The aim of this study is the comparative assessment of long term clinical (subjective and objective), functional and quality of life outcome data between primary and revision THA. 122 patients (130 hips) who underwent cementless revision THA of both components (TMT cup, Wagner SL stem, Zimmer Biomet) for aseptic loosening only (Group A) were compared to a matched group of 100 patients (100 hips) who underwent cementless primary THA for osteoarthritis (Synergy stem, R3 cup, Smith & Nephew) (Group B). Outcomes were evaluated with survival analysis curves, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford hip score (OHS), Short form-12 health survey (SF-12) and EQ-5D-5L scales. Mobility was assessed with walking speed, timed up and go test (TUG), Parker mobility, Lower extremity function score (LEFS) and UCLA scores. At a mean follow up of 14.4 years (10 to 20) a cumulative success rate of 96% (95% CI 96 to 99%) in Group A and 98% (95% CI 97 to 99%) in Group B with operation for any reason as an end point was recorded. Statistically significant differences between groups were developed for WOMAC (Mann-Whitney U test, p= 0.014), OHS (Mann-Whitney U test, p= 0.020) and physical component of SF-12 scores (Mann-Whitney U test, p= 0.029) only. In Group A, in multiple regression analysis, patients’ cognition (p=0.001), BMI (p=0.007) and pain (p=0.022) were found to be independent factors influencing functional recovery (WOMAC). Similarly, pain (p=0.03) was found to influence quality of life (EQ-5D-5). In the long term, revision THA shows satisfactory but inferior clinical, functional, and quality of life outcomes when compared to primary THA. Residual pain, BMI and cognitive impairment independently affect functional outcomes

This prospective cohort study examined the relationship between waiting time for elective total hip arthroplasty (THA) and changes in pre- to post-operative quality of life. It included one hundred and forty-seven patients who entered the waiting list for primary THA with osteoarthritis. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to assess patients at surgical consultation time (baseline) and one year post-operation. Baseline WOMAC score was a significant predictor for follow-up WOMAC score. Expedited access to THA results in a larger proportion of patients showing “better than expected” function at twelve months after the operation.

This study examined the relationship between waiting time for elective total hip arthroplasty (THA) and changes in pre- to post-operative quality of life.

Expedited access to THA results in a larger proportion of patients showing “better than expected” function at twelve months after the operation. The odds of a “better than expected” functional outcome decreased by 8% for each additional month on the wait list.

The study provides the estimates of decreased probability of “better than expected” outcome given a prolonged waiting time. Our study indicates that timely access to THA is needed for optimal post-operative outcome.

Baseline WOMAC score was a significant predictor for the follow-up WOMAC score in function (p=0.0005), pain (p=0.0036), and stiffness (p= 0.0004). Waiting for six months or less doubled the odds of achieving a “better than expected” functional outcome compared to longer waits (p= 0.05).

This prospective cohort study included one hundred and forty-seven patients who entered the waiting list for primary THA with osteoarthritis. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to assess patients at the surgical consultation time (baseline) and one year post operation. Regression models were used to determine the “expected” outcome for a certain individual baseline score. By using expected HRQOL outcome, we identified patients whose benefit from THA is better than expected. Logistic regression models were used to assess the relationship between waiting time and the probability of “better than expected” outcome.

Introduction: Optimal management of proximal humeral fractures is still to be defined. The objective of this study is to present the functional and quality of life results of proximal humeral fractures conservatively treated in elderly population

Material and Methods: Prospective study including 74 fractures in patients over 60 and less than 85 years-old. 4 patients lost at final follow-up. Fractures were assessed by X-ray and C.T. exam. There were 14 one-part fractures, 15 two-part greater tuberosity (GT), 17 two-part surgical neck, 10 three-part GT, 6 four-part, 6 two-part GT fracture dislocation, 1 four-part fracture dislocation and 1 impression fracture. Constant Score, EuroQol 5-D and X-Ray study at two-year follow-up. U Mann-Whitney for non parametric and t-student for parametric.

