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Kamenova M, Li E, Soleman J, Fiebig O, Mehrkens A, Schaeren S. Posterior stabilization with polyetheretherketone (PEEK) rods and transforaminal lumbar interbody fusion (TLIF) with titanium rods for single-level lumbar spine degenerative disease in patients above 70 years of age. Arch Orthop Trauma Surg 2022; 143:2831-2843. [PMID: 35511354 DOI: 10.1007/s00402-022-04448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/09/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Given the lack of guidelines regarding the operative management of elderly patients needing lumbar spine fusion for degenerative disease, it is often difficult to balance between invasiveness respecting the fragile spine and geriatric comorbidities. AIM To compare reoperation rates and clinical outcome in patients above 70 years of age undergoing Transforaminal Lumbar Interbody Fusion (TLIF) with titanium rods or posterior stabilization with Polyetheretherketone (PEEK) rods for the treatment of one-level lumbar spine degenerative disease. METHODS Retrospective review of baseline characteristics, reoperation rates as well as the clinical and radiological outcomes of patients, older than 70 years, undergoing posterolateral fusion with PEEK rods (n = 76, PEEK group) or TLIF with titanium rods (n = 67, TLIF group) for a single-level lumbar degenerative disease from 2014 to 2020. Additional subanalysis on the patients above 80 years of age was performed. RESULTS Our results showed similar reoperation rates and outcomes in the TLIF and PEEK groups. However, intraoperative blood loss, administration of tranexamic acid, and operation time were significantly higher in the TLIF group. In patients older than 80 years, reoperation rates at first follow-up were significantly higher in the TLIF group, too. CONCLUSION According to our results, posterior stabilization with PEEK rods is less invasive and was associated with significantly lower blood loss, administration of blood products and shorter operation time. Moreover, in patients above 80 years of age reoperations rates were lower with PEEK rods, as well. Nevertheless, the benefits of PEEK rods for foraminal stenosis still have to be investigated.
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Affiliation(s)
- M Kamenova
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland. .,Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
| | - E Li
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland.,Department of Orthopedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
| | - J Soleman
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - O Fiebig
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland
| | - A Mehrkens
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland
| | - S Schaeren
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4051, Basel, Switzerland
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Gryadunova A, Kasamkattil J, Gay M, Dasen B, Pelttari K, Mironov V, Martin I, Schaeren S, Barbero A, Krupkova O, Mehrkens A. Spheroids derived from human nasal chondrocytes for nucleus pulposus repair. Cytotherapy 2021. [DOI: 10.1016/s1465324921002930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kamenova M, Schaeren S, Wasner MG. Intradural extraarachnoid sutureless technique combined with laminoplasty for indirect repair of ventral dural defects in spontaneous intracranial hypotension: technical note and case series. Acta Neurochir (Wien) 2021; 163:2551-2556. [PMID: 33963904 PMCID: PMC8357649 DOI: 10.1007/s00701-021-04868-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is a significant variance in surgical treatment strategies of ventral cerebrospinal fluid (CSF) leaks causing spontaneous intracranial hypotension (SIH). Posterior approaches might represent a preferable alternative to the more invasive anterior and lateral routes, as long as the spinal cord is not exposed to harmful manipulation. The aim of this technical note is to report and illustrate a new surgical technique using an intradural extraarachnoid sutureless technique via laminoplasty for indirect repair of ventral CSF leaks causing intractable SIH symptoms. METHODS The surgical technique is described in a step by step fashion. Between May 2018 and May 2020, five patients with ventral spinal CSF leaks were operated on, utilizing this technique. All dural defects were located at the level of the thoracic spine. A retrospective review on demographic and radiological findings, symptoms, outcome, and follow-up was performed. RESULTS The intra- and postoperative course was uneventful in all patients with no surgery-related complications. Three patients recovered completely at discharge, while neurological symptoms significantly improved in two patients. A postoperative MRI of the spine was obtained for all patients, demonstrating regressive signs of CSF leak. CONCLUSION Based on the presented case series, this intradural extraarachnoid sutureless technique combined with laminoplasty seems to be a safe and effective option for indirect repair of ventral dural defects in SIH. In our opinion, it represents a valid alternative to traditional more aggressive approaches.
