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
Aims. Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we sought to determine if a difference in functional outcomes exists between monopolar and bipolar hemiarthroplasty (HA). Methods. This study is a secondary analysis of patients aged 50 years or older with a displaced femoral neck fracture who were enrolled in the HEALTH trial and underwent monopolar and bipolar HA. Scores from the Western Ontario and McMaster University Arthritis Index (WOMAC) and 12-Item Short Form Health Survey (SF-12)
Aims. Acetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years. Methods. Eligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36)
Aims. To evaluate the impact of negative pressure wound therapy (NPWT) on the odds of having deep infections and health-related quality of life (HRQoL) following open fractures. Methods. Patients from the Fluid Lavage in Open Fracture Wounds (FLOW) trial with Gustilo-Anderson grade II or III open fractures within the lower limb were included in this secondary analysis. Using mixed effects logistic regression, we assessed the impact of NPWT on deep wound infection requiring surgical intervention within 12 months post-injury. Using multilevel model analyses, we evaluated the impact of NPWT on the
Elective orthopaedic procedures, and particularly total hip arthroplasty (THA), in octogenarians and nonagenarians patients are burdened of several implications. Besides the comorbidities and the anesthesiological issues, legal and ethical implications are present. Some literature data show the clinical improvement of THA in elderly patient but the psychological aspects are not yet evaluated. Aim of this study is to evaluate the clinical aspects and the psychological impact in daily living in octogenarians and nonagenarians patients addressing THA. We conducted a retrospective evaluation of 81 THA in 81 patients of age more than 85 years with a minimum follow-up of 6 months. Clinical aspects were evaluated using the Hip disability and Osteoarthritis Outcome Score (HOOS). The psychological issues were evaluated with the Short Form 12 (SF-12) using both the
Aims. Acetabular fractures in older adults lead to a high risk of mortality and morbidity. However, only limited data have been published documenting functional outcomes in such patients. The aims of this study were to describe outcomes in patients aged 60 years and older with operatively managed acetabular fractures, and to establish predictors of conversion to total hip arthroplasty (THA). Methods. We conducted a retrospective, registry-based study of 80 patients aged 60 years and older with acetabular fractures treated surgically at The Alfred and Royal Melbourne Hospital. We reviewed charts and radiological investigations and performed patient interviews/examinations and functional outcome scoring. Data were provided by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Survival analysis was used to describe conversion to THA in the group of patients who initially underwent open reduction and internal fixation (ORIF). Multivariate regression analyses were performed to identify factors associated with conversion to THA. Results. Seven patients (8.8%) had died at a median follow-up of 18 months (interquartile range (IQR) 12 to 25), of whom four were in the acute THA group. Eight patients (10%) underwent acute THA. Of the patients who underwent ORIF, 17/72 (23.6%) required conversion to THA at a median of 10.5 months (IQR 4.0 to 32.0) . After controlling for other factors, transport-related cases had an 88% lower rate of conversion to THA (hazard ratio (HR) 0.12, 95% confidence interval (CI) 0.02 to 0.91). Mean standardized
Aims. While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years’ follow-up. Methods. Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and
There has been a substantial increase in the surgical treatment of unstable chest wall injuries recently. While a variety of fixation methods exist, most surgeons have used plate and screw fixation. Rib-specific locking plate systems are available, however evidence supporting their use over less-expensive, conventional plate systems (such as pelvic reconstruction plates) is lacking. We sought to address this by comparing outcomes between locking plates and non-locking plates in a cohort of patients from a prior randomized trial who received surgical stabilization of their unstable chest wall injury. We used data from the surgical group of a previous multi-centred, prospective, randomized controlled trial comparing surgical fixation of acute, unstable chest wall injuries to non-operative management. In this substudy, our primary outcome was hardware-related complications and re-operation. Secondary outcomes included ventilator free days (VFDs) in the first 28 days following injury, length of ICU and hospital stay, and general health outcomes (SF-36
Aims. The aim of this study was to determine the trajectory of recovery following fixation of tibial plateau fractures up to five-year follow-up, including simple (Schatzker I-IV) versus complex (Schatzker V-VI) fractures. Patients and Methods. Patients undergoing open reduction and internal fixation (ORIF) for tibial plateau fractures were enrolled into a prospective database. Functional outcome, using the 36-Item Short Form Health Survey
Aims. The purpose of this study was to investigate the risk of additional surgery in the lumbar spine and to describe long-term changes in patient-reported outcomes after surgery for lumbar disc herniation in adolescents and young adults. Patients and Methods. We conducted a retrospective study design on prospectively collected data from a national quality register. The 4537 patients were divided into two groups: adolescents (≤ 18 years old, n = 151) and young adults (19 to 39 years old, n = 4386). The risk of additional lumbar spine surgery was surveyed for a mean of 11.4 years (6.0 to 19.3) in all 4537 patients. Long-term patient-reported outcomes were available at a mean of 7.2 years (5.0 to 10.0) in up to 2716 patients and included satisfaction, global assessment for leg and back pain, Oswestry Disability Index, visual analogue scale for leg and back pain, EuroQol five-dimension questionnaire (EQ-5D), and 36-Item Short-Form Health Survey (SF-36) Mental
Aims. The primary aim of this study was to quantify the improvement in patient-reported outcome measures (PROMs) following total hip arthroplasty (THA), as well as the extent of any deterioration through the seven-year follow-up. The secondary aim was to identify predictors of PROM improvement and deterioration. Patients and Methods. A total of 976 patients were enrolled into a prospective, international, multicentre study. Patients completed a battery of PROMs prior to THA, at three months post-THA, and at one, three, five, and seven-years post-THA. The Harris Hip Score (HHS), the 36-Item Short-Form Health Survey (SF-36)
Aims. This study reports the mid-term results of total hip arthroplasty (THA) performed using a monoblock acetabular component with a large-diameter head (LDH) ceramic-on-ceramic (CoC) bearing. Patients and Methods. Of the 276 hips (246 patients) included in this study, 264 (96%) were reviewed at a mean of 67 months (48 to 79) postoperatively. Procedures were performed with a mini posterior approach. Clinical and radiological outcomes were recorded at regular intervals. A noise assessment questionnaire was completed at last follow-up. Results. There were four re-operations (1%) including one early revision for insufficient primary fixation (0.4%). No hip dislocation was reported. The mean University of California, Los Angeles (UCLA) activity score, 12-Item Short-Form Health Survey (SF-12) Mental Component Summary (MCS) score, SF-12
Introduction. The number of total hip arthroplasties (THAs) performed per year is increasing for reasons that are not fully explained by a growing and aging population. The purpose of this study was to determine the role of patient health status as an indication for surgery and determine if patients are undergoing surgery at a better health status than in the past. Methods. To examine how pre-operative functional health status has changed over time, a systematic review and meta-analysis of the Medline, Embase, and Cochrane databases was performed in accordance with the PRISMA guidelines. Health status was assessed using the
Aims. The aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation. Patients and Methods. A cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12). Results. A second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days . (sd. 46.5) and 47 days . (sd. 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm . (sd. 10.3) and a mean VAS for arm pain of 6.3 mm . (. sd. 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (. sd. 12.4; p < 0.001); mean NPAD, 19.3 (. sd. 24.3; p = 0.041); mean SF-12
Introduction. The objective of this study was to verify the long-term outcome of transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) in young patients with systemic lupus erythematosus (SLE). Methods. Consecutive series of 21 symptomatic ONFH patients with SLE (33 hips), aged 20 to 40 years, underwent ARO between 1980 and 1988. We reviewed the cases of 16 patients (25 hips), which represents a 76% rate of follow-up. Patients included 4 men and 12 women who had a mean age of 29 years at the time of surgery. A Kaplan-Meier curve was used for the survivorship analysis of ARO. Patients with surviving hips were evaluated by the modified Oxford hip score and the Medical Outcomes Study Short Form 36 (SF-36). Results. Twelve hips in 8 patients survived at the final follow-up. The average length of surviving was 25 years (range, 20 to 27 years). Three patients (6 hips) had died of unrelated causes without any conversion at the mean time of 9 years after ARO. Based on Kaplan-Meier analysis with the end point defined as any conversion, the survival rate at 25 years was 73.7% (95% confidence interval, 53.9 to 93.5%). Based on the classification of the modified Oxford hip score, 5 hips were classified as excellent, 2 hips were good, and the remaining 5 hips were fair. The average SF-36
