The SF 36 questionnaire has been validated and used in multiple studies. However, it remains unclear how well patients complete the SF-36 questionnaire in a spinal outpatient clinic setting outside the context of a study. We aim to assess the quality of information gained if the SF 36 is used as an audit and outcome measure in real clinical practice. The SF 36 has been used in our clinic as a routine for the initial assessment and outcome audit of patients for the last 4 years. A prospective, consecutive sample of 85 patients’ SF-36 forms was evaluated during a spinal out-patient clinic over one month at our teaching hospital. Completeness of data entry was assessed. All patients had access to a translator and clinic nurse to help complete the questionnaire if needed. There were 34 males and 51 females (age range 16 to 81, average 48). Thirty seven patients were White British, 22 other and 26 undisclosed ethnicities. Thirty eight (45%) forms were complete leaving 47 (55%) which had at least one question unanswered or spoiled. Of these, two had five to ten errors, one had 10 to 15 errors, four had 15 to 20 errors, seven had 20 to 25 errors, ten had 25 to 30 errors and 17 had 30 to 35 errors. In addition six forms were entirely incomplete beyond patient identifier information. White British patients had fewer errors (average 4) compared to other (9) and unknown (9) ethnicities. Outside the context of a research study, the SF-36 questionnaire in an urban teaching hospital spinal outpatient clinic is not a reliable tool. Redesign of the questionnaire may be required. The SF-36 questionnaire is less well completed by patients declared as non White British, even with the facility for a clinic nurse and a translator

Objective: The purpose of this study was to determine how changes in functional shoulder score (Constant Score) affected the values of the SF-36 score, to determine the amount of functional score change to be considered relevant. Material and Method: 427 patients were included. All of them were assessed with a functional shoulder score (Constant Score) and fulfilled SF-36 score. Mean age was of 50,61(18–85), 200 of them were male and 227 female. 280 were considered to be active while 147 were retired as far as working status is concerned. There were 191 patients with university studies and 236 with primary studies. Primary diagnosis was cuff disorders in 265 patients, old-fracture in 43, degenerative in 72 and instability in 34. Correlations were performed with Spearman’s rho and regression models were evaluated. Results: There was a moderate but significant correlation between the total Constant Score and PF_NORM (0,511) and US standardized physical component (US STPH) (0,491) of the SF-36. For every point of increase in the Constant score the SF-36 increases 0,235 points. Looking into the different items of the Constant Score, Activities of daily living (ADL) and strength presented the stronger correlation with SF-36 (0,428, 0,411). In the regression model, every point of increase of pain, ADL, forward elevation, external rotation and internal rotation means an increase of 0,472, 0,39, 0,84, 0,82 and 0,86 of the US STPH of the SF-36. Conclusions: Whenever the outcome of any shoulder treatment is analyzed it has to be taken into account that for every point of increase of the Total Constant Score just 0,235 points of the US SPTH of the SF-36 increase. Depending on the mean value of the US SPTH of the SF-36 of the population studied, the relevant increase of Constant Score can be calculated. Mobility improvements seem to have more influence that pain changes as far as increasing the US SPTH of the SF-36 is concerned