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Affiliation(s)
- M. Kamenova
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - S. Schaeren
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - M-G. Wasner
- Department of Spine Surgery, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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Gay MH, Mehrkens A, Rittmann M, Haug M, Barbero A, Martin I, Schaeren S. Nose to back: compatibility of nasal chondrocytes with environmental conditions mimicking a degenerated intervertebral disc. Eur Cell Mater 2019; 37:214-232. [PMID: 30900738 DOI: 10.22203/ecm.v037a13] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Nasal chondrocytes (NCs) have gained increased recognition for cartilage tissue regeneration. To assess NCs as a source for cell therapy treatment of intervertebral disc (IVD) degeneration, tissue-forming properties of NCs under physiological conditions mimicking the degenerated IVD were compared to those of mesenchymal stromal cells (MSCs) and articular chondrocytes (ACs), two cell sources presently used in clinical trials. Cells were cultured in a combination of low glucose, hypoxia, acidity and inflammation for 28 d. Depending on the conditions, cells were either cultured in the absence of instructive growth factors or underwent chondrogenic instructional priming by addition of transforming growth factor β1 (TGFβ1) for the first 7 d. Histology, immunohistochemistry, biochemistry, enzyme-linked immunosorbent assay (ELISA) and quantitative real-time reverse transcriptase-polymerase chain reaction (qRT-PCR) analyses demonstrated limited cell maintenance and accumulation of cartilaginous extracellular matrix for MSCs in IVD conditions. ACs maintained a steady accumulation of glycosaminoglycans (GAGs) throughout all non-acidic conditions, with and without priming, but could not synthesise type II collagen (Col2). NCs accumulated both GAGs and Col2 in all non-acidic conditions, independent of priming, whereas MSCs strongly diminished their GAG and Col2 accumulation in an inflamed environment. Supplementation with inflammatory cytokines or an acidic environment affected NCs to a lower extent than ACs or MSCs. The data, overall indicating that in an inflamed IVD environment NCs were superior to ACs and MSCs, encourage further assessment of NCs for treatment of degenerative disc disease.
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Affiliation(s)
| | | | | | | | - A Barbero
- University of Basel, Hebelstrasse 20, 4031 Basel,
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Kamenovam M, Leu S, Schaeren S, Mariani L, Soleman J. Management of Incidental Dural Tear during Lumbar Spine Surgery. To Suture or Not To Suture? J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Suhm N, Rikli D, Schaeren S, Studer P, Jakob M, Kates SL. Recent aspects on outcomes in geriatric fracture patients. Osteoporos Int 2010; 21:S523-8. [PMID: 21057991 DOI: 10.1007/s00198-010-1397-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 09/03/2010] [Indexed: 11/30/2022]
Abstract
As the population ages, the number of fragility fractures is expected to increase dramatically. These injuries are frequently associated with less than satisfactory outcomes. Many of the patients experience adverse events or death, and few regain their pre-injury functional status. Many also lose their independence as a result of their fracture. This manuscript will explore problems and some potential solutions to evaluate the outcomes of geriatric fracture care. Specific, system-wide, and societal concerns will be discussed. Limited suggestions will be made for future steps to improve outcomes assessments.
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Affiliation(s)
- N Suhm
- Basel University Hospital, Basel, Switzerland.
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Bocelli-Tyndall C, Bracci L, Schaeren S, Feder-Mengus C, Barbero A, Tyndall A, Spagnoli GC. Human bone marrow mesenchymal stem cells and chondrocytes promote and/or suppress the in vitro proliferation of lymphocytes stimulated by interleukins 2, 7 and 15. Ann Rheum Dis 2009; 68:1352-9. [PMID: 18647856 DOI: 10.1136/ard.2008.094003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate whether human bone marrow-derived mesenchymal stem cells (BM-MSCs) and articular chondrocytes (ACs) affect the in vitro proliferation of T lymphocytes and peripheral blood mononuclear cells (PBMCs) driven by the homeostatic interleukin (IL)2, IL7 and IL15 cytokines binding to the common cytokine receptor gamma-chain (gamma(c)) in the absence of T cell receptor (TCR) triggering. METHODS PBMCs, total T cells and T cell subsets (CD4+ and CD8+) were stimulated with IL2, IL7 or IL15 and exposed to cultured BM-MSCs and ACs at varying cell:cell ratio either in contact or in transwell conditions. Lymphocyte proliferation was measured by (3)H-thymidine uptake or by flow cytometry of carboxyfluorescein succinimidyl ester (CFSE)-labelled lymphocytes. RESULTS MSCs and ACs enhanced and inhibited lymphocyte proliferation depending on the extent of lymphocyte baseline proliferation and on the MSC/AC to lymphocyte ratio. Enhancement was significant on poorly proliferating lymphocytes and mostly at lower MSC/AC to lymphocyte ratio. Suppression occurred only on actively proliferating lymphocytes and at high MSC/AC to lymphocyte ratio. Neither enhancement nor inhibition required cell-cell contact. CONCLUSIONS There is a dichotomous effect of MSCs/ACs on lymphocytes proliferating in response to the homeostatic IL2, IL7 and IL15 cytokines likely to be encountered in homeostatic and autoimmune inflammatory conditions. The effect is determined by baseline lymphocyte proliferation, cell:cell ratio and is dependent on soluble factor(s). This should be taken into account when planning cellular therapy for autoimmune disease (AD) using stromal-derived cells such as MSCs.