Persistent post-surgical pain and associated disability are common after a traumatic fracture repair. Preliminary evidence suggests that patients' beliefs and perceptions may influence their prognosis. We sought to explore this association. We used data from the Fluid Lavage of Open Wounds trial to determine, in 1560 open fracture patients undergoing surgical repair, the association between Somatic PreOccupation and Coping (captured by the SPOC questionnaire) and recovery at 1 year. Of the 1218 open fracture patients with complete data available for analysis, 813 (66.7%) reported moderate to extreme pain at 1 yr. The addition of SPOC scores to an adjusted regression model to predict persistent pain improved the concordance statistic from 0.66 to 0.74, and found the greatest risk was associated with high SPOC scores [odds ratio: 5.63, 99% confidence interval (CI): 3.59–8.84, absolute risk increase 40.6%, 99% CI: 30.8%, 48.6%]. Thirty-eight per cent (484 of 1277) reported moderate to extreme pain interference at 1 yr. The addition of SPOC scores to an adjusted regression model to predict pain interference improved the concordance statistic from 0.66 to 0.75, and the greatest risk was associated with high SPOC scores (odds ratio: 6.06, 99% CI: 3.97–9.25, absolute risk increase: 18.3%, 95% CI: 11.7%, 26.7%). In our adjusted multivariable regression models, SPOC scores at 6 weeks post-surgery accounted for 10% of the variation in short form-12
Purpose: To assess patients quality of life, pain, and functional limitations with with endstage ankle arthritis (EAA) and compared this to a similar cohort of patients with endstage hip arthritis (EHA). Methods: Preoperative data (Short Form SF36) was collected prospectively from patients (n=130) with end stage ankle arthritis and compared to a similar cohort of patients (n=130) with end stage hip arthritis. Patients with ankle arthritis were registered in the Canadian Orthopedic Foot and Ankle Society (COFAS) multi-center study investigating the clinical outcome of ankle arthroplasty and fusion and patients with hip arthritis were randomly selected from the Halifax Joint Replacement Registry Database. Results: All symptom and functional SF36 subscales for patients with EAA or EHA, were approximately two standard deviations below normal population scores. All differences between ankle and hip SF36 subscales scores were less than 4 points (40% of STD) in both direct and adjusted comparisons. A direct comparison of SF36 scores revealed that patients with EAA had significantly worse mental health according to the SF36 Mental Component Summary Score (MCS) (p= 0.0059), physical limitations with work and daily activities - role physical score (p= <
0.0001), and general health (p= 0.0004). Patients with EHA reported poorer physical function (p= 0.0007) although the
The aim of this study was to compare the outcome of bilateral sequential total ankle replacement (TAR) with that of unilateral TAR. We reviewed 23 patients who had undergone sequential bilateral TAR under a single anaesthetic and 46 matched patients with a unilateral TAR. There were no significant pre-operative differences between the two groups in terms of age, gender, body mass index, American Society of Anaesthesiologists classification and aetiology of the osteoarthritis of the ankle. Clinical and radiological follow-up was carried out at four months, one and two years. After four months, patients with simultaneous bilateral TAR reported a significantly higher mean pain score than those with a unilateral TAR. The mean American Orthopaedic Foot and Ankle Society hindfoot score and short-form 36
Purpose: Deciding how to allocate scarce surgical resources is a worldwide issue. These decisions can be especially difficult when considering procedures aimed primarily at improving functional quality of life, such as lower extremity joint replacement (LEJR) surgery, and those procedures that can be perceived primarily as life preserving but should also have an impact on physical function, such as coronary artery bypass graft (CABG) surgery. A comparison of the functional outcomes of these two different procedures may provide further evidence to guide resource allocation decisions. The purpose of this study is to compare patient-reported functional outcomes following CABG and LEJR surgery using standardized, validated outcome metrics. Method: A retrospective review of prospectively collected pre and post-operative health related quality of life (SF-36) measures from patients undergoing elective CABG and elective LEJR surgery in an academic surgical center. The sample included 112 CABG patients who were matched with LEJR patients based on gender and age. Results: The mean age in the CABG group was 63 years, in the LEJR group 64 years. Seventy eight percent (78%) of the patients were male. Pre-operatively, CABG patients reported statistically higher (p<
0.05) Physical Functioning, less Bodily Pain, and superior
Introduction. Total joint arthroplasty is regarded as a highly successful procedure. However, patient outcomes and implant longevity require proper alignment and prosthesis position. Computer-assisted total knee arthroplasty (TKA) has been found to improve the accuracy of component positioning and reduce rates of revision, however there remains debate whether it provides improvements in patient reported outcomes (PROs). The purpose of our study was to compare PROs between computer-assisted and conventional TKA. Methods. A retrospective review of all total knee arthroplasty patients was conducted using a single institution's FORCE database for reporting PROs. Knee Society Score (KSS), procedure satisfaction,
The outcome in 83 patients with congenital clubfoot was evaluated at a mean age of 64 years using three validated questionnaires assessing both quality of life (short-form (SF)-36 and EQ-5D) and foot and ankle function (American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle questionnaire). In SF-36, male patients scored significantly better than male norms in seven of the eight domains, whereas female patients scored significantly worse than female norms in two of the eight. Male patients scored better than male norms in both the EQ-5D index (p = 0.027) and visual analogue scale (VAS) (p = 0.013), whereas female patients scored worse than female norms in the VAS (p <
0.001). Both male and female patients had a significantly worse outcome on the AAOS Core Scale than did norms. There was a significant correlation for both genders between the SF-36
A significant portion of ankle arthroplasty and ankle arthrodesis procedures performed in British Columbia are funded by the public medical services plan (MSP). However, some patients are treated privately through self-pay or by the workers compensation board (WCB), with the latter two groups being more likely to receive treatment sooner. The potential effect of payer on patient-reported outcomes and reoperation rates has not been previously explored. A retrospective chart review was performed using data from the Canadian Orthopaedic Foot and Ankle Society Prospective Ankle Reconstruction Database. N=443 patients (393 MSP, 26 self-pay, 24 WCB), treated with total ankle replacement or ankle arthrodesis by three subspecialty-trained surgeons in Vancouver from 1999–2003, were analyzed. Outcomes were compared, by payer, preoperatively and at long-term follow-up (6.3 years, range 2–14 years). Function was assessed using the Ankle Osteoarthritis Scale (AOS) Total score (primary outcome) and the AOS Pain and Difficulty subscores. Expectation and satisfaction with symptoms was assessed using the Musculoskeletal Outcomes Data Evaluation and Management Scale, and physical and emotional quality of life was assessed using the Short Form-36 (SF-36) Health Survey in terms of the mental component summary (MCS) and
INTRODUCTION. Lumbar total disc replacement (TDR) is an alternative treatment to avoid fusion related adverse events, specifically adjacent segment disease. New generation of elastomeric non-articulating devices have been developed to more effectively replicate the shock absorption and flexural stiffness of native disc. This study reports 5 years clinical and radiographic outcomes, range of motion and position of the center of rotation after a viscoelastic TDR. Material and methods. This prospective observational cohort study included 61 consecutive patients with monosegmental TDR. We selected patients with intermediate functional activity according to Baecke score. Hybrid constructs had been excluded. Only cases with complete clinical and radiological follow-up at 3, 6, 12, 24 and 60 months were included. Mean age at the time of surgery was 42.8 +7.7 years-old (27–60) and mean BMI was 24.2 kg/m² +3.4 (18–33). TDR level was L5-S1 in 39 cases and L4-L5 in 22 cases. The clinical evaluation was based on Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI) score, Short Form-36 (SF36) including
There is clear evidence to support removal of the calcific deposit in patients with calcific tendonitis, however, there is conflicting evidence as to whether concomitant subacromial decompression (SAD) is of benefit to the patient. The aim of this study was to conduct a prospective double blind randomised control trial to assess the independent effect of SAD upon the functional outcome of arthroscopic management of calcific tendonitis. During a four year period 80 patients (power calculation was performed) were recruited to the study who presented with acute calcific tendonitis of the shoulder. Forty patients were randomised to have SAD and 40 were randomised not to have a SAD in combination with arthroscopic decompression of the calcific deposit. All surgery was performed by the senior author who was blinded to the functional assessment of the patients. There were 21 male and 59 female patients with a mean age of 48.9 (32 to 75) years. The pre-operative short form 12
Purpose. There is no clear definition of a critical sized defect of the tibia. We defined it as a fracture gap at least one centimeter in length and involving over 50% of the cortical diameter. We explored if the presence of a critical-sized defect predicted reoperation, and which other factors predict reoperation in patients with the critical defect. The patient based outcomes of these patients were compared to patients without a critical defect. Method. Patients enrolled in the SPRINT trial with a critical sized defect were evaluated for secondary interventions to gain union. Other factors predicting the need for reoperation were studied. We also compared the patients with critical sized defects to the larger cohort of patients without a defect with respect to demographics, injury mechanism, fracture characteristics, and patient-based outcome. Results. Tibial diaphyseal defects of greater than or equal to one centimeter and >50% cortical circumference healed without additional surgery in 47% of cases. Fewer reoperations were required in patients treated with a reamed nail (p=0.04). The mean of the SF-36
