Purpose of Study: This study was done to assess the efficacy of EQ5D (EuroQol), a simple quality of life (QOL) score. The study was designed to test the feasibility and reliability of using this simple QOL score alongside Constant score following arthroscopic shoulder surgery. Though Constant score gives a shoulder related outcome it does not provide a patient perspective of outcome in relation to their quality of life. Methodology: A prospective cohort study of 100 consecutive patients listed for arthroscopic shoulder surgery between May and December 2005 were recruited. Assessments were undertaken both preoperatively and at 6 months post operatively. EuroQol is a simple 5 question self administered questionnaire and the Constant score was recorded by the treating physician who was blinded to the result of the EuroQol. Data was assessed for normality and non parametric tests were used. Statistical significance was assumed at the p< 0.05 level. Results: The median age of 54 years (32 to 79). 60% were male. The median pre operative EuroQol score was 0.26 with a median post operative score of 0.71. Preoperatively, the median constant score was 31.0 with a postoperative score of 72.0 The difference between pre and post operative scores in both the EuroQol and Constant scores was shown to be statistically significant (p< 0.0001 in each group). In the 200 paired observations the two scores were also shown to be closely correlated RS statistic 0.71 (p< 0.0001). Conclusion: EQ5D is easily completed by the patient by a self administered questionnaire and reflects the quality of life improvement attained after shoulder surgery. It is very easy to use compared to other available QOL scores like SF12, SF36. We recommend its routine usage along with Constant Shoulder score as there is a strong positive correlation

Introduction. Chronic ankle instability is a common condition that can be effectively treated with arthroscopic lateral ankle ligament reconstruction to restore ankle stability and function. The aim of this study was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the MOXFQ, VAS, and EQ5D patient-reported outcome measures (PROMs). Methods. This prospective series included 38 patients who underwent arthroscopic lateral ligament reconstruction for chronic ankle instability between December 2019 and April 2022. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, as well as at6, and 12 months postoperatively. The MOXFQ is a disease-specific PROM that assesses foot and ankle function, while the VAS measures pain and the EQ5D evaluates health-related quality of life. Results. At the 12-month follow-up, the mean MOXFQ Index score had improved significantly from 53.3 ± 23.1 preoperatively to 16.0 ±21.1 (p < 0.001). Similarly, the mean VAS score had improved from 36.2 ± 22.4 preoperatively to 14.7 ± 15.0 (p < 0.001), and the meanEQ5D score had improved from 0.55 ± 0.26 preoperatively to 0.87 ± 0.12 (p < 0.001). No major complications were observed. Conclusion. Arthroscopic lateral ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes

Objectives. Acetabular fractures with quadrilateral plate involvement have been shown to have a high rate of complications. Anatomic suprapectineal plating systems have been developed to manage these injuries with good short-term outcomes, however long-term maintenance of anatomical reduction and functional outcomes is yet to be established. Efficacy of maintenance of reduction and functional outcomes at a minimum of 5-years follow-up is the aim of this study. Design and Methods. A retrospective cohort study examining patients aged over 16 years following fixation of acetabular fractures with quadrilateral plate involvement at a trauma centre in the United Kingdom. All patients had acetabular fracture fixation with an anatomically designed suprapectineal plate. Patients were admitted from March 2014 to January 2017. Primary outcomes included objective radiological outcomes such as reduction quality, maintenance of reduction, metalwork failure, complications (such as reoperation, neurological deficit and mortality) and subjective patient-related outcome measures (PROMs) using the Oxford Hip Score and EuroQol EQ5D Score at a minimum of 5-years post-operatively. Results. 16 patients met our eligibility criteria in this cohort. Post-operative mean Oxford Hip Score (OHS) at a minimum of 5-years was 40.5 (SD 11.9) with a median score of 45. Post-operative mean EuroQol EQ-5D scores at a minimum of 5-years were 0.83 (SD 0.25). Comparison of OHS and EQ5D at 1-year and 5-years showed no significant difference (OHS p = 0.27 / EQ5D p = 0.128). Radiographic outcomes were assessed with AP and Judet plain radiographs at a minimum of 5-years follow-up. Rate of conversion to total hip replacement was 6.25%. 56.3% showed some evidence of dome comminution with 18.8% demonstrating dome impaction. 93.7% showed evidence of quadrilateral plate involvement. 12.5% showed evidence of femoral head injury. Conclusion. Maintenance of reduction and functional and patient reported outcomes using anatomically contoured suprapectineal plates do not change significantly between 1 year and 5 years follow-up

