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Scuderi GR, Bonanni S, Mont MA. The Impact of Mental Health on Patient Outcomes After Total Knee and Hip Arthroplasty. J Arthroplasty 2024; 39:1199-1200. [PMID: 38462142 DOI: 10.1016/j.arth.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
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Blackburn AZ, Ottesen TD, Katakam A, Bedair HS, Melnic CM. Mental Robustness May Be Associated With Improved Physical Function in Bilateral Total Knee Arthroplasty Patients. J Arthroplasty 2024; 39:1207-1213. [PMID: 37981110 DOI: 10.1016/j.arth.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND In accordance with the high incidence of bilateral knee osteoarthritis, many patients have undergone bilateral total knee arthroplasty (BTKA). Whether patients undergo bilateral procedures in a staged or simultaneous fashion, the physical and mental burden of undergoing 2 major orthopedic procedures is considerable. The aims of this study were to (1) investigate differences between minimal clinically important difference (MCID) achievement between staged versus simultaneous BTKA, and (2) identify the patient variables, specifically mental scores, that were associated with MCID achievement in patients undergoing BTKA. METHODS Simultaneous and staged BTKA patients within a single health care network from 2016 to 2021 were retrospectively reviewed. Patient demographics, surgery details, and Patient-Reported Outcome Measurement Information System Physical Function Short Forms 10a (PROMIS PF10a), PROMIS Mental scores, and Knee Disability Osteoarthritis Outcome Scores (KOOS) were reviewed. Preoperative and postoperative patient-reported outcome measures were collected before the first total knee arthroplasty (TKA) and after the second TKA, respectively, in staged BTKA patients. The final cohort consisted of 249 patients, with an average age of 66 years (range, 21 to 87), 63% women, and an average body mass index of 32 (range, 20 to 52), at a mean follow-up of 1.1 years (range, 0.5 to 2.4). Multivariate regressions were performed on MCID PF10a and KOOS achievement, as well as whether the BTKA was performed simultaneously versus staged. RESULTS A preoperative PROMIS Mental score in the upper 2 quartiles was associated with MCID PF10a achievement in BTKA. Men and surgeries performed at an Academic Medical Center were negatively associated with the achievement of MCID KOOS. Interestingly, those who underwent simultaneous BTKA were less likely to achieve MCID KOOS than those who underwent a staged BTKA. CONCLUSIONS Preoperative mental robustness may be positively associated with improved physical function outcome in BTKA patients.
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Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Taylor D Ottesen
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Zhang S, Tay DKJ, Pang HN, Lo NN, Yeo SJ, Liow MHL. Preoperative mental distress is associated with poorer physical improvements after revision total hip arthroplasty. J Orthop 2023; 35:18-23. [PMID: 36345326 PMCID: PMC9636491 DOI: 10.1016/j.jor.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/17/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Aims Despite the increasing prevalence of mental health disorders in revision arthroplasty patients, the impact of preoperative mental distress on functional outcomes after revision total hip arthroplasty (rTHA) remains unclear. Our study aims to investigate the impact of preoperative mental distress on functional outcomes after rTHA. Methods Prospectively collected data of 84 rTHAs was extracted from a single institution's joint replacement registry. Preoperative Short Form-36 (SF-36) mental component summary (MCS) was used to dichotomize patients to those who were distressed (MCS <50) and non-distressed (MCS ≥50). Multivariable analysis was used to analyze the impact of preoperative mental distress on various outcomes such as the SF-36 physical component summary (PCS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Hip Score (OHS), patient satisfaction and expectation fulfilment at 6 months and 2 years postoperatively. Results Compared to non-distressed patients, patients with preoperative mental distress had poorer improvements in PCS (+11.4 vs + 16.9, p = 0.007) and lower rates of minimal clinically important difference (MCID) attainment (55.2% vs 73.0%, p = 0.026) at 2 years postoperatively. However, there were no significant differences in improvements for WOMAC and OHS (p > 0.05). Despite experiencing greater absolute improvements in MCS (+12.1 vs -2.1, p < 0.001) and higher MCID attainment rates (65.5% vs 24.3%, p = 0.005) at 2 years, preoperatively distressed patients had lower MCS levels compared to their non-distressed counterparts at all time points (p-value<0.05). There were no significant differences in patient satisfaction (p = 0.509) or expectation fulfilment (p-value = 0.342) at 2 years postoperatively. Conclusion Revision THA led to substantial mental health improvements in patients with preoperative mental distress. Despite this, preoperative mental distress was associated with poorer physical improvements after surgery.
