The aim of the this study was to determine the effect of the knee flexion angle (KFA) during tibial anterior cruciate ligament (ACL) graft fixation on patient reported outcomes, graft stability, extension loss and re-operation following anatomic single-bundle ACL reconstruction. All 169 included patients (mean age 28.5 years, 65% male) were treated with anatomic single bundle ACL reconstruction using patellar tendon autograft and randomized to tibial fixation of the ACL graft at either 0o (n=85) or 30o (n=84). The primary outcome was the Knee Injury and Osteoarthritis Outcome Score (KOOS) two years following surgery. Secondary outcomes were the Marx Activity Scale (MAS), the rate of re-operation, and physical exam findings at one year including KT-1000 and side to side differences in knee extension. The follow-up rate was 82% (n=139) for the primary outcome. Graft failure rate at two years was 1% (n=2, 1 per group). ACL tibial graft fixation at 0o or 30o did not have a significant effect on KOOS scores at two years following ACLR. Patients whose graft was fixed at a knee flexion angle of 0o had greater scores on the Marx Activity Scale (mean 9.6 [95%CI 8.5-10.6] versus 8.0 [95%CI 6.9-9.1, p=0.04) and a greater proportion of patients who achieved the minimal clinical important difference (MCID) for the KOOS pain subscale (94% vs 81%, p=0.04). There was no significant difference in knee extension loss, KT-1000 measurements or re-operation between the two groups. In the setting of anatomic single-bundle ACLR using patellar tendon autograft and anteromedial portal femoral drilling, there was no difference in KOOS scores among patients fixed at 0o and 30o. Patient fixed in full extension did demonstrate higher activity scores at 2 years following surgery and a greater likelihood of achieving the MCID for KOOS pain

Utility score is a preference-based measure of general health state – where 0 is equal to death, and 1 is equal to perfect health. To understand a patient's smallest perceptible change in utility score, the minimal clinically important difference (MCID) can be calculated. However, there are multiple methods to calculate MCID with no consensus about which method is most appropriate. The aim of this study is to calculate MCID values for the Veterans-RAND 12 (VR12) utility score using varying methods. Our hypothesis is that different methods will yield different MCID values. A tertiary institutional registry (SMART) was used as the study cohort. Patients who underwent unilateral TKA for osteoarthritis from January 2012 to January 2020 were included. Utility score was calculated from VR12 responses using the standardised Brazier's method. Distribution and anchor methods were used for the MCID calculation. For distribution methods, 0.5 standard deviations of the baseline and change scores were used. For anchor methods, the physical and emotional anchor questions in the VR12 survey were used to benchmark utility score outcomes. Anchor methods included mean difference in change score, mean difference in 12 month score, and receiver operating characteristics (ROC) analysis with the Youden index. Complete case analysis of 1735 out of 1809 eligible patients was performed. Significant variation in the MCID estimates for VR12 utility score were reported dependent on the calculation method used. The MCID estimate from 0.5 standard deviations of the change score was 0.083. The MCID estimate from the ROC analysis method using physical or emotional anchor question improvement was 0.115 (CI95 0.08-0.14; AUC 0.656). Different MCID calculation methods yielded different MCID values. Our results suggest that MCID is not an umbrella concept but rather many distinct concepts. A general consensus is required to standardise how MCID is defined, calculated, and applied in clinical practice