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Affiliation(s)
- C Bocelli-Tyndall
- Institute of Surgical Research and Hospital Management and Department of Biomedicine, University Hospital Basel, Basel, Switzerland.
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Majewski M, Schaeren S, Kohlhaas U, Ochsner PE. Postoperative rehabilitation after percutaneous Achilles tendon repair: Early functional therapy versus cast immobilization. Disabil Rehabil 2009; 30:1726-32. [DOI: 10.1080/09638280701786831] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Haller P, Bruderer T, Schaeren S, Laifer G, Frei R, Battegay M, Flückiger U, Bassetti S. Vertebral osteomyelitis caused by Actinobaculum schaalii: a difficult-to-diagnose and potentially invasive uropathogen. Eur J Clin Microbiol Infect Dis 2007; 26:667-70. [PMID: 17618471 DOI: 10.1007/s10096-007-0345-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report the first case of vertebral osteomyelitis caused by Actinobaculum schaalii and review all cases of A. schaalii identified at our institution between 2002 and 2005. A. schaalii causes urinary tract infections - especially in elderly people - occasionally with septic complications.
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Affiliation(s)
- P Haller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
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Goldhahn J, Neuhoff D, Schaeren S, Steiner B, Linke B, Aebi M, Schneider E. Osseointegration of hollow cylinder based spinal implants in normal and osteoporotic vertebrae: a sheep study. Arch Orthop Trauma Surg 2006; 126:554-61. [PMID: 16865404 DOI: 10.1007/s00402-006-0185-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Osteoporosis is not only responsible for an increased number of metaphyseal and spinal fractures but it also complicates their treatment. To prevent the initial loosening, we developed a new implant with an enlarged implant/bone interface based on the concept of perforated, hollow cylinders. We evaluated whether osseointegration of a hollow cylinder based implant takes place in normal or osteoporotic bone of sheep under functional loading conditions during anterior stabilization of the lumbar spine. MATERIALS AND METHODS Osseointegration of the cylinders and status of the fused segments (ventral corpectomy, replacement with iliac strut, and fixation with testing implant) were investigated in six osteoporotic (age 6.9 +/- 0.8 years, mean body weight 61.1 +/- 5.2 kg) and seven control sheep (age 6.1 +/- 0.2 years, mean body weight 64.9 +/- 5.7 kg). Osteoporosis was introduced using a combination protocol of ovariectomy, high-dose prednisone, calcium and phosphor reduced diet and movement restriction. Osseointegration was quantified using fluorescence and conventional histology; fusion status was determined using biomechanical testing of the stabilized segment in a six-degree-of-freedom loading device as well as with radiological and histological staging. RESULTS Intact bone trabeculae were found in 70% of all perforations without differences between the two groups (P = 0.26). Inside the cylinders, bone volume/total volume was significantly higher than in the control vertebra (50 +/- 16 vs. 28 +/- 13%) of the same animal (P<0.01), but significantly less (P<0.01) than in the near surrounding (60 +/- 21%). After biomechanical testing as described in Sect. "Materials and methods", seven spines (three healthy and four osteoporotic) were classified as completely fused and six (four healthy and two osteoporotic) as not fused after a 4-month observation time. All endplates were bridged with intact trabeculae in the histological slices. CONCLUSIONS The high number of perforations, filled with intact trabeculae, indicates an adequate fixation; bridging trabeculae between adjacent endplates and tricortical iliac struts in all vertebrae indicates that the anchorage is adequate to promote fusion in this animal model, even in the osteoporotic sheep.
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Affiliation(s)
- J Goldhahn
- AO Research Institute Davos, Davos, Switzerland.
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Huegli RW, Schaeren S, Jacob AL, Martin JB, Wetzel SG. Percutaneous cervical vertebroplasty in a multifunctional image-guided therapy suite: hybrid lateral approach to C1 and C4 under CT and fluoroscopic guidance. Cardiovasc Intervent Radiol 2006; 28:649-52. [PMID: 16010512 DOI: 10.1007/s00270-004-0159-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 76-year-old patient suffering from two painful osteolytic metastases in C1 and C4 underwent percutaneous vertebroplasty by a hybrid technique in a multi-functional image-guided therapy suite (MIGTS). Two trocars were first placed into the respective bodies of C1 and C4 under fluoroscopic computed tomography guidance using a lateral approach. Thereafter, the patient was transferred on a moving table to the digital subtraction angiography unit in the same room for implant injection. Good pain relief was achieved by this minimally invasive procedure without complications. A hybrid approach for vertebroplasty in a MIGTS appears to be safe and feasible and might be indicated in selected cases for difficult accessible lesions.