The aim of this study was to evaluate the long-term outcomes of patients who had sustained an unstable ankle fracture with a posterior malleolus fracture (PMF) and without (N-PMF). Adult patients presenting to a single academic trauma centre in Edinburgh, UK, between 2009 and 2012 with an unstable ankle fracture requiring surgery were identified. The primary outcome measure was the Olerud Molander Ankle Score (OMAS). Secondary measures included Euroqol-5D-3L Index (Eq5D3L), Euroqol-5D-VAS and Manchester Oxford Foot Questionnaire (MOXFQ). There were 304 patients in the study cohort. The mean age was 49.6 years (16.3–78.3) and 33% (n=100) male and 67% (n=204) female. Of these, 67% (n=204) had a PMF and 33% did not (n=100). No patient received a computed tomography (CT) scan pre-operatively. Only 10% of PMFs (22/204) were managed with internal fixation. At a mean of 13.8 years (11.3 – 15.3) the median OMAS score was 85 (Interquartile Range 60 – 100). There was no difference in OMAS between the N-PMF and PMF groups (85 [56.25 – 100] vs 85 [61.25 – 100]; p = 0.580). There was also no difference for MOXFQ (N-PMF 7 [0 – 36.75] vs PMF 8 [0–38.75]; p = 0.643), the EQ5D Index (N-PMF 0.8 [0.7 – 1] vs PMF 0.8 [0.7 – 1]; p = 0.720) and EQ5D VAS (N-PMF 80 [70 – 90] vs PMF 80 [60 – 90]; p = 0.224). The presence of a PMF does not affect the long-term patient reported outcomes in patients with a surgically managed unstable ankle fracture

It is unclear whether patients with early radiographic osteoarthritis (OA) but severe hip symptoms benefit from total hip replacement (THR). We aimed to assess which factors were associated with successful THR in this patient group. From a consecutive series of 1,935 patients undergoing THR we identified 70 (3.6%) patients with early OA (Kellgren and Lawrence (KL) grades 0-2). These were compared with 200 patients with advanced OA (KL grades 3–4). Outcomes were Oxford Hip Scores (OHS), EQ5D and EQ-VAS scores; compared pre-operatively with one year post-operatively. We investigated which clinical and radiographic (plain x-ray, CT, MRI) features predicted successful THR in the early OA group. Success was defined as reaching a postoperative OHS≥42. The early OA group were significantly younger (61 vs 66 years; P=0.0035). There were no significant differences in body mass index, ASA grade or gender. After adjusting for confounders, the advanced OA group had a significantly greater percentage of possible change (PoPC) in OHS (75.8% versus 50.4%; P<0.0001) and improvement in EQ5D (0.151 versus 0.002; P<0.0001). There were no significant differences in complication, revision or readmission rates. In the early OA group, we identified 16/70 (22.9%) patients who had a ‘successful’ THR. Of those with early OA, 38 patients had pre-operative CT or MRI scans. Patients who had a ‘successful’ THR were significantly more likely to have subchondral cysts on CT/MRI (91.7% versus 57.7%; P=0.0362). The presence of cysts on CT/MRI was associated with a significantly greater PoPC in OHS (61.6% versus 38.2%; P=0.0353). The combination of cysts and joint space width (JSW) <1mm was associated with a PoPC of 68%. Plain radiographs were found to significantly underestimate the narrowest JSW compared to CT/MRI (2.4mm versus 1.0mm; P<0.0001). We advise caution in performing THRs in patients with early OA (KL grades 0-2) on plain radiographs. We advocate pre-operative cross-sectional imaging (CT or MRI) in these patients. In the absence of cysts on cross-sectional imaging, a THR seems unlikely to provide a satisfactory outcome