Results: Constant Score: non-displaced fractures mean of 73,58 while displaced fractures 59,41 (p0,003). Significant differences between them in all Constant items except for External rotation (p0,17). Total Constant Score diminished as fracture pattern increased complexity: 2-part GT 72,78, 2-part surgical neck 65,88, 2-part GT fracture dislocation 71, 3-part GT 54,64 and 4-part 33,66. Despite these differences there were no significant differences as far as pain was concerned among all displaced fractures.

Quality of life perception: no significant differences in VAS between displaced and non-displaced fractures (p 0,75). 4 avascular necrosis at final follow-up, 2 in the 4-part group, 1 in 3-part GT and 1 in 4-part fracture dislocation.

Conclusion: Conservative treatment of proximal humeral fractures give reasonable good functional results in 1-part, 2-part GT, 2-part surgical neck and 2-part GT fracture dislocation in specially selected elderly population. 3-part GT and 4-part fractures achieve a limited functional result with conservative treatment. No differences have been observed between non-displaced and displaced fractures conservatively treated as far as quality of life perception is concerned in such elderly population.

Aims. The aim of this study was to describe and compare joint-specific and generic health-related quality of life outcomes of the first versus second knee in patients undergoing staged bilateral total knee arthroplasty (BTKA) for osteoarthritis. Methods. This retrospective cohort study used Australian national arthroplasty registry data from January 2013 to January 2021 to identify participants who underwent elective staged BTKA with six to 24 months between procedures. The primary outcome was Oxford Knee Score (OKS) at six months postoperatively for the first TKA compared to the second TKA, adjusted for age and sex. Secondary outcomes compared six-month EuroQol five-dimension five-level (EQ-5D-5L) domain scores, EQ-5D index scores, and the EQ visual analogue scale (EQ-VAS) between knees at six months postoperatively. Results. The cohort included 635 participants (1,270 primary procedures). Preoperative scores were worse in the first knee compared to the second for all instruments; however, comparing the first knee at six months postoperatively with the second knee at six months postoperatively, the mean between-knee difference was minimal for OKS (-0.8 points; 95% confidence interval (CI) -1.4 to -0.2), EQ-VAS (3.3; 95% CI 1.9 to 4.7), and EQ-5D index (0.09 points; 95% CI 0.07 to 0.12). Outcomes for the EQ-5D-5L domains ‘mobility’, ‘usual activities’, and ‘pain/discomfort’ were better following the second TKA. Conclusion. At six months postoperatively, there were no clinically meaningful differences between the first and second TKA in either the joint-specific or overall generic health-related quality of life outcomes. However, individual domain scores assessing mobility, pain, and usual activities were notably higher after the second TKA, likely reflecting the cumulative improvement in quality of life after both knees have been replaced. Cite this article: Bone Jt Open 2024;5(3):202–209

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

Aims. The aim of this study was to estimate the incremental use of resources, costs, and quality of life outcomes associated with surgical reconstruction compared to rehabilitation for long-standing anterior cruciate ligament (ACL) injury in the NHS, and to estimate its cost-effectiveness. Methods. A total of 316 patients were recruited and randomly assigned to either surgical reconstruction or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment). Healthcare resource use and health-related quality of life data (EuroQol five-dimension five-level health questionnaire) were collected in the trial at six, 12, and 18 months using self-reported questionnaires and medical records. Using intention-to-treat analysis, differences in costs, and quality-adjusted life years (QALYs) between treatment arms were estimated adjusting for baseline differences and following multiple imputation of missing data. The incremental cost-effectiveness ratio (ICER) was estimated as the difference in costs divided by the difference in QALYs between reconstruction and rehabilitation. Results. At 18 months, patients in the surgical reconstruction arm reported higher QALYs (0.052 (95% confidence interval (CI) -0.012 to 0.117); p = 0.177) and higher NHS costs (£1,017 (95% CI 557 to 1,476); p < 0.001) compared to rehabilitation. This resulted in an ICER of £19,346 per QALY with the probability of surgical reconstruction being cost-effective of 51% and 72% at a willingness-to-pay threshold of £20,000 and £30,000 per QALY, respectively. Conclusion. Surgical reconstruction as a management strategy for patients with long-standing ACL injury is more effective, but more expensive, at 18 months compared to rehabilitation management. In the UK setting, surgical reconstruction is cost-effective. Cite this article: Bone Joint J 2024;106-B(1):38–45