In multilevel posterior cervical instrumented fusions, extending the fusion across the cervico-thoracic junction at T1 or T2 (CTJ) has been associated with decreased rate of re-operation and pseudarthrosis but with longer surgical time and increased blood loss. The impact on patient reported outcomes (PROs) remains unclear. The primary objective was to determine whether extending the fusion through the CTJ influenced PROs at 3 and 12 months after surgery. Secondary objectives were to compare the number of patients reaching the minimally clinically important difference (MCID) for the PROs and mJOA, operative time duration, intra-operative blood loss (IOBL), length of stay (LOS), discharge disposition, adverse events (AEs), re-operation within 12 months of the surgery, and patient satisfaction. This is a retrospective analysis of prospectively collected data from a multicenter observational cohort study of patients with degenerative cervical myelopathy. Patients who underwent a posterior instrumented fusion of 4 levels of greater (between C2-T2) between January 2015 and October 2020 with 12 months follow-up were included. PROS (NDI, EQ5D, SF-12 PCS and MCS, NRS arm and neck pain) and mJOA were compared using ANCOVA, adjusted for baseline differences. Patient demographics, comorbidities and surgical details were abstracted. Percentafe of patient reaching MCID for these outcomes was compared using chi-square test. Operative duration, IOBL, AEs, re-operation, discharge disposittion, LOS and satisfaction were compared using chi-square test for categorical variables and independent samples t-tests for continuous variables. A total of 206 patients were included in this study (105 patients not crossing the CTJ and 101 crossing the CTJ). Patients who underwent a construct extending through the CTJ were more likely to be female and had worse baseline EQ5D and NDI scores (p> 0.05). When adjusted for baseline difference, there was no statistically significant difference between the two groups for the PROs and mJOA at 3 and 12 months. Surgical duration was longer (p 0.05). Satisfaction with the surgery was high in both groups but significantly different at 12 months (80% versus 72%, p= 0.042 for the group not crossing the CTJ and the group crossing the CTJ, respectively). The percentage of patients reaching MCID for the NDI score was 55% in the non-crossing group versus 69% in the group extending through the CTJ (p= 0.06). Up to 12 months after the surgery, there was no statistically significant differences in PROs between posterior construct extended to or not extended to the upper thoracic spine. The adverse event profile did not differ significantly, but longer surgical time and blood loss were associated with construct extending across the CTJ

Thumb Carpometacarpal (CMC) arthritis is a common pathology of the hand. Surgical treatment with thumb reconstruction is well described. Retrospective outcomes have been described for multiple techniques, suggesting patient satisfaction with multiple different techniques. The Thompson technique uses a slip of Abductor Pollicis Longus for suspension and interposition as well as excision of the trapezium. Retrospective outcomes suggest good patient satisfaction. We describe the improvement in Patient rated outcomes scores (PROS) and changes in pinch and grip strength in a prospectively collected cohort of patients treated with a modification of the Thompson technique. To assess changes in Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (QDASH) scores, as well as to determine the percentage of patients that surpassed the Minimal Clinically Important Difference (MCID) figure that has been described in the literature for these tests. In addition, measurements for evaluation of pinch and grip strength prior to surgery, at six, and at twelve months follow-up were done. Between June 2016 and February 2019, a consecutive prospective series of Thirty-seven LRTI procedures with APL suspension arthroplasty (Thompson technique) were performed on 34 patients with osteoarthritis of the thumb CMC joint (24 women / 13 men; age 63±8.553). All surgeries were performed by the senior surgeon. Data was collected as part of a wrist pain database. Patients failing conservative treatment and electing surgical management of thumb arthritis were enrolled into the database. Patients were evaluated pre-operatively with the PRWE and QDASH questionnaires and grip and pinch strength measurements, and postoperatively at 6 and 12 months. The MCID for QDASH and PRWE is 14 and will be evaluated at the same time points for each patient. Paired student T-test was used to determine differences in the means. Data are presented as mean ± SD unless stated otherwise. Differences with p<.05 were considered significant. Compared to the pre-operative assessment, at six months, the means of PRWE pain score and PRWE functional score decreased significantly (32.824 SD±10.721 vs. 19.265 SD±12.268 and 30.262 SD±10.050 vs. 16.431 SD± 9.697 respectively, n=34,, p<0.05). 69% of the patients surpassed the MCID of 14 six months after the surgery. In addition, QDASH mean score also dropped from 56.108 to 32.219 (SD± 21.375 n=32. p<0.05) at six months. At one year, 76% of the patients were above the MCID of 14. The mean scores of these three questionnaires did not show significant change between six and twelve months. Compared to the initial pre-operative assessment, we found no statistically significant difference in the means of grip strength, point pinch, and lateral key pinch at six and twelve months. Thumb reconstruction with APL suspension arthroplasty demonstrates significant improvement in pain and functionality. No significant improvement in grip and pinch strength is observed, even at one year postoperatively