In multilevel posterior cervical instrumented fusions, extending the fusion across the cervico-thoracic junction at T1 or T2 (CTJ) has been associated with decreased rate of re-operation and pseudarthrosis but with longer surgical time and increased blood loss. The impact on patient reported outcomes (PROs) remains unclear. The primary objective was to determine whether extending the fusion through the CTJ influenced PROs at 3 and 12 months after surgery. Secondary objectives were to compare the number of patients reaching the minimally clinically important difference (MCID) for the PROs and mJOA, operative time duration, intra-operative blood loss (IOBL), length of stay (LOS), discharge disposition, adverse events (AEs), re-operation within 12 months of the surgery, and patient satisfaction. This is a retrospective analysis of prospectively collected data from a multicenter observational cohort study of patients with degenerative cervical myelopathy. Patients who underwent a posterior instrumented fusion of 4 levels of greater (between C2-T2) between January 2015 and October 2020 with 12 months follow-up were included. PROS (NDI, EQ5D, SF-12 PCS and MCS, NRS arm and neck pain) and mJOA were compared using ANCOVA, adjusted for baseline differences. Patient demographics, comorbidities and surgical details were abstracted. Percentafe of patient reaching MCID for these outcomes was compared using chi-square test. Operative duration, IOBL, AEs, re-operation, discharge disposittion, LOS and satisfaction were compared using chi-square test for categorical variables and independent samples t-tests for continuous variables. A total of 206 patients were included in this study (105 patients not crossing the CTJ and 101 crossing the CTJ). Patients who underwent a construct extending through the CTJ were more likely to be female and had worse baseline EQ5D and NDI scores (p> 0.05). When adjusted for baseline difference, there was no statistically significant difference between the two groups for the PROs and mJOA at 3 and 12 months. Surgical duration was longer (p 0.05). Satisfaction with the surgery was high in both groups but significantly different at 12 months (80% versus 72%, p= 0.042 for the group not crossing the CTJ and the group crossing the CTJ, respectively). The percentage of patients reaching MCID for the NDI score was 55% in the non-crossing group versus 69% in the group extending through the CTJ (p= 0.06). Up to 12 months after the surgery, there was no statistically significant differences in PROs between posterior construct extended to or not extended to the upper thoracic spine. The adverse event profile did not differ significantly, but longer surgical time and blood loss were associated with construct extending across the CTJ

Arthroscopic procedures are increasingly performed for femoroacetabular impingement (FAI). The Non-Arthroplasty Hip Register (NAHR) collects data including the iHOT12 and EQ5D. However there is currently little evidence of its usefulness in assessing hip arthroscopy outcomes. This study aims to assess minimum 1-year outcomes of hip arthroscopy for FAI using the minimum data set (MDS) of the NAHR by comparing these to a patient satisfaction questionnaire. Pre-operative scores for 78 consecutive hips in 76 patients (43F/33M, mean age at surgery 31.76±10.02 years) undergoing hip arthroscopy for FAI at our institution between February 2013-June 2015 were entered into the NAHR. Insufficient post-operative data was available from the registry. Therefore we collected iHOT12, EQ5D and satisfaction data by postal survey. Preoperative mean iHOT-12 score was 32.67±14.23, median EQ5D Index score 0.653 (IQR 0.277) and median EQ5D Visual Analogue Scale 70 (IQR 25). Postoperative scores were available for 56 cases (55 patients, 71.8%) at median 18.9 months (IQR 13.77). There was a significant postoperative improvement in self-reported outcome as measured by iHOT-12 (mean improvement 35.7 points, p<0.001) and EQ5DIndex scores (median improvement 0.127, p=0.001). 24 patients were very satisfied, 19 satisfied, 6 neutral, 4 dissatisfied and 1 very dissatisfied. Satisfied patients exhibited greater improvement in iHOT-12 (mean 41.64±19.29 vs 2.8±24.08, p<0.001) and EQ5D index scores (p=0.013) but no difference in EQ5D VAS (p=0.15). Improvement in iHOT12 correlated with improvement in EQ5DIndex (r=0.676, p<0.001) and EQ5DVAS(r=0.552, p<0.001). Hip arthroscopy for FAI yielded significant improvements in iHOT-12 and EQ5D index scores and 80% of responders were satisfied/very satisfied at a minimum one year postop. iHOT12 and EQ5DIndex correlated with patient satisfaction and improvements in iHOT12 correlated with improvements in general quality of life. Our findings suggest that the MDS of the NAHR is useful for assessing the outcome in these patients

