Increasingly more emphasis is being placed on Patient Reported Outcome Measures (PROMs). There are many used and reported in clinical studies, but there are no universally accepted or preferred measures. It is important for a researcher with a non-clinical background to understand how these assessments are performed, the type of information provided by each of the measures, and which diseases states are best reported by each measure.
The NHS Plan (2000) identified the need for change in the way patients are asked to give consent for surgery to make the process more explicit. A new NHS operation consent form was introduced in April 2002 following the Bristol enquiry into deaths associated with Cardiac Surgery.
Shoulder – Arthroscopic Sub-Acromial Decompression, Anterior stabilisation, Rotator Cuff repair, excision lateral end of clavicle and Shoulder Arthroplasty. Elbow – Tennis elbow release, Arthroscopic Debridement, OK Operation and Elbow Replacement We became increasingly aware throughout this exercise that although there were many papers published; collating the relevant evidence based information for patients was either difficult or impossible. Evidence was therefore been categorised into 4 levels:
National &
International published results Our own results, either published or presented at scientific meetings Our own results as identified in internal audited outcome studies – unpublished Our opinion of the risks or benefits unsupported by any scientific or published evidence.
Background. The purpose of this study was to determine if thresholds regarding the percentage of maximal improvement in the Simple Shoulder Test (SST) and American
Among the advanced technology developed and tested for orthopaedic surgery, the Rizzoli (IOR) has a long experience on custom-made design and implant of devices for joint and bone replacements. This follows the recent advancements in additive manufacturing, which now allows to obtain products also in metal alloy by deposition of material layer-by-layer according to a digital model. The process starts from medical image, goes through anatomical modelling, prosthesis design, prototyping, and final production in 3D printers and in case post-production. These devices have demonstrated already to be accurate enough to address properly the specific needs and conditions of the patient and of his/her physician. These guarantee also minimum removal of the tissues, partial replacements, no size related issues, minimal invasiveness, limited instrumentation. The thorough preparation of the treatment results also in a considerable shortening of the surgical and of recovery time. The necessary additional efforts and costs of custom-made implants seem to be well balanced by these advantages and savings, which shall include the lower failures and revision surgery rates. This also allows thoughtful optimization of the component-to-bone interfaces, by advanced lattice structures, with topologies mimicking the trabecular bone, possibly to promote osteointegration and to prevent infection. IOR's experience comprises all sub-disciplines and anatomical areas, here mentioned in historical order. Originally, several systems of Patient-Specific instrumentation have been exploited in total knee and total ankle replacements. A few massive osteoarticular reconstructions in the shank and foot for severe bone fractures were performed, starting from mirroring the contralateral area. Something very similar was performed also for pelvic surgery in the Oncology department, where massive skeletal reconstructions for bone tumours are necessary. To this aim, in addition to the standard anatomical modelling, prosthesis design, technical/technological refinements, and manufacturing, surgical guides for the correct execution of the osteotomies are also designed and 3D printed. Another original experience is about en-block replacement of vertebral bodies for severe bone loss, in particular for tumours. In this project, technological and biological aspects have also been addressed, to enhance osteointegration and to diminish the risk of infection. In our series there is also a case of successful custom reconstruction of the anterior chest wall. Initial experiences are in progress also for
Aim: To evaluate patient satisfaction and the effectiveness of a telephone clinic designed to follow up patients who have received
BACKGROUND. Abnormal glenoid version positioning has been recognized as a cause of glenoid component failure caused by the rocking horse phenomenon. In contrast, the importance of the glenoid inclination has not been investigated. MATERIALS AND METHODS. The computed tomography scans of 152 healthy shoulders were evaluated. A virtual glenoid component was positioned in 2 different planes: the maximum circular plane (MCP) and the inferior circle plane (ICP). The MCP was defined by the best fitting circle of the most superior point of the glenoid and 2 points at the lower glenoid rim. The ICP was defined by the best fitting circle on the rim of the inferior quadrants. The inclination of both planes was measured as the intersection with the scapular plane. We defined the force vector of the rotator force couple and calculated the magnitude of the shear force vector on a virtual glenoid component in both planes during glenohumeral abduction. RESULTS. The inclination of the component positioned in the MCP averaged 95° (range, 84°–108°) and for the ICP averaged 111° (range, 94°–126°). A significant reduction in shear forces was calculated for the glenoid component in the ICP vs the MCP: 98% reduction in 60° of abduction to 49% reduction in 90° of abduction. CONCLUSION. Shear forces are significantly higher when the glenoid component is positioned in the MCP compared with the ICP, and this is more pronounced in early abduction. Positioning the glenoid component in the inferior circle might reduce the risk of a rocking horse phenomenon. Copyright © 2015 Journal of
