved successful outcomes after their surgical intervention. Potential uses include the integration of these values into predictive models to enhance shared decision-making and guide more informed decisions to optimize patient outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ignacio Pasqualini
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Michael Mariorenzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Pedro J Rullán
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Chao Zhang
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Trevor G Murray
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Longo UG, Papalia R, Campi S, De Salvatore S, Piergentili I, Bandini B, Lalli A, Denaro V. Evaluating the Minimum Clinically Important Difference and Patient Acceptable Symptom State for the Womac Osteoarthritis Index after Unicompartmental Knee Arthroplasty. J Clin Med 2023; 12:7618. [PMID: 38137685 PMCID: PMC10744230 DOI: 10.3390/jcm12247618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
Patient-Reported Outcome Measures (PROMs) are standardized questionnaires that gather information on health-related quality of life directly from patients. Since a significant statistical mean change may not correspond to a clinical improvement, there is a need to calculate a considerable change in scores. This is done by the Minimum Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS). The objective of this article is to report the MCID and the PASS values of the WOMAC (Western Ontario and McMaster University) osteoarthritis index for patients undergoing Unicompartmental Knee Arthroplasty (UKA). A total of 37 patients (25 females and 12 males; mean age 68 ± 8.1 years and mean BMI 28.7 ± 4) who underwent UKA were enrolled. All patients were assessed using the WOMAC and the Oxford Knee Score (OKS) questionnaires before and six months following the procedure. To measure the cut-off values for MCID, distribution methods and anchor methods were applied, while the PASS was assessed only via anchor approaches. The MCID related to the WOMAC average global score was 90.7 ± 7.6, the average pain dimension score was 93.2 ± 6.6, the average stiffness dimension score was 92.6 ± 17, and the average physical function dimension score was 89.7 ± 7.6. In terms of PASS, the normalized WOMAC was 82.8, the pain dimension was 87.5, the stiffness dimension was 93.7, and the functional dimension was 83.1. A 34.5 amelioration in the WOMAC score, from initial evaluation to final follow-up, using change in OKS > 5 as anchor, indicates that the patients' health state improved to a clinically significant degree. A value at least of 82.8 in WOMAC score after treatment denotes that the symptom state is deemed acceptable by most of the patients.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (R.P.); (S.C.); (S.D.S.); (B.B.); (A.L.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rocco Papalia
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (R.P.); (S.C.); (S.D.S.); (B.B.); (A.L.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Stefano Campi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (R.P.); (S.C.); (S.D.S.); (B.B.); (A.L.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Sergio De Salvatore
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (R.P.); (S.C.); (S.D.S.); (B.B.); (A.L.); (V.D.)
- Research Unit of Ospedale Pediatrico Bambin Gesù, Dipartimento di Medicina e Chirurgia, Via della Torre di Palidoro, 00050 Fiumicino, Italy
| | - Ilaria Piergentili
- Consiglio Nazionale delle Ricerche—Istituto di Analisi dei Sistemi ed Informatica CNR-IASI, Laboratorio di Biomatematica, 00185 Roma, Italy;
| | - Benedetta Bandini
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (R.P.); (S.C.); (S.D.S.); (B.B.); (A.L.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Alberto Lalli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (R.P.); (S.C.); (S.D.S.); (B.B.); (A.L.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Vincenzo Denaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; (R.P.); (S.C.); (S.D.S.); (B.B.); (A.L.); (V.D.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Rupp MC, Khan ZA, Dasari SP, Berthold DP, Siebenlist S, Imhoff AB, Chahla J, Pogorzelski J. Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptomatic State following Patellofemoral Inlay Arthroplasty for Visual Analog Scale Pain, Western Ontario and McMaster Universities Arthritis Index, and Lysholm Scores. J Arthroplasty 2023; 38:2580-2586. [PMID: 37286052 DOI: 10.1016/j.arth.2023.05.