Endoscopic spine surgery is a promising and minimally invasive technique for the treatment of disc herniation and spinal stenosis. However, the literature on the outcome of interlaminar endoscopic decompression (IED) versus conventional microsurgical technique (CMT) in patients with lumbar spinal stenosis is scarce. We analyzed 88 patients (IED: 36/88, 40.9%; CMT: 52/88, 59.1%) presenting with lumbar central spinal stenosis between 2018–2020. Surgery-related (operation time, complications, time to hospital release (THR), ASA score, C-reactive protein (CRP), white blood cell count (WBC), side (unilateral/bilateral), patient-reported (ODI, NRS (leg-, back pain), eQ5D, COMI), and radiological (preoperative dural sack cross-sectional area (DSCA), Shizas score (SC), left (LRH) and right (RRH) lateral recess heights, left (LFA) and right (RFA) facet angle) parameters were extracted. Complication (most often re-stenosis due to hematoma and/or residual sensorimotor deficits) rates were higher in the endoscopic (38.9%) than microsurgical (13.5%) treatment group (p<0.01). Age, THR, SC, CRP, and DSCA revealed significant correlations with 3 weeks and 1 year postoperatively evaluated ODI, COMI, eQ5D, NRS leg, or NRS back values in our cohort. We did not observe significant differences in the endoscopic versus microsurgical group for the patient-reported outcomes. Age, THR, SC, CRP, and DSCA revealed significant correlations with patient-centered outcomes and should be considered in future studies. Endoscopic treatment of lumbar spinal stenosis was similarly successful as the conventional microsurgical approach, although it was associated with higher complication rates in our single-center study experience. This was probably because of the surgeons' lack of experience with this method and the resulting different learning curve compared with the conventional technique

Glenoid failure remains the most common mode of total shoulder arthroplasty failures. Porous tantalum metal (Trabecular Metal™, Zimmer) have grown in popularity in hip and knee arthroplasty. First-generation porous tantalum metal-backed glenoid components demonstrated metal debris, resulted in failure, and were revised to second-generation glenoid implants. Evidence for second-generation porous tantalum metal implants in shoulder arthroplasty is sparse.1–4 The purpose of this study was to assess clinical and radiographic outcomes in a series of patients with second-generation porous tantalum glenoid components at a minimum two-years postoperative. We retrospectively reviewed the clinical and radiographic outcomes of patients who received a second-generation porous tantalum glenoid component anatomic shoulder arthroplasty between May 2009 and December 2017 with minimum 24 months follow-up. The shoulder arthroplasties were performed by one of two senior fellowship-trained surgeons. We collected postoperative clinical outcome indicators: EQ5D visual analog scale (VAS), Western Ontario Osteoarthritis of the Shoulder (WOOS) Index, American Shoulder and Elbow Surgeons (ASES) Score, and Constant Score (CS). Radiographic review was performed by an independent fellowship-trained surgeon. The Endrizzi metal debris grading system1 was utilized to grade metal debris. We computed descriptive statistics and compared outcome scores between groups via the non-parametric Wilcoxon rank-sum test, with group-wise comparisons defined by: metal debris and humeral head migration (secondary analyses). Thirty-five patients [23 male (65.7%) and 12 female (34.3%)] with 40 shoulder replacements participated in the study. Forty of 61 shoulders (65.6%) had an average of 64 ± 20.3 months follow-up (range 31 to 95). Average BMI was 27.5 ± 4.4 kg/m2 (range 19.5 to 39.1). The average postoperative EQ5D VAS at final follow-up was 74.6 ± 22.5, WOOS Index 87.9 ± 16.6, ASES Score 88.3 ± 10.9, and CS 80.4 ± 13. At final follow-up, 18 of 40 shoulders (45%) had metal debris [15 of 40 (37.5%) Endrizzi grade 1 and three of 40 (7.5%) Endrizzi grade 2], and 22 of 40 shoulders (55%) did not show evidence of metal debris. There was one non-revision reoperation (open subscapularis exploration), one shoulder with anterosuperior escape, three shoulders with glenoid radiolucencies indicative of possible glenoid loosening, and nine shoulders with superior migration of the humeral head (>2mm migration at final follow-up compared to immediate postoperative). When comparing postoperative scores between patients with vs without metal debris, we found no statistically significant difference in the EQ5D VAS, WOOS Index, ASES Score and CS. On further analyses, when comparing superior migration of the humeral head and postoperative outcomes scores, we found no statistically significant difference. We report the longest published follow-up with clinical and radiographic outcomes of second-generation porous tantalum glenoid anatomic shoulder arthroplasties. In this series of patients, 45% of total shoulder arthroplasties with a second-generation porous tantalum glenoid implant had radiographic evidence of metal debris. This metal debris was not statistically associated with poorer postoperative outcomes. Further investigation and ongoing follow-up are warranted