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Affiliation(s)
- R W Huegli
- Department of Radiology, University Hospital of Basel, Basel, Switzerland.
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Schaeren S, Bischoff-Ferrari HA, Knupp M, Dick W, Huber JF, Theiler R. A computer touch-screen version of the North American Spine Society outcome assessment instrument for the lumbar spine. ACTA ACUST UNITED AC 2005; 87:201-4. [PMID: 15736743 DOI: 10.1302/0301-620x.87b2.15548] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We validated the North American Spine Society (NASS) outcome-assessment instrument for the lumbar spine in a computerised touch-screen format and assessed patients' acceptance, taking into account previous computer experience, age and gender. Fifty consecutive patients with symptomatic and radiologically-proven degenerative disease of the lumbar spine completed both the hard copy (paper) and the computerised versions of the NASS questionnaire. Statistical analysis showed high agreement between the paper and the touch-screen computer format for both subscales (intraclass correlation coefficient 0.94, 95% confidence interval (0.90 to 0.97)) independent of computer experience, age and gender. In total, 55% of patients stated that the computer format was easier to use and 66% preferred it to the paper version (p < 0.0001 among subjects expressing a preference). Our data indicate that the touch-screen format is comparable to the paper form. It may improve follow-up in clinical practice and research by meeting patients' preferences and minimising administrative work.
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Affiliation(s)
- S Schaeren
- The University Hospital, Basel, Switzerland.
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Schaeren S, Roth J, Dick W. [Effective in vivo radiation dose with image reconstruction controlled pedicle instrumentation vs. CT-based navigation]. Orthopade 2002; 31:392-6. [PMID: 12056281 DOI: 10.1007/s00132-001-0281-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED There is a rapid increase of computer-assisted surgery (CAS) in the spine for insertion of pedicle screws. In contrast to the traditional technique using fluoroscopy, CT is the primary source for surgical navigation systems. PURPOSE OF THE STUDY To compare organ and effective doses of fluoroscopy-controlled versus computer-assisted pedicle screw insertion under the aspect of risk reduction and number needed to treat. MATERIALS AND METHODS In 20 consecutive cases of traditional pedicle screw instrumentation under fluoroscopic control the effective doses were recorded in vivo and the organ doses then calculated. Simulating a spiral CT necessary for the 3-D-model for navigation we defined a spiral CT protocol for the instrumented levels and calculated organ and effective doses from Monte Carlo Results from CT examinations. RESULTS Organ doses were clearly higher for the CT model than in any of the fluoroscopic procedures in vivo. The mean effective dose for the CT model was fifteen times higher than the fluoroscopic dose: 7.27 mSv versus 0.48 mSv. CONCLUSIONS In experienced hands open pedicle screw insertion in the thoracic and lumbar spine using fluoroscopy-control requires a fifteen times lower radiation dose than do CT scans necessary for computer-assisted surgery. Regarding the published small percentage of neurological complications in traditional screw insertion technique the use of computer-assisted surgery in pedicle screw insertion using CT scan should be limited to carefully chosen indications. The development of navigation systems based on other data sources than CT should be encouraged.
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Affiliation(s)
- S Schaeren
- Orthopädische Universitätsklinik, Felix-Platter-Spital, CH-4012 Basel, Schweiz.
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Theiler R, Sangha O, Schaeren S, Michel BA, Tyndall A, Dick W, Stucki G. Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities. Osteoarthritis Cartilage 1999; 7:515-9. [PMID: 10558848 DOI: 10.1053/joca.1999.0262] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a questionnaire format of the Lequesne-Algofunctional Index in patients with OA of the lower extremities. METHODS Longitudinal analysis of the instruments' responsiveness [standardized response mean (SRM), effect size (ES)] in ambulatory patients undergoing hip or knee arthroplasty. RESULTS At six months 36, and at one year 40 out of 43 patients undergoing hip (N=30) or knee arthroplasty (N=13) could be examined. Both responsiveness statistics revealed the same order of responsiveness. For both indices and for both locations, the pain sections were more responsive than the function sections. However, the WOMAC scales and the WOMAC global index (hip at 12 months: SRM=2.4; knee at 12 months: SRM=2.0 ) were more responsive than the comparable Lequesne sections and Lequesne index (hip at 12 months: SRM=2.1; knee at 12 months: SRM=1.5). CONCLUSIONS Although our results are based on a German version using a self-report format, the WOMAC scales appear to be more responsive than the Lequesne index in patients with OA of the lower extremities.
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Affiliation(s)
- R Theiler
- The Clinic of Rheumatology, Aarau General Hospital, Aarau, Switzerland
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