Background. Optimal management of displaced intra-articular calcaneal fractures remains controversial. The aim of this prospective cohort study was to compare the clinical and radiological outcomes of minimally invasive surgery (MIS) versus non-operative treatment in displaced intra-articular calcaneal fracture up to 2-years. Methods. All displaced intra-articular calcaneal fractures between August 2014 and January 2019 that presented to a level 1 trauma centre were considered for inclusion. The decision to treat was made by a multidisciplinary meeting. Operative treatment protocol involved sinus tarsi approach or percutaneous reduction & internal fixation. Non-operative protocol involved symptomatic management with no attempt at closed reduction. All fractures were classified, and the MOXFQ/EQ-5D-5L scores were used to assess foot and ankle and general health-related quality of life outcomes respectively. Results. 101 patients were recruited at a level 1 major trauma centre, between August 2014 and January 2019. Our propensity score matched 44 patients in the surgical cohort to 44 patients in the non-surgical cohort. At 24 months, there was no significant difference in the MOXFQ Index score (p<0.05) however the patients in the surgical cohort had a significantly higher EQ-5D-5L Index score (p<0.05). There was also a higher return to work (91% vs 72%, p<0.05) and physical activity rate (46 vs. 35%, p<0.05) in the surgical cohort despite a higher proportion of more complex fractures in the surgical cohort. The wound complication rate following surgery was 16%. 14% of patients in the non-operative cohort subsequently underwent arthrodesis compared to none of the patients in the surgical cohort. Conclusion. In this study, we found operative treatments were associated with low rates of surgical complication at 2-years and long term pain improvement, facilitating earlier and better functional outcomes for complex injury patterns compared to nonoperative treatment

Abstract. Introduction. We aimed to compare the outcomes of elderly patients with periarticular distal femur or supracondylar periprosthetic fractures treated with either open reduction internal fixation or distal femoral replacement. Methods. A retrospective review of patients over 65 years with AO Type B and C fractures of the distal femur or Su type I and II periprosthetic fractures treated with either a DFR or ORIF was undertaken. Outcomes including Length of Stay, PROMs (Oxford Knee Score and EQ 5D), infection, union, mortality, complication and reoperation rates were assessed. Data on confounding variables were also collected for multivariate analysis. Patients below 65 years and extra articular fractures were excluded. Results. 23 patients (11 in DFR group and 12 in ORIF group) fulfilled inclusion criteria and were included in the analysis. There was no difference between the DFR and ORIF groups with respect to SDI, demographic variables, ASA grade, FCI, preoperative Hb and renal function. There was no difference in 30 day mortality, reoperation rates, 30 day readmission rates and LOS between the two groups. Mean follow up was 12.7 and 15.9 months respectively in the DFR and ORIF groups. At final follow up after accounting for all confounding variables on multivariate analysis, functional outcomes using OKS (adjusted mean: 29.5 vs 15.8) and Health related Quality of Life outcomes using EQ 5D (adjusted mean: 0.453 vs −0.07) were significantly better in the DFR group. Conclusion. DFR for periarticular and periprosthetic distal femoral fractures in the elderly are associated with better patient reported outcomes

Controversy exists regarding the optimal technique for arthroscopic rotator cuff repair. No previous comparative trials have reported on the long-term follow-up of single and double row fixation in arthroscopic cuff repair. The purpose of this study was to compare the long-term functional outcomes of single-row and double-row suture techniques for repair of the rotator cuff 10-years post-operatively. Ninety patients undergoing arthroscopic rotator cuff repair were randomized to receive either single-row or double-row repair. The primary objective was to compare the Western Ontario Rotator Cuff Index (WORC) score 10-years post-operatively. Secondary objectives included comparison of the Constant, and American Shoulder and Elbow Surgeons (ASES) scores and supraspinatus strength between groups. Out of 90 patients originally randomized, 57 returned for the long-term 10-year follow-up. Baseline demographic data did not differ between groups. The WORC score was not significantly different between groups at long-term follow-up (p=0.13). No statistical differences were observed between groups for the Constant (p=0.51), ASES (p=0.48) scores, or strength scores (p=0.93). A significant improvement was observed between pre-operative and the final 10-year follow-up. There were no differences observed in all outcomes between two and 10-years post-operatively. No statistically significant differences in functional or quality of life outcomes were identified between single-row and double-row fixation techniques at long-term follow-up