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The purposes of the study were to define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after patello-femoral inlay arthroplasty (PFA) and to identify factors predictive for the achievement of clinically important outcomes (CIOs). METHODS A total of 99 patients who underwent PFA between 2009 and 2019 and had a minimum of 2-year postoperative follow-up were enrolled in this retrospective monocentric study. Included patients had a mean age of 44 years (range, 21 to 79). The MCID and PASS were calculated using an anchor-based approach for the visual analog scale (VAS) pain, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Lysholm patient-reported outcome measures. Factors associated with CIO achievement were determined using multivariable logistic regression analyses. RESULTS The established MCID thresholds for clinical improvement were -2.46 for the VAS pain score, -8.5 for the WOMAC score, and + 25.4 for the Lysholm score. Postoperative scores corresponding to the PASS were <2.55 for the VAS pain score, <14.6 for the WOMAC score, and >52.5 points for the Lysholm score. Preoperative patellar instability and concomitant medial patello-femoral ligament reconstruction were independent positive predictors of reaching both MCID and PASS. Additionally, inferior baseline scores and age were predictive of achieving MCID, whereas superior baseline scores and body mass index were predictive of achieving PASS. CONCLUSION This study determined the thresholds of MCID and PASS for the VAS pain, WOMAC, and Lysholm scores following PFA implantation at 2-year follow-up. The study demonstrated a predictive role of patient age, body mass index, preoperative patient-reported outcome measure scores, preoperative patellar instability, and concomitant medial patello-femoral ligament reconstruction in the achievement of CIOs. LEVEL OF EVIDENCE Prognostic Level IV.
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Affiliation(s)
- Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Zeeshan A Khan
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Suhas P Dasari
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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9
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Longo UG, Papalia R, De Salvatore S, Casciaro C, Piergentili I, Bandini B, Lalli A, Franceschetti E, Denaro V. Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) of the Shoulder Disability Questionnaire (SDQ) in Patients Undergoing Rotator Cuff Repair. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5950. [PMID: 37297554 PMCID: PMC10252243 DOI: 10.3390/ijerph20115950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/13/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
The Shoulder Disability Questionnaire (SDQ) is a Patient-Reported Outcome Measure (PROM) applied to evaluate shoulder surgery outcomes. The purpose of this study is to identify the accurate Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB) and Patient Acceptable Symptom State (PASS) values for the SDQ score. A total of 35 patients (21 women and 16 men, mean age 76.6 ± 3.2 years) were followed up at 6 months postoperatively. To assess the patient's health satisfaction and symptoms, anchor questions were used. The MCID and SCB values of the SDQ score for patients who underwent arthroscopic rotator cuff repair from inception to final follow-up were 40.8 and 55.6, respectively. A change of 40.8 in the SDQ score at 6 months after surgery shows that patients achieved a minimum clinically important improvement in their state of health, and a 55.6 change in the SDQ score reflects a substantial clinically important improvement. The PASS cut-off of the SDQ score at 6 months postoperatively ranged from 22.5 to 25.8. If an SDQ score of 22.5 or more is attained after surgery, the health condition can be recognized as acceptable by the majority of patients. These cut-offs will help with understanding specific patient results and allow clinicians to personally assess patient improvement after rotator cuff repair.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Carlo Casciaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Ilaria Piergentili
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy
| | - Benedetta Bandini
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Alberto Lalli
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Edoardo Franceschetti
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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Longo UG, De Salvatore S, Borredon A, Manon KY, Marchetti A, De Marinis MG, Denaro V. The Effects of Sarcopenia on Hip and Knee Replacement Surgery: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:524. [PMID: 36984525 PMCID: PMC10058612 DOI: 10.3390/medicina59030524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