Purpose. We explored the role of patients beliefs and attitudes towards their likelihood of recovery from severe physical trauma. Method. We developed and validated an instrument designed to capture the impact of patients beliefs and attitudes towards functional recovery from injury; the Somatic Pre-Occupation and Coping (SPOC) questionnaire. At six weeks post-surgical fixation, we administered the SPOC questionnaire to 359 consecutive patients with operatively managed tibial shaft fractures. We constructed multi-variable regression models to explore the association between SPOC scores and functional outcome at one year, as measured by return to work and Short Form-36 (SF-36)
Purpose. The measurement of functional outcomes in pelvic fracture patients remains difficult for authors. We aimed to test the construct validity, respondent burden, and patient perception of three previously published pelvic outcome questionnaires. Method. Subjects completed three pelvic specific, and three general functional outcome instruments. Time for each pelvic instrument was recorded, as was which score the patient felt best addressed their symptoms. Patients stated the three most significant impacts the pelvic fracture had on their life. Results. We recruited 33 patients, who were a mean of 61 months from surgery (13–115 months). Mobility difficulty (26), emotional stress (20), employment difficulty (15), sleep and anxiety (7), sexual function (4), were the most important consequences of their injuries. All pelvic questionnaires correlated with the
Balloon kyphoplasty (BKP) is a minimally invasive treatment for vertebral fractures (VCF) aiming to correct deformity using balloon tamps and bone cement to stabilize the body. Patients with 1 - 3 non-traumatic acute VCF were enrolled within three months of diagnosis and randomly assigned to receive either BKP (N=149) or nonsurgical care (N=151). Follow-up was 2 years. The mean SF-36
Purpose: We aimed to preliminarily validate a newly developed system, the radiographic union scale for tibial (RUST) fracture healing. We hypothesized that RUST would demonstrate better inter-rater reliability than assessment of the number of cortices bridged and correlate with functional outcomes at least as strongly as surgeon’s assessment of cortical bridging. Method: Three blinded orthopaedic trauma surgeons independently assigned a RUST score and a number of cortices bridged by callus (zero to four) to each set of AP and lateral radiographs at each follow up period. RUST is scored from four (definitely not healed) to 12 (definitely healed) based on the presence or absence of callus and of a visible fracture line at the total of four cortices visible. Results: For 549 sets of reviewed radiographs, inter-rater reliability for RUST scores were found to be substantially higher than for assessment of the number of cortices bridged (intra-class correlation coefficient=0.84; 95% CI, 0.80–0.87 versus kappa = 0.73; 95% CI, 0.64 – 0.81, respectively). Both methods of assessing radiographic healing were strongly correlated with weight-bearing status (r and ρ>
0.50), moderately correlated with patient-reported functional recovery and the SF-36 Physical Functioning component scores (r and ρ>
0.30), and minimally correlated with HUI Mark II scores, return to work, and the SF-36 Role Physical component and
The primary objective of this study was to determine if surgical treatment for spinal stenosis is comparable to total hip and knee arthroplasty in improving patients’ self-reported quality of life. An age, sex and time of surgery matched cohort of patients who had undergone elective primary one-two level spinal decompression (n=90) with (n=26 /90) or without fusion for spinal stenosis (n=40 with degenerative spondylolisthesis) and elective primary total hip (n=90) and knee (n = 90) arthroplasty for osteoarthritis were compared. The primary outcome measure was the preoperative and two year postoperative Medical Outcomes Study Short Form-36 (SF-36) questionnaire. There was no significant difference in the mean pre-operative
Background. Deciding how to allocate scarce surgical resources is a worldwide issue. These decisions are difficult when considering procedures aimed primarily at improving functional quality of life, such as lower extremity joint replacement (LEJR) surgery, and procedures perceived as life preserving which also have impacts on physical function, such as coronary artery bypass graft (CABG) surgery. Comparing functional outcomes of these two procedures may provide further evidence to guide resource allocation decisions. Methods. We compared patient-reported functional outcomes following CABG and LEJR surgery using standardised, validated outcome metrics. A retrospective review of prospectively collected pre- and post-operative health related quality of life (SF-36) measures were conducted from 105 patients undergoing elective CABG and 105 elective LEJR surgery patients. Patients were matched based on gender and age. Results. Pre-operatively, CABG patients reported statistically superior (p< 0.05) Physical Functioning, Bodily Pain, and
Background. Vertebral body compression fractures (VCFs) impair quality of life (QOL) and increase patient morbidity and mortality. The international, multicentre, randomised, controlled Fracture Reduction Evaluation (FREE) trial was initiated to compare effectiveness and safety of Balloon kyphoplasty (BKP) to non-surgical management (NSM) for the treatment of acute painful VCFs. We describe the primary endpoint of the ongoing 2-year study. Methods. Patients with 1-3 non-traumatic VCFs (< 3 months old) were randomised to either BKP or NSM. The primary endpoint was the change in QOL as measured by the SF-36 Health Survey
Purpose: The primary objective of this study was to determine if surgical treatment for spinal stenosis is comparable to total hip arthroplasty in improving patients’ self-reported quality of life. Methods: An age, sex and time of surgery matched cohort of patients who had undergone elective primary 1–2 level spinal decompression (n=90) with (n=30/90) or without fusion for spinal stenosis (n=40 with degenerative spondylolisthesis) and elective primary total hip arthroplasty for osteoarthritis (n=90) were compared. The primary outcome measure was the preoperative and one year postoperative Medical Outcomes Study Short Form-36 (SF-36) questionnaire. Results: The mean
Introduction Hallux valgus (HV) is a common foot deformity with a prevalence of up to 48%. It usually affects females and its radiographic severity is expressed by various angles, such as the HV Angle, the Inter Metatarsal Angle (IMA) and the Distal Metatarsal Articular Angle (DMAA). The aim of our study was to assess the impact that HV has on patients’ quality of life and to correlate each of the above angles to SF-36 sub-scales. Method Twenty-three female patients with a mean age of 48.5 years were included in the study. Diagnosis was established by clinical and standardised radiological examination. Patients were medically fit and the only pathology that could affect their SF-36 score was HV. They all completed in the SF-36 form on their first visit at the clinic. Statistical analysis was performed via SPSS 12.0. Results Mean radiographic angular deformities measured 35, 13, and 17 degrees for HVA, IMA, and DMAA respectively. The HVA and IMA demonstrated significant association (p=0.018) as regarding their severity, indicating that they probably interact during the progression of the deformity. The
Oxidized Zirconium (Oxinium, Smith &
Nephew, Inc., Memphis, TN) is a relatively new material that features an oxidized ceramic surface chemically bonded to a tough metallic substrate. This material has demonstrated the reduced polyethylene wear characteristics of a ceramic, without the increased risk of implant fracture. The purpose of the current investigation was to assess clinical outcomes following primary total hip arthroplasty with Oxinium versus Cobalt Chrome femoral heads. One hundred uncemented primary total hip arthroplasty procedures were prospectively performed in 100 patients. There were 52 males and 48 females with mean age at the time of surgery of 51 years (SD 11, range, 19–76). Using a process of sealed envelope randomization, patients were divided into 2 groups. Each group contained fifty patients. Those in group 1 received an Oxinium femoral head (OX), while those in group 2 a cobalt-chrome femoral head (CC). The current study reports clinical outcome measures for both the OX and CC groups at a minimum follow-up of 2 years postoperatively. At the time of latest follow-up, stem survival for both groups was 98%. There was a significant improvement in all clinical outcome scores between preoperative and 2 year postoperative time periods for both bearing groups (p<
0.003). There were no significant differences between bearing groups for any of the clinical outcome scores at final follow-up (p>
0.159). Mean Harris Hip Scores at 2 years postoperatively were 92 and 92.5 for OX and CC, respectively (range; 65–100 OX, 60–100 CC). For SF-12, both the
We report the follow-up of a cohort of 86 patients who underwent total hip replacement (THR) with custom-made stem prosthesis. Fixation mode, cemented (group 1) or uncemented (group 2) is based on the bone quality. Aspects of physical health and changes in mental health are documented using 3 patient-administered questionnaires, pre-operatively and 6 weeks, 3, 6 and 12 months post-operatively. Harris Hip Score (HHS), Hip disability and osteoarthritis outcome score (HOOS) and SF-36, multi-purpose, short-form health survey were used. Globally HHS increases significantly (p<
0.01). In group 1 up to 3 months post-operatively and in group 2 up to 1 year. (p <
0.05). In group 2 HHS is significantly higher 6 months and 1 year postoperatively (p<
0.05). No significant differences in HOOS subscores between subjects of group 1 and 2 for subsequent time points were found. The scores related to Pain and Symptoms increased significantly 6 weeks after THR (p<
0.01). Sports and recreation scores increased significantly up to 3 months after THR (p<
0.01). Activities of daily living, and Quality of Life (QoL) improved up to 6 months after surgery (p<
0.01). No significant difference between the 2 groups in QoL was observed. The
In the litterature patients suffering Mb. Scheuermann (MS) have been reported to experience more back pain and other back related constrains compared to subjects matched for age and sex. We have been unable to find publications on health-related quality of life by SF-12 or SF-36 in MS. The aim of the present study was to compare health-related quality of life status in MS to the background population. Materials and Methods: The present cohorts are derived from The Danish Twin Registry and consist of all Danish twins born from 1931 through 1982. This twin cohort has been shown to very closely resemble the general Danish population. A total of 46,418 twins received and 75% returned a questionnaire of which 34,007(97.3 %) answered the question ‘Have you been diagnosed with Scheuermann’s disease?’ Included in the questionnaire were the standardised questions for The Medical Outcome Study Short Form-12 (SF-12), from which we calculated the SF-12