Purpose of Study: It has been widely reported that smokers undergoing lumbar spinal surgery are more likely to develop postoperative complications such as pseudarthrosis, superficial and deep wound infection, as well as diminished clinical improvement. New spine instrumentation was developed (SpineLinkTM, Biomet) which enables surgeons to fuse multiple levels by linking single level fusions in series. This is accomplished through titanium links and polyaxialscrews which preserve lordosis without the bending of rods or plates. During an ongoing 5 year prospective investigation on fusion with intrasegmental fixation the authors analysed and compared outcomes in smokers versus non-smokers to determine the impact of this new system on outcomes in smokers. Materials and Methods: 64 patients who underwent spine fusion with intrasegmental fixation were prospectively studied at Mayday University Hospital beginning in 1997, 54 have sufficient follow-up to be included in the analysis. Patients were assessed pre and postoperatively, both radiographically and clinically, using validated outcome instruments including the SF-36. Results: There were 54 patients in the analysis (34 patients in the smoker group and 20 patients in the non-smoking group) with an average age of 52 years and an average follow-up of 28 months. 32 patients had multilevel procedures (25 two level, 5 three level, 2 four level). The treatment groups were comparable with respect to demographic, diagnostic (53% spondylolisthesis, 35% degenerative disc disease, 12% other) and surgical variables. No other significant medical problems affected patients in either group. Radiographically there were no pseudarthroses observed in either group. The SF-36 physical health score increased from 22.4 to 40.1 (+18.0) following surgery in smokers compared to an increase from 25.0 to 36.0 (+11.0) in non-smokers. The SF-36 mental health score increased from 36.4 to 45.0 (+8.6) in smokers compared to an increase of 30.8 to 42.7 (+2.9) in non-smokers. Complications included 2 nerve root injuries requiring hardware removal, and 3 deep infections which resolved with appropriate treatment. Conclusions: There were no differences between smokers and non-smokers in radiographic fusion success or postoperative complications. As expected, smokers had lower SF-36 physical health and mental health scores pre-op, but unexpectedly, smokers had a greater degree of improvement in these scores postoperatively than non-smokers. Thus, from our experience, there is an incremental benefit to the use of intrasegmental fixation in smokers and warrants further investigation

Background: There are many clinical and radiographic long term results of Total Hip Arthroplasties reported in literature but very few attend to the subjective quality of life of patients living with an implant. In the last few years different quality of life assessment scores were developed. In this study the subjective SF-36 and the WOMAC score were evaluated and the results were compared to the commonly used clinical Harris Hip Score. Patients and methods: From a total number of 152 cement-less Total Hip Arthroplasties (Alloclassic®) performed between October 1987 and December 1988 at our clinic, 103 hips in 99 patients were available for a clinical and radiographic evaluation with an average follow-up of 14.3 years. For clinical evaluation the Harris Hip Score was used. Additionally all patients got SF-36 and WOMAC questionnaires. 78 questionnaires were returned fully completed and could be evaluated. The overall results and the results in the domain “pain” and “function” which occur in all three scores were compared statistically. Results: The mean Harris Hip Score was 88.2 (range 24 – 100), pain score 41.9 and function score 48.4. The mean WOMAC Score was 10.6 in total, pain 2.8 and function 3.9. The SF-36 domain “Bodily Pain” was 56.6 and “physical function” 48.2. Concerning the domain “function” a significant correlation was found in all of the three scores (p < 0.01). A significant “pain” correlation was seen comparing the SF-36 to the WOMAC score (p < 0.01). No significant correlation was found comparing the clinical Harris Pain Score to the SF-36 domain “Bodily Pain” and to the WOMAC pain score. Conclusion: In this study the subjective assessment questionnaires SF-36 and WOMAC show significant similar results to the clinical Harris Hip Score concerning the domain “function”. Concerning “Pain” comparable results were found between the SF-36 and the WOMAC with no significant correlation to the HHS. These data suggest that the quality of life assessment questionnaires can not replace the clinical evaluation using a clinical score

Aims. To identify the responsiveness, minimal clinically important difference (MCID), minimal clinical important change (MIC), and patient-acceptable symptom state (PASS) thresholds in the 36-item Short Form Health Survey questionnaire (SF-36) (v2) for each of the eight dimensions and the total score following total knee arthroplasty (TKA). Methods. There were 3,321 patients undergoing primary TKA with preoperative and one-year postoperative SF-36 scores. At one-year patients were asked how satisfied they were and “How much did the knee arthroplasty surgery improve the quality of your life?”, which was graded as: great, moderate, little (n = 277), none (n = 98), or worse. Results. Physical function, role limitations due to physical problems (‘role physical’), bodily pain, and the total score SF-36 scores demonstrated the greatest effect sizes (> 0.9). The MCID for each of SF-36 dimensions ranged from 1.7 for role emotional to 6.4 for bodily pain. The MICs for a cohort of patients ranged from -1.0 for general health to 11.1 for bodily pain. The MICs for an individual patient were marginally greater (one to two points) compared to those for a cohort, and ranging from 0.0 for general and mental health to 13.5 for physical function. The lowest PASS score threshold was associated with physical function (> 34 points) whereas the greatest threshold (> 69 points) was associated with mental health. Conclusion. The SF-36 is a responsive tool, and the estimates for MCID, MIC, and PASS thresholds that can be used to power studies, assess whether there has been a meaningful change in patients’ health-related quality of life, and can be used as a marker of achieving patient satisfaction following TKA. Cite this article: Bone Joint Res 2022;11(7):477–483