Sarcopenia is a progressive and generalized skeletal muscle disorder associated with poor outcomes and complications, including falls, fractures, physical disability, and death. The aim of this review is to assess the possible influence of sarcopenia on outcomes of sarcopenia in patients who underwent knee or hip replacement. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Medline, EMBASE, Scopus, CINAHL, and CENTRAL bibliographic databases were searched. General study characteristics extracted were: primary author and country, year of publication, type of study, level of evidence (LOE), sample size, mean age, gender, follow-up, type of surgery, diagnosis, and outcomes. At the final screening, five articles met the selection criteria and were included in the review. Sarcopenia influences the Barthel Index (BI), which is significantly lower compared to patients without sarcopenia, which indicates that the patient is subjected to a worsening of this condition that can influence their normal life since they will become dependent on someone else. No difference in mortality rate was found was found between the studies. This systematic review addressed the possible role of sarcopenia in patients undergoing joint replacement surgery. Despite the lack of high-quality literature on this topic, a general trend in considering sarcopenia as a negative factor for quality of life in joint replacement patients was reported. However, the lack of significant results means it is not possible to report useful conclusions.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
- Italy Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
- Italy Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Alessandro Borredon
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Khazrai Yeganeh Manon
- Unit of Food Science and Nutrition, Department of Science and Technology for Humans and the Environment, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
- Italy Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 00128 Rome, Italy
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11
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Longo UG, De Salvatore S, Intermesoli G, Pirato F, Piergentili I, Becker R, Denaro V. Metaphyseal cones and sleeves are similar in improving short- and mid-term outcomes in Total Knee Arthroplasty revisions. Knee Surg Sports Traumatol Arthrosc 2023; 31:861-882. [PMID: 35234976 DOI: 10.1007/s00167-022-06914-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this systematic review and metanalysis was to assess clinical and radiological outcomes of metaphyseal sleeves and cones and to identify their possible advantages and disadvantages. METHODS A comprehensive search from the inception of the databases to March 2021 was performed on Medline, Scopus, CINAHL, Cochrane, Embase, Ovid, and Google scholar databases. Coleman Methodology Score was used for quality assessment. Author, year of publication, type of study, level of evidence, sample size, number of patients, number of knees treated, mean age, gender, mean follow-up, clinical outcomes, complications, the reason for revision and, type of prosthesis were extracted for analysis. Clinical studies providing data about patient's outcomes after the primary and Total Knee Arthroplasty revision with the usage of sleeves or cones and a minimum of 2 years of follow-up were included. RESULTS The literature search and cross-referencing resulted in a total of 93 articles, but only 30 articles were appropriate for the systematic review. Comparable clinical results were reported between cones and sleeves. The meta-analysis showed a greater incidence of intraoperative fractures in patients treated with sleeves (1.6%, [95% CI 0.7; 3.4] in cones and 4.6%, [95% CI 3.3; 6.4] in sleeves, p = 0.01), while the risk of postoperative fractures (4.3%, [95% CI 2.7; 7] in cones and 2.1%, [95% CI 1.2; 3.5] in sleeves, p = 0.04) and infections (8.5%, [95% CI 6; 12] in cones and 3.7%, [95% CI 2.1; 7.3] in sleeves, p = 0.03) was higher with cones. CONCLUSION A higher incidence of intraoperative fracture was reported in patients treated with sleeves, while a higher rate of postoperative fractures and infections was described in patients treated with cones. Nonetheless, complications were reported in both groups. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Umile Giuseppe Longo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy. .,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Sergio De Salvatore
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giovanni Intermesoli
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Francesco Pirato
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Ilaria Piergentili
