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 aim is to assess the cost-effectiveness of patellofemoral arthroplasty (PFA) in comparison with total knee arthroplasty (TKA) for the treatment of isolated patellofemoral osteoarthritis (OA) based on prospectively collected data on health outcomes and resource use from a blinded, randomized, clinical trial. A total of 100 patients with isolated patellofemoral osteoarthritis were randomized to receive either PFA or TKA by experienced knee surgeons trained in using both implants. Patients completed patient-reported outcomes including EuroQol five-dimension questionnaire (EQ-5D) and 6-Item Short-Form Health Survey questionnaire (SF-6D) before the procedure. The scores were completed again after six weeks, three, six, and nine months, and again after one- and two-year post-surgery and yearly henceforth. Time-weighted outcome measures were constructed. Cost data were obtained from clinical registrations and patient-reported questionnaires. Incremental gain in health outcomes (quality-adjusted life-years (QALYs)) and incremental costs were compared for the two groups of patients. Net monetary benefit was calculated assuming a threshold value of €10,000, €35,000, and €50,000 per QALY and used to test the statistical uncertainty and central assumptions about outcomes and costs.Aims
Methods
We have undertaken a prospective evaluation of health-related quality-of-life outcomes in 26 consecutive patients undergoing periacetabular osteotomy with a minimum follow-up of 24 months (24 to 42). The Western Ontario-Macmaster (WOMAC) and Short Form 36 (SF-36) outcome measures were evaluated preoperatively and at follow-up. Secondary outcome measures included retrospective assessment of sports activity and satisfaction with the procedure. Follow-up data were available for 22 patients (85%). A significant improvement in the pain (p <
0.0001) and function (p <
0.0001) scales of the WOMAC and the
We have assessed the influence of somatisation on the outcome of treatment in 81 patients with chronic low back pain. All, irrespective of whether treatment was surgical or conservative, had a significantly better (p <
0.001) health-related quality of life at follow-up on all but one scale of the
The Swedish Knee Arthroplasty Registry (SKAR) has recorded knee arthroplasties prospectively in Sweden since 1975. The only outcome measure available to date has been revision status. While questionnaires on health outcome may function as more comprehensive endpoints, it is unclear which are the most appropriate. We tested various outcome questionnaires in order to determine which is the best for patients who have had knee arthroplasty as applied in a cross-sectional, discriminative, postal survey. Four general health questionnaires (NHP, SF-12,
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
We studied the outcome and functional status of 33 patients with 34 severe open tibial fractures (Gustilo grade IIIb and IIIc). The treatment regime consisted of radical debridement, immediate bony stabilisation and early soft-tissue cover using a muscle flap (free or rotational). The review included standardised assessments of health-related quality of life (SF-36 and Euroqol) and measurement of the following parameters: gait, the use of walking aids, limb-length discrepancy, knee and ankle joint function, muscle wasting and the cosmetic appearance of the limb. Personal comments and overall patient satisfaction were also recorded. The mean follow-up was 46 months (15 to 80). There were 30 Gustilo grade IIIb fractures and and four grade IIIc fractures. Of the 33 patients, 29 had primary internal fixation and four, external fixation; 11 (34%) later required further surgery to achieve union and two needed bone transport procedures to reconstruct large segmental defects. The mean time to union was 41 weeks (12 to 104). Two patients (6.1%) developed deep infection; both resolved with treatment. The mean
The purpose of this study was to compare the effectiveness of surgical repair to conservative treatment and subacromial decompression for the treatment of chronic/degenerative tears of the rotator cuff. PubMed, Cochrane database, and Medline were searched for randomized controlled trials published until March 2018. Included studies were assessed for methodological quality, and data were extracted for statistical analysis. The systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.Aims
Materials and Methods
The aim of this study was to determine how the short- and medium-
to long-term outcome measures after total disc replacement (TDR)
compare with those of anterior cervical discectomy and fusion (ACDF),
using a systematic review and meta-analysis. Databases including Medline, Embase, and Scopus were searched.
Inclusion criteria involved prospective randomized control trials
(RCTs) reporting the surgical treatment of patients with symptomatic
degenerative cervical disc disease. Two independent investigators
extracted the data. The strength of evidence was assessed using
the Grading of Recommendations, Assessment, Development and Evaluation
(GRADE) criteria. The primary outcome measures were overall and
neurological success, and these were included in the meta-analysis. Standardized
patient-reported outcomes, including the incidence of further surgery
and adjacent segment disease, were summarized and discussed.Aims
Patients and Methods
Displaced, comminuted acetabular fractures in the elderly are increasingly common, but there is no consensus on whether they should be treated non-surgically, surgically with open reduction and internal fixation (ORIF), or with acute total hip arthroplasty (THA). A combination of ORIF and acute THA, an approach called ’combined hip procedure’ (CHP), has been advocated and our aim was to compare the outcome after CHP or ORIF alone. A total of 27 patients with similar acetabular fractures (severe acetabular impaction with or without concomitant femoral head injury) with a mean age of 72.2 years (50 to 89) were prospectively followed for a minimum of two years. In all, 14 were treated with ORIF alone and 13 were treated with a CHP. Hip joint and patient survival were estimated. Operating times, blood loss, radiological outcomes, and patient-reported outcomes were assessed.Aims
Patients and Methods
Aims
Patients and Methods
Little is known about the relative outcomes of revision of unicompartmental
knee arthroplasty (UKA) and high tibial osteotomy (HTO) to total
knee arthroplasty (TKA). The aim of this study is to compare the
outcomes of revision surgery for the two procedures in terms of
complications, re-revision and patient-reported outcome measures (PROMs)
at a minimum of two years follow-up. This study was a retrospective review of data from an institutional
arthroplasty registry for cases performed between 2001 and 2014.
A total of 292 patients were identified, of which 217 had a revision
of HTO to TKA, and 75 had revision of UKA to TKA. While mean follow-up
was longer for the HTO group compared with the UKA group, patient
demographics (age, body mass index and Charlson co-morbidity index)
and PROMs (Short Form-36, Oxford Knee Score, Knee Society Score,
both objective and functional) were similar in the two groups prior
to revision surgery. Outcomes included the rate of complications
and
re-operation, PROMS and patient-reported satisfaction at six months
and two years post-operatively. We also compared the duration of
surgery and the need for revision implants in the two groups. Aims
Patients and Methods
The aim of this study was to assess the quality and scope of the current cost-effectiveness analysis (CEA) literature in the field of hand and upper limb orthopaedic surgery. We conducted a systematic review of MEDLINE and the CEA Registry to identify CEAs that were conducted on or after 1 January 1997, that studied a procedure pertaining to the field of hand and upper extremity surgery, that were clinical studies, and that reported outcomes in terms of quality-adjusted life-years. We identified a total of 33 studies that met our inclusion criteria. The quality of these studies was assessed using the Quality of Health Economic Analysis (QHES) scale.Aims
Materials and Methods
The aim of this study was to evaluate the functional outcome in patients undergoing implant removal (IR) after fracture fixation below the level of the knee. All adult patients (18 to 75 years) undergoing IR after fracture fixation below the level of the knee between November 2014 and September 2016 were included as part of the WIFI (Wound Infections Following Implant Removal Below the Knee) trial, performed in 17 teaching hospitals and two university hospitals in The Netherlands. In this multicentre prospective cohort, the primary outcome was the difference in functional status before and after IR, measured by the Lower Extremity Functional Scale (LEFS), with a minimal clinically important difference of nine points.Aims
Patients and Methods