In revision total hip arthroplasty (THA), acetabular reconstruction while dealing with severe bone loss is a challenge. The porous tantalum revision acetabular shells have been in use for the past decade. Several reports have documented successful use at early to mid-term follow up. There is, however, very little literature around the long-term survival and quality of life outcome with the use of these shells. We reviewed the results of 46 acetabular revisions with Paprosky 2 and 3 acetabular bone defects reconstructed with a hemispheric, tantalum acetabular shell and multiple supplementary screws. There were 31 females. Average age at revision was 64 years (range 23–85 years). The mean and median follow up was 11 years (range 10–12 years, SD 1). Morselised femoral allograft was used in 34 hips to fill contained cavitary defectes. Bulk femoral allografting was performed in 2 hips. At a minimum follow-up of 10 (range 10–12) years, the survivorship of the porous tantalum acetabular shell, with revision of the shell as end point was 96%. The minimum 10-year survivorship with hip revision for any reason as end point was 92%. We noted excellent pain relief (mean WOMAC pain 92.6) and good functional outcome (mean WOMAC function 90.3, mean UCLA 5); and generic quality of life measures (mean SF-12 physical component 48.3; mean SF-12 mental component 56.7). Patient satisfaction with pain relief, function and return to recreational activities were noted to be excellent. Cementless acetabular revision with the tantalum acetabular shell demonstrated excellent clinical and quality of life outcomes at minimum 10-year follow-up. As far as we are aware this is the first report of minimum 10-year follow up of use of this technique for revision hip arthroplasty

Introduction: The aims of this study were to. determine predictors of pain, function and activity level 1–2 years after revision hip arthroplasty and. define quality of life outcomes after revision total hip replacement. Methods: A prospective cohort of 222 patients who underwent revision hip arthroplasty were evaluated. Predictive models were developed and proportional odds regression analyses were performed to identify factors that predict quality of life outcomes at 1 and 2 years post surgery. The dependent outcome variables were WOMAC function, pain and UCLA activity. The independent variables included patient demographic, surgery specific and objective parameters including baseline Western Ontario McMaster Universities (WOMAC) osteoarthritis index, and the Short Form-12 mental component. The Loess method was used to plot the change of WOMAC and SF-12 scores over time. Results: There was a significant improvement (p< 0.001) in all patient quality of life scores from baseline with results plateauing at 1 year. UCLA activity remained static between 1 and 2 years. In the predictive model, higher baseline WOMAC function (p < 0.001), age between 60–70 (p< 0.037), male gender (0.017), lower Charnley class (p < 0.001) and diagnosis of aseptic loosening (p < 0.003) were significant predictors of improved function. When considering WOMAC pain as an outcome variable, factors predictive of improving category outcome included baseline WOMAC function (p= 0.001), age between 60–70 (p< 0.004), male gender (p= 0.005), lower Charnley class (p< 0.001) and no previous revisions (p < 0.023). Baseline WOMAC pain did not predict final pain outcome. Baseline WOMAC function (p=0.001), the indication for the operation (p=0.007), and the operating surgeon were significant predictors of UCLA activity at follow up. Peri or post-operative complications were not an adverse predictor of physical function, pain or activity. Conclusions: Predictors of quality of life outcomes after revision hip replacement-showed that although some patient specific and surgical specific variables were important, age, gender, Charnley class and baseline WOMAC function had the most robust associations with outcomes