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Affiliation(s)
- Siyuan Zhang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, 169865, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, 169865, Singapore
| | - Hee Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, 169865, Singapore
| | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, 169865, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, 169865, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, 169865, Singapore
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Deng W, Shao H, Zhou Y, Li H, Wang Z, Huang Y. Reliability and validity of commonly used patient-reported outcome measures (PROMs) after medial unicompartmental knee arthroplasty. Orthop Traumatol Surg Res 2022; 108:103096. [PMID: 34607057 DOI: 10.1016/j.otsr.2021.103096] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/29/2021] [Accepted: 06/21/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Many patient-reported outcome measures (PROMs) have been utilized to assess outcomes after unicompartmental knee arthroplasty (UKA). However, most are not specifically designed for UKA and the measurement properties of these PROMs have never been elucidated in the setting of UKA. This study aimed to evaluate the reliability and validity of commonly used PROMs after UKA, which includes the Oxford knee score (OKS), Knee Society Score (KSS)-function score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). HYPOTHESIS The four commonly used PROMs after UKA are of good reliability and validity, but with different floor/ceiling effect. MATERIAL AND METHODS Prospectively collected postoperative follow-up PROMs scores of patients after medial UKA cases for osteoarthritis between May 2015 and June 2018 were retrospectively analyzed. All of the PROMs were finished on the same electronic questionnaires. Reliability (internal consistency, test-retest reliability, measurement error), construct validity and floor/ceiling effects were assessed. RESULTS The whole cohort was composed of 207 cases, with a median age of 62.0 years and a male ratio of 59/207 (28.50%). Internal consistency was high in the OKS, weak in the KSS-function score and with redundancy in the WOMAC and KOOS scores (Cronbach alpha=0.915, 0.610, 0.953, 0.961, respectively). Each of the four PROMs had a high test-retest reliability (all intraclass correlation coefficient (ICC) >0.97). Convergent validity of the four PROMs with the physical component score of the 12-Item Short Form Health Survey (SF-12 PCS) were proven (all r>0.5; p<0.001). While no ceiling effect occurred in the OKS, one was detected in the KSS-function score with 19.81% of patients achieving the best possible score, as well as in the WOMAC sub-score for pain (54.11%) and stiffness (50.72%), in addition to the KOOS sub-score for symptoms (27.54%) and pain (38.16%). DISCUSSION The four commonly used PROMs after UKA showed good test-retest reliability and construct validity. The OKS is more recommended for its better performance in internal consistency and ceiling effect than the KSS-function score, the WOMAC and KOOS scores. LEVEL OF EVIDENCE III; Diagnostic study.
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Affiliation(s)
- Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China.
