Background. The effect of hallux valgus (HV) on health-related quality of life (HRQOL) and the relationship between radiographic severity of deformity and patient reported outcome measures (PROMs) is poorly understood. The aim of this study was to compare the HRQOL of female patients with HV to the UK population. The secondary aim was to assess the correlation between PROMs, including HRQOL, with radiographic severity of deformity. Methods. Weight bearing radiographic data (hallux valgus (HVA) angle; intermetatarsal (IM) angle) were measured in consecutive female patients presenting with HV. Each patient prospectively completed the Euroqol EQ-5D-5L questionnaire (EQ-5D), Visual Analogue Scale for Pain (VAS-Pain) and Manchester Oxford Foot Questionnaire (MOXFQ). Data were stratified into age ranges and compared with an EQ-5D United Kingdom general population reference dataset. Pearson R correlation values were calculated for the PROMs and radiographic deformity. Results. Between July 2015 and March 2020, 425 consecutive female patients presented with HV for consideration for surgery. EQ-5D-5L data were prospectively collected for 396 of these patients (93.2%). Females less than 65 years with HV had a statistically significantly worse quality of life compared with females of the same age group in the general population. Above the age of 65, there was no statistically significant difference in EQ-5D-5L Index score between the two groups. There was no correlation between radiographic HV deformity and HRQOL measures or MOXFQ scores. Conclusion. Female patients presenting with HV deformity have a significantly reduced quality of life compared with the UK general population. The radiographic severity of deformity did not correlate with HRQOL measures or foot and ankle specific PROMs. Foot and ankle specific clinical PROMs moderately correlate with HRQOL and may be a better marker of the negative effect of symptomatic hallux valgus deformity on quality of life

Aim. People awaiting surgery for bone and joint infection may be recommended to stop smoking to improve anaesthetic and surgical outcomes. However, restricting curative surgical treatment to non-smokers on the basis of potentially worse surgical outcomes is not validated for functional outcomes or quality of life differences between patients who do and do not smoke. This study used secondary analysis of trial data to ask: do peri-operative non-smokers have a greater improvement in their quality of life 12 months after surgery for bone and joint infection, compared with non-smokers?. Method. Participants in the SOLARIO and OVIVA clinical trials who had complete baseline and 12 month EQ-5D-5L or EQ-5D-3L scores were included. Smoking status was ascertained at baseline study enrolment from participant self-report. Normalised quality of life scores were calculated for participants at baseline and 12 months, based on contemporaneous health state scores for England. Baseline and 12 month scores were compared to calculate a post-operative increment in quality of life. Results. Mean quality of life increment over 12 months was +0.17 for people who reported smoking peri-operatively (95% confidence interval −0.55 to +0.89), compared to +0.23 for people who did not report smoking peri-operatively (95% confidence interval −0.48 to +0.94). Linear regression analysis found no significant difference between the improvement in quality of life for smokers and non-smokers (p>0.1). Mean increments for both groups were greater than estimates of Minimal Clinically Important Difference in quality of life in musculoskeletal conditions. [1,2]. Conclusions. People who smoke peri-operatively still experience an improvement in quality of life after surgery for orthopaedic infections, commensurate with the improvement experienced by non-smokers. Surgery should not be denied to people on the basis of reported smoking status alone

Acute Haematogenous Osteomyelitis (AHO) remains a cause of severe illness among children with the possibility of long-term consequences for growth and development. Previous research on sequelae from AHO rarely considers outcomes more than two years following treatment. This study aims to establish the quality of life of patients diagnosed with AHO in childhood up to 13 years after diagnosis, evaluating the impact on social, emotional, physical, and school function. Children treated for AHO between 2008–2018 at a tertiary referral centre in New Zealand were identified. PedsQL™ questionnaires were conducted via phone with either the child or primary caregiver and responses analysed. 40 patients met inclusion criteria, were contactable by phone, and consented to participate. The mean age was 7 years (range 0–15) and most were female (60%). Health related quality of life (HRQOL) was scored as a percentage with most participants scoring >80% (n=27). Those who do experience reduced quality of life following treatment for AHO were likely to complain of pain, stiffness, or anxiety. The impact of significant childhood illness on mental health was not adequately captured by the PedsQL™ but was highlighted in qualitative feedback. We conclude that the majority of children treated for AHO reported excellent health-related quality of life up to 13 years following treatment although an negative impact on mental health was reported using qualitative analysis. A refined scoring system is needed to assess the long-term impact of musculoskeletal infection