Interstitial supraspinatus tears can cause persistent subacromial impingement symptoms despite non operative treatment. Autologous tendon cell injection (ATI) is a non-surgical treatment for tendinopathies and tear. We report a randomised controlled study of ATI compared to corticosteroid injection (CS) as treatment for interstitial supraspinatus tears and tendinopathy. Inclusion criteria were patients with symptom duration > 6 months, MRI confirmed intrasubstance supraspinatus tear, and prior treatment with physiotherapy and ≥ one CS or PRP injection. Participants were randomised to receive ATI to the interstitial tear or corticosteroid injection to the subacromial bursa in a 2:1 ratio, under ultrasound guidance. Assessments of pain (VAS) and function (ASES) were performed at baseline, and 1, 3, 6 and 12 months post treatment. 30 participants (19 randomised to ATI) with a mean age of 50.5 years (10 females) and a mean duration of symptoms of 23.5 months. Baseline VAS pain and ASES scores were comparable between groups. While mean VAS pain scores improved in both groups at 3 months after treatment, pain scores were superior with ATI at 6 months (p=0.01). Mean ASES scores in the ATI group were superior to the CS group at 3 months (p=0.026) and 6 months (p=0.012). Seven participants in the CS group withdrew prior to 12 months due to lack of improvement. At 12 months, mean VAS pain in the ATI group was 1.6 ± 1.3. The improvements in mean ASES scores in the ATI group at 6 and 12 months were greater than the MCID (12.0 points). At 12 months, 95% of ATI participants had an ASES score > the PASS (patient acceptable symptom state). This is the first level one study using ATI to treat interstitial supraspinatus tear. ATI results in a significant reduction in pain and improvement in shoulder function

Significance. In spite of evidence that total knee replacement (TKR) surgery is effective, numerous studies have demonstrated that approximately 20 percent of patients who have undergone TKR surgery are not satisfied. This relatively high rate of patients who are not satisfied is the result of unmet patient expectations. The strongest predictor of dissatisfaction after TKR is unmet expectations (RR = 10.7, Bourne, Chesworth, et al, 2010). This is confirmed by Dunbar, Richardson, and Robertsson (2013): “Unmet expectation seems to be a major cause of unsatisfactory outcomes and satisfaction is most strongly correlated with relief of pain, followed by improvement in physical function.” Objective: To develop patient reported outcome (PRO) recovery graphs for knee function, activity level, and pain relief to be used as a shared decision making tool for total knee replacement surgery. Methods. A proprietary joint arthroplasty database of patient reported outcomes (PROs) was analyzed to determine the recovery curve means and standard deviations of four PROs at six time points: pre-operatively, 6 weeks, 3 months, 6 months, 1 year, and 2 years post-operatively for total knee replacement surgery. The recovery graphs are stratified by percentile (10%, 26%, 50%, 75%, and 90%) The PROs analyzed were: (1) European quality of life (EQ-5D); Oxford Knee Score (OKS); (3) Lower Extremity Activity Scale (LEAS); and (4) Likert Pain Scale (LPS). The minimum clinically important difference (MCID) was calculated using a distribution method where the MCID equals one half the standard deviation of the score change, MCID = σΔ/2. The LEAS and LPS are used to measure patients’ expectations for pain relief and activity improvement. Prior to discussing surgery, patients are asked to report their pre-operative pain and activity levels and to specify their expected pain relief and activity improvement one year after surgery. Results. EQ-5D: MCID 0.086, mean pre-op 0.695, 1 year post op 0.845, mean change 0.150 (1.74 MCIDs). Oxford Knee Score: MCID 4.55, mean pre-op 25.7, 1 year post op 39.7, mean change 14.0 (3.08 MCIDs). Lower Extremity Activity Scale: MCID 1.61, mean pre-op 9.08, 1 year post op 10.82, mean change 1.74 (1.08 MCIDs). Likert Pain Scale: MCID 1.26, mean pre-op 5.98, 1 year post op 1.41, mean change −4.57 (3.63 MCIDs). Stratified recovery graphs for Oxford Knee Score, Lower Extremity Activity Scale, and Likert Pain Scale are attached. Conclusions. Pain relief (3.63 MCIDs) and improved knee function (3.08 MCIDs) will be the most dramatic improvements for patients undergoing total knee replacement surgery. Stratified recovery graphs can be used as a shared decision making tool to manage both realistic and unrealistic expectations. The recovery graphs delineate the time course for rehabilitation. Patients typically do not exceed their pre-operative activity level until three months after surgery