Approximately 20% of patients feel unsatisfied 12 months after primary total knee arthroplasty (TKA). Current predictive tools for TKA focus on the clinician as the intended user rather than the patient. The aim of this study is to develop a tool that can be used by patients without clinician assistance, to predict health-related quality of life (HRQoL) outcomes 12 months after total knee arthroplasty (TKA). All patients with primary TKAs for osteoarthritis between 2012 and 2019 at a tertiary institutional registry were analysed. The predictive outcome was improvement in Veterans-RAND 12 utility score at 12 months after surgery. Potential predictors included patient demographics, co-morbidities, and patient reported outcome scores at baseline. Logistic regression and three machine learning algorithms were used. Models were evaluated using both discrimination and calibration metrics. Predictive outcomes were categorised into deciles from 1 being the least likely to improve to 10 being the most likely to improve. 3703 eligible patients were included in the analysis. The logistic regression model performed the best in out-of-sample evaluation for both discrimination (AUC = 0.712) and calibration (gradient = 1.176, intercept = -0.116, Brier score = 0.201) metrics. Machine learning algorithms were not superior to logistic regression in any performance metric. Patients in the lowest decile (1) had a 29% probability for improvement and patients in the highest decile (10) had an 86% probability for improvement. Logistic regression outperformed machine learning algorithms in this study. The final model performed well enough with calibration metrics to accurately predict improvement after TKA using deciles. An ongoing randomised controlled trial (ACTRN12622000072718) is evaluating the effect of this tool on patient willingness for surgery. Full results of this trial are expected to be available by April 2023. A free-to-use online version of the tool is available at . smartchoice.org.au.

The Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) is a patient-reported disease-specific quality of life (QOL) outcome measure used to assess patients with recurrent lateral patellofemoral instability (LPI) both pre- and post-operatively. The purpose of this study was to compare the BPII 2.0 to four other relevant patient reported outcome measures (PROMs): the Tampa Scale-11 for kinesiophobia (TSK-11), the pain catastrophizing scale (PCS), a general QOL (EQ-5D-5L), and a return to sport index (ACL-RSI). This concurrent validation sought to compare and correlate the BPII 2.0 with these other measures of physical, psychological, and emotional health. The psychological and emotional status of patients can impact recovery and rehabilitation, and therefore a disease-specific PROM may be unable to consistently identify patients who would benefit from interventions encompassing a holistic and person-focused approach in addition to disease-specific treatment. One hundred and ten patients with recurrent lateral patellofemoral instability (LPI) were assessed at a tertiary orthopaedic practice between January and October 2021. Patients were consented into the study and asked to complete five questionnaires: the BPII 2.0, TSK-11, PCS, EQ-5D-5L, and the ACL-RSI at their initial orthopaedic consultation. Descriptive demographic statistics were collected for all patients. A Pearson's r correlation coefficient was employed to examine the relationships between the five PROMs. These analyses were computed using SPSS 28.0 © (IBM Corporation, 2021). One hundred and ten patients with a mean age of 25.7 (SD = 9.8) completed the five PROMs. There were 29 males (26.3%) and 81 females (73.6%) involving 50% symptomatic left knees and 50% symptomatic right knees. The mean age of the first dislocation was 15.4 years (SD = 7.3; 1-6) and the mean BMI was 26.5 (SD = 7.3; range = 12.5-52.6) The results of the Pearson's r correlation coefficient demonstrated that the BPII 2.0 was statistically significantly related to all of the assessed PROM's (p. There was significant correlation evident between the BPII 2.0 and the four other PROMs assessed in this study. The BPII 2.0 does not explicitly measure kinesiophobia or pain catastrophizing, however, the significant statistical relationship of the TSK-11 and PCS to the BPII 2.0 suggests that this information is being captured and reflected. The preliminary results of this concurrent validation suggest that the pre-operative data may offer predictive validity. Future research will explore the ability of the BPII 2.0 to predict patient quality of life following surgery