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Roland Becker
- Department of Orthopaedic and Traumatology, Brandenburg Medical School Theodor Fontane, Hochstrasse 29, 14770, Brandenburg/Havel, Germany
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery), Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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12
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Longo UG, De Salvatore S, Santamaria G, Indiveri A, Piergentili I, Salvatore G, De Marinis MG, Bandini B, Denaro V. Total Hip Replacement: Psychometric Validation of the Italian Version of Forgotten Joint Score (FJS-12). J Clin Med 2023; 12:jcm12041525. [PMID: 36836060 PMCID: PMC9966760 DOI: 10.3390/jcm12041525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND One million Total Hip Replacements (THA) are thought to be performed annually. To measure prosthesis awareness throughout daily activities, the FJS-12 patient-reported outcome scale was developed. This article's goal is to undertake a psychometric validation of the Italian FJS-12 among a sample of related THA patients. METHODS Between January and July 2019, data from 44 patients were retrieved. The participants were required to complete the Italian version of FJS-12 and of the WOMAC at preoperative follow-up, after two weeks, 1, 3, and 6 months postoperatively. RESULTS The Pearson correlation coefficient between the FJS-12 and WOMAC was 0.287 (p = 0.002) at preoperative follow-up, r = 0.702 (p < 0.001) at 1 month, r = 0.516 (p < 0.001) at 3 months and r = 0.585 (p < 0.001) at 6 months. The ceiling effect surpassed the acceptable range (15%) for FJS-12 in 1 month (25.5%) and WOMAC in 6 months follow-up (27.3%). CONCLUSIONS The psychometric validation of the Italian version of this score for THA was executed with acceptable results. FJS-12 and WOMAC reported no ceiling and floor effects. Therefore, to distinguish between patients who had good or exceptional results following UKA, the FJS-12 could be a reliable score. Under the first four months, FJS-12 had a smaller ceiling effect than WOMAC. It is recommended to use this score in clinical research concerning the outcomes of THA.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
- Correspondence: ; Tel.: +39-06-225411613; Fax: +39-06-225411638
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giulia Santamaria
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy
| | - Anna Indiveri
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giuseppe Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | | | - Benedetta Bandini
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
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13
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Brilliant ZR, Garvey MD, Haffner R, Chiu YF, Mayman DJ, Blevins JL. Unicompartmental Knee Arthroplasty Patients Have Lower Joint Awareness and Higher Function at 5 Years Compared to Total Knee Arthroplasties: A Matched Comparison. J Arthroplasty 2023:S0883-5403(23)00084-0. [PMID: 36764405 DOI: 10.1016/j.arth.2023.01.063] [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: 08/27/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate postoperative outcomes at minimum 5-year follow-up in patients following unicompartmental knee arthroplasty (UKA) compared to a matched cohort of total knee arthroplasty (TKA) patients. METHODS Patients who had primarily medial compartment osteoarthritis (OA) who met criteria for medial UKA underwent TKA or medial UKA between 2014 and 2015 at a single institution, matched for age, sex, and body mass index. There were 127 UKAs in 120 patients and 118 TKAs in 116 patients included with minimum 5-year follow-up (range, 6 to 8). Mean age was 69 years (range, 59 to 79) and 71 years (range, 62 to 80) in the UKA and TKA groups, respectively (P = .049). RESULTS Patients who underwent UKA had significantly higher mean (±SD) Forgotten Joint Scores (87 ± 20 versus 59 ± 34, P < .001); higher Knee Society Scores (88 ± 14 versus 75 ± 21, P < .001); and lower Numeric Pain Rating Scores (0.8 ± 1.6 versus 1.9 ± 2.2, P < .001). Survivorship free from all-cause revision was 96% (95% CI = 93%-99%) and 99% (95% CI = 97%-100%) at 5 years for TKA and UKA, respectively (P = .52). There were 8 both component revisions in the TKA group within 5 years from the date of surgery and 2 UKA conversions to TKA after 5-year follow-up. CONCLUSION Patients who have medial compartment OA and underwent UKA had significantly lower joint awareness, decreased pain, improved function, and higher satisfaction compared to matched TKA patients at minimum 5-year follow-up while maintaining excellent survivorship.