Significance. In ideal shared decision making (SDM), evidence-based treatment options, their likelihood of success, and the probability of adverse events is discussed with the patient. However, current SDM is fundamentally flawed because evidence for patient-specific treatment effectiveness and patient-specific adverse event risks is lacking. Observational outcome registries are better than randomized clinical trials for determining patient prognostic factors for outcomes and adverse events. No orthopaedic SDM clinical tools exist to predict patient-specific outcomes. Hypothesis: A patient-specific shared decision making tool can predict clinically significant outcomes and adverse events for total knee replacement (TKR) surgery. Methods. A web–based prospective observational outcome registry collects patient reported outcomes (PROs) for TKR surgery. The data set for TKR surgery includes: (1) European quality of life (EQ-5D); (2) Oxford Knee Score (OKS); (3) Lower Extremity Activity Scale (LEAS); and (4) Pain Likert Scale (PLS). A TKR outcome calculator predicts patient-specific functional outcome with a regression model using patient-specific pre-operative Oxford Knee Scores, diagnosis, co-morbidities, and demographics. Patient-specific joint infection relative risk is calculated using diagnosis, co-morbidities, and demographics. Functional outcomes are presented as minimum clinically important differences (MCIDs). MCID=σ. Δ. /2. Results. The MCID for the EQ-5D Health State Score (HSS) is 0.094 (0.000–1.000). The MCID for the EQ-5D Visual Analog Scale (VAS) is 9.1 (0–100). The MCID for the OKS is 4.45 (0–48). The MCID for the LEAS is 1.6 (1–18). The MCID for the PLS is 1.4 (0–10). Examples. (1) A 55-year-old white male with post-traumatic arthritis (ICD-9 716.16, BMI = 28.7, non-diabetic, recently quit smoking) has a pre-operative Oxford Knee Score of 10. His predicted outcome is 6.3 MCIDs and his relative risk of infection is 6.1 (4.4%) (Figure 1). He is expected to have an excellent outcome. His risk of infection can be reduced by using antibiotic-laden cement. Depending on the patient's preferences, he is an excellent candidate for a total knee replacement. (2) A 60-year-old white male with osteoarthritis (ICD-9 715.16, BMI = 25.0, non-diabetic, non-smoker) has a pre-operative Oxford Knee Score of 45. He has full thickness cartilage loss on his medial femoral condyle by MRI only. His predicted outcome is 0.67 MCIDs and his relative risk of infection is 1.9 (1.4%) (Figure 2). He is expected to have a poor outcome even though his risk of infection is low. Although he has full thickness cartilage loss on MRI, his pre-operative Oxford Knee Score of 45 demonstrates that he is very functional and has minimal opportunity for improving his knee function with a total knee replacement. He is a poor candidate for TKR surgery. Conclusions. The patient-specific SDM tool for TKR surgery can distinguish between excellent and poor surgical candidates when both patients meet radiographic criteria for surgery. The pre-operative Oxford Knee Score assesses knee function and/or disability. Patients with relatively high OKSs are less likely to achieve clinically significant improvements after total knee replacement surgery