Background: This meta-analysis aims to evaluate the quality of life in post traumatic amputees in comparison with a limb salvage group, using peer-reviewed studies in these areas. Methods: Electronic databases were searched for studies on lower limb amputation and limb reconstruction following trauma. A manual review of the literature and abstracts was also conducted. Only studies having more than 24 months of follow up, and those using generic scales using physical and psychological parameters (SIP or SF36), were included. Two reviewers performed the search, inclusion, and data extraction independently. Results: 214 studies were identified after extensive searching, Eleven studies fulfilled all the inclusion criteria, reviewing the outcomes of 1874 patients including 899 cases of amputation and 975 cases of reconstruction. Outcome assessments were based on two generic scales of measurement for quality of life, namely SIP or SF 36. In the studies using SF36, the mean
Purpose: Tibial shaft fractures are a common injury. Tibial nailing is the current standard of care for these injuries, yet there is little information regarding patient based outcomes after nailing. We sought to determine the 1 year patient based outcomes and return to activities for patients with tibia fractures in a randomized trial of reamed and unreamed nail insertion. Method: Over a 5 year period 1226 patients with 842 closed and 406 open tibial shaft fractures were enrolled in a randomized trial comparing reamed with unreamed tibial nail insertion in 29 trauma centers and had one year follow-up. The average age was 39±16 years and 74% were male. Patient based outcomes were determined using the validated Short Form-36 (SF-36)
Purpose: Balloon kyphoplasty (BKP) is a minimally invasive treatment for acute vertebral compression fractures (VCF) that aims both to correct associated vertebral deformity (reduce) and stabilize the fracture by injecting bone cement. We performed the first multicenter randomized trial to assess the effect of BKP. Method: Patients with 1–3 non-traumatic vertebral compression fractures diagnosed within 3 months were randomly assigned to receive either BKP (N=149) or usual nonsurgical care (NSC) (N=151). Measurements of quality of life, back pain and function, days of disability and bed rest were assessed at baseline, 1, 3, 6 and 12 months. Results: The primary outcome measure, the difference between groups in change from baseline scores in the
Purpose. The prevalence of focal chondral lesions reported inthe literature during knee arhroscopy can be as high as 63%. Of these, more than half are either grade III or grade IV lesions (Outerbridge). Full thickness cartilage lesions ranging from 2cm2 to 10cm2 are the most challenging to treat. To goal of this study was to evaluate clinical outcomes of pain, function and quality of life, along with radiological outcomes of cartilage repair using microfracture, autologous minced cartilage and polymeric scaffold. Method. A cohort of thirty-eight patients with Outerbridge grade III or IV cartilage injuries larger than 2cm2 in the knee's femoral condyle, trochlea or patella were prospectively folowed since 2008. They were all treated with microfracture, fresh minced autologous cartilage grafting and a polymeric scaffold technique through mini-arthrotomy of the knee. Autografts and scaffolds were secured to subchondral bone using fibrin glue and tran-sosseous resorbable sutures. Patients were evaluated pre and postoperatively using VAS scores for pain, WOMAC and IKDC scores for knee function and SF-36 questionnaire for quality of life. Clinical evaluations were done by physical examination, and imaging was done using X-Rays, MRI and arthro-CT. Results. Mean follow-up time was14.64.6 months. Mean age was 48.39.3 years old. Pre-op lesions averaged 3.51.5 cm2. VAS pain scores were significantly reduced after surgery (7,62 to 2,52.3, p<. 0001). Improvement in knee function using IKDC score improved from 26,717.5 to 55,415.3, p<. 001). In addition, WOMAC total scores showed significant reduction from 55,520.3 to 27,517.6. SF-36 quality of life
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
Purpose: To report the clinical and radiographic prospective results of a consecutive series of patient with a minimum two year follow-up with the Charite Total Disc Arthroplasty (TDA). Method: Between 2001 and 2005, sixty patients underwent a Charite TDA (Depuy Spine, Raynham, MA) at either L4-5 or L5-S1. The primary indication for surgery was discogenic low back pain confirmed by provocative discography. Clinical assessment was carried out preoperatively and postoperatively at 3, 6, 12 months, and once a year thereafter using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back and leg pain, and SF-36. Radiographic analysis included: angle of sagittal rotation, translation of the rostral vertebra onto the caudal vertebra, anterior vertical motion (AVM), middle vertical motion (MVM), posterior vertical motion (PVM), pre- and post-operative lumbar lordosis, disc height and subsidence of the TDA. The radiographic measurements were performed using the GE Medical Systems Centricity PACS Software Version 1.0. Results: There were 36 female and 24 male patients with a mean age of 39 (range 21–59). The mean duration of low back pain was 70 months. Twenty-five percent claimed work compensation status. The mean postoperative hospital stay was 4.8 days. A statistical significant improvement was demonstrated between the mean pre-operative ODI (50) and all post-operative intervals (p<
0.0001) which had declined to 27.7 by one year. Similarly, pre-operative VAS back pain (8.0), leg pain (6.1), SF-36
Introduction: Minimally invasive total hip arthroplasty has evoked substantial controversy with regard to whether it provides superior outcomes compared with conventional total hip arthroplasty. The objective of this study was to compare the results of a minimal invasive direct anterior approach (MIDA) with those of a conventional lateral transgluteal approach (CLT). Methods: 120 patients (120 hips) admitted for unilateral total hip arthroplasty were randomized to undergo surgery via minimal invasive direct anterior or conventional lateral transgluteal approach. Patients with a body mass index of more than 35, previous hip surgery, preoperative neurological deficits and with an age of more than 80 years were excluded. Two surgeons performed all procedures. To estimate muscle damage serum creatinkinase was assessed. Blood loss was calculated according to Rosencher by comparing preoperative to postoperative hematocrit. Postoperative pain and the ability to perform the activities of daily living were recorded in a dairy via modified WOMAC first on a daily basis, then on each second day and finally once a week for a total of 12 weeks. WOMAC questionnaire and SF-36 were administered at 6 weeks and 3 months follow-up. Results: The groups were similar demographically. Patients in MIDA group had significantly less total blood loss (p = 0.006), postoperative blood levels of creatinine kinase were significantly lower (p = 0.001). Operative time was similar in both groups, we found no difference in component placement.
Introduction: Clubfoot – Congenital talipes equinovarus (CTEV) – is one of the most common congenital conditions requiring orthopaedic surgery. However little is known about the impact on health-related quality of life in these patients. A score on physical- and mental-health is used for this purpose. The aim of the present study was to compare health-related quality of life in CTEV to a background population. Materials and Methods: The Odense based Danish Twin Registry (DTR) is unique as it contains data on all 73,000 twin pairs born in Denmark over the last 130 years. All 46,418 twins born from 1931 through 1982 received an Omnibus questionnaire in the spring of 2002. The incidence of CTEV was self-reported. Included in the questionnaire were questions for The Medical Outcome Study Short Form-12 (SF-12). We calculated SF-12
Purpose: The treatment of large osteochondral lesions of the talus (OLT) remains a challenge. Fresh Osteo-chondral Allograft is a method that has been used for the treatment of larger lesions, with the advantage of transplanting living cartilage that is biologically attached to the subchondral bone. The purpose of this clinical series is to prospectively review the clinical and radiographic outcomes of patients that have undergone a Fresh Osteochondral Allograft. Method: Between January 2003 and January 2007, 17 feet in 8 male and 8 female patients at a mean age of 35.8 (15–53) years underwent fresh osteochondral talar allo-grafting by a single surgeon. Data was prospectively collected, including preoperative and postoperative AOFAS, AOS, AAOS foot &
ankle worksheets and SF-36 scores. Statistical analysis consisted of one tailed student T-test with alpha set a 5%. All patients were followed up clinically and radiographically by x-ray and CT scan. Results: Average follow up was 3.2 (0.9–6.2) years. All scoring systems showed significant improvement postoperatively, except for AAOS shoe comfort scores, and the Mental Component Summary of the SF-36 questionnaire. The AOFAS score improved significantly (p=0.0001) from a mean score of 53.4 (30–71) to 86.3 (72–96). AOS pain scores improved significantly (p=0.0053) from a mean score of 45.4 (8.7–72.2) to 24.1 (4.2–58.9). AOS disability score improved significantly (p=0.0013) from a mean of 53.8 (7.8–77.3) to 25.9 (6.6 – 62.5). The AAOS foot &
ankle core scale (standardized mean) improved significantly (p=0.0015) from a mean of 52.3 (21–81) to 80.1 (56–99). The AAOS foot &
ankle core scale (normative score) improved significantly (p=0.0016) from a mean of 16.9 (−9 to 40) to 39.5 (20–55). The SF-36