Aims: Assessment of results in lumbar spine surgery with the SF-36 and NASS (lumbar element) Study design: Prospective monocentric study. Included were all patients with complete data sets. Excluded were patients with incomplete data, who could not read, did not understand german language. Patients and methods: 85 patients were included, 43 women, 42 men. Average age 59 years, SD ±17 years. The patients had surgical treatment (decompression and stabilization) after at least 6 months conservative treatement without amelioration. The questionaires were þlled out the day before operation, after 3, 6 and 12 months. The calculations for the dimensions were the effect size and standardized response mean (delta/SD of delta). Results: ES were large (> 0.8) for all the follow ups (0–3, 0–6, 0–12 months) in the NASS pain and disability dimensions and in the bodily pain and physical function (SF-36) also. ES were small (> 0.2) for all the follow ups (0–3, 0–6, 0–12 months) in the NASS neurology dimension and in the role physical (0–6, 0–12 months) and vitality (0–12 months) (SF-36). SRM showed analogue results. The back pain questions (NASS) depicted greater effects than the leg pain questions. The ES for disturbance was always greater (30%) than that for the frequency. Conclusion: The effect sizes depict large effects regarding back pain, leg pain and disability, small effects regarding neurology. The effects after three/six months are larger than after a year

Objectives

We aimed first to summarise minimal clinically important differences (MCIDs) after total hip (THR) or knee replacement (TKR) in health-related quality of life (HRQoL), measured using the Short-Form 36 (SF-36). Secondly, we aimed to improve the precision of MCID estimates by means of meta-analysis.

Aims. It is well described that patients with bone and joint infections (BJIs) commonly experience significant functional impairment and disability. Published literature is lacking on the impact of BJIs on mental health. Therefore, the aim of this study was to assess health-related quality of life (HRQoL) and the impact on mental health in patients with BJIs. Methods. The AO Trauma Infection Registry is a prospective multinational registry. In total, 229 adult patients with long-bone BJI were enrolled between 1 November 2012 and 31 August 2017 in 18 centres from ten countries. Clinical outcome data, demographic data, and details on infections and treatments were collected. Patient-reported outcomes using the 36-Item Short-Form Health Survey questionnaire (SF-36), Parker Mobility Score, and Katz Index of Independence in Activities of Daily Living were assessed at one, six, and 12 months. The SF-36 mental component subscales were analyzed and correlated with infection characteristics and clinical outcome. Results. The SF-36 physical component summary mean at baseline was 30.9 (95% CI 29.7 to 32.0). At one month, it was unchanged (30.5; 95% CI 29.5 to 31.5; p = 0.447); it had improved statistically significantly at six months (35.5; 95% CI 34.2 to 36.7; p < 0.001) and at 12 months (37.9; 95% CI 36.4 to 39.3; p < 0.001). The SF-36 mental component summary mean at baseline was 42.5 (95% CI 40.8 to 44.2). At one month, it was unchanged (43.1; 95% CI 41.4 to 44.8; p = 0.458); it had improved statistically significantly at six months (47.1; 95% CI 45.4 to 48.7; p < 0.001) and at 12 months (46.7; 95% CI 45.0 to 48.5; p < 0.001). All mental subscales had improved by the end of the study, but mental health status remained compromised in comparison with the average USA population. Conclusion. BJIs considerably impact HRQoL, particularly mental health. Patients suffering from BJIs reported considerable limitations in their daily and social activities due to psychological problems. Impaired mental health may be explained by the chronic nature of BJIs, and therefore the mental wellbeing of these patients should be monitored closely. Cite this article: Bone Jt Open 2024;5(9):721–728