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Affiliation(s)
- Zachary R Brilliant
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York; University of Maryland School of Medicine, Baltimore, Maryland
| | - Matthew D Garvey
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Rowan Haffner
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Jason L Blevins
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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14
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Singh V, Fiedler B, Huang S, Oh C, Karia RJ, Schwarzkopf R. Patient Acceptable Symptom State for the Forgotten Joint Score in Primary Total Knee Arthroplasty. J Arthroplasty 2022; 37:1557-1561. [PMID: 35346809 DOI: 10.1016/j.arth.2022.03.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In order to better understand the clinical benefits of total knee arthroplasty (TKA) and improve the interpretability of the Forgotten Joint Score (FJS-12), the establishment of a meaningful change in score is necessary. The purpose of this study is to determine the threshold of the FJS-12 for detecting the patient acceptable symptom state (PASS) following primary TKA. METHODS We retrospectively reviewed all patients who underwent elective, primary TKA and answered both the FJS-12 and the Knee Injury Osteoarthritis Outcome Survey, Joint Replacement KOOS, JR surveys 1-year postoperatively. The questionnaires were administered via a web-based electronic application. KOOS, JR score was used as the anchor. The anchor for PASS calculation should relate pain, physical function, and patient satisfaction. Two statistical methods were employed: (1) the receiver operating characteristic (ROC) curve point; (2) 75th percentile of the cumulative percentage curve of patients who had the KOOS, JR score difference larger than the cut-off value. RESULTS This study included 457 patients. The mean 1-year FJS-12 score was 42.6 ± 27.8. The mean 1-year KOOS, JR score was 68.0 ± 17.2. A high positive correlation between FJS-12 and KOOS, JR was found (r = 0.72, P < .001) making the KOOS, JR a valid external anchor. The threshold score of the FJS-12 which maximized the sensitivity and specificity for detecting a PASS was 33.3 (AUC = 0.78, 95% CI [0.74, 0.83]). The cut-off value computed with the 75th percentile approach was 77.1 (95% CI [73.9, 81.5]). CONCLUSION The PASS threshold for the FJS-12 was 33.3 and 77.1 at 1-year follow-up after primary TKA using the receiver operating characteristic (ROC) curve and 75th percentile approaches, respectively. These values can be used to assess the successful achievement of a forgotten joint. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Benjamin Fiedler
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Shengnan Huang
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Cheongeun Oh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Raj J Karia
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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15
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Orr MN, Klika AK, Emara AK, Piuzzi NS. Combinations of Preoperative Patient-Reported Outcome Measure Phenotype (Pain, Function, and Mental Health) Predict Outcome After Total Knee Arthroplasty. J Arthroplasty 2022; 37:S110-S120.e5. [PMID: 35240283 DOI: 10.1016/j.arth.2022.02.090] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Value-driven healthcare models prioritize patient-perceived benefits to quantify the quality of care through patient-reported outcome measures (PROMs). The Patient Acceptable Symptom State (PASS) is the highest level of symptom beyond which a patient considers his/her condition satisfactory. We identified preoperative phenotypes of PROMs associated with not achieving PASS at 1 year following total knee arthroplasty (TKA) and explored the relationships between such phenotypes with hospital utilization parameters. METHODS A prospective institutional cohort of 5,274 primary TKAs for osteoarthritis from 2016 to 2019 with 1-year follow-up were included. Preoperative scores on Knee Disability and Osteoarthritis Outcome Score (KOOS) Pain, KOOS-Physical function Short form (PS), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were used to develop patient phenotypes. Associations between preoperative "phenotype" and 1-year PASS, discharge disposition, length of stay, 90-day readmission, and 1-year reoperation were evaluated using multivariate regression. RESULTS In total, 16.3% (n = 862) of patients reported their state as "not acceptable" at 1 year. A combination of low scores in each of the presently examined PROMs was associated with the highest odds of 1-year dissatisfaction (odds ratio 2.18, 95% confidence interval 1.74-2.74). The PROM phenotypes were the greatest drivers compared to sociodemographic variables in predicting satisfaction. Combinations of low scores in VR-12 MCS and KOOS-PS were significantly associated with both non-home discharge status and prolonged length of stay. CONCLUSION Patients with combined lower preoperative scores across multiple PROMs (KOOS-Pain <41.7, KOOS-PS <51.5, and VR-12 MCS <52.8) have increased odds of dissatisfaction after TKA. Measuring pain, function, and mental health concurrently as phenotypes may help identify TKA patients at risk for not achieving a satisfactory outcome at 1 year.