Significance. Increasing health care costs are bankrupting the United States and other industrialized countries. To control and/or reduce costs in health care, hospitals, payers, and patients are turning to evidence-based meta-analyses and health economic analyses to identify medical treatments that provide value (value=outcome/cost). Objective: To determine if clinical outcome (patient reported outcomes) analyses or value/economic analyses are more likely to provide the evidence needed for adoption of new technologies in arthroplasty. Methods. A proprietary joint arthroplasty database of patient reported outcomes (PROs) was analyzed to determine the minimum clinically important differences (MCIDs) for PROs used for total knee replacement surgery. The PROs analyzed were: (1) European quality of life (EQ-5D); Oxford Knee Score (OKS); (3) Lower Extremity Activity Scale (LEAS); and (4) Likert Pain Scale (LPS). The MCID was calculated using a distribution method where the MCID equals one half the standard deviation of the score change, MCID = σΔ/2. For clinical meta-analyses, new technologies must demonstrate statistically significant better PROs and the difference must be greater than the MCID. For economic analyses, quality adjusted life years (QALYs) are used. For example, if a total knee replacement (TKR) improved a patient's health-related quality of life by 10% (0.10) and the assumed implant life is 15 years, the patient received 1.5 QALYs (0.10 × 15 years). If the total cost of care for the knee replacement surgery is $30,000, the cost per QALY is $20,000 ($30,000/1.5 QALYs). Results. The MCIDs for EQ-5D, OKS, LEAS, and LPS are 0.086%, 4.6 points, 1.6 points, and 1.3 points, respectively. The mean change (one-year post-operative EQ-5D minus pre-operative EQ-5D) for health-related quality of life is 15% (0.15). The average patient received 2.25 QALYs (0.15 × 15 years) from the surgery. The average cost per QALY is $13,333. However, if a new technology improves the mean health-related quality of life by 1% and the assumed implant life is 15 years, the patient receives 0.15 QALYs of improvement. With an average cost per QALY of $13,333, the new technology will be cost effective if the new technology cost is less than or equal to $2,000 (0.15 × $13,333) per patient. Conclusions. Achieving clinical superiority with new arthroplasty technology will be difficult because the minimum clinically important differences that need to be achieved are significant (EQ-5D 8.6%, OKS 4.6 points, LEAS 1.3 points, and LPS 1.3 points). However, small mean improvements in health-related quality of life (1%) can make the new technology cost effective. New technologies for arthroplasty surgery will increasingly need economic analyses to demonstrate cost effectiveness. Orthopaedic surgeons and manufacturers must collaborate to routinely collect health-related quality of life (EQ-5D) patient reported outcomes to provide a pathway for adoption of new innovative arthroplasty technologies

Up to one-third of patients experience limited benefit following surgical intervention for LS-OA. Thus, identifying contributing factors to this is important. People with OA often have multijoint involvement, yet this has received limited attention in this population. We documented the occurrence and evaluated the influence of multijoint symptoms on outcome following surgery for LS-OA. 141 patients undergoing decompression surgery+/−fusion for LS-OA completed the Oswestry Disability Index (ODI) pre- and 12-months post-surgery. Also captured pre-surgery: age, sex, education, BMI, smoking, depressive symptoms and comorbidities. Any joints with “pain/stiffness/swelling most days of the month” were indicated on a homunculus. A symptomatic joint site count (e.g. one/both knees= one site), excluding the back, was derived (range zero to nine) and considered as a predictor of magnitude of ODI change, and likelihood of achieving minimally clinically important improvement in ODI (MCID=12.8) using multivariable adjusted linear and log-Poisson regression analyses. Mean age: 66 years (range:42–90), 46% female. 76% reported one+ joint site other than the back, 43% reported three+, and nearly 10% reported six+. (< MCID) for those with three sites, and four units for those with six+ sites. Associated with a greater likelihood of not achieving MCID were increasing joint count (11% increase per site (p=0.012)), higher BMI, current/former smoker, and worse baseline ODI tertile. Results suggest there is more than just the back to consider to understand patient-reported back outcomes. Multijoint symptoms directly contribute to disability, but there is potential they may contribute to systemic, largely inflammatory, effects in OA as well