Aims. Rotator cuff disease (RCD) can considerably decrease quality of life. Here, we investigated whether health-related quality of life (HRQoL) influences the need for surgery in patients with RCD. Methods. We performed an analysis of 417 patients with symptomatic RCD who were recruited from two hospitals between June 2008 and December 2014 to be randomized to receive non-surgical or surgical treatment. After a three-month rehabilitation period, 36-Item Short-Form Health Survey questionnaire (SF-36), shoulder pain (visual analogue scale (VAS)), and shoulder function (Constant-Murley score) data were available from 191 still-symptomatic patients who were eligible for surgery. A control group was formed from 87 excluded patients who were no longer eligible for surgery due to relief of symptoms. Results. Mean pain on the VAS was 51.3 (SD 20.1) in the patients eligible for surgery and 41.7 (SD 21.2) in the control group. The following domains of the SF-36 were associated with being eligible for surgery in univariate analyses: bodily pain, general health, vitality, social functioning, and emotional wellbeing. In multivariate analysis, only bodily pain was associated with pursuing surgical treatment. The RCD population’s values for physical role, bodily pain, and physical functioning were poorer compared to the values of the general population. Conclusion. Lower HRQoL, as indicated by the lower bodily pain score on the SF-36, was associated with the decision to undergo surgical treatment in patients with RCD. Therefore, HRQoL should be considered when determining treatment options for RCD. Cite this article: Bone Jt Open 2024;5(9):793–799

LCPD can cause femoral head deformity and osteoarthritis requiring total hip replacement (THR). Currently, there is little data on how patients are functioning after a THR from patients’ perspective. The purpose of this study was to collect a large patient-reported outcome data set on adults with LCPD, including those who had a THR, using a Web-survey method and to compare their outcomes to a normative population. An English REDCap-based survey was built and made available on a LCPD study group website. The survey included childhood and adult LCPD history, SF-36 Health Survey, and the Hip Disability and Osteoarthritis Outcome Score (HOOS). Statistical analysis included t-test and linear and proportional odds regressions. Of the 1182 participants who completed the survey, 261 participants (89 M, 172 F) had a THR. The mean age at survey was 44.6±12.4 years (range 20–79). The mean duration since THR was 7.2±8 years (median 4, range 0–43). Gender and age matched analysis showed that THR participants had significantly lower HOOS Quality-of-Life and Sports scores (p<0.0001) for all age groups in comparison to a normative cohort. In women, the HOOS Symptoms, Daily Living, and Pain scores were also significantly lower in the <55 age groups (p<0.05). Similarly, SF-36 scores were significantly lower (p<0.05) in female <45 age groups in 5 out of 8 SF-36 scales. Overall, hip dysplasia and the number of years-from-THR were the main factors associated with worse SF-36 and HOOS scores. In comparison to the non-THR participants, THR participants had higher scores in some of the HOOS and SF-36 scales. LCPD participants with THR had significantly worse HOOS and SF-36 scores in most of the scales studied than a normative cohort, especially in women. There is significant disability even after a THR, warranting continued efforts to improve treatment and outcome

Aims. The primary aim of our study was to assess the influence of age on hip-specific outcome following total hip arthroplasty (THA). Secondary aims were to assess health-related quality of life (HRQoL) and level of activity according to age. Methods. A prospective cohort study was conducted. All patients were fitted with an Exeter stem with a 32 mm head on highly cross-linked polyethylene (X3RimFit) cemented acetabulum. Patients were recruited into three age groups: < 65 years, 65 to 74 years, and ≥ 75 years, and assessed preoperatively and at three, 12, 24, and 60 months postoperatively. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and Hip disability and Osteoarthritis Outcome Score (HOOS), were used to assess hip-specific outcome. EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 36-Item Short Form Survey (SF-36) scores were used to assess HRQoL. The Lower Extremity Activity Scale (LEAS) and Timed Up and Go (TUG) were used to assess level of activity. Results. There were no significant (p > 0.05) differences in the WOMAC scores, HSS, HOOS, or EQ-5D-5L at any postoperative timepoint between the age groups. Patients aged ≥ 75 years had significantly lower physical function (p ≤ 0.010) and physical role (p ≤ 0.047) SF-36 scores at 12, 24, and 60 months, but were equal to that expect of an age-matched population. No differences according to age were observed for the other six domains of the SF-36 (p > 0.060). The ≥ 75 years group had a lower LEAS (p < 0.001) and longer TUG test times (p ≤ 0.032) compared to the < 65 years group, but older age groups had significant (p < 0.001) improvement relative to their preoperative baseline measures. Conclusion. Age did not influence postoperative hip-specific outcome or HRQoL (according to the EQ-5D) following THA. Despite a significant improvement, older patients had lower postoperative activity levels compared to younger patients, but this may be reflective of the overall physical effect of ageing. Cite this article: Bone Jt Open 2022;3(9):692–700