Introduction. Intra articular distal tibia fractures can lead to post-traumatic osteoarthritis. Joint distraction has shown promise in elective cases. However, its application in acute fractures remains unexplored. This pilot study aims to fill this knowledge gap by investigating the benefits of joint distraction in acute fractures. Materials & Methods. We undertook a restrospective cohort study comprising patients with intra-articular distal tibia and pilon fractures treated with a circular ring fixator (CRF) at a single center. Prospective data collection included radiological assessments, Patient-Reported Outcome Measures (PROM), necessity for additional procedures, and Kellgren and Lawrence grade (KL) for osteoarthritis (OA). 137 patients were included in the study, 30 in the distraction group and 107 in the non-distraction group. There was no significant difference between the groups. Results. Mean follow-up was 3.73 years. There was no significant difference between the groups in overall complications or need for further procedures. There was no significant difference in progression of KL between the groups (1.81 vs 2.0, p=0.38) mean follow up 1.90 years. PROM data was available for 44 patients (6 distraction, 38 non-distraction) with a mean follow-up of 1.71 years. There was no significant difference in EQ5D (p=0.32) and C Olerud-H Molander scores (p=0.17). Conclusions. This pilot study suggests that joint distraction is safe in the acute setting. However, the study's impact is constrained by a relatively small patient cohort and a short-term follow-up period. Future investigations should prioritise longer-term follow-ups and involve a larger patient population to more comprehensively evaluate the potential benefits of joint distraction in acute fractures

Aim. Surgical options for management of a failed ankle arthroplasty are currently limited; typically conversion to fusion is recommended with only a few patients being considered for revision replacement surgery. This paper presents our experience of revision ankle replacements in a cohort of patients with failed primary replacements. Method. A total of 18 revision TAR in 17 patients were performed in patients with aseptic loosening. The technique was performed by a single surgeon (CSK) over a 4 year period between July 2014 and August 2018 using the Inbone total ankle replacement system. Patient demographics and clinical outcomes were collected retrospectively using - MOXFQ, EQ5D, VAS pain score and patient satisfaction questionnaires. Results. 12 right and 6 left ankle replacements were revised in 17 patients (11 male/ 6 female). The mean age at revision was 69.1 years (range 56–81 years) with a mean BMI of 31. The mean surgical time was 171 minutes with 22% of cases requiring bone grafting. 6 patients had early wound complications, all superficial and settled with dressings. There were no deep infections, 2 patients had further surgery for exploration for possible nerve injuries. At a mean follow up of 20.6 months, 4 patients had mild/moderate ongoing pain with the majority of patients being satisfied with the outcome of their surgery. Conclusion. This study represents one of the largest group of patients reported to have undergone revision total ankle arthroplasty. Our experience shows that this results in acceptable level of complications and provides satisfactory function in most patients. We feel revision TAR is a viable option in patients with failed primary arthroplasty who wish to continue to maintain mobility at the ankle joint

A fracture of the tuberosity is associated with 16% of anterior glenohumeral dislocations. Manipulation of these injuries in the emergency department is safe with less than 1% risk of fracture propagation. However, there is a risk of associated neurological injury, recurrent instability and displacement of the greater tuberosity fragment. The risks and outcomes of these complications have not previously been reported. The purpose of this study was to establish the incidence and outcome of complications associated with this pattern of injury. We reviewed 339 consecutive glenohumeral dislocations with associated greater tuberosity fractures from a prospective trauma database. Documentation and radiographs were studied and the incidence of neurovascular compromise, greater tuberosity fragment migration and intervention and recurrent instability recorded. The mean age was 61 years (range, 18–96) with a female preponderance (140:199 male:female). At presentation 24% (n=78) patients had a nerve injury, with axillary nerve being most common (n=43, 55%). Of those patients with nerve injuries 15 (19%) did not resolve. Greater tuberosity displacement >5mm was observed in 36% (n=123) of patients with 40 undergoing acute surgery, the remainder did not due to comorbidities or patient choice. Persistent displacement after reduction accounted for 60 cases, later displacement within 6 weeks occurred in 63 patients. Recurrent instability occurred in 4 (1%) patients. Patient reported outcomes were poor with average EQ5D being 0.73, QDASH score of 16 and Oxford Shoulder Score of 41. Anterior glenohumeral dislocation with associated greater tuberosity fracture is common with poor long term patient reported outcomes. Our results demonstrate there is a high rate of neurological deficits at presentation with the majority resolving spontaneously. Recurrent instability is rare. Late tuberosity fragment displacement occurs in 18% of patients and regular follow-up for 6 weeks is recommended to detect this