Purpose. Tenodesis of the long head of biceps is an established technique for management of biceps pathology including tears, instability, and chronic tendinosis intractable to non-operative management. Very few studies have reported on clinical outcomes of all-arthroscopic, non-interference, biceps tenodesis techniques. The purpose of this study is to evaluate the functional and quality of life outcomes of patients treated with an all-arthroscopic biceps tenodesis with a suture anchor. Method. Case Series Level 4 Evidence. Fifty-eight (58) patients with a mean age of 58.5 years were treated with an arthroscopic biceps tenodesis in a single surgeons practice. A single suture anchor was used with a non-interference technique, either in isolation or in association with an arthroscopic rotator cuff repair. A retrospective analysis was performed on prospectively collected outcome measures on patients with a minimum one-year follow-up. Patients were evaluated with an ASES, Constant, and WORC scores pre-operatively and at 6 and 12 months post-operatively. In addition, patients were questioned post-operatively as to whether they experienced any biceps cramping, fatigue, or cosmetic deformity (popeye sign). Results. Following an all-arthroscopic biceps tenodesis, the ASES, Constant, and WORC scores improved significantly from 45, 54, 32 to 58, 75, 73 respectively (P<0.001). When analyzed separately, patients who underwent an arthroscopic biceps tenodesis in isolation (no cuff repair) and in association with an arthroscopic cuff repair demonstrated similar gains in functional and quality of life outcomes. (P<0.001). Few patients reported post-operative bicipital cramping, fatigue, or cosmetic deformity. Conclusion. The all-arthroscopic biceps tenodesis is a reliable procedure that results in significant improvement in functional outcome and quality of life measures

Purpose. An open superior capsular shift is a well-established technique for the management of patients with multidirectional shoulder laxity and the absence of a Bankart lesion. Few studies have reported on functional and quality of life outcomes using arthroscopic technique for shoulder stabilization using superior capsular shift in patients with no Bankart lesion. The purpose of this study was to assess the functional and quality of life outcome scores following shoulder stabilization with a selective arthroscopic superior capsular shift with suture anchors, for treatment of multidirectional laxity and the absence of a Bankart lesion. Method. Case Series Level 4 Evidence. Thirty-six (36) patients with a mean age of 30.8 years, with a diagnosis of recurrent anterior atraumatic shoulder instability, and no Bankart lesion, were identified in a single surgeons practice. These patients underwent an arthroscopic shoulder stabilization with an anterior inferior to superior capsular shift. The labrum was arthroscopically released from the anterior/inferior glenoid and was shifted superiorly in conjunction with a capsular plication. A retrospective analysis was performed on prospectively collected outcome scores of patients who had with a minimum of 1 year of follow-up. The ASES and WOSI scores were administered pre-operatively and at 6 and 12 month follow-up. The presence of a positive post-operative apprehension sign was also recorded on follow-up. Results. After an arthroscopic capsular shift, the ASES and WOSI scores improved significantly from 57, 28 to 78, 68 respectively (P<0.001). Few patients had a positive apprehension sign at 1 year follow-up. Conclusion. An arthroscopic capsular shift is a reliable procedure that resulted in satisfactory outcomes in patients with shoulder instability and the absence of a Bankart lesion

Aims. The aims of this study were to compare the use of resources, costs, and quality of life outcomes associated with subacromial decompression, arthroscopy only (placebo surgery), and no treatment for subacromial pain in the United Kingdom National Health Service (NHS), and to estimate their cost-effectiveness. Patients and Methods. The use of resources, costs, and quality-adjusted life-years (QALYs) were assessed in the trial at six months and one year. Results were extrapolated to two years after randomization. Differences between treatment arms, based on the intention-to-treat principle, were adjusted for covariates and missing data were handled using multiple imputation. Incremental cost-effectiveness ratios were calculated, with uncertainty around the values estimated using bootstrapping. Results. Cumulative mean QALYs/mean costs of health care service use and surgery per patient from baseline to 12 months were estimated as 0.640 (standard error (. se. ) 0.024)/£3147 (. se. 166) in the decompression arm, 0.656 (. se. 0.020)/£2830 (. se. 183) in the arthroscopy only arm and 0.522 (. se. 0.029)/£1451 (. se. 151) in the no treatment arm. Statistically significant differences in cumulative QALYs and costs were found at six and 12 months for the decompression versus no treatment comparison only. The probabilities of decompression being cost-effective compared with no treatment at a willingness-to-pay threshold of £20 000 per QALY were close to 0% at six months and approximately 50% at one year, with this probability potentially increasing for the extrapolation to two years. Discussion. The evidence for cost-effectiveness at 12 months was inconclusive. Decompression could be cost-effective in the longer-term, but results of this analysis are sensitive to the assumptions made about how costs and QALYs are extrapolated beyond the follow-up of the trial