Aims. Psychological status may be an important predictor of outcome after periacetabular osteotomy (PAO). The aim of this study was to investigate the influence of psychological distress on postoperative health-related quality of life, joint function, self-assessed pain, and sports ability in patients undergoing PAO. Methods. In all, 202 consecutive patients who underwent PAO for developmental dysplasia of the hip (DDH) at our institution from 2015 to 2017 were included and followed up at 63 months (SD 10) postoperatively. Of these, 101 with complete data sets entered final analysis. Patients were assessed by questionnaire. Psychological status was measured by Brief Symptom Inventory (BSI-18), health-related quality of life was raised with 36-Item Short Form Survey (SF-36), hip functionality was measured by the short version 0f the International Hip Outcome Tool (iHOT-12), Subjective Hip Value (SHV), and Hip Disability and Outcome Score (HOS). Surgery satisfaction and pain were assessed. Dependent variables (endpoints) were postoperative quality of life (SF-36, HOS quality of life (QoL)), joint function (iHOT-12, SHV, HOS), patient satisfaction, and pain. Psychological distress was assessed by the Global Severity Index (GSI), somatization (BSI Soma), depression (BSI Depr), and anxiety (BSI Anx). Influence of psychological status was assessed by means of univariate and multiple multivariate regression analysis. Results. In multiple multivariate regression, postoperative GSI, BSI Soma, and BSI Depr had a negative effect on postoperative SF-36 (e -2.07, -3.05, and -2.67, respectively; p < 0.001), iHOT-12 (e -1.35 and -4.65, respectively; p < 0.001), SHV (e -1.20 and -2.71, respectively; p < 0.001), HOS QoL (e -2.09 and -4.79, respectively; p < 0.001), HOS Function (e -1.00 and -3.94, respectively; p < 0.001), and HOS Sport (e -1.44 and -5.29, respectively; p < 0.001), and had an effect on postoperative pain (e 0.13 and 0.37, respectively; p < 0.001). Conclusion. Psychological distress, depression, and somatization disorders affect health-related quality of life, perceived joint function, and sports ability. Pain perception is significantly increased by somatization. However, patient satisfaction with surgery is not affected. Cite this article: Bone Jt Open 2023;4(10):758–765

Introduction. The condition of the soft tissues surrounding an ankle fracture influences timing and treatment of injuries. Conventional treatment used an open approach to facilitate anatomical reduction and rigid internal fixation. Intramedullary devices for fibular fractures provide a safe alternative in patients in which the condition of the soft tissue envelope or the patient's co-morbidities may benefit from a less invasive approach. We compared outcomes for patients treated with open reduction internal fixation (ORIF) with those undergoing treatment with fibular nails (FN). Methods. 13 consecutive patients treated with fibular nails (FN) were compared with 13 age-matched patients that underwent open reduction and internal fixation (ORIF). All patients were followed to union. Study outcomes were time from admission to surgery, length of stay, wound failure, implant failure, revision surgery, OMAS and SF-36. Results. There was no difference in age or sex distribution between groups. There was no difference in OMAS at 1 year (83 ± 9 in FN group; 80± 21 in ORIF group) and SF-36 (94 ± 11 and 90 ± 20). There were 2 implant failures in the ORIF group and none in the FN group. There was one wound failure in the ORIF group and none in the FN group. Patients treated with FN had a shorter time to surgery (1 day ± 24 hours vs 3 days ± 24 hours) and shorter length of stay (1 day ± 24 hours vs 4 days ± 96 hours). Conclusion. FN is a safe method to treat patients with displaced distal fibular fractures that may have a poor soft tissue envelope and risk factors for wound healing. FN reduces the time to surgery and overall length of stay compared with similar patients treated with conventional ORIF