Purpose: To report the clinical and radiographic prospective results of a consecutive series of patient with a minimum two year follow-up with the Charite Total Disc Arthroplasty (TDA). Methods: Between 2001 and 2005 sixty patients underwent a Charite TDA (Depuy Spine, Raynham, MA) at either L4–5 or L5-S1. The primary indication for surgery was discogenic low back pain confirmed by provocative discography. Clinical assessment was carried out preoperatively and postoperatively at 3, 6, 12 months, and once a year thereafter using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back and leg pain, and SF-36. Radiographic analysis included: angle of sagittal rotation, translation of the rostral vertebra onto the caudal vertebra, anterior vertical motion (AVM), middle vertical motion (MVM), posterior vertical motion (PVM), pre- and post-operative lumbar lordosis, disc height and subsidence of the TDA. The radiographic measurements were performed using the GE Medical Systems Centricity PACS Software Version 1.0. Results: There were 36 female and 24 male patients with a mean age of 39 (range 21–59). The mean duration of low back pain was 70 months. Twenty-five percent claimed work compensation status. The mean post-operative hospital stay was 4.8 days. A statistical significant improvement was demonstrated between the mean pre-operative ODI (50) and all post-operative intervals (p<
0.0001) which had declined to 27.7 by one year. Similarly, pre-operative VAS back pain (8.0), leg pain (6.1), SF-36
Purpose. The purpose of this study was to compare the outcomes and complications of normal weight, class one obese (BMI=30-34.9 kg/m2) and superobese (BMI≥50 kg/m2) primary total knee replacement (TKR) patients. Method. Between January 1995 and December 2005, 4104 primary TKR were performed in our centre. Patients were stratified for their obesity level according the World Health Organisation (WHO) and current surgical literature classification. Sixty-seven superobese patients (group one) were identified. They were matched with normal weight (group two) and class one obese (group three) primary TKR patients for sex, age, side, preoperative diagnosis, implants used, time since surgery and preoperative SF-12 mental component summary score (MCS). Patient clinical outcomes (WOMAC, SF-12 and Knee Society scores), radiographs, complications, readmissions, and revisions rates were compared for normal BMI, class one obese and superobese patients. Results. The mean BMI of our primary TKR patients was 32,6. Using the WHO BMI classification, 0.3% were underweight, 10.4% normal weight, 30.1 % overweight, 31.0 % class 1 obesity, 16.5 % class 2 obesity, 9.8 % class 3 obesity and 1.9 % superobese. Superobese population (n=67) was 61.59.2 yo, with sex ratio at 5.1 (F=56;M=11), preoperative SF-12 MCS at 52.610.6. Their preoperative diagnosis was osteoarthritis (n=62) or inflammatory arthritis (n=5). All groups were equal (n=67) and were similar for these characteristics. Mean clinical and radiographic follow-up was 7.33.2 yrs. Superobese patients presented lower preoperative SF-12
Objectives: (i) To compare and correlate outcome in Sanders Type 2 Os Calcis fractures using two disease-specific scores (Kerr-Atkin score &
American Orthopaedic Foot and Ankle society score) and a general quality of life score (short form 36 health status questionnaire). (ii) To compare results of operative with non operative treatment, in this group of patients. Design: Retrospective study using a combination of case notes, plain x-rays and CT scan films review along with current clinical assessment. Patients: 30 patients with 32 fractures of Os Calcis (Sanders type 2) were identified. These patients were treated during 1994–1997 with mean follow up of 40 months. Intervention: 16 patients were treated by open reduction and internal fixation using a lateral approach. The remaining 14 patients were managed non operatively. Treatment modality was decided by consultant preference. Outcome measurements: Kerr-Atkin score, AOFAS score, SF36. Results: We found an extremely significant correlation (p,.001, Spearman) between the two disease specific scores. AOFAS score showed a stronger correlation with
No studies have focused on the relationships between pathological changes in the subsynovial connective tissue and clinical or neurophysiological findings in patients suffering from carpal tunnel syndrome (CTS). Twenty-five consecutive patients (mean age 58.8±10 years; range 39–79) operated on for idiopathic CTS were evaluated before surgery and six month later. The indication for surgery was the presence of symptoms despite a three-month trial of conservative management. Mean duration of symptoms was 5.3±4.6 years (range 0.5–15). On admission, demographic and medical history data were recorded from all the patients. Subsequently, patients underwent preoperative physical examination and an outcome set including a mixed historic and objective scale (Hi-Ob), the Italian version of the Boston Carpal Tunnel Questionnaire (BCTQ) and the official Italian version of the SF-36 questionnaire was administered. The baseline diagnostic work-up included standard radiographs of the hand and wrist, blood examination and neurophysiological testing. Patients underwent open carpal tunnel release and thickened synovium from the flexor digitorum superficialis tendons was harvested. The number of cells, the number, diameter and density of the vessels, and the total surface of angiogenetic foci were measured. On the SF-36 questionnaire, the preoperative
Introduction: A consecutive series of patients with adolescent idiopathic scoliosis, treated between 1968 and 1977 before 21 years of age, either with distraction and fusion using Harrington rods (ST, n=156; 145 females and 11 males) or with brace (BT, n=127; 122 females and 5 males) were followed at least twenty years after completion of the treatment to determine the long-term outcome in terms of health related quality of life (HRQL) in patients treated for adolescent idiopathic scoliosis. No results on long term outcome of HRQL have previously been presented for this group of patients. Methods and Results: Ninety-four per cent of ST and 91% of BT patients filled in a questionnaire comprising the SF-36, Psychological General Well-Being Index (PGWB), Oswestry Disability Back Pain Questionnaire, parts of SRS/MODEM’s questionnaire and study-specific questions concerning the treatment, as a part of an unbiased personal follow-up examination. An age and sex-matched control group of 100 persons was randomly selected and subjected to the same examinations. There were no differences in terms of sociodemographic data between the groups. Both ST and BT patients had a slightly, but significantly reduced physical function using the SF-36 subscales, SF-36/
The use of metal on polyethylene articulations was a key development in establishing total hip arthroplasty as a successful and reproducible treatment for end stage osteoarthritis. In order to ensure implant durability in relatively younger populations, there is a need for alternative, wear resistant bearing surfaces. Oxidized Zirconium (Oxinium, Smith &
Nephew, Inc., Memphis, TN) is a relatively new material that features an oxidized ceramic surface chemically bonded to a tough metallic substrate. This material has demonstrated the reduced polyethylene wear characteristics of a ceramic, without the increased risk of implant fracture. The purpose of the current investigation was to assess early clinical outcomes following primary total hip arthroplasty with Oxinium versus Cobalt Chrome femoral heads. One-hundred primary THA procedures were prospectively performed in 100 patients. There were 52 males and 48 females. Using a process of sealed envelope randomization, patients were divided into 2 groups. Group 1 consisted of fifty patients, each receiving primary THA implants with an Oxinium femoral head (OX). The mean age of each patient was 51 years (SD 10.8, Range 22–74) with 26 males and 24 females. Group 2 also consisted of 50 patients. Within this group again each patient received primary THA implants however with a cobalt-chrome femoral head (CC). Demographics were similar with mean age 51 years (SD 11.0, Range 19–76) and again 26 males and 24 females. The current study reports clinical outcome measures for both the OX and CC groups at a minimum follow-up of 2 years postoperatively. At the time of latest follow-up, stem survival for both groups was 98%. There was a significant improvement in all clinical outcome scores between preoperative and 2 year postoperative time periods for both bearing groups (p<
0.003). There were no significant differences between bearing groups for any of the clinical outcome scores at final follow-up (p>
0.159). Mean Harris Hip Scores at 2 years postoperatively were 92 and 92.5 for OX and CC, respectively (range; 65–100 OX, 60–100 CC). For SF-12, both the
The aim of this study was to investigate whether the type of cervical disc herniation influences the severity of symptoms at the time of presentation, and the outcome after surgical treatment. The type and extent of disc herniation at the time of presentation in 108 patients who underwent anterior discectomy for cervical radiculopathy were analyzed on MRI, using a four-point scale. These were dichotomized into disc bulge and disc herniation groups. Clinical outcomes were evaluated using the Neck Disability Index (NDI), 36-Item Short Form Survey (SF-36), and a visual analogue scale (VAS) for pain in the neck and arm at baseline and two years postoperatively. The perceived recovery was also assessed at this time.Aims
Methods
PURPOSE: Patients who sustain fall-related distal forearm fractures are at risk to sustain new fractures later in life. Risk factors for falls such as low physical activity, impaired gait and neuromuscular function, and comorbidity are well known, as well as risk factors for fractures such as female gender, old age, low body mass index (BMI) and low mobility. Fracture prevention is often directed toward bone mass density treatment, but there is evidence that high level of physical activity reduces falls and therefore also reduces fractures. Health related quality of life (HRQoL) has become an important additional measure. The aims of this study were to evaluate the HRQoL, reported with EQ-5D and SF-12, in women who had sustained fall-related distal forearm fracture one year earlier and compare with Swedish normative data, and to physical performance and self-reported comorbidity. PARTICIPANTS: Sixty women with a fall-related distal forearm fracture were invited to examine health-related quality of life and physical performance at a mean time of 13 months after they had sustained their fracture (S.D. 1.6, range 10–17). The inclusion criteria were that they should be able to perform the physical tests and to understand verbal and written Swedish. Forty three women (72%), mean age 68 (SD 8.4, range 50–84), agreed to participate. METHODS: The women filled in two generic HRQoL-questionnaires; EQ-5D and SF-12. They self-rated their physical activity and reported ailments, which were regularly examined by a doctor, and intake of prescribed medication. They reported problems or difficulties from the locomotor system and depressive symptoms during the three last months. All women underwent physical performance tests; handgrip strength, one leg standing (OLS) and walking speed. Fisher’s exact test, Mann Whitney U test and Spearman’s rank correlation coefficient were used in the statistical analyses. RESULTS: In the younger women (age 50–59) the HRQoL was lower compared to Swedish normative data. The EQ-5D index and VAS scores correlated moderately to the