Aim. We aimed to evaluate the impact of knee periprosthetic joint infection (PJI) by assessing the patients’ long-term quality of life and explicitly their psychological wellbeing after successful treatment. Method. Thirty-six patients with achieved eradication of infection after knee PJI were included. Quality of life was evaluated with the EQ-5D and SF-36 outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data. Results. At a follow-up of 4.9± 3.5 years the mean SF-36 score was 24.82± 10.0 regarding the physical health component and 46.16± 13.3 regarding the mental health component compared to German normative values of 48.36± 9.4 (p< .001) and 50.87± 8.8 (p= .003). The mean EQ-5D index reached 0.55± 0.33 with an EQ-5D VAS rating of 52.14± 19.9 compared to reference scores of 0.891 (p< .001) and 68.6± 1.1 (p< .001). Mean scores of the ISR revealed psychological symptom burden on the depression scale. Conclusions. PJI patients still suffer from significant lower quality of life compared to normative data even years after surgically successful treatment. Future clinical studies should focus on patient-related outcome measures. Newly emerging treatment strategies, prevention methods and interdisciplinary approaches should be implemented to improve the quality of life of PJI patients

Introduction. The purpose of this research is to compare the quality of life in children during gradual deformity correction using external fixators with intramedullary lengthening nails. Materials and Methods. Prospective analysis of children during lower limb lengthening. Group A included children who had external fixation, patients in group B had lengthening nails. Patients in each group were followed up during their limb reconstruction. CHU-9D and EQ-5DY instruments were used to measure quality of life at fixed intervals. The first assessment was during the distraction phase (1 month postop.), the second was during the early consolidation phase (3 months postop.) and the final one was late consolidation phase (6–9 months depends on the frame time). Results. Group B patients reported significantly better utility compared to Group A. This was observed during all the stages of the treatment. Group B children were less worried (P 0.004), less sad (P 0.0001), less pain (p <0.0001), less tired (P 0.0002), better school work (P0.0041), better sleep (p 0.016), more able to do sports activities (p 0.004) and, they were more independent (p <0.0001) compared to group B. QALYS was better for the nails group compared to external fixation group 0.44 compared to 0.36 for external fixators. Conclusions. Lengthening nails had the potential to improve the quality of life and utility compared to external fixation. This will help further economic evaluation to measure ICER to further explore the cost effectiveness of these devices