| | - Hua Li
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China; Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, Beijing 100035, China
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Goh GS, Baker CM, Tarabichi S, Clark SC, Austin MS, Lonner JH. The Paradox of Patient-Reported Outcome Measures: Should We Prioritize "Feeling Better" or "Feeling Good" After Total Knee Arthroplasty? J Arthroplasty 2022; 37:1751-1758. [PMID: 35436528 DOI: 10.1016/j.arth.2022.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of preoperative patient-reported outcome measure (PROM) thresholds for patient selection in arthroplasty care has been questioned recently. This study aimed to identify factors affecting achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) after total knee arthroplasty (TKA) and determine the overlap between the two outcomes. METHODS We identified 1,239 primary, unilateral TKAs performed at a single institution in 2015-2019. PROMs including the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and 12-item Short Form Health Survey (SF-12) were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS as per attainment of MCID was assessed. A multivariable regression was used to identify predictors of MCID and PASS. RESULTS In total, 71.3% achieved MCID and 75.5% achieved PASS for KOOS-JR. Only 7.7% achieved MCID but not PASS, whereas almost twice this number did not achieve MCID but did achieve PASS (11.9%). Poorer preoperative KOOS-JR (OR 0.925), better SF-12 physical (OR 1.025), and mental (OR 1.027) were associated with MCID attainment. In contrast, better preoperative KOOS-JR (OR 1.030) and SF-12 mental (OR 1.025) were associated with PASS attainment. Age, gender, race, ethnicity, body mass index, Charlson index, American Society of Anesthesiologists classification, and smoking status were not significant predictors. CONCLUSION Preoperative PROMs were associated with achieving MCID and PASS after TKA, albeit some positively and some negatively. In the era of value-based care, clinicians should not only strive to help patients "feel better" but also ensure that patients "feel good" after surgery. This study does not support the use of PROMs in prioritizing access to care.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Sean C Clark
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Zu X, Wang J, Lu M, Yin Z. [Comparison of the effectiveness of unicompartmental arthroplasty and total knee arthroplasty based on patient scale data]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1574-1579. [PMID: 34913314 DOI: 10.7507/1002-1892.202108115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the patient-reported outcomes regarding function, joint amnesia, and the quality of life after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods The clinical data of patients who received UKA or TKA between September 2017 and June 2018 were retrospectively analyzed. After propensity score matching, 40 patients (40 knees) each in TKA group and UKA group were finally included in the study. There was no significant difference between the two groups in gender, age, body mass index, surgical side, preoperative knee range of motion, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, clinical and function scores of knee society score (KSS) ( P>0.05). At 2 years after operation, WOMAC score, KSS clinical and function scores were performed on the two groups of patients, and compared with preoperative ones; knee injury and osteoarthritis outcome score-physical function short form (KOOS-PS), short-form 36 health survey scale (SF-36 scale), and forgotten joint score (FJS) were also performed. Results At 2 years after operation, the total score of WOMAC, the clinical and function scores of KSS in the two groups significantly improved when compared with preoperative ones ( P<0.05), but there was no significant difference in the total score of WOMAC, the individual score of WOMAC, the clinical and function scores of KSS between the two groups ( P>0.05). The total KOOS-PS score in the UKA group was significantly lower than that in the TKA group ( t=4.243, P=0.000), and the scores of writhing/knee rotation, kneeling, and squatting in the UKA group were significantly lower than those in the TKA group ( P<0.05). The total FJS score in the UKA group was significantly higher than that in the TKA group ( t=-6.334, P=0.000). In the UKA group, the scores of 7 items were significantly lower than those of the TKA group ( P<0.05) including when walking over 15 minutes, when climbing stairs, when walking on uneven ground, when standing for long periods, when doing housework or gardening, when taking a walk or hiking, and when doing your favorite sport. The SF-36 scales of physiological function, energy, social function, emotional function, and mental health in the UKA group were significantly higher than those in the TKA group ( P<0.05). Conclusion Compared with TKA, patients treated with UKA may have better knee function recovery, joint amnesia, and higher quality of life.
