There is evidence that preoperative physical fitness impacts surgical outcomes, specifically preceding abdominal, cardiovascular and spine surgery. To our knowledge, there are no papers on self-reported exercise frequency as a predictor of cervical spine surgery outcomes. Our objectives were to quantify self-report of exercise frequency in cervical spine surgery patients, and to elucidate if self-reported exercise prior to surgery confers less pain, improved health state and/or less disability post-surgery.

We performed a retrospective review of prospectively collected data from the Canadian Spine Outcomes and Research Network (CSORN) Database from the time of its inception. Inclusion criteria specified all elective cervical surgery patients over 18 years old with degenerative pathology who proceeded to surgery and completed the pre- and post-operative outcomes measures up to 24 months post surgery (n=460). Outcome measures were visual analog scales (VAS) for neck and arm pain, Neck Disability Index (NDI), and EuroQOL score at baseline and 3, 12 and 24 months post-op. Exercise frequency was self-reported as “none” (n=212) versus “some” (n=248). These groups were further categorized into “none due to physical limitations”, “none” (not due to physical limitations), those to exercised “once or less per week” and those that exercised “twice or more per week”. Student's t-tests were used to compare the mean scores of the outcome measures, and analysis of variance for subgroup comparisons, with results considered significant at p < 0 .05.

At baseline, 56% of total patients reported exercise prior to surgery, of which 73% reported doing so twice or more per week. Of the 44% reporting no exercise, 74% could not exercise due to physical limitations. Those who reported “some” exercise had more favorable VAS neck and arm pain scores pre-operatively (neck: 5.55 vs 6.11, p < 0 .001) (arm: 5.69 vs 6.04, p=0.011), but no difference at 3 and 24 months post-operatively. Significantly lower NDI scores and higher EuroQOL Index scores were seen in the exercise group compared to the no exercise group pre-operatively (NDI: 39 vs 48, p < 0 .001) (EuroQOL: 0.60 vs 0.50 p < 0 .001) as well as at 3, 12, and 24 months post-op (NDI: 24 vs 31, p=0.007) (EuroQOL: 0.75 vs 0.68, p=0.001). Further subgroup analysis demonstrated that compared to the “no exercise due to physical limitation” group, the “twice or more” exercise group showed favorable NDI and EuroQOL scores up to 24 months post-op (NDI: 24.32 vs 32.33, p=0.001) (EuroQOL: 0.76 vs 0.66, p=0.001), whereas the “once or less times per week” group no longer demonstrated any significant difference at 24 months (NDI: 28.79 vs 32.33, p=1) (EuroQOL: 0.73 vs 0.66, p=0.269).

Self-reported exercise prior to cervical spine surgery does not predict improved long-term neck and arm pain at 2 years post-op. However, self-reported exercise does demonstrate less disability and improved health state at baseline and up to 2 years post-op and this relationship is dose dependent.

Familial osteochondritis dissecans (FOCD) is an inherited defect of cartilage and bone characterized by development of large cartilage lesions in multiple joints, short stature and early onset osteoarthritis. We have studied a family from Northern Sweden with FOCD over five generations. All affected family members have a heterozygous missense mutation on exon 17 of the aggrecan gene, resulting in a Val-Met amino acid replacement in the G3 aggrecan C-type lectin domain (CLD). Aggrecan, a major proteoglycan of articular cartilage produced by chondrocytes, has a large protein core richly substituted with sulfated glycosaminoglycan chains. The unique structure, its high concentration within the cartilage extracellular matrix and its ability to form a supermolecular complex with hyaluronan and bind to other matrix proteins all profoundly influence the biomechanical properties of the tissue. Deletion of CLD in a chick aggrecan construct was found to influence its secretion from chondrocytes and human aggrecan constructs carrying the V2303M mutation showed diminished interactions with the ECM proteins tenascin-R, fibulin-1 and fibulin-2. To investigate the pathogenesis of FOCD, we studied chondrogenic differentiation of patient bone marrow mesenchymal stem cells and induced pluripotent stem cells. We demonstrated that the mutation results in accumulation of unfolded or misfolded aggrecan within the lumen of the chondrocyte endoplasmic reticulum. Associated with this is the failure to assemble a normal extracellular matrix. This explains the susceptibility of these patients to cartilage injury and the degenerative changes that lead to early onset osteoarthritis.