Introduction. Day Case Surgery (defined as same day discharge) is a priority within the National Health Service and has been shown to provide beneficial outcomes for patients and hospitals. We report our experience developing a Day Case Programme for Total Ankle Replacement (TAR). Methods. Prior to the introduction of a Day Case Programme, average length of stay following TAR in our unit was 3.5 days. Stakeholders were consulted about ways in which same day discharge could be facilitated. Patients' post-operative pain charts were reviewed prior to the introduction of this programme. Inclusion criteria included non-complex surgery (anticipated tourniquet < 2hrs), friend or relative support and pre-operative walking-aid assessment. An enhanced recovery protocol included long-acting popliteal block and dexamethasone. Patients were discharged with opiate analgesia and written pain instructions. Patients were asked to complete a pain and satisfaction questionnaire. Patient Reported Outcome Measures (PROMs) were recorded. Results. From September 2017 to April 2019 21 of 70 patients underwent TAR as a Day Case. Mean age was 67 years (43-85 years). Complications included two delayed wound healings and one representation on day three with urinary retention. No patients reported post-operative nausea or vomiting, 60% did not use Oramorph at home. Average Visual Analogue Score for pain was 23/100 on day one and 21/100 day three post-operatively. There was no significant difference in pre-operative or overall change in MOXFQ, VAS or EQ5D PROMS. Conclusions. Early results suggest that Day Case Total Ankle Replacements are safe. Appropriate patient selection is necessary. Day Case Surgery relies on support and communication between multiple teams to organise and run effectively

The prevalence of gluteal tendinopathy (GT) associated with osteoarthritis of the hip is difficult to determine as it is frequently undiagnosed or misdiagnosed as trochanteric bursitis. Its relationship to total hip arthroplasty (THA) outcomes is currently unknown. The aim of this study was to determine the incidence of GT at the time of hip arthroplasty and examine the relationship between GT and patient reported outcomes (PROMS) before and after THA. Patients undergoing THA for primary osteoarthritis between August 2017 and August 2020 were recruited. Tendinopathy was assessed and graded at time of surgery. PROMS included the Oxford Hip Score (OHS), HOOS JR, EQ-5D, and were collected preoperatively and at one year after THA. Satisfaction with surgery was also assessed at 1 year. 797 patients met eligibility criteria and were graded as Grade 1: normal tendons (n =496, 62%), Grade 2: gluteal tendinopathy but no tear (n=222, 28%), Grade 3: partial/full thickness tears or bare trochanter (n=79, 10%). Patients with abnormal gluteal tendons were older (p=0.001), had a higher mean BMI (p=0.01), and were predominately female (p=0.001). Patients with higher grade tendinopathy had statistically significant inferior PROMS at one year, OHS score (44.1 v 42.9 v 41.3, p 0.001) HOOS JR (89.3 V 86.3 V 85.6 p 0.005). Increasing gluteal tendon grade was associated with a greater incidence of problems with mobility (p=0.001), usual activities (p=0.001) and pain (p=0.021) on EQ5D. There was a 3 times relative risk of overall dissatisfaction with THA in the presence of gluteal tears. This study demonstrated that gluteal tendinopathy was commonly observed and associated with inferior 1-year PROMS in patients undergoing THA for OA. Increasing degree of tendinopathy was a negative prognostic factor for worse functional outcomes and patient satisfaction