Amputation is one of the most feared injuries in service personnel, particularly a worry that it will mean the end of their military career. The aim of this study was to determine the outcome, in relation to military service in UK military amputees. UK service personnel who sustain an amputation undergo rehabilitation and prosthetic limb fitting at the Defence Medical Rehabilitation Centre Headley Court. This includes a realistic assessment of their employment capabilities, and they are graded by a Functional Activity Assessment (FAA). FAA ranges from 1 (fully fit) to 5 (unfit all duties). In addition the Short Form-36 Health Survey (SF-36) is completed on initial admission and at follow-up. We reviewed this information to determine the outcome of military amputees. We identified 53 casualties who had sustained amputations. 8 had sustained an upper limb amputation, 41 a lower limb amputation, and 4 had sustained both an upper and lower limb amputation. 9 patients (including 1 Reservist) have left the forces by medical discharge, with the remaining 44 continuing to serve. 32 of the 44 have returned to work, albeit at a lower level. 49 patients have FAA grades and are at least 6 months post-injury. No patients were graded as FAA 1, 8 as FAA 2 (Fit for Trade and fit for restricted General or Military Duties), 18 as FAA 3 (Unfit for Trade but fit for restricted General or Military Duties), 18 as FAA 4 (Unfit for all but Sedentary Duties) and 5 as FAA 5. All bilateral and triple amputees were FAA 4 or 5. Other injuries such as blindness, severe brain injury or mental health issues also increased the FAA. Of the 32 patients who have returned to work, 8 are FAA 2, 12 are FAA 3, 11 are FAA 4, and 1 has not been graded. SF-36 data was available in 40 patients, available as paired scores for 34. The mean time between SF-36 scoring was 6.7 months (range 0.2 – 17.4). The mean SF-36 scores for
The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population. We performed a post hoc exploratory analysis of a fitter cohort of patients from the HEALTH trial. Participants were aged over 50 years and had sustained a low-energy displaced femoral neck fracture (FNF). The fittest participant cohort was defined as participants aged 70 years or younger, classified as American Society of Anesthesiologists grade I or II, independent walkers prior to fracture, and living at home prior to fracture. Multilevel models were used to estimate the effect of THA versus HA on functional outcomes. In addition, a sensitivity analysis of the definition of the fittest participant cohort was performed.Aims
Methods
The purpose of this study was to assess the success rate and functional outcomes of bone grafting for periprosthetic bone cysts following total ankle arthroplasty (TAA). Additionally, we evaluated the rate of graft incorporation and identified associated predisposing factors using CT scan. We reviewed a total of 37 ankles (34 patients) that had undergone bone grafting for periprosthetic bone cysts. A CT scan was performed one year after bone grafting to check the status of graft incorporation. For accurate analysis of cyst volumes and their postoperative changes, 3D-reconstructed CT scan processed with 3D software was used. For functional outcomes, variables such as the Ankle Osteoarthritis Scale score and the visual analogue scale for pain were measured.Aims
Methods
This prospective study reports longitudinal, within-patient, patient-reported outcome measures (PROMs) over a 15-year period following cemented single radius total knee arthroplasty (TKA). Secondary aims included reporting PROMs trajectory, 15-year implant survival, and patient attrition from follow-up. From 2006 to 2007, 462 consecutive cemented cruciate-retaining Triathlon TKAs were implanted in 426 patients (mean age 69 years (21 to 89); 290 (62.7%) female). PROMs (12-item Short Form Survey (SF-12), Oxford Knee Score (OKS), and satisfaction) were assessed preoperatively and at one, five, ten, and 15 years. Kaplan-Meier survival and univariate analysis were performed.Aims
Methods
Lateral femoral cutaneous nerve (LFCN) injury is a complication after periacetabular osteo-tomy (PAO) using an anterior approach, which might adversely affect the outcome. However, no prospective study has assessed the incidence and severity of this injury and its effect on the clinical outcomes over a period of time for longer than one year after PAO. The aim of this study was to assess the incidence and severity of the symptoms of LFCN injury for ≥ three years after PAO and report its effect on clinical outcomes. A total of 40 hips in 40 consecutive patients who underwent PAO between May 2016 and July 2018 were included in the study, as further follow-up of the same patients from a previous study. We prospectively evaluated the incidence, severity, and area of symptoms following LFCN injury. We also recorded the clinical scores at one year and ≥ three years postoperatively using the 36-Item Short Form Health Survey (SF-36) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) scores.Aims
Methods
The primary outcome was investigating differences in wear, as measured by femoral head penetration, between cross-linked vitamin E-diffused polyethylene (vE-PE) and cross-linked polyethylene (XLPE) acetabular component liners and between 32 and 36 mm head sizes at the ten-year follow-up. Secondary outcomes included acetabular component migration and patient-reported outcome measures (PROMs) such as the EuroQol five-dimension questionnaire, 36-Item Short-Form Health Survey, Harris Hip Score, and University of California, Los Angeles Activity Scale (UCLA). A single-blinded, multi-arm, 2 × 2 factorial randomized controlled trial was undertaken. Patients were recruited between May 2009 and April 2011. Radiostereometric analyses (RSAs) were performed from baseline to ten years. Of the 220 eligible patients, 116 underwent randomization, and 82 remained at the ten-year follow-up. Eligible patients were randomized into one of four interventions: vE-PE acetabular liner with either 32 or 36 mm femoral head, and XLPE acetabular liner with either 32 or 36 mm femoral head. Parameters were otherwise identical except for acetabular liner material and femoral head size.Aims
Methods
Introduction: The role of spinal fusion in patients suffering degenerative spine disease may be scrutinized more as costs of surgical treatment rise. Health-related quality of life (HRQL) measurement instruments enable outcome comparisons following treatment of different medical conditions. Rampersaud et al (1) recently presented the results of a comparative study of HRQL outcomes after surgery for lumbar spinal stenosis and hip and knee total joint arthroplasty. The latter are now accepted benchmarks for improvement in patient health. Methods: A retrospective, observational cohort study was undertaken of 12-item Short Form Health Survey (SF-12) outcome data of 105 consecutive patients of two surgeons (1st and 2nd authors) who underwent single level Posterior Lumbar Interbody Fusion (PLIF) for lumbar spinal stenosis associated with degenerative spondylolisthesis. Minimum 12-month (F/U) data was available for 98 patients (93%). Comparison was made with published SF-12 results of hip and knee total joint arthroplasty (THR and TKR) and with age-related Australian population norms. Analyses were performed using XLSTAT version 7.5.3. Non-parametric statistics were used for assessment of skewed continuous variables. Overlappng 95%CIs were interpreted as indicating lack of significant difference in outcomes between patient and population groups. Results: Median follow-up was 24months (range: 12–60months). Median age was 65 (Interquartile range: 59–75) years. Male:female ratio 2.8:1. Mean (95%CI) pre-op
Background context: Stable thoracolumbar spinal fracture is a common injury, yet there remains a relative lack of evidence that would allow reliable prediction of outcome. Variation in outcome in stable thoracolumbar spine fracture without neurological deficit could not be explained by the assessment made from x-rays and CT imaging alone, which measures mainly the bony injury severity. So far, no good classification system has been developed to assess the severity of soft tissue injury (disc). Objectives: To measure short-term outcome of stable thoracolumbar fracture and analyse aspects of injury severity for their ability to predict outcome. To develop a new disc injury severity grading system in thoracolumbar spine fractures. Study design: Prospective observational. Patient sample: 44 patients with stable fractures between T11 and L5 vertebra with no neurological deficit and treated conservatively were selected. Methods: All had plain x-rays, CT and MRI scans post-injury and at one year post-injury (except CT). Bony injury severity was scored on a seven-point ordinal scale based on (a) communication, (b) apposition and (c) kyphosis. Disc injury severity was scored by the newly developed six-point ordinal scale (none to severe) based on the following variables: (a) Herniation of the disc, (b) Indentation of the end plate, (c) Change in height and (d) Change in signal. Outcome was assessed at one to two years from injury. The following outcome measures were collected: (A) Five domains of pain symptoms – intensity, duration, bothersome, interference and satisfaction. (B) Five domains of function –
This edition of the Cochrane Corner looks at the three reviews that were published in the second half of 2023: surgical versus non-surgical interventions for displaced intra-articular calcaneal fractures; cryotherapy following total knee arthroplasty; and physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents.
The February 2023 Spine Roundup360 looks at: S2AI screws: At what cost?; Just how good is spinal deformity surgery?; Is 80 years of age too late in the day for spine surgery?; Factors affecting the accuracy of pedicle screw placement in robot-assisted surgery; Factors causing delay in discharge in patients eligible for ambulatory lumbar fusion surgery; Anterior cervical discectomy or fusion and selective laminoplasty for cervical spondylotic myelopathy; Surgery for cervical radiculopathy: what is the complication burden?; Hypercholesterolemia and neck pain; Return to work after surgery for cervical radiculopathy: a nationwide registry-based observational study.