Aim. Patient quality of life (QoL) in untreated bone infection was compared to other chronic conditions and stratified by disease severity. Method. Patients referred for treatment of osteomyelitis (including fracture related infection) were identified prospectively between 2019 and 2023. Patients with confirmed infection completed the EuroQol EQ-5D-5L questionnaire. Clinicians blinded to EQ-index score, grouped patients according to JS-BACH Classification into ‘Uncomplicated’, ‘Complex’ or ‘Limited treatment options’. A systematic review of the literature was performed of other conditions that have been stratified using EQ-index score. Results. 257 patients were referred, and 219 had suspected osteomyelitis. 196 patients had long bone infection and reported an average EQ-index score of 0.455 (SD 0.343). 23 patients with pelvic osteomyelitis had an average EQ-index score of 0.098 (SD 0.308). Compared to other chronic conditions, patients with long-bone osteomyelitis had worse QoL when compared to different types of malignancy (including bladder, oropharyngeal, colorectal, thyroid and myeloma), cardiorespiratory disease (including asthma, COPD and ischaemic heart disease), psychiatric conditions (including depression, pain and anxiety), endocrine disorders (including diabetes mellitus), neurological conditions (including Parkinson's disease, chronic pain and radiculopathy) and musculoskeletal conditions (including osteogenesis imperfecta, fibrous dysplasia and x-linked hypophosphataemic rickets). QoL in long-bone infection was similar to conditions such as Prada-Willi syndrome, Crohn's disease and juvenile idiopathic arthritis. Patients who had a history of stroke or multiple sclerosis reported worse QoL scores compared to long-bone infection. Patients who had pelvic osteomyelitis gave significantly lower QoL scores when compared to all other conditions that were available for comparison in the literature. In long bone infection, 41 cases (21.0%) were classified as ‘Uncomplicated’, 136 (69.4%) as ‘Complex’ and 19 (9.7%) as ‘Limited treatment options available’. Within classification stratification, patients with ‘Uncomplicated’ long bone infections reported a mean EQ-index score of 0.618 (SD 0.227) which was significantly higher compared to ‘Complex’ (EQ-index: 0.410 SD 0.359, p=0.004) and ‘Limited treatment options available’ (EQ-index: 0.400 SD 0.346, p=0.007). Conclusions. Bone and joint infections have a significant impact on patient quality of life. It is much worse when compared to other common chronic conditions, including malignancy, cardiovascular and neurological diseases. This has not been previously reported but may focus attention on the need for more investment in this patient group

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

The optimal treatment strategy for post-traumatic long bone non-unions is subject of an ongoing discussion. At the Maastricht University Medical Center (MUMC+) the induced membrane technique is used to treat post-traumatic long bone non-unions. This technique uses a multimodal treatment algorithm involving bone marrow aspirate concentrate (BMAC), the reamer-irrigator-aspirator (RIA) and P-15 bioactive peptide (iFactor, Cerapedics). Bioactive glass (S53P4 BAG, Bonalive) is added when infection is suspected. This study aims to objectify the effect of this treatment algorithm on the health-related quality of life (HRQoL) of patients with post-traumatic long bone non-unions. We hypothesized that HRQoL would improve after treatment. From January 2020 to March 2023, consecutive patients who were referred to a multidisciplinary (trauma, orthopaedic and plastic surgery) non-union clinic at the MUMC+, The Netherlands, were evaluated using the Non-Union Scoring System (NUSS). The EQ-5D-5L questionnaire and the Lower Extremity Functional Scale (LEFS) were employed to obtain HRQoL outcomes both prior to and subsequent to surgery, with a follow-up at 6, 18 and 35 weeks. Seventy-six patients were assessed at baseline (T0), with a mean NUSS of 40 (± 13 SD). Thirty-eight patients had their first follow-up, six weeks after surgery (T1). Thirty-one patients had a second follow-up at 18 weeks (T2), and twenty patients had the third follow-up at 35 weeks (T3). The EQ-5D index mean at baseline was 0.480, followed by an index of 0.618 at T1, 0.636 at T2, and 0.702 at T3. A significant difference was found in the HRQoL score between T0 and T1, as well as T2 and T3 (p<0.001; p=0.011). The mean LEFS significantly increased from 26 before intervention to 34, 39, and 43 after treatment (p<0.001; p=0.033; p=0.016). This study demonstrated a significant improvement in the health-related quality of life of patients with post-traumatic long bone non-unions after the standardized treatment algorithm following the induced membrane technique