Obesity is a common in individuals undergoing arthroplasty, and the potential for weight loss with improved mobility may be expected by some. The aim of this study was 1. determine the proportion that achieved weight loss after hip or knee arthroplasty, and 2. examine the effect of obesity on patient reported outcomes (PROMS) and satisfaction with surgery. Participants underwent primary TKA or THA between July 2015 and December 2020 and consented to participation in a research database with baseline PROMS, including weight, BMI, Oxford Knee, or Hip Score, and EQ5D. Participants repeated PROMS at 12 months after surgery with additional questions regarding satisfaction with surgery. 3449 patients completed PROMS 1 year after arthroplasty with weight and BMI. There were 1810 THA and 1639 TKA procedures. The mean baseline BMI was higher in TKA (29.8, SD 5.2) compared to THA (27.7, SD 5.0), p=0.001. A higher proportion of TKA were classified as obese class 1 (29% TKA, 19% THA), obese class 2 (11% TKA and 6% THA), and obese class 3 (5% TKA and 2% THA), p=0.001. The mean weight loss after 1 year was 0.4kg and 0.9kg in obese THA subjects and TKA subjects respectively. In the obese >5kg weight loss was achieved in 13% of TKA and 7% of THA (p=0.001). Obese experienced equivalent improvement in Oxford scores, compared to non-obese subjects. Satisfaction with surgery was reported by 95% of THA and 91% of TKA subjects with no significant differences between BMI group grades (p=0.491 THA and p=0.473 TKA). Preoperative obesity was observed in 44% of TKA and 27% of THA subjects. In the obese only 1 in 10 subjects lost 5kg or more over 12 months. Obese patients experienced equivalent improvements in outcome after arthroplasty and rates of satisfaction with surgery to the non-obese

Background. PROMs have become an integral assessment tool of clinical effectiveness and patient satisfaction. To date, PROMs for lumbar discectomy are not an NHS requirement, although voluntary collection via the British Spine Registry is encouraged. Despite this, PROMs for day case microdiscectomy is scarcely reported. We present PROMs for day case microdiscectomy at Lancashire Teaching Hospitals. Aims. 1). To review PROMs to quantify leg pain, back pain, EQ5D and ODI scores. 2). Evaluate PROMs data collection compliance. Methods. We studied PROMs data, taken prospectively as part of routine clinical care for all patients who underwent single level day case microdiscectomy between January 2013 to December 2015. PROMs included VAS for back and leg pain, EQ5D and ODI scores. Preoperative PROMs were compared to all available postoperative PROMs at 3 months, 6 months, 12 months and 24 months. Paired student T-tests were used to compare preoperative to postoperative scores. Results. Preoperative PROMs were recorded for 132 patients. Postoperative PROMs were recorded for 48 patients at 3 months, 51 patients at 6 months, 37 patients at 12 months and 15 patients at 24 months. Significant postoperative improvements (p<0.05) were found at all time points for back pain, leg pain, EQ5D and ODI, with the exception EQ5D at 24 months (p = 0.10). Conclusion. There was significant improvement in VAS back and leg scores, as well as ODI scores over 24 months. Further work is needed to improve compliance with postoperative PROMs and to optimise the benefit of these health assessment tools. No conflicts of interest. No funding obtained

This study aims to correlate Oxford shoulder score (OSS) to EQ5D score in healthy patients presenting to a shoulder clinic with shoulder pain. OSS and EQ5D scores were collected prospectively from 101 consecutive patients presenting with shoulder pain in a shoulder clinic at one specialist centre. Patients with ASA > 2 and other significant joint arthritis were excluded from the study. Scores were collected from electronic patient records. Spearman's rho correlation of oxford shoulder scores and EQ5D scores was completed. Mean age of subjects was 51.8 (range 19.1–81.9) years, 55 of 101 subjects were men (54%). Median OSS was 26 (range 3–48) and median EQ5D score was 0.76 (range 0–0.76). Correlation for all patients was 0.624 (Sig p<0.001). This study demonstrates a strong correlation between Oxford shoulder scoring and EQ5D in a fit and well shoulder surgery clinic population. It is possible that Oxford shoulder scores may be a useful indicator of quality of life in healthy shoulder clinic patients presenting with shoulder pain