Instability is a common cause of failure after total hip arthroplasty. A novel reverse total hip has been developed, with a femoral cup and acetabular ball, creating enhanced mechanical stability. The purpose of this study was to assess the implant fixation using radiostereometric analysis (RSA), and the clinical safety and efficacy of this novel design. Patients with end-stage osteoarthritis were enrolled in a prospective cohort at a single centre. The cohort consisted of 11 females and 11 males with mean age of 70.6 years (SD 3.5) and BMI of 31.0 kg/m2 (SD 5.7). Implant fixation was evaluated using RSA as well as Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score, Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score, 38-item Short Form survey, and EuroQol five-dimension health questionnaire scores at two-year follow-up. At least one acetabular screw was used in all cases. RSA markers were inserted into the innominate bone and proximal femur with imaging at six weeks (baseline) and six, 12, and 24 months. Independent-samples Aims
Methods
We compared decompression alone to decompression with fusion surgery for lumbar spinal stenosis, with or without degenerative spondylolisthesis (DS). The aim was to evaluate if five-year outcomes differed between the groups. The two-year results from the same trial revealed no differences. The Swedish Spinal Stenosis Study was a multicentre randomized controlled trial with recruitment from September 2006 to February 2012. A total of 247 patients with one- or two-level central lumbar spinal stenosis, stratified by the presence of DS, were randomized to decompression alone or decompression with fusion. The five-year Oswestry Disability Index (ODI) was the primary outcome. Secondary outcomes were the EuroQol five-dimension questionnaire (EQ-5D), visual analogue scales for back and leg pain, and patient-reported satisfaction, decreased pain, and increased walking distance. The reoperation rate was recorded.Aims
Methods
Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD. ASD patients with two-year data were included. Complications were categorized as follows: any complication, major, medical, surgical, major mechanical, major radiological, and reoperation. Modifiable risk factors included smoking, obesity, osteoporosis, alcohol use, depression, psychiatric diagnosis, and hypertension. Patients were stratified by the degree of baseline deformity (low degree of deformity (LowDef)/high degree of deformity (HighDef): below or above 20°) and age (Older/Younger: above or below 65 years). Complication rates were compared for modifiable risk factors in each age/deformity group, using multivariable logistic regression analysis to adjust for confounders.Aims
Methods
To systematically review the predominant complication rates and changes to patient-reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation for shoulder instability. This systematic review, following PRISMA guidelines and registered in PROSPERO, involved a comprehensive literature search using PubMed, Embase, Web of Science, and Scopus. Key search terms included “allograft”, “shoulder”, “humerus”, and “glenoid”. The review encompassed 37 studies with 456 patients, focusing on primary outcomes like failure rates and secondary outcomes such as PROMs and functional test results.Aims
Methods
The aim of this study was to determine the effectiveness of home-based prehabilitation on pre- and postoperative outcomes in participants awaiting total knee (TKA) and hip arthroplasty (THA). A systematic review with meta-analysis of randomized controlled trials (RCTs) of prehabilitation interventions for TKA and THA. MEDLINE, CINAHL, ProQuest, PubMed, Cochrane Library, and Google Scholar databases were searched from inception to October 2022. Evidence was assessed by the PEDro scale and the Cochrane risk-of-bias (ROB2) tool.Aims
Methods
Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed.Aims
Methods
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). 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.Aims
Methods
The aim of this study was to identify factors associated with poor outcome following coccygectomy on patients with chronic coccydynia and instability of the coccyx. From the Danish National Spine Registry, DaneSpine, 134 consecutive patients were identified from a single centre who had coccygectomy from 2011 to 2019. Patient demographic data and patient-reported outcomes, including pain measured on a visual analogue scale (VAS), Oswestry Disability Index (ODI), EuroQol five-dimension five-level questionnaire, and 36-Item Short-Form Health Survey questionnaire (SF-36) were obtained at baseline and at one-year follow-up. Patient satisfaction was obtained at follow-up. Regression analysis, including age, sex, smoking status, BMI, duration of symptoms, work status, welfare payment, preoperative VAS, ODI, and SF-36 was performed to identify factors associated with dissatisfaction with results at one-year follow-up.Aims
Methods
To map literature on prognostic factors related to outcomes of revision total knee arthroplasty (rTKA), to identify extensively studied factors and to guide future research into what domains need further exploration. We performed a systematic literature search in MEDLINE, Embase, and Web of Science. The search string included multiple synonyms of the following keywords: "revision TKA", "outcome" and "prognostic factor". We searched for studies assessing the association between at least one prognostic factor and at least one outcome measure after rTKA surgery. Data on sample size, study design, prognostic factors, outcomes, and the direction of the association was extracted and included in an evidence map.Aims
Methods
This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up.Aims
Methods
To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey.Aims
Methods
Our objective was to conduct a systematic review and meta-analysis, to establish whether differences arise in clinical outcomes between autologous and synthetic bone grafts in the operative management of tibial plateau fractures. A structured search of MEDLINE, EMBASE, the online archives of Bone & Joint Publishing, and CENTRAL databases from inception until 28 July 2021 was performed. Randomized, controlled, clinical trials that compared autologous and synthetic bone grafts in tibial plateau fractures were included. Preclinical studies, clinical studies in paediatric patients, pathological fractures, fracture nonunion, or chondral defects were excluded. Outcome data were assessed using the Risk of Bias 2 (ROB2) framework and synthesized in random-effect meta-analysis. The Preferred Reported Items for Systematic Review and Meta-Analyses guidance was followed throughout.Aims
Methods
Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively.Aims
Methods
To report early (two-year) postoperative findings from a randomized controlled trial (RCT) investigating disease-specific quality of life (QOL), clinical, patient-reported, and radiological outcomes in patients undergoing a total shoulder arthroplasty (TSA) with a second-generation uncemented trabecular metal (TM) glenoid versus a cemented polyethylene glenoid (POLY) component. Five fellowship-trained surgeons from three centres participated. Patients aged between 18 and 79 years with a primary diagnosis of glenohumeral osteoarthritis were screened for eligibility. Patients were randomized intraoperatively to either a TM or POLY glenoid component. Study intervals were: baseline, six weeks, six-, 12-, and 24 months postoperatively. The primary outcome was the Western Ontario Osteoarthritis Shoulder QOL score. Radiological images were reviewed for metal debris. Mixed effects repeated measures analysis of variance for within and between group comparisons were performed.Aims
Methods
Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°. A matched cohort of patients similar for demographics and components used but differing in preoperative coronal-plane tibiotalar valgus deformity ≥ 15° (valgus, n = 50; 52% male, mean age 65.8 years (SD 10.3), mean body mass index (BMI) 29.4 (SD 5.2)) or < 15° (control, n = 50; 58% male, mean age 65.6 years (SD 9.8), mean BMI 28.7 (SD 4.2)), underwent TAA by one surgeon. Preoperative and postoperative radiographs, Ankle Osteoarthritis Scale (AOS) pain and disability and 36-item Short Form Health Survey (SF-36) version 2 scores were collected prospectively. Ancillary procedures, secondary procedures, and complications were recorded.Aims
Methods
Chronic low back pain due to degenerative disc disease is sometimes treated with fusion. We compared the outcome of three different fusion techniques in the Swedish Spine Register: noninstrumented posterolateral fusion (PLF), instrumented posterolateral fusion (IPLF), and interbody fusion (IBF). A total of 2874 patients who were operated on at one or two lumbar levels were followed for a mean of 9.2 years (3.6 to 19.1) for any additional lumbar spine surgery. Patient-reported outcome data were available preoperatively (n = 2874) and at one year (n = 2274), two years (n = 1958), and a mean of 6.9 years (n = 1518) postoperatively and consisted of global assessment and visual analogue scales of leg and back pain, Oswestry Disability Index, EuroQol five-dimensional index, 36-Item Short-Form Health Survey, and satisfaction with treatment. Statistical analyses were performed with competing-risks proportional hazards regression or analysis of covariance, adjusted for baseline variables.Aims
Patients and Methods
The primary aim of this study was to assess whether pain in the contralateral knee had a clinically significant influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary aims were to: describe the prevalence of contralateral knee pain; identify if it clinically improves after TKA; and assess whether contralateral knee pain independently influences patient satisfaction with their TKA. A retrospective cohort of 3,178 primary TKA patients were identified from an arthroplasty database. Patient characteristics, comorbidities, and WOMAC scores were collected preoperatively and one year postoperatively for the index knee. In addition, WOMAC pain scores were also collected for the contralateral knee. Overall patient satisfaction was assessed at one year. Preoperative contralateral knee pain was defined according to the WOMAC score: minimal (> 78 points), mild (59 to 78), moderate (44 to 58), and severe (< 44). Multivariate regression analysis was used to adjust for confounding.Aims
Methods
The primary aim of this study was to establish the cost-effectiveness of the early fixation of displaced midshaft clavicle fractures. A cost analysis was conducted within a randomized controlled trial comparing conservative management (n = 92) Aims
Patients and Methods