The pain of arthritic disorders occurs in a social and environmental context. Thus, the pain of arthritis not only can affect the patient, but also the spouse. Numerous investigations have shown that the spouses of individuals with persistent pain report lower levels of marital satisfaction, higher rates of depression and lower quality of life. For the vast majority of patients with osteoarthritis, total hip (THA) or total knee (TKA) arthroplasty results in a significant reduction in pain, emotional distress, disability and a significant improvement in their quality of life and function. Little is currently known about how these recovery-related changes impact on the spouse or the marital relationship. Patients and their spouses were recruited within one-year following the arthroplasty surgery. Couples participated in a semi-structured interview and were each asked to recall their level of pain on a numerical rating scale from 1 to 10 before and after recovering from surgery, and provide a numerical rating score (10 points) for a set of seven questions pertaining to their level of disability in seven different activities of daily living. In addition, the spouses were asked to list in order of importance the ways in which the surgery of their spouse affected their overall quality of life. In total, 33 couples (66 respondents) answered the survey questionnaire. There were 17 male patients, 16 female patients who underwent 29 THAs and 4 TKAs. With regard to pain, the spouses estimated their partner's pain, both preoperatively and at the time of the survey, to be at a significantly higher level than the patient's perception (p=0.05). The spouses perceived a greater improvement in family/home responsibilities, recreation and social activities, and in their occupation than that noted by the partner. After the arthroplasty, the spouses indicated that their lives had improved with respect to doing more activities/leisure (70%), because there partner had less suffering (61%), they had more independence/less caregiving (54%), it improved their marital relationship (54%), they had a better social/family life (27%) and they were able to travel (27%). In addition to the patient, THA and TKA result in a significant improvement in quality of life and marital functioning of the spouse. This should not continue to be unrecognized as a significant benefit of the procedure

The benefits of total hip arthroplasty (THA) may be significantly magnified in children, since the improvement in quality of life has a far greater exposure time and occurs during key developmental stages which may help to maximise lifetime achievement. The purpose of this study is to describe implant survival and patient reported outcomes (PROMS) in a cohort of children following THA. Retrospective cohort review of all patients treated with THA in a single centre. Routine data analysis did not require ethical approval. Survival was estimated using Kaplan-Meier and PROMs were recorded (EQ5D-S, Oxford hip score and modified Harris Hip Score) in a sub-group of patients. 66 hips in 47 patients with a median age of 16 years (range 10 to 19 years) underwent THA between 1971 and 2023. 57% (38/68) patients were female, the commonest indications were Mucopolysaccharidoses n = 15, Stills disease (n=15), and Avascular necrosis (n=12). 27 (41%) of constructs were cemented, 5 (8%) were hybrid, and 34 (51%) were cementless. 30 stems were custom made cementless stems. Median follow up was 3.8 years (range 0–34 years). Implant survival was 87% at 10 years, 61.6% at 20 years and 52.8% at 30 years. PROMS demonstrated mean preoperative OHS was 12, preoperative MHHS was 23 and EQ5Ds VAS of 38. PROMS improved steadily overtime with mean OHS of 43, MMHS of 75 and EQ5Ds VAS of 89 at one year. THA was associated with a very large change in patient reported hip function and quality of life. In this study, THA delivered a long-lasting solution to hip pain with survival similar to that seen in patients undergoing THA in the fourth and fifth decades of life. Socioeconomic benefits of THA need further investigation to establish treatment guidelines for children suffering with hip pain

