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Bone & Joint Open
Vol. 4, Issue 8 | Pages 573 - 579
8 Aug 2023
Beresford-Cleary NJA Silman A Thakar C Gardner A Harding I Cooper C Cook J Rothenfluh DA

Aims

Symptomatic spinal stenosis is a very common problem, and decompression surgery has been shown to be superior to nonoperative treatment in selected patient groups. However, performing an instrumented fusion in addition to decompression may avoid revision and improve outcomes. The aim of the SpInOuT feasibility study was to establish whether a definitive randomized controlled trial (RCT) that accounted for the spectrum of pathology contributing to spinal stenosis, including pelvic incidence-lumbar lordosis (PI-LL) mismatch and mobile spondylolisthesis, could be conducted.

Methods

As part of the SpInOuT-F study, a pilot randomized trial was carried out across five NHS hospitals. Patients were randomized to either spinal decompression alone or spinal decompression plus instrumented fusion. Patient-reported outcome measures were collected at baseline and three months. The intended sample size was 60 patients.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 303 - 304
1 Jul 2008
McHugh G Luker K Campbell M Kay P Silman A
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Introduction: In the United Kingdom, the wait for hip or knee joint replacement surgery can be particularly long. There are conflicting research accounts whether debilitating symptoms, such as pain and the effects on physical function and quality of life deteriorate or remain the same in individuals who are on the waiting list for hip or knee joint replacement. This study was conducted to investigate the severity of pain, level of physical function and quality of life amongst adults with osteoarthritis awaiting hip or knee joint replacement.

Methods: A longitudinal study was undertaken in the North West of England during 2003–2005. A total of 105 patients listed for primary hip or knee joint replacement were recruited, interviewed at baseline, and followed-up at three, six and nine months, or until their joint replacement. Measurement tools used were a visual analogue scale (VAS), Western Ontario McMaster’s University (WOMAC) Osteoarthritis Index and the Medical Outcomes Study Short Form Health Survey (SF-36).

Results: High levels of pain and poor physical function and quality of life were experienced by patients on the waiting list for joint replacement. At the three month follow-up (n=84) changes in VAS pain scores (0.6; 95% CIs mean difference 0.3,1.0); WOMAC pain scores (1.2 (95% CIs mean difference 0.7, 1.8) and WOMAC physical function scores (4.8; 95% CIs mean difference 2.8, 6.7) were significantly worse compared to baseline. However, there were minimal changes in quality of life as measured by the SF-36 while on the waiting list.

Discussion: The often long wait for joint replacement surgery and deterioration in pain and physical function has highlighted the need for active management by health professionals while patients are on the waiting list. There needs to be a clinical reassessment of patients by health professionals while on the waiting list for joint replacement.