Paediatric femoral fractures are a common result of significant trauma, and always require intervention. Hip spica casting, traction, and surgical fixation can all be used to treat these fractures. This variety in treatment options leads to a vast potential for variability in management decisions among surgeons and has prevented effective comparative studies to show which treatment methods provide optimal outcomes for patients. The purpose of this study was to identify practice variability in management and follow-up and assess patient outcomes to aid in the development of a comprehensive, prospective, evidence-based pathway for the management of paediatric femoral fractures. A retrospective chart review was performed of all patients treated surgically for isolated femoral fractures during a six year period at a single tertiary care paediatric centre. Patients were identified from a surgical database and were included if there was no pre-existing pathology and no history of previous femoral fracture. Demographic data, operative details, post-operative management, and clinical outcomes were collected. Radiographic images and reports were analyzed to determine fracture classification and imaging parameters. Variability in treatment among eight surgeons was assessed, including number of follow-up appointments and length of follow-up. Patient demographics and follow up measures were summarised for each surgeon and between surgeon variability was assessed with linear models. In total, 138 femoral fractures in 134 patients (101 male, 33 female) were included in analysis. Of these patients, 55 had right femoral fractures, 76 left, and three bilateral (one bilateral patient had three distinct femoral fractures). Of 138 total fractures, 131 were of the diaphysis of the femur. 14 patients sought initial surgical treatment at our institution but received follow-up management elsewhere. Across all patients, median follow-up time was 32.8 weeks (0–201.4) with a median of three follow-up visits (0–26) in that period. Mean number of follow-up clinic visits ranged from 3 to 4.8 among surgeons, and mean length of follow-up ranged from 31.8 to 62.3 weeks. No significant differences in follow-up between surgeons were found, but small sample sizes are a likely contributing factor. Summary statistics show large ranges in most variables and differences in patient demographics between surgeon groups. The large ranges in follow-up time and visit number suggest a lack of consensus on optimal management for paediatric femoral fractures. Further prospective study examining long-term functional and quality of life outcomes will be required to identify and develop optimized management guidelines

Purpose: The upward migration index (UMI) is a useful radiographic parameter for assessment of disorders of the rotator cuff. Utility of the UMI as a prognostic indicator for outcome following cuff repair has not been previously studied. The objective of this study was to determine if an association exists between the pre-operative UMI and the improvement in clinical and quality of life outcome scores following arthroscopic rotator cuff repair. Method: Patients with a full thickness tear of the rotator cuff who underwent an arthroscopic repair of the cuff were selected for review. Eighty-four patients were included in the series. Mean patient age was 55 (range 25–78). The UMI was measured by MRI, and patients were divided into three groups: < 1.25 (GROUP A), 1.25–1.35 (GROUP B) and > 1.35 (GROUP C). Outcome variables were the non-weighted Constant-Murley score, ASES and the WORC assessed at baseline, 6 month and 12 months post-operatively. The paired t-test was used to carry out comparisons in follow up and one-way ANOVA was used to carry out comparisons between groups. Results: There were 9 patients in group A, 33 in group B and 42 in group C. The improvement in scores from baseline to 1 year were as follows: ASES; 21.1 (A), 32.6 (B), and 38.4 (C); Constant 21.4 (A) 19.8 (B), and 24.2 (C) and WORC 31.9 (A), 42.7 (B), and 44 (C). Statistically significant improvements were observed in all groups in all outcome measures from baseline to 6 months and from 6 months to 1 year. Although the differences were not statistically significant (p> 0.05), a trend toward greater improvement in outcomes was observed with higher upward migration indices. Conclusion: A lower UMI was associated with less improvement in functional and quality of life outcomes following arthroscopic rotator cuff repair, although these differences were not statistically significant. Patients with a low UMI demonstrated a significant improvement in functional and quality of life scores following surgery. In isolation, a low UMI should not represent a significant contraindication to treatment by arthroscopic rotator cuff repair