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

Previous studies revealed the close relation of anxiety and low back pain. Among people with chronic low back pain, anxiety is the most commonly reported mental disorder. Thus, in the literature, there are several studies considering the anxiety as a risk factor for chronic low back pain. The authors also documented a significant differences between sexes in anxiety and quality of life due to low back pain. US National Institute of Mental Health reports that the lifetime prevalence of an anxiety disorder is 60 % higher in women than in men and that the onset, severity, clinical course, and treatment response of anxiety disorders differ significantly in women. In addition, literature has showed that women may have a worse quality of life when they have low back pain. University students may undergo an undue amount of stress, with negative outcomes in terms of academic resuşts and personal, emotional or health, consequences. Moreover, stress can be experienced at different time periods, not only during university life, but also before, during the transition from undergraduate to professional level, and after, during the transition to the life work. After all these literature knowledge, we designed the study to compare the anxiety and quality of life levels of female and male specifically university students with low back pain aged between 18–26. In this study, 100 female and male university students with low back pain aged between 18–26 were included. The low back pain level were measured by Visual Analogue Scale (VAS) and the disability level due to the pain was measured by Revised Oswestry Low Back Pain Disability Questionnaire (ODI). Beck Anxiety Inventory (BAI) was used to evaluate the anxiety level and also, Short Form 36 survey (SF-36) was used to understand the quality of life for subjects. These questionnaires were asked to participants on online platform via Google Forms between March 2020 and May 2020. SPSS Version 25.0 program was used for statistical analyses. The result of the study showed that there was a statistically significant difference between female and male students on anxiety levels (p<0.05). There were no statistically differences between female and male students on ODI and VAS (p>0.05). In female group, BAI and “Physical function” and “General Health” subgroups of SF-36 have negative correlations (p<0.05). When we correlated BAI and all subgroups of SF-36 in male group, the statistical results were showed that negative correlation with all subgroups (p<0.05) except “Energy and Fatigue” subgroup (p>0.05). We conclude that female university students with low back pain have higher anxiety levels than male students. Future studies can work on young students to cope with the psychological problems for well-being

Purpose: Some of nowadays treatments in shoulder pathology are focused in pain drop, but is to be evidenced than pain is the most reliable item in shoulder patient’s quality of life. The purpose of this study is to analyze quality of life in patients affected of different shoulder pathologies and check how pain and movement influence quality of life perception (QLP). Material And Methods: 134 patients correctly filled the shoulder functional Constant score and the SF-36 score. Patients were classified by age, sex, labor status, level of education and diagnosis. There were 56 men (41,79%) and 78 women (58,21%). Mean age was 53,77 (18–85). Amongst them, 74 patients were classified as subacromial syndrome, 19 as fractures, 29 degenerative pathology and 12 as shoulder instability. Student’s T test was performed to study quantitative variables. Qualitive variables were studied using ANOVA test. Impact of pain and mobility on patients’ quality of life was assessed by Rho-Spearman’s test. Statistical regression coefficient was used to evaluate the impact of pain and mobility in perceived quality of life. Results: There were statistically significant differences amongst age, sex and diagnosis groups (p< 0,001). Patients older than 65 years old significatively (p< 0.001) perceived worst quality of life. Women and patients affected by a degenerative disorder significatively perceived worst quality of life (p< 0.001). A relationship between movement and quality of life was founded (linear trend). In patients with preserved range of motion, changes in pain perception significatively affected PQL (p< 0,001), meanwhile patients with poor range of motion, changes in pain perception did not affect PQL (p> 0,001). The regression coefficient for pain related to SF-36 Physical component scale was 0,629 (IC: 0,301–0.958), meanwhile the regression coefficient for external rotation is 1,196 (IC: 0,693–1,699), giving thus a predominant effect of extenal rotation in PQL. Conclusion/Discussion: Age, sex and etiology of shoulder disorder determine different perceptions of quality of life independently of the shoulder functional scoring. Range of motion significatively affect QLP independently of the level of pain. Pain affects QLP in patients whom range of motion is preserved. External rotation is the most important item affecting QLP. Factors determining quality of life perception should be taken into account when planning surgery strategies for different shoulder disorders