Introduction. Total knee arthroplasty (TKA) is an excellent treatment for end-stage osteoarthritis of the knee. In Asian countries, the number of TKA performed has rapidly increased, and is expected to continue so with its 4.4 billion population and increasing life expectancy. Asians' knees are known to be kinematically different to Caucasians after TKA. Controversy exists as to whether multi-radius (MR) or the newer single-radius (SR) TKA has superior outcome. Studies regarding this have been largely based on Caucasian data with few small sample Asian data. Methods. This is a retrospective analysis of prospectively collected institutional registry data between 2004 and 2015. Outcomes of 133 single-radius (SR) (Scorpio NRG, Stryker) and 363 multi-radius (MR) (Nexgen LPS, Zimmer) primary TKA for primary osteoarthritis were compared. All TKA was performed or directly supervised by the senior author. Range of motion (ROM), Oxford Knee Score (OKS), SF-36 physical component score (SF36-PCS), SF-36 mental component score (SF36-MCS), Knee Society Function Score (KS-FS) and Knee Score (KS-KS) were recorded preoperatively and at 2 years post-operation. Results. The mean age in both groups were similar at 66 ± 8 years (p=0.66). Both groups were in majority female (71% and 70% females in SR and MR respectively, p=0.10) and ethnic Chinese (79% and 84% in SR and MR respectively, p=0.53). The preoperative ROM and outcome scores in both groups were similar. MR-TKA achieved significantly greater improvement over 2 years in terms of ROM (7.5º ± 18.2º vs. 3.5º ± 19.3º, p=0.04), KS-KS (49.0 ± 20.9 vs. 42.7 ± 21.1, p=0.01), OKS (17.4 ± 18.4, p=0.03), and SF36-PCS (17.1 ± 12.5, p=0.02). At 2-years follow up, MR-TKA group fared slightly better for SF36-PCS (48 ± 10 vs. 46 ± 10, p=0.032), but the absolute difference was only 2 points. There were no significant differences between SR-TKA and MR-TKA for ROM (115º ± 16º vs. 117º ± 16º, p=0.218), KS-KS (81 ± 16 vs. 85 ± 12, p=0.795), KS-FS (74 ± 21 vs. 75 ± 20, p=0.627), OKS (20 ± 7 vs. 18 ± 6, p=0.099), and SF36-MCS (56 ± 10 vs. 55 ± 10, p=0.324). There were larger proportions of MR-TKA patients who achieved the minimum clinically important difference (MCID) for OKS (95% vs. 82%, p<0.001) and SF36-PCS (67% vs. 55%, p=0.011) at 2-years follow-up. Logistic regression, controlling for all preoperative variables, showed SR-TKA is less likely to achieve MCID for OKS with an odds ratio of 0.275 (95% confidence interval: 0.114 – 0.663, p=0.004), and SF36-PCS with an odds ration of 0.547 (0.316 – 0.946, p=0.031). Discussion and conclusion. SR-TKA and MR-TKA produced similar outcomes, in concordance with current literature. However, SR-TKA has lower odds of achieving MCID in OKS and SF36-PCS, possibly due to its smaller improvement in flexion over 2 years. This subtle difference has a greater impact in the context of Asian patients due to the cultural practice of kneeling and/or squating

Significance. In spite of evidence that total knee replacement (TKR) surgery is effective, numerous studies have demonstrated that approximately 20 percent of patients who have undergone TKR surgery are not satisfied. This relatively high rate of patients who are not satisfied is the result of unmet patient expectations. The strongest predictor of dissatisfaction after TKR is unmet expectations (RR = 10.7, Bourne, Chesworth, et al, 2010). This is confirmed by Dunbar, Richardson, and Robertsson (2013): “Unmet expectation seems to be a major cause of unsatisfactory outcomes and satisfaction is most strongly correlated with relief of pain, followed by improvement in physical function.” Hypothesis: One year post-operative pain relief and activity level expectations can be measured pre-operatively and used for shared decision making. Methods. A web–based system for prospectively collecting patient reported outcomes (PROs) has been developed. The data set for total hip/knee replacement surgery includes: (1) European quality of life, EQ-5D; Oxford Hip Score/Oxford Knee Score; (3) Lower Extremity Activity Scale (LEAS); and (4) Pain Likert Scale (PLS). The EQ-5D was selected as the health related quality of life (HRQL) general outcome measure because it has been adopted by multiple international joint replacement registries (Swedish Hip Arthroplasty Register, Norwegian Arthroplasty Register, United Kingdom National Joint Registry). The EQ-5D can be used to calculate quality adjusted life years (QALYs) for economic and/or comparative effectiveness analyses. The OHS/OKS questionnaires are used by the United Kingdom National Joint Registry and the New Zealand Joint Registry. The LEAS and PLS are used to measure patient's expectations for pain relief and functional improvement by asking patients to report their pre-operative pain and activity level before surgery and asking patients to report their pain and activity level expectations one year after surgery. Results. The LEAS change (one-year post-operative activity level minus pre-operative activity level) mean and standard deviation are 1.45 and 3.18. The LEAS minimum clinically important difference (MCID) is 1.59. The mean LEAS change is 0.91 MCIDs. The PLS change (one-year post-operative pain score minus pre-operative pain score) mean and standard deviation are −4.57 and 2.85. The PLS MCID is 1.43. The mean PLS change is −3.2 MCIDs. The z statistic for expected change is z = (Δ. expect. – μ. Δ. )/σ. Δ. The probability of realizing an expected activity level change greater than or equal to 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10 is 68%, 56%, 43%, 31%, 21%, 13%, 7.6%, 4.0%, 2.0%, 0.9%, and 0.4%, respectively. The probability of realizing an expected pain change greater than or equal to 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10 is 95%, 90%, 82%, 71%, 58%, 44%, 31%, 20%, 11%, 6.0%, and 2.8%, respectively. Conclusions. Dramatic improvement in activity level is unlikely. However, 86 percent of patients can expect clinically significant pain relief defined by pain relief greater than the MCID. Shared decision making should discuss unrealistic expectations prior to proceeding with surgery