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Affiliation(s)
- Melissa N Orr
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
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16
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Singh V, Bieganowski T, Huang S, Karia R, Davidovitch RI, Schwarzkopf R. The Forgotten Joint Score patient-acceptable symptom state following primary total hip arthroplasty. Bone Jt Open 2022; 3:307-313. [PMID: 35387474 PMCID: PMC9044089 DOI: 10.1302/2633-1462.34.bjo-2022-0010.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The Forgotten Joint Score-12 (FJS-12) is a validated patient-reported outcome measure (PROM) tool designed to assess artificial prosthesis awareness during daily activities following total hip arthroplasty (THA). The patient-acceptable symptom state (PASS) is the minimum cut-off value that corresponds to a patient’s satisfactory state-of-health. Despite the validity and reliability of the FJS-12 having been previously demonstrated, the PASS has yet to be clearly defined. This study aims to define the PASS of the FJS-12 following primary THA. Methods We retrospectively reviewed all patients who underwent primary elective THA from 2019 to 2020, and answered both the FJS-12 and the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) questionnaires one-year postoperatively. HOOS, JR score was used as the anchor to estimate the PASS of FJS-12. Two statistical methods were employed: the receiver operating characteristic (ROC) curve point, which maximized the Youden index; and 75th percentile of the cumulative percentage curve of patients who had the HOOS, JR score difference larger than the cut-off value. Results This study included 780 patients. The mean one-year FJS-12 score was 65.42 (SD 28.59). The mean one-year HOOS, JR score was 82.70 (SD 16.57). A high positive correlation between FJS-12 and HOOS, JR was found (r = 0.74; p<0.001), making the HOOS, JR a valid external anchor. The threshold score of the FJS-12 that maximized the sensitivity and specificity for detecting a PASS was 66.68 (area under the curve = 0.8). The cut-off score value computed with the 75th percentile approach was 92.20. Conclusion The PASS threshold for the FJS-12 at one year following primary THA was 66.68 and 92.20 using the ROC curve and 75th percentile approaches, respectively. These values can be used to achieve consensus about meaningful postoperative improvement to maximize the utility of the FJS-12 to evaluate and counsel patients undergoing THA. Cite this article: Bone Jt Open 2022;3(4):307–313.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Shengnan Huang
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Raj Karia
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Roy I. Davidovitch
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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17
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Itou J, Kuwashima U, Itoh M, Okazaki K. Perioperative varus alignment does not affect short-term patient-reported outcome measures following mobile-bearing unicompartmental knee arthroplasty. J Orthop Surg Res 2022; 17:98. [PMID: 35168658 PMCID: PMC8848965 DOI: 10.1186/s13018-022-02999-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Although favorable long-term survival of Oxford unicompartmental knee arthroplasty (UKA) has been reported regardless of postoperative varus alignment, the effect of degree of varus alignment on patient-reported outcome measures (PROMs) remains unclear. Furthermore, the Forgotten Joint Score-12 (FJS-12), which has a low ceiling effect, may be useful for such assessment. The objective of this study was to evaluate short-term clinical outcomes after Oxford UKA in knees with a greater degree of preoperative varus alignment focusing on use of the FJS-12. Methods This retrospective study involved 66 knees that had undergone primary Oxford UKA. Based on the hip-knee-ankle angle, the knees were divided into two alignment groups: severe varus group (≥ 185° varus alignment) and a mild varus group (< 185° varus alignment). PROMs, including the FJS-12, Knee Injury and Osteoarthritis Outcome Score, and Knee Society Score, were obtained pre- and postoperatively for assessment of clinical outcomes. In addition, the ceiling effect of the FJS-12 was evaluated. Results All PROMs showed significant improvement after surgery. However, there were no statistically significant differences between the severe varus group and the mild varus group. Moreover, no ceiling effect was found for the FJS-12 in this study. Conclusion Short-term results were good for Oxford UKA in knees with a greater degree of varus alignment and were not significantly different from those in knees with mild varus alignment.