Abstract. Background. Daycase pathways which aim to discharge patients the same day following Unicompartmental Knee Replacement have been introduced in some centres, though most continue with Standard pathways. While Daycase pathways have cost savings, recovery data comparing pathways is limited. This study aims to compare patient-reported early recovery between Daycase and Standard pathways following UKR. Method. This study was carried out in two centres that originally used the same Standard recovery pathway for UKR. In one centre, the Standard pathway was modified into a Daycase pathway. 26 Daycase-Outpatient, 11 Daycase-Inpatient, and 18 Standard patients were recruited. Patients completed the Oxford Arthroplasty Early Recovery Score (OARS) and SF-36 (Acute) measure between Days 1–42. Results. Standard patients had significantly better Day-1 scores than Daycase patients, but this difference rapidly diminished, and from Day-3 onwards both groups had near-identical scores (OARS Day-1, 59 vs 37, p=0.002, stemming from differences in Pain, Nausea/Feeling-Unwell, Function/Mobility subscores p=0.003,0.014,0.011. OARS Day-3 48 vs 49, p=0.790). Daycase-Outpatients had a higher overall OARS (p=0.002), recovering 1–2 weeks faster than Daycase-Inpatients. OARS subscores demonstrated that Daycase-Outpatients had better Pain, Nausea/Feeling-Unwell, Fatigue/Sleep scores (p=0.020,0.0004,0.019 respectively). SF-36 scores corroborate OARS scores. Conclusion. The Standard cohort had better Day-1 scores than the Daycase cohort, likely due to later mobilisation and stronger inpatient analgesia; these differences diminished by Day-3. Daycase-Outpatients recovered substantially faster than Daycase-Inpatients – likely due to the factors that delayed their discharge. The convergence of scores at 6 weeks demonstrates that both pathways have similar early recovery outcomes

The use of intraoperative navigation and robotic surgery for minimally invasive lumbar fusion has been increasing over the past decade. The aim of this study is to evaluate postoperative clinical outcomes, intraoperative parameters, and accuracy of pedicle screw insertion guided by intraoperative navigation in patients undergoing lumbar interbody fusion for spondylolisthesis. Patients who underwent posterior lumbar fusion interbody using intraoperative 3D navigation since December 2021 were included. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Short Form Health Survey-36 (SF-36) were assessed preoperatively and postoperatively at 1, 3, and 6 months. Screw placement accuracy, measured by Gertzbein and Robbins classification, and facet joint infringement, measured by Yson classification, were assessed by intraoperative Cone Beam CT scans performed at the end of instrumentation. Finally, operation time, intraoperative blood loss, hospital stay, and screw insertion time were evaluated. This study involved 50 patients with a mean age of 63.7 years. VAS decreased from 65.8±23 to 20±22 (p<.01). ODI decreased from 35.4%±15 to 11.8%±14 (p<.01). An increase of SF-36 from 51.5±14 to 76±13 (p<.01) was demonstrated. The accuracy of “perfect” and “clinically acceptable” pedicle screw fixation was 89.5% and 98.4%, respectively. Regarding facet violation, 96.8% of the screws were at grade 0. Finally, the average screw insertion time was 4.3±2 min, hospital stay was 4.2±0.8 days, operation time was 205±53 min, and blood loss was 169±107 ml. Finally, a statistically significant correlation of operation time with hospital stay, blood loss and placement time per screw was found. We demonstrated excellent results for accuracy of pedicle screw fixation and violation of facet joints. VAS, ODI and SF-36 showed statistically significant improvements from the control at one month after surgery. Navigation with intraoperative 3D images represents an effective system to improve operative performance in the surgical treatment of spondylolisthesis