This prospective cohort study examined the relationship between waiting time for elective total hip arthroplasty (THA) and changes in pre- to post-operative quality of life. It included one hundred and forty-seven patients who entered the waiting list for primary THA with osteoarthritis. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to assess patients at surgical consultation time (baseline) and one year post-operation. Baseline WOMAC score was a significant predictor for follow-up WOMAC score. Expedited access to THA results in a larger proportion of patients showing “better than expected” function at twelve months after the operation.

This study examined the relationship between waiting time for elective total hip arthroplasty (THA) and changes in pre- to post-operative quality of life.

Expedited access to THA results in a larger proportion of patients showing “better than expected” function at twelve months after the operation. The odds of a “better than expected” functional outcome decreased by 8% for each additional month on the wait list.

The study provides the estimates of decreased probability of “better than expected” outcome given a prolonged waiting time. Our study indicates that timely access to THA is needed for optimal post-operative outcome.

Baseline WOMAC score was a significant predictor for the follow-up WOMAC score in function (p=0.0005), pain (p=0.0036), and stiffness (p= 0.0004). Waiting for six months or less doubled the odds of achieving a “better than expected” functional outcome compared to longer waits (p= 0.05).

This prospective cohort study included one hundred and forty-seven patients who entered the waiting list for primary THA with osteoarthritis. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to assess patients at the surgical consultation time (baseline) and one year post operation. Regression models were used to determine the “expected” outcome for a certain individual baseline score. By using expected HRQOL outcome, we identified patients whose benefit from THA is better than expected. Logistic regression models were used to assess the relationship between waiting time and the probability of “better than expected” outcome.

Introduction and Aims: The aim was to study: 1) Patients’ ability to recall their pre-operative function following total hip replacement and how this recall alters with time. 2) Whether validated quality of life (QOL) assessment tools can be administered in the post-operative period to assess pre-operative function.

Method: The null hypothesis was: There is no correlation between functional scores collected pre-operatively and those collected post-operatively. Patients admitted for primary and revision hip arthroplasty between September 2002 and January 2003 were included.

Subjects completed the same questionnaire regarding pre-operative function before surgery, and then three days, six weeks and three months post-operatively. The questionnaire was a combination of the WOMAC, Oxford-12 and SF-12 questionnaires. Pearson’s correlation coefficient was used to evaluate the correlation between the pre- and post-surgery scores, and intra-class correlation coefficient (ICC) was used to assess agreement. Test-retest reliability was evaluated by Kendall’s Tau-b statistic.

Results: One hundred and four patients with a mean age of 61 years were included. There were 57 female patients and 47 males, 79 patients had primary hip replacements and 25 had revisions.

The results showed excellent correlation between pre-operative scores and those from all three postoperative time points. Pearson’s correlation coefficient for the WOMAC score was 0.75, 0.78 and 0.87 at three days, six weeks and three months respectively. The values for the Oxford-12 were 0.83, 0.78 and 0.92 at the same time points, and for the SF-12 they were 0.71, 0.63 and 0.81.

Agreement between pre- and post-operative scores was high. The ICC results for the WOMAC score at the same time points were 0.86, 0.88, and 0.93. For the Oxford-12 they were 0.91, 0.88 and 0.96 and for the SF-12 they were 0.83, 0.77 and 0.9.

Kendall’s Tau-b statistic showed high degrees of reliability for all three measures. The values for the WOMAC score at the three time points were 0.64, 0.61 and 0.72, and the results for the Oxford-12 and SF-12 scores were similarly high.

The effects on the statistics of age, sex, unilateral versus bilateral disease, and primary versus revision surgery were assessed, and no differences were found.

Conclusion: We found a high degree of correlation, agreement and test-retest reliability between QOL scores taken before hip replacement and those taken up to three months afterwards. Patients were able to recall their pre-operative functional status after surgery, and accurate pre-operative data may be collected retrospectively during the early post-operative period.