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Affiliation(s)
- Junya Itou
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masafumi Itoh
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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18
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HEIJBEL S, W-DAHL A, NILSSON KG, HEDSTRÖM M. Substantial clinical benefit and patient acceptable symptom states of the Forgotten Joint Score 12 after primary knee arthroplasty. Acta Orthop 2022; 93:158-163. [PMID: 34984472 PMCID: PMC8815411 DOI: 10.2340/17453674.2021.887] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Knowing how to interpret values obtained with patient reported outcome measures (PROMs) is essential. We estimated the substantial clinical benefit (SCB) and patient acceptable symptom state (PASS) for Forgotten Joint Score 12 (FJS) and explored differences depending on methods used for the estimates. Patients and methods - The study was based on 195 knee arthroplasties (KA) performed at a university hospital. We used 1 item from the Knee injury and Osteoarthritis Outcome Score domain quality of life and satisfaction with surgery, obtained 1-year postoperatively, to assess SCB and PASS thresholds of the FJS with anchor-based methods. We used different combinations of anchor questions for SCB and PASS (satisfied, satisfied with no or mild knee difficulties, and satisfied with no knee difficulties). A novel predictive approach and receiver-operating characteristics curve were applied for the estimates. Results - 70 and 113 KAs were available for the SCB and PASS estimates, respectively. Depending on method, SCB of the FJS (range 0-100) was 28 (95% CI 21-35) and 22 (12-45) respectively. PASS was 31 (2-39) and 20 (10-29) for satisfied patients, 40 (31-47) and 38 (32-43) for satisfied patients with no/mild difficulties, and 76 (39-80) and 64 (55-74) for satisfied patients with no difficulties. The areas under the curve ranged from 0.82 to 0.88. Interpretation - Both the SCB and PASS thresholds varied depending on methodology. This may indicate a problem using meaningful values from other studies defining outcomes after KA. This study supports the premise of the FJS as a PROM with good discriminatory ability in patients undergoing KA.
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Affiliation(s)
- Siri HEIJBEL
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm
| | - Annette W-DAHL
- Orthopedics, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Department of Orthopedics, Lund,The Swedish Knee Arthroplasty Register
| | - Kjell G NILSSON
- Department of Surgical and Perioperative Sciences, Orthopedics, Umeå University, Umeå
| | - Margareta HEDSTRÖM
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Trauma & Reparative Medicine Theme, Karolinska University Hospital Huddinge, Stockholm, Sweden
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19
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Longo UG, Berton A, De Salvatore S, Piergentili I, Casciani E, Faldetta A, De Marinis MG, Denaro V. Minimal Clinically Important Difference and Patient Acceptable Symptom State for the Pittsburgh Sleep Quality Index in Patients Who Underwent Rotator Cuff Tear Repair. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168666. [PMID: 34444415 PMCID: PMC8391581 DOI: 10.3390/ijerph18168666] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 12/22/2022]
Abstract
The Pittsburgh Sleep Quality Index (PSQI) is a valid patient-reported outcome measure developed to assess sleep quality and disturbances in clinical populations. This study aimed to calculate the minimum clinically important difference (MCID) and the patient acceptable symptom state (PASS) for the PSQI in patients who underwent rotator cuff repair (RCR). Preoperative and six-month postoperative follow-up questionnaires were completed by 50 patients (25 males and 25 females, mean age 58.7 ± 11.1 years). The MCID of the PSQI was calculated using distribution-based and anchor methods. To calculate the PSQI’s PASS, the 75th percentile approach and the receiver operating characteristic (ROC) curve were used. The MCID from preoperative to 6 months postoperative follow-up is 4.4. Patients who improved their PSQI score of 4.4 from baseline to 6 months follow-up had a clinically significant increase in their health status. The PASS is 5.5 for PSQI; therefore, a value of PSQI at least 5.5 at six months follow-up indicates that the symptom state can be considered acceptable by most patients.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
- Correspondence: ; Tel.: +39-06-225411613
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
| | - Ilaria Piergentili
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
| | - Erica Casciani
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (E.C.); (A.F.); (M.G.D.M.)
| | - Aurora Faldetta
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (E.C.); (A.F.); (M.G.D.M.)
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, 00128 Rome, Italy; (E.C.); (A.F.); (M.G.D.M.)
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, Trigoria, 00128 Rome, Italy; (A.B.); (S.D.S.); (I.P.); (V.D.)
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