Aim. This study assessed quality of life (QoL) in patients having external fixation for treatment of osteomyelitis and fracture-related infection (OM/FRI). Method. Patients who had surgery for OM/FRI and who completed the EuroQoL EQ-5D-5L or EQ-5D- 3L questionnaires, were identified between 2010 and 2020. Patients were followed-up for 2 years after surgery. QoL was compared between patients who had either an Ilizarov frame or a monolateral external fixator with those who did not receive external fixation. Results. 165 patients were included. Of these, 37 (22.4%) underwent application of external fixation which included 23 circular frames and 14 monolateral external fixators. Patients in the frame group had more BACH ‘Complex’ infections (34/37; 91.9%), compared to non-frame patients (57/81; 70.3%). Pre-operatively, the mean EQ-index score for patients planned to receive a frame (0.278 SD 0.427) was worse compared to other treatments (0.453 SD 0.338, p=0.083). At 6 weeks after surgery, the EQ-index score remained significantly lower in frame patients compared to non-frame patients (frame: 0.379 SD 0.363; no frame: 0.608 SD 0.326, p=0.016). By 6 months, 26/37 patients had undergone frame removal. The patients who had frames in situ at 6 months had lower EQ-index scores when compared to patients who had their frames removed (frame in situ: 0.187 SD 0.213; frame removed 0.674 SD 0.206, p=0.076). At one year, 36/37 (97.3%) patients had their frame removed. QoL had greatly improved, to levels similar to non-frame patients (no frame: 0.652 SD 0.357; frame removed: 0.657 SD 0.247, p=0.949). Conclusions. Frame treatment leads to significant improvement in Quality of Life in patients suffering from osteomyelitis, with similar results in EQ5D scores after 1 year compared to patients who did not need an external fixator. These effects cannot be felt until after the frame has been removed with impaired QoL during frame treatment, especially in those patients with frames in situ for more than 6 months. This underlines the need for close and professional patient support during frame treatment for bone infection

Objectives. This study examines variations in knee arthroplasty patient reported outcome measures according to patient age. Methods. We analysed prospectively collected outcome data (OKS, Eq5D, satisfaction, and revision) on 2456 primary knee arthroplasty patients. Patients were stratified into defined age groups (< 55, 55–64, 65–74, 75–84, and ≥85 years). Oxford Knee Score and Eq5D were analysed pre-operatively, and postoperatively at 6 months and 2 years. Absolute scores and post-operative change in scores were calculated and compared between age groups. Satisfaction scores (0–100) were analysed at 6 months post-operatively. Linear, logistic and ordinal regression modelling was used to describe the association between age and outcomes, for continuous, binary and ordinal outcomes, respectively. Kaplan-Meier analysis was performed to describe revision rates at 2 years. Results. Patients aged 65–85 years demonstrated better preoperative status than those aged under 65 (OKS, p=0.03; Eq5D, p=0.048), and over 85 years (OKS, p=0.03). Postoperatively, no significant difference in OKS or Eq5D was observed between age groups. Postoperative change in score showed a linear trend for a greater post-operative change in younger patients at 6-months and 2-years (p< 0.04). Overall satisfaction score was 84.9, but patient satisfaction was significantly lower in those aged < 55 years compared to all other age groups (78.1 Vs. 84.8, p=0.031). Cumulative overall 2-year revision rate was 1.3%. Conclusion. This study demonstrates that good early outcomes, as measured by the OKS and Eq5D, can be anticipated following knee replacement regardless of the patient's age, although younger patients gain greater improvement. However, the lower satisfaction in those aged < 55 years is a concern and suggests that outcome is not fully encapsulated by the OKS and Eq5D alone. This raises the question as to whether the OKS alone is an appropriate measure of pain and function in the younger, more active population

Abstract. Introduction. In revision knee arthroplasty, rotating hinge implants (RHK) have been considered to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). The aims of this study were to compare patient reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high volume elective orthopaedic centre with previously validated bespoke database. Methodology. One hundred and eight patients who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EQ5D, Health State and Oxford Knee Scores were collected pre-operatively and at 1 year post-operatively. Complication data was collected at 6 weeks, 6 months, 1 year and 2 years post-operatively. NJR data was interrogated, in addition to our own database, to investigate implant survival. Results. There was no statistically significant difference between RHK and CCK in implant survival at two to twelve years of follow up. In addition, we observed no statistically significant difference in the PROMs scores and complication rates of the two implants. Conclusion. This study shows that both the RHK and CCK remain viable options in revision arthroplasty, the implant survival and complication rate were comparable. We recommend prospective randomised control trials with long-term follow up to further investigate the use of CCK and RHK implants in revision knee arthroplasty