Introduction. This study assesses self-reported quality of life (QoL) in patients with osteomyelitis referred to a specialist centre in the UK. Materials and Methods. All patients newly referred to a specialist tertiary bone infection clinic within the UK between January 2019 and February 2020 were prospectively included. Diagnosis of osteomyelitis was made according to the presence of clinical and radiological criteria for ≥6 months. An EQ-5D-5L questionnaire and visual analogue score (VAS) were completed during the initial clinic appointment. Long-bone osteomyelitis was classified by the attending orthopaedic surgeon using the BACH classification system as either uncomplicated, complex or with limited options available. Patients managed non-operatively were subclassified into those who were (i) unfit to receive an operation or (ii) fit and well with stable disease. EQ-5D index scores were compared to a published UK value-set of 41 chronic health conditions within the UK. Results. 201 new patients were referred during the study period. 159 (79.1%) met the criteria for long-bone osteomyelitis and 16 (8.0%) for osteomyelitis of the pelvic bones. Patients with pelvic osteomyelitis reported lower EQ-5D index scores compared to long-bone osteomyelitis (EQ-5D:0.097 vs. 0.435, p<0.001) but similar VAS (60.2 vs. 54.6, p=0.37). Long-bone and pelvic osteomyelitis gave the lowest EQ-5D scores respectively when compared to 41 other chronic health conditions including stroke, chronic obstructive pulmonary disease, kidney disease, liver disease and malignancy. Patients classified as having uncomplicated long-bone osteomyelitis reported significantly higher QoL compared to those classified as complex osteomyelitis (EQ-5D:0.527 vs. 0.401, p<0.05; VAS: 66.9 vs. 58.4, p<0.05). Patients not fit for surgery due to co-morbidity reported similar QoL scores compared to those patients with complex osteomyelitis (EQ-5D: 0.293, p=0.07; VAS: 46.6, p=0.06). Patients with stable disease who did not require surgery, gave significantly better QoL scores when compared to the other classifications of osteomyelitis (EQ-5D: 0.746, p<0.01; VAS: 81.9, p<0.01). Conclusions. Patient reported QoL in osteomyelitis correlates with disease complexity as classified according to the BACH classification system. Patients with pelvic and long-bone osteomyelitis rate their QoL lower than patients with other major chronic diseases

Aim. To investigate the impact of waiting for surgical treatment for bone and joint infection (BJI) on patient self-reported quality of life (QoL). Method. Patients presenting to clinic between January 2019 and February 2020 completed the EuroQol EQ-5D-5L questionnaire. Patients were divided into three groups: surgery performed; on the waiting list for surgery; or decision for non-operative management. All patients were followed-up for 2 years. The EQ-index score was calculated and change from presentation to 1-year and 2-year follow-up was compared across the 3 groups. Mortality at final follow-up was measured in all groups. Results. 188 patients were included. Of these, 98 had an operation performed, 50 were on the waiting list for surgery but did not receive an operation and 40 were treated non-operatively. At presentation, all three groups had similar EQ-5D-5L index scores (surgery:0.412 SD0.351; waiting list:0.510 SD0.320; non-operative management: 0.467 SD0.354; p=0.269). There was a significant improvement in QoL in patients who underwent surgery when compared to their pre-operative state (mean increase of EQ-index score +0.241 in the first year (SD0.333, p<0.001) and +0.259 (SD0.294, p<0.001) in the second year. Patients on the waiting list for surgery had a small time-dependent decrease in EQ-index score at 1 year (−0.077, SD0.282, p=0.188) and 2 years (−0.140, SD0.359, p=0.401). Patients treated non-operatively had similar changes in EQ-index scores at 1 year (−0.052, SD0.309, p=0.561) and 2 years (−0.146, SD 0.234, p=0.221). Patients who had surgery had significantly better QoL at 2-years after treatment compared to other groups (mean EQ-index scores: surgery performed 0.671 vs. waiting list 0.431, p<0.001; surgery performed vs. non-operative management 0.348, p<0.001). Mortality in the operated group was 3.1%, which was similar to patients who were on the waiting list for surgery (6.5%, p=0.394) but lower than patients who were non-operatively managed (14.7%, p=0.014). Conclusions. The Covid-19 pandemic created long waiting times for some patients. Selecting patients with BJI who can safely wait for surgery is difficult. QoL for patients with BJI deteriorates over time if surgery is delayed or not performed. When patients decline surgery, they should be counselled that their QoL is likely to be impaired over time. The relationship between waiting time and mortality merits further study