Posterior lumber interbody fusion (PLIF) has the theoretical advantage of optimising foraminal decompression, improving sagittal alignment and providing a more consistent fusion mass in adult patients with isthmic spondylolisthesis (IS) compared to posterolateral fusion (PLF). Previous studies with only short-term follow-up have not shown a difference between fusion techniques. An observational cohort study was performed of a single surgeon's patients treating IS over a ten year period (52 patients), using either PLF (21 pts) or PLIF (31pts). Preoperative and 12-month data were collected prospectively, and long-term follow-up was by mailed questionnaire. Preoperative patient characteristics between the two groups were not significantly different. Average follow-up was 7 years, 10 months, and 81% of questionnaires were returned. Outcome measures were Roland Morris Disability Questionnaire (RMDQ), Low Back Outcome Score (LBOS), SF-12v2 and SF-6D R2. The SF-6D R2 is a “whole of health” measure. PLIF provided better short- and long-term results than PLF. The PLIF group had significantly better LBOS scores in the long term, and non-significantly better RMDQ scores in the long term. As measured by RMDQ Minimum Clinically Important Difference (MCID) short term set at 4, RMDQ MCID set at 8, the LBOS MCID set at 7.5 points and by SF-12v2 physical component score (PCS), PLIF patients performed better than PLF patients. When analysing single level fusions alone, the difference is more pronounced, with PCS, mental component scores and SF-6D R2 all being significantly better in the PLIF group rather than the PLF group. This paper strongly supports the use of PLIF to obtain equivalent or superior clinical outcomes when compared to PLF for spinal fusion for lumbar isthmic spondylolisthesis. The results of this study are the first to report to such long-term follow-up comparing these two procedures

Aims

The aim of this study was to develop and evaluate machine-learning-based computerized adaptive tests (CATs) for the Oxford Hip Score (OHS), Oxford Knee Score (OKS), Oxford Shoulder Score (OSS), and the Oxford Elbow Score (OES) and its subscales.

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.

Aims

The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized contolled trial (RCT) and to study patterns of change between subspecialties and nationalities.

It is unusual, if not unique, for three major research papers concerned with the management of the fractured neck of femur (FNOF) to be published in a short period of time, each describing large prospective randomized clinical trials. These studies were conducted in up to 17 countries worldwide, involving up to 80 surgical centers and include large numbers of patients (up to 2,900) with FNOF. Each article investigated common clinical dilemmas; the first paper comparing total hip arthroplasty versus hemiarthroplasty for FNOF, the second as to whether ‘fast track’ care offers improved clinical outcomes and the third, compares sliding hip with multiple cancellous hip screws. Each paper has been deemed of sufficient quality and importance to warrant publication in The Lancet or the New England Journal of Medicine. Although ‘premier’ journals, they only occationally contain orthopaedic studies and thus may not be routinely read by the busy orthopaedic/surgical clinician of any grade. It is therefore our intention with this present article to accurately summarize and combine the results of all three papers, presenting, in our opinion, the most important clinically relevant facts.

Cite this article: Bone Joint Open 2020;1-6:198–202.

Aims

Single-event multilevel surgery (SEMLS) has been used as an effective intervention in children with bilateral spastic cerebral palsy (BSCP) for 30 years. To date there is no evidence for SEMLS in adults with BSCP and the intervention remains focus of debate.