There is limited literature on the effects of socioeconomic factors on outcomes after total ankle arthroplasty (TAA). In the setting of hip or knee arthroplasty, patients of a lower socioeconomic status demonstrate poorer post-operative satisfaction, longer lengths of stay, and larger functional limitations. It is important to ascertain whether this phenomenon is present in ankle arthritis patients. This is the first study to address the weight of potential socioeconomic factors in affecting various socioeconomic classes, in terms of how they benefit from ankle arthroplasty. This is retrospective cohort study of 447 patients who underwent a TAA. Primary outcomes included pre-operative and final follow-up AAOS pain, AAOS disability, and SF-36 scores. We then used postal codes to determine median household income using Canadian 2015 census data. Incomes were divided into five groups based on equal amounts over the range of incomes. This method has been used to study medical conditions such as COPD and cardiac disease. These income groups were then compared for differences in outcome measures. Statistical analysis was done using unpaired t-test. A total of 447 patients were divided into quintiles by income. From lowest income to highest income, the groups had 54, 207, 86, 64, and 36 patients, respectively. The average time from surgery to final follow up was 85.6 months. Interestingly, we found that patients within the middle household income groups had significantly lower AAOS disability scores compared to the lowest income groups at final follow-up (26.41 vs 35.70, p=0.035). Furthermore, there was a trend towards middle income households and lower post-operative AAOS pain scores compared to the lowest income group (19.57 vs 26.65, p=0.063). There was also a trend toward poorer AAOS disability scores when comparing middle income groups to high income groups post-operatively (26.41 vs 32.27, p=0.058). Pre-operatively, patients within the middle-income group had more pain, compared to the lowest and the highest income groups. No significant differences in SF-36 scores were observed. There were no significant differences seen in middle income groups compared to the highest income group for AAOS pain post-operatively. There were no significant differences found in pre-operative AAOS disability score between income groups. Patients from middle income groups who have undergone TAA demonstrate poorer function and possibly more pain, compared to lower and higher income groups. This suggests that TAA is a viable option for lower socioeconomic groups and should not be a source of discouragement for surgeons. In this circumstance there is no real disparity between the rich and the poor. Further investigation is needed to explore reasons for diminished performance in middle class patients

Osteoarthritis (OA) is one of the most common causes of knee pain in the aging population and presents with higher odds with increased BMI. Total knee arthroplasty (TKA) has become the standard of care for the treatment of OA. Over “719,000 TKA's were performed in 2010 in the USA alone, with dramatic economic burden- costing 16,000 USD per TKA” (CDC 2012). Over the past two decades, this cost was compounded by the unknown increasing rate of primary TKA and cannot be explained by the expanding population or worldwide obesity epidemic. These facts raise two key questions: are patients' quality of life expectations higher and driving the TKA rate up, or have surgeons changed their indications and started to operate on less disabled people? Our study aimed to determine the average functional profile for patients undergoing TKA using patient reported Outcome Measure (SF-36), to document if preoperative SF-36 scores have changed over the past two decades, and lastly to asses if patient pre-operative SF-36 scores are lower in in the USA vs the rest of the world. A literature search of Medline, Embase and Cochrane databases was performed extracting data from publishing year 1966 to 2016 with a search date of Dec 12, 2016. Two independent reviewers revised the abstracts and excluded articles with: no TKA, revision TKA, no pre-op SF-36, no SF-36 reported, incomplete scores to calculate SF-36, duplicates, review article, meta-analysis, letter to the editor, conference proceeding or abstract, disagreements were resolved with a third reviewer. All languages were included to maximize the catchment of data. All remaining articles were independently read and excluded if they did not provide data required for our study. Included articles were analyzed for data including: for year of patient enrollment, location (USA vs. non-USA), pre-operative SF-36 mental (MCS) and physical (PCS) component summary, level of evidence. Recorded data was compared post completion to assess inter-observer accuracy as per PRISMA guidelines for meta-analysis. After applying all the exclusion criteria on 923 selected abstracts, a total of 136 articles of which 30 were randomized control trials, were completely reviewed and included in our study. A total of 56,713 patients' physical component scores were analyzed and revealed an overall pre-operative SF-36 physical component score 31.93. When stratifying the data, it was revealed that patients operated in the USA had an average score of 32.3 whereas Non-US countries were 31.7, with no statistical significance. No statistical difference between SF36 scores was seen over time amongst studies of all nations. Based on the results of this study, we have shown that orthopaedic surgeons are performing TKA universally at the same pre-operative scores, independent of country of origin or year of surgery. The indications thus have remained consistent for two decades regardless of the advances in technology. Functional profiles of patients appear similar among US and Non-US countries. Further, we infer that based on pre-operative SF-36 PCS scores, the optimal time to undergo a TKA is when PCS is 31.9 +/−3