A commonly misunderstood principle in medical literature is statistical significance. Often, statistically non-significant or negative results are thought to be evidence for equivalence; mistakenly validating treatment modalities and putting patients at risk. This study examines the prevalence of misinterpretation of negative results of superiority trials in orthopaedic literature and outlines the need for a non-inferiority or equivalence research design. Four orthopaedic journals – Journal of Paediatric Orthopaedics A, Journal of Bone and Joint Surgery American Volume, Journal of Arthroplasty and Journal of
Thirty years ago, rotator cuff surgery was exceedingly uncommon and shoulder arthroplasty almost unknown. Surgery for shoulder instability was largely empirical, non-anatomical and frequently unsuccessful. With the help of arthroscopy and MR scanning, a complex array of labral, ligament and tendon pathologies can now be recognised and treated, precisely and predictably. Anatomy-restoring arthroscopic techniques have largely replaced open stabilisation surgery. As life expectancy rises and citizens remain active into their seventh and eighth decades, the call for rotator cuff surgery has risen dramatically. Complex tendon transfers have expanded the indications for cuff surgery. Open repair has in part been supplanted by increasingly sophisticated arthroscopic techniques. The potential use of orthobiologics and stem cells promises further advances in the foreseeable future. Following the successful development of humeral hemiarthroplasty, and later of total shoulder replacement, surgical techniques and clinical indications for arthroplasty are now well refined. Predictable outcomes have been further enhanced by the present generation of ‘anatomic’ prostheses. More recently, the ‘rediscovery’ and improvement of semi-constrained (reverse) prostheses has transformed the previously dismal outlook for sufferers of cuff arthropathy and similar conditions. Many Australian Orthopaedic Association trainees undertake post-specialisation fellowships in shoulder surgery, both at home and abroad, and there is a steady flow of young overseas fellows through Australian shoulder units. The Shoulder and Elbow Society of Australia, founded in 1990 as a loose grouping of interested colleagues, now boasts over 70 active members. Australian surgeons and researchers are well represented in the prestigious Journal of
Introduction In view of the legal claim for quality assurance in Germany, complete documentation and a professional evaluation of shoulder arthroplasty procedures are indispensable. Under the auspices of German AO International (DAOI), the German Society of Orthopeadics and Orthopeadic Surgery (DGOOC), the German Society of Trauma Surgery (DGU) and the German Society of
Introduction: Glenohumeral arthritis secondary to chronic cuff deficiency not only leads to serious compromise in shoulder function but also poses a surgical challenge. There is no consensus regarding management of this problem although different arthroplasty options have been tried with variable results. We present our experience with managing this difficult problem using a shoulder resurfacing and subscapularis Z-plasty in order to improve shoulder movements, pain and function. Patient and Methods: This study was conducted on 30-patients with rotator cuff arthropathy operated by a single surgeon at a district general hospital. There were 21 female and 9 male patients with mean age 73 years (range 62–85 years). The average duration of symptoms prior to treatment was 5.45 years (range 2–15 years). Twenty patients had uncemented shoulder resurfacing while remaining ten patients had cemented resurfacing procedure. The mean follow-up was 21 months (range 36–18 months). The patients were assessed at 3 months, 6 months, 12 months and 24 months postoperatively with European Society for
Background: Increasing number of
The deltopectoral approach is a common approach for Shoulder joint replacements where a normal subscapularis tendon is divided. Despite meticulous attention to the subscapular repair, suboptimal return of function was found on clinical examination in 92% of patients (Miller S L: Journal of
Purpose: Few studies have investigated the relationship between patients requiring rotator cuff surgery and their body mass index (BMI). The objective of this retrospective study was to evaluate the association between BMI and pre-operative pain and function in patients awaiting rotator cuff repair surgery as measured by the American