Introduction. There are currently no quality of life Patient Reported Outcome Measures (PROMs) that have been validated for patients with conditions requiring lower limb reconstructive surgery. The extent to which current generic and lower limb specific PROMs address relevant dimensions for these patients is unclear. Materials and Methods. We will present an overview of the PROLLIT (Patient-Reported Outcome Measure for Lower Limb Reconstruction) mixed-methods study. PROLLIT aims to establish the adequacy of current PROMS for this population, whether a new measure is required, and to develop a new measure if appropriate. Results. The PROLLIT study consists of three phases:. Phase 1 is currently underway and involves the development of a conceptual model to map the key quality of life constructs relevant to people undergoing reconstructive surgery, to specify the intended population and uses of a PROM in this field. The conceptual model is being developed in a 3 step process: (i) Existing evidence is being collated in a systematic review of published qualitative research (Qualitative Evidence Synthesis); (ii) a multi-site qualitative study of patients, orthopaedic surgeons, specialist nurses and physiotherapists; (iii) an interdisciplinary panel of patients, surgeons, healthcare professionals and methodologists to finalise the conceptual framework based on the findings of the Qualitative Evidence Synthesis (i) and qualitative study (ii). Phase 2 involves mapping the conceptual framework onto existing PROMs measures that are used with this population to determine whether the constructs identified as important by patients and healthcare professionals are reflected in existing PROMS. Phase 3 involves developing a new outcome measure, if deemed necessary/appropriate during Phase 2. Conclusions. Current PROMS may not adequately address the issues relevant to patients recovering from lower limb reconstructive surgery. Phase 1 and 2 will provide robust evidence as to whether this is the case in order to seek funding for research to develop a new measure (Phase 3)

Aim. This study was conducted to investigate the clinical outcome, functional outcome, and quality of life of patients treated for post traumatic osteomyelitis (PTO) of femur and tibia from July 2007 to June 2014. Method. Forty seven patients consented and participated in this study. The median age of participants was 44 years old, and ranges from 16 to 80 years old. There were 26 tibia and 21 femur osteomyelitis evaluated in this study. Thirty-eight participants (80.9%) had implants inserted. The PTO patients were classified according to Cierny-Mader (CM) classification: 2 CM-I; 8 CM-II; 18 CM III; 19 CM IV and 25 CM-A and 19 CM-B. The participants were follow up for a mean duration of 4.6 years (range 2.3–9.5 years). Interviews were then conducted and clinical assessments were performed to evaluate the clinical outcome. Their functional outcome was evaluated using the Lower Extremity Functional Score (LEFS) and the quality of life was evaluated using the validated SF-36v2 and the results were compared to the general population (GP). Results. Forty four (93.6%) of participants had achieved union without recurrence of infection. Others who had failure of treatment were CM-IIIA, CM-IVA, and CM-IVB. Concurrent medical problem and CM-B (Systemic) hosts significantly contributed to poorer functional outcome, and lower quality of life score especially the Physical Component domain. Conclusions. Most patients with post traumatic osteomyelitis had successful treatment. However their quality of life was poorer in comparison to the general population. Concurrent medical problem and CM-B (Systemic) hosts had significantly poorer functional outcome and quality of life than the general population