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Affiliation(s)
- Xiangyu Zu
- Department of Joint Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P.R.China
| | - Jun Wang
- Department of Joint Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P.R.China
| | - Ming Lu
- Department of Joint Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P.R.China
| | - Zongsheng Yin
- Department of Joint Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230022, P.R.China
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Khow YZ, Liow MHL, Yeoh ZGF, Chen JY, Lo NN, Yeo SJ. A Weighted Scoring System Based on Preoperative and Long-Term Patient-Reported Outcome Measures to Guide Timing of Knee Arthroplasty. J Arthroplasty 2021; 36:3894-3900. [PMID: 34454804 DOI: 10.1016/j.arth.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is currently no existing consensus regarding timing of knee arthroplasty. This study aimed to develop a weighted scoring system from patient-reported outcome measures (PROMs) to guide timing of knee arthroplasty based on preoperative severity and long-term effectiveness. METHODS Prospectively collected data of 766 total knee arthroplasties (TKAs) and 382 unicompartmental knee arthroplasties (UKAs) at a single institution were analyzed. PROMs were assessed preoperatively and at 10 years using the Knee Society Score (KSS), Oxford Knee Score (OKS), and Short Form-36 physical component score (SF-36 PCS). Receiver operating characteristic analysis identified thresholds where preoperative PROMs predicted 10-year clinically meaningful improvements (minimal clinically important difference [MCID]). Threshold weights were assigned to PROMs based on their ability to predict MCID in isolation or in combination. RESULTS Poorer baseline PROMs predicted 10-year MCID attainments. The threshold of 49.5 points for the KSS, 30.5 points for the OKS, and 40.7 points for the SF-36 PCS and 55.5 points for the KSS, 33.5 points for the OKS, and 40.5 points for the SF-36 PCS was weighted 1 point for predicting MCID in 1 PROM for TKA and UKA, respectively. The threshold of 33.4 and 33.9 points for the SF-36 PCS was weighted 2 points for predicting MCID in 2 PROMs, whereas 29.3 and 31.3 points for the SF-36 PCS were weighted 3 points for predicting MCID in 3 PROMs for TKA and UKA, respectively. The sum of weighted components from 0 (lowest) to 5 (highest) represented likelihood for long-term benefits at 10 years. CONCLUSION This scoring system is a useful clinical adjunct for deciding timing of knee arthroplasty and prioritizing patients in institutions with long waitlists. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Yong Zhi Khow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | | | | | - Ngai Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Goh GS, Thever Y, Tay AYW, Rikhraj IS, Koo K. Can patients with psychological distress achieve comparable functional outcomes and satisfaction after hallux valgus surgery? A 2-year follow-up study. Foot Ankle Surg 2021; 27:660-664. [PMID: 32917525 DOI: 10.1016/j.fas.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study assessed the influence of preoperative mental health on functional outcomes and satisfaction, and the change in mental health after hallux valgus surgery. METHODS 383 patients who underwent scarf osteotomy were analyzed. Visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society score (AOFAS) and SF-36 were assessed at 6 months and 2 years. The cohort was stratified into patients with and without psychological distress (i.e. SF-36 Mental Component Summary [MCS] <50 vs ≥50). RESULTS After adjusting for demographics and baseline scores, VAS and AOFAS were poorer in the distressed group at 6 months. However, there was no difference in scores at 2 years and a similar proportion of patients were satisfied. SF-36 MCS in distressed patients significantly improved, but remained lower compared to non-distressed patients at follow-up. CONCLUSIONS Patients with psychological distress undergoing hallux valgus surgery had poorer short-term outcomes, but these differences resolved at 2 years.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Yogen Thever
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Adriel You Wei Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Zhu M, Chen JY, Yeo NEM, Koo K, Rikhraj IS. Health-related quality-of-life improvement after hallux valgus corrective surgery. Foot Ankle Surg 2021; 27:539-542. [PMID: 32694077 DOI: 10.1016/j.fas.