Purpose. This prospective, expertise-based randomized clinical trial compares arthroscopic to open shoulder stabilization by measuring the disease-specific quality of life outcome in patients with traumatic unidirectional anterior shoulder instability, and determining the incidence of recurrent instability at 2-years post-operatively. Method. One hundred and ninety-six patients were randomly allocated to arthroscopic (n=98) or open (n=98) repair using an expertise-based approach with a surgeon specializing in one type of surgery. Randomization was performed using computer-generation, variable block sizes and concealed envelopes. Outcomes were measured at baseline, 3 and 6 months, 1 and 2 years post-operatively. These outcomes included the Western Ontario Shoulder Instability (WOSI) Index quality of life outcome and the American Shoulder and Elbow Society (ASES) functional outcome. Both outcomes were measured on a visual analog scale from 0 to 100, where a higher score represents better quality of life or function. Recurrent instability was categorized as traumatic/atraumatic, and as a subluxation/dislocation. Analyses included ANOVA of repeated measures and independent t-tests. Bonferroni adjustments for pairwise contrasts were made for multiple comparisons. Chi-squared analyses were performed on recurrence. Statistical significance was reported at p < 0.05. Results. There were no statistically significant differences at baseline with respect to gender, involved dominant shoulders, age, WOSI or ASES scores. At 2-years post-operatively, 19 patients in the Open group and 14 patients in the Arthroscopic group were lost to follow-up. A comparison of the baseline characteristics of these lost to follow-up patients showed no statistically significant differences in WOSI and ASES scores, age, involved dominant shoulder, gender and presence of Hill Sachs lesions between the groups. Of the patients that completed 2-year follow-up, there was no difference in mean WOSI score between the two groups: Open = 85 (SD = 20; 95% CI = 81 89), Arthroscopic = 82 (SD = 20; 95% CI = 77 86), p = 0.31. The ASES score for the Open group at 2-years was 91 (SD = 13; 95% CI = 88 94) and 88 (SD = 16; 95% CI = 85 92) for the Arthroscopic group, p = 0.17. Recurrence rates at 2-years were statistically different with 11% in the Open (9/80) and 23% in the Arthroscopic (20/87) groups, p = 0.05. Conclusion. At 2-years post-operative follow-up, there was no difference in disease-specific quality of life between Open and Arthroscopic repair. Open repair had a significantly lower risk of recurrence

Two stage exchange has been the gold standard in North America for the treatment of infected knee replacements. The choice of static vs. articulated spacers has been debated for a number of years. At our institution our choice of spacer for 2 stage exchanges is an articulated spacer. This allows motion between stages which facilitates recovery, and makes the second stage technically easier. In a study from our institution we followed 115 infected TKAs treated with the PROSTALAC articulated spacer for 5–9 years. Success for eradication of infection was 88%. With a repeat 2 stage, overall infection control was 98%. In addition, we compared functional outcomes to a group of aseptic knee revisions and found no difference in functional outcomes with standard quality of life outcome scores. While the articulated spacer was our treatment of choice in 2 stage exchange around 2012, the company that manufactured the PROSTALAC knee components ceased to manufacture them. At that time, based on the work of 2 previous studies (Hofmann, Lee), we continued to use articulated spacers. However, this was now the so-called Hofmann technique with a new standard femoral component with an all polyethylene tibia. The only difference from a standard knee revision was no stems and the utilization of high dose antibiotics. We also followed the principles from Europe of one stage exchange, such as wide debridement and soaking in dilute betadine for 15 minutes. More recently as of Sept 2015 we have used an all polyethylene tibia with a keel. The hope being that this will give a more stable tibia than previous and perhaps make a second stage unnecessary. Our first case was September 2015. The intention was not to do a second stage if the infection was eradicated and the patient had good pain relief and function. To date we have implanted 28 of these and in 80% of cases we have not had to do a second stage revision. Further study will reveal where this inadvertent one stage fits in our practi