Aim: To determine the quality of life and radiological outcome of the rotating hinge total knee prosthesis as a salvage procedure for failed knee arthroplasty. Methods: Forty-seven consecutive revision total knee arthroplasties, using the rotating hinge component, implanted between November 1983 and June 1997, were studied. The principal indications for surgery were pain with ligamentous laxity and gross bone loss. There were 43 patients, 11 males, 32 females, 19 left and 28 right, 21 with rheumatoid disease and 22 with osteoarthritis. The mean age at revision was 68 years, mean time from primary procedure to revision of 8 years and a mean number of previous knee procedures of 1.6 (range 1–5). The average time to final follow-up was 5 years. Quality of life was determined using the Nottingham Health Profile (NHP) combined with standard clinical and radiological assessment. Results: Of the 47 revision procedures, full clinical follow-up information was available on 43 (91.5%), radiographic follow-up on 38 (80.9%). Complications occurred in 10 out of the 47 arthroplasties (21.3%) including 4 deep infections, 2 femoral fractures, 2 patients with clinically apparent aseptic loosening and 2 significant extensor mechanism problems. Survivorship analysis revealed a 5year cumulative implant survival of 89%. Significant improvements in quality of life (pain and physical mobility) were shown at 12 months post-operatively. Discussion: This is a prospectively-studied series of salvage arthroplasty procedures. We regard quality of life as a key indicator of surgical success after knee arthroplasty. Rotating hinge arthroplasty offers objective and reproducible improvement in quality of life for failed knee arthroplasty with ligamentous instability

Purpose: To assess the change in disease-specific quality of life associated with operating on patients with AIS, compared to non operative patients. Methods: The Climent Quality of Life for Spinal Deformities Scale (QLPSD)was administered prospectively to 119 patients undergoing scoliosis surgery and 42 patients followed for bracing or observation. Change in quality of life after two years (adjusted for baseline quality of life) was used to estimate the short term benefit of scoliosis surgery. Bracing status was also analyzed at baseline as a covariate to determine its effect on improvement in quality of life. Results: The operated group experienced an increase in quality of life of 4.3 points (95% C.I. 0.69, 7.88) on the 105 point Climent scale. Although statistically significant, this increase was lower than the 5.5 point cutoff we had defined a priori as clinically significant. Among the operative patients, there was no difference in the quality of life score between those braced at baseline (91.2) and those not (90.5) (p=0.73). In non operative patients, those braced had a baseline quality of life score of 88.2, and those not braced 83.3, this difference was also not significant (p=0.13). Conclusions: Scoliosis surgery results in a small increase, of questionable clinical significance, in spine-related quality of life at two years. Funding: Commerical funding. Funding Parties: This trial was funded by (in alphabetical order) Canadian Institutes of Health Research, DePuyAcroMed-Johnson & Johnson Medical Products, and Synthes, Canada

The two most common surgical approaches used in primary hip arthroplasty are the anterolateral and posterolateral approach. While both approaches have potential advantages and disadvantages in comparison to the other, there are no reports with sufficient power to compare their effect on post-operative function and quality of life. This prospective cohort study evaluates and compares the independent effect of surgical approach on function and quality of life among patients who have received their total hip arthroplasty through one of these techniques. Results suggest that there is no significant difference in function or quality of life among these respective cohorts. The purpose of this study was to evaluate and compare the effect of anterolateral versus posterolateral approach on function and quality of life following primary total hip arthroplasty. There is no significant difference in outcome as a result of surgical approach. Significance: This is the first report with sufficient power to evaluate and compare outcomes of these two approaches among high volume hip surgeons. This study suggests that surgeons need not worry that the anterolateral or posterolateral approach may compromise patient function or generic quality of life more-so than the alternative approach. Univariate and regression analyses demonstrate similar outcomes on WOMAC, Oxford-12, SF-12 and satisfaction among cohorts of patients receiving the anterolateral or posterolateral approach for primary total hip arthroplasty. A prospective evaluation of function and quality of life outcomes was performed on patients receiving the anterolateral or posterolateral approach for primary hip arthroplasty. All participating surgeons were considered to be high volume arthroplasty surgeons. One hundred and sixty procedures were followed and provided complete outcomes data including WOMAC, Oxford, SF-12, and satisfaction scores. Univariate analyses demonstrated no differences among the two cohorts with regards to baseline variables. Regression analyses were performed for the outcome measures with surgical approach treated as an independent covariate while controlling for other potential confounders. The results suggest that there is no independent effect of surgical approach on patient reported outcomes. This suggests that the surgeon should continue to employ the approach which is the most familiar and most likely to result in consistent results in their clinical environment