This study of patients with osteoarthritis (OA) of the hip aimed to: 1) characterize the contribution of the hip, spinopelvic complex, and lumbar spine when moving from the standing to the sitting position; 2) assess whether abnormal spinopelvic mobility is associated with worse symptoms; and 3) identify whether spinopelvic mobility can be predicted from static anatomical radiological parameters. A total of 122 patients with end-stage OA of the hip awaiting total hip arthroplasty (THA) were prospectively studied. Patient-reported outcome measures (PROMs; Oxford Hip Score, Oswestry Disability Index, and Veterans RAND 12-Item Health Survey Score) and clinical data were collected. Sagittal spinopelvic mobility was calculated as the change from the standing to sitting position using the lumbar lordosis angle (LL), sacral slope (SS), pelvic tilt (PT), pelvic-femoral angle (PFA), and acetabular anteinclination (AI) from lateral radiographs. The interaction of the different parameters was assessed. PROMs were compared between patients with normal spinopelvic mobility (10° ≤ ∆PT ≤ 30°) or abnormal spinopelvic mobility (stiff: ∆PT < ± 10°; hypermobile: ∆PT > ± 30°). Multiple regression and receiver operating characteristic (ROC) curve analyses were used to test for possible predictors of spinopelvic mobility.Aims
Patients and Methods
The number of rotator cuff repairs that are undertaken is increasing. Reverse shoulder arthroplasty (RSA) is the procedure of choice for patients with rotator cuff arthropathy. We sought to determine whether patients who underwent rotator cuff repair and subsequent RSA had different outcomes compared with a matched control group who underwent RSA without a previous rotator cuff repair. All patients with a history of rotator cuff repair who underwent RSA between 2000 and 2015 with a minimum follow-up of two years were eligible for inclusion as the study group. Outcomes, including the American Shoulder and Elbow Surgeons (ASES) scores, were compared with a matched control group of patients who underwent RSA without having previously undergone rotator cuff repair.Aims
Patients and Methods
The purpose of this study was to determine the functional outcome and implant survivorship of mobile-bearing total ankle arthroplasty (TAA) performed by a single surgeon. We reviewed 205 consecutive patients (210 ankles) who had undergone mobile-bearing TAA (205 patients) for osteoarthritis of the ankle between January 2005 and December 2015. Their mean follow-up was 6.4 years (2.0 to 13.4). Functional outcome was assessed using the Ankle Osteoarthritis Scale, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, 36-Item Short-Form Health Survey (SF-36) score, visual analogue scale, and range of movement. Implant survivorship and complications were also evaluated.Aims
Patients and Methods
The purpose of the present study was to compare patient-specific instrumentation (PSI) and conventional surgical instrumentation (CSI) for total knee arthroplasty (TKA) in terms of early implant migration, alignment, surgical resources, patient outcomes, and costs. The study was a prospective, randomized controlled trial of 50 patients undergoing TKA. There were 25 patients in each of the PSI and CSI groups. There were 12 male patients in the PSI group and seven male patients in the CSI group. The patients had a mean age of 69.0 years (Aims
Patients and Methods
Robotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used. A search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “robotic”, “knee”, and “surgery”. The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies.Aims
Materials and Methods
The aim of this study was to assess the effect of multimorbidity
on improvements in health-related quality of life (HRQoL) following
total hip arthroplasty (THA) and total knee arthroplasty (TKA). Using data from a regional joint registry for 14 573 patients,
HRQoL was measured prior and one year following surgery using the
Oxford Hip Score (OHS) and Oxford Knee Score (OKS), and the 12-Item
Short-Form Health Survey Physical and Mental Component Summary scores
(PCS and MCS, respectively). Multimorbidity was defined as the concurrence
of two or more self-reported chronic conditions. A linear mixed-effects
model was used to test the effects of multimorbidity and the number
of chronic conditions on improvements in HRQoL.Aims
Patients and Methods
The primary aim of this study was to compare the knee-specific functional outcome of patellofemoral arthroplasty with total knee arthroplasty (TKA) in the management of patients with patellofemoral osteoarthritis. A total of 54 consecutive Avon patellofemoral arthroplasties were identified and propensity-score-matched to a group of 54 patients undergoing a TKA with patellar resurfacing for patellofemoral osteoarthritis. The Oxford Knee Score (OKS), the 12-Item Short-Form Health Survey (SF-12), and patient satisfaction were collected at a mean follow up of 9.2 years (8 to 15). Survival was defined by revision or intention to revise.Aims
Patients and Methods
We performed a meta-analysis investigating the association between preoperative psychological distress and postoperative pain and function after total knee arthroplasty (TKA). Pubmed/Medline, Embase, PsycINFO, and the Cochrane library were searched for studies on the influence of preoperative psychological distress on postoperative pain and physical function after TKA. Two blinded reviewers screened for eligibility and assessed the risk of bias and the quality of evidence. We used random effects models to pool data for the meta-analysis.Aims
Materials and Methods
The aims of this study were to evaluate the abductor function in moderate and severe slipped capital femoral epiphysis (SCFE), comparing the results of a corrective osteotomy at the base of the femoral neck and osteoplasty with 1) A total of 24 patients (mean age 14.9 years (Aims
Patients and Methods
The primary aim of this study was to assess whether patient satisfaction
one year after total knee arthroplasty (TKA) changed with longer
follow-up. The secondary aims were to identify predictors of satisfaction
at one year, persistence of patient dissatisfaction, and late onset
dissatisfaction in patients that were originally satisfied at one year. A retrospective cohort consisting of 1369 patients undergoing
a primary TKA for osteoarthritis that had not undergone revision
were identified from an established arthroplasty database. Patient
demographics, comorbidities, Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) scores, and Short Form 12 (SF-12) questionnaire
scores were collected preoperatively, and one and five years postoperatively.
In addition, patient satisfaction was assessed at one and five years
postoperatively. Logistic regression analysis was used to identify
independent predictors of satisfaction at one and five years.Aims
Patients and Methods
Pain catastrophising is an adverse coping mechanism,
involving an exaggerated response to anticipated or actual pain. The purpose of this study was to investigate the influence of
pain ‘catastrophising’, as measured using the pain catastrophising
scale (PCS), on treatment outcomes after surgery for lumbar spinal
stenosis (LSS). A total of 138 patients (47 men and 91 women, mean age 65.9;
45 to 78) were assigned to low (PCS score <
25, n = 68) and high
(PCS score ≥ 25, n = 70) PCS groups. The primary outcome measure
was the Oswestry Disability Index (ODI) 12 months after surgery.
Secondary outcome measures included the ODI and visual analogue
scale (VAS) for back and leg pain, which were recorded at each assessment
conducted during the 12-month follow-up period The overall changes in the ODI and VAS for back and leg pain
over a 12-month period were significantly different between the
groups (ODI, p <
0.001; VAS for back pain, p <
0.001; VAS
for leg pain, p = 0.040). The ODI and VAS for back and leg pain
significantly decreased over time after surgery in both groups (p
<
0.001 for all three variables). The patterns of change in the
ODI and VAS for back pain during the follow-up period significantly
differed between the two groups, suggesting that the PCS group is
a potential treatment moderator. However, there was no difference
in the ODI and VAS for back and leg pain between the low and high
PCS groups 12 months after surgery. In terms of minimum clinically important differences in ODI scores
(12.8), 22 patients (40.7%) had an unsatisfactory surgical outcome
in the low PCS group and 16 (32.6%) in the high PCS group. There
was no statistically significant difference between the two groups
(p = 0.539). Pre-operative catastrophising did not always result in a poor
outcome 12 months after surgery, which indicates that this could
moderate the efficacy of surgery for LSS. Cite this article:
The primary aim of this study was to assess the rate of patient
satisfaction one year after total knee arthroplasty (TKA) according
to the focus of the question asked. The secondary aims were to identify
independent predictors of patient satisfaction according to the
focus of the question. A retrospective cohort of 2521 patients undergoing a primary
unilateral TKA were identified from an established regional arthroplasty
database. Patient demographics, comorbidities, Western Ontario and
McMaster Universities Osteoarthritis Index (WOMAC) and 12-Item Short-Form
Health Survey (SF-12) scores were collected preoperatively and one
year postoperatively. Patient satisfaction was assessed using four
questions, which focused on overall outcome, activity, work, and
pain. Logistic regression analysis was used to identify independent
preoperative predictors of increased stiffness when adjusting for
confounding variables.Aims
Patients and Methods
Patients with diabetes are at increased risk of wound complications
after open reduction and internal fixation of unstable ankle fractures.
A fibular nail avoids large surgical incisions and allows anatomical
reduction of the mortise. We retrospectively reviewed the results of fluoroscopy-guided
reduction and percutaneous fibular nail fixation for unstable Weber
type B or C fractures in 24 adult patients with type 1 or type 2
diabetes. The re-operation rate for wound dehiscence or other indications
such as amputation, mortality and functional outcomes was determined.Aims
Patients and Methods
This 501-patient, multi-centre, randomised controlled trial sought
to establish the effect of low-intensity, pulsed, ultrasound (LIPUS)
on tibial shaft fractures managed with intramedullary nailing. We
conducted an economic evaluation as part of this trial. Data for patients’ use of post-operative healthcare resources
and time taken to return to work were collected and costed using
publicly available sources. Health-related quality of life, assessed
using the Health Utilities Index Mark-3 (HUI-3), was used to derive
quality-adjusted life years (QALYs). Costs and QALYs were compared
between LIPUS and control (a placebo device) from a payer and societal
perspective using non-parametric bootstrapping. All costs are reported
in 2015 Canadian dollars unless otherwise stated.Aims
Patients and Methods