In health care, several studies have suggested worse outcomes in African-Americans. Our objective was to study the relationships of race with outcomes in a series of total hip arthroplasty (THA) cases. A consecutive series of 2,435 total hip/knee arthroplasties (primaries and revisions) performed in a single hospital by a single surgeon were studied. Revisions due to infections were excluded. Data on race was available for 718 THAs which were finally included. Cases of African-Americans (AA) (n=55) and Whites (n=663) were compared on baseline demographics, Charlson, ASA, preoperative-diagnosis; preoperative and postoperative pain intensity/frequency visual-analogue-scale, QWB-7, SF-36, WOMAC, Hip Harris, Postel-D'Aubigne scores; and on postoperative transfusion rates. T-tests, Chi-Square, MANCOVA (age, ethnicity, BMI, and preoperative-diagnosis adjustments) were used. Mean follow-up: 3 years. Alpha was set at 0.05. At baseline and compared to Whites, African-Americans were significantly younger (mean, 67 vs. 59 years), had fewer Hispanics (61% vs. 26%), and had higher BMI (28.5 vs. 30.6 Kg/m. 2. ) (all p≤0.048), respectively. Preoperative diagnoses were significantly different (p<0.001). There were no significant differences between the groups on preoperative scores after adjusting for confounders. Postoperatively, SF-36 bodily-pain (70 vs. 57), SF-36 mental-component-summary (56 vs. 53), WOMAC-total (5 vs. 12), and WOMAC-stiffness (0.14 vs. 0.57) were significantly worse in African-Americans (all p≤0.043), respectively. African-Americans underwent more transfusions (28% vs. 65%, p=0.001). Compared to Whites, African-Americans underwent THA earlier in life, with higher BMI, and different preoperative-diagnosis. They also had worse postoperative scores and more transfusions. Race seems to be strongly associated with outcomes

Aims. The aim of this study was to perform a cross-cultural adaptation of Oxford Hip Score (OHS) to Indonesian, and to evaluate its psychometric properties. Methods. We performed a cross-cultural adaptation of Oxford Hip Score into Indonesian language (OHS-ID) and determined its internal consistency, test-retest reliability, measurement error, floor-ceiling effect, responsiveness, and construct validity by hypotheses testing of its correlation with Harris Hip Score (HHS), vsual analogue scale (VAS), and Short Form-36 (SF-36). Adults (> 17 years old) with chronic hip pain (osteoarthritis or osteonecrosis) were included. Results. A total of 125 patients were included, including 50 total hip arthroplasty (THA) patients with six months follow-up. The OHS questionnaire was translated into Indonesian and showed good internal consistency (Cronbach’s alpha = 0.89) and good reliability (intraclass correlation = 0.98). The standard error of measurement value of 2.11 resulted in minimal detectable change score of 5.8. Ten out of ten (100%) a priori hypotheses were met, confirming the construct validity. A strong correlation was found with two subscales of SF-36 (pain and physical function), HHS (0.94), and VAS (-0.83). OHS-ID also showed good responsiveness for post-THA series. Floor and ceiling effect was not found. Conclusion. The Indonesian version of OHS showed similar reliability and validity with the original OHS. This questionnaire will be suitable to assess chronic hip pain in Indonesian-speaking patients. Cite this article: Bone Jt Open 2021;2(9):765–772

Aims. This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. Methods. A systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis. Results. A total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. Conclusion. This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I. Cite this article: Bone Jt Open 2021;2(10):842–849