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/13/2020] [Accepted: 07/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus is a common forefoot deformity that affects function of foot and quality of life (QoL). This study aims to identify factors associated with clinically important improvements in QoL after hallux valgus corrective surgery. METHODS A retrospective analysis on 591 cases of hallux valgus corrective surgery performed between 2007 and 2013 was conducted. Patients' preoperative and 2-year postoperative Physical Component Score (PCS) and Mental Component Score (MCS) were compared to identify the presence of clinically significant improvements in patient-reported QoL. A multiple logistic regression model was developed through a stepwise variable-selection model building approach. Age, BMI, preoperative patient reported outcome score, PCS, MCS, pain score, gender, side of surgery, type of surgery, and presence of lesser toe deformities or metatarsalgia were considered. RESULTS Median PCS significantly improved from 49 to 53 (p < 0.001), and median MCS remained at 56 (p = 0.724). Age, preoperative MCS and PCS were independent predictors for significant improvements of PCS at 2-year postoperatively. CONCLUSION Three groups of patients were more likely to have significant QoL improvements after hallux valgus corrective surgery. These were the younger patients, those with better preoperative mental health or those with poorer preoperative physical health. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Meng Zhu
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | | | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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No difference in patient satisfaction after mobile bearing or fixed bearing medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2021; 29:947-954. [PMID: 32399616 DOI: 10.1007/s00167-020-06053-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Medial unicompartmental knee arthroplasty (UKA) has excellent survival rates using one of the two implant designs: mobile bearing (MB) or fixed bearing (FB). There is a lack of studies comparing patient-reported outcomes (PROs) of both implants. This study aimed to document and compare PROs of MB UKA to FB UKA at 6, 12 and 24 months after surgery. METHODS A single high-volume surgeon, retrospective cohort study with prospectively collected data of two groups of UKA patients, with a MB (n = 66) or FB (n = 97) implant. Primary outcome was patient satisfaction (0-10; NRS). Secondary outcomes were pain at rest (NRS), pain during activity (NRS), function (OKS, KOOS-PS), quality of life (EQ-5D-3L), anchor pain, anchor function and anchor recovery. PROs were collected 6, 12 and 24 months postoperatively. The complication rate and revision rate within one year after surgery were recorded. RESULTS For the MB group, the median NRS satisfaction score was 9.0 (8.0-10.0) compared to 9.0 (8.0-9.5) for the FB group at 6 months (p = 0.620). Similar scores were found at 12 and 24 months; both MB 9.0 (8.0-10.0) and FB 9.0 (8.0-10.0) (p = 0.556 and p = 0.522, respectively). There were no statistically significant differences between MB and FB groups in all secondary outcomes postoperatively. CONCLUSION Medial UKA performed by a high-volume surgeon, using a MB or a FB implant, results in excellent patient satisfaction, pain relief, functional improvement and quality of life improvement at 6, 12 and 24 months after surgery. The recommendation and use of one over the other is not justified based on the outcomes in the current study. LEVEL OF EVIDENCE III.
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Goh GS, Zeng GJ, Thever Y, Foong WS, Tay DKJ, Lo NN, Yeo SJ, Liow MHL. Unicompartmental knee arthroplasty in patients with Parkinson's disease. Knee 2020; 27:1325-1331. [PMID: 33010744 DOI: 10.1016/j.knee.2020.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Parkinson's disease (PD) adversely affects physical function after joint replacement. The biomechanical advantages of unicompartmental knee arthroplasty (UKA) may be particularly beneficial for these patients who suffer from gait and kinetic abnormalities. We aimed to describe the functional outcomes, complications and survivorship after UKA in patients with PD. METHODS Ten patients (11 knees) undergoing primary fixed-bearing UKA for medial osteoarthritis were studied. Knee Society Knee (KSKS) and Function Scores (KSFS), as well as the Short-Form-36 (SF-36) Mental (MCS) and Physical Component Scores (PCS) were assessed preoperatively, at six months and at two years postoperatively. Complications, survivorship and all-cause mortality were analyzed. RESULTS No perioperative complications occurred. Length of stay was 5 ± 2 days and no patients were discharged to rehabilitation or readmitted. Nine of 11 knees had a flexion contracture preoperatively and this remained unchanged at two years. KSKS and SF-36 PCS improved significantly. However, there was no improvement in KSFS or SF-36 MCS. All patients achieved minimal clinically important difference for KSKS, six of 11 for KSFS and nine of 11 for SF-36 PCS. At mean 10 ± 5 years, there was one revision for progression of osteoarthritis. Seven of 10 patients progressed in Hoehn and Yahr stage and only three were able to ambulate independently at last follow-up. CONCLUSIONS Patients suffering from osteoarthritis and PD can experience a substantial improvement in knee pain with low morbidity after UKA. However, the improved kinematics of UKA did not translate to an improved range of motion or knee function postoperatively.
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Affiliation(s)
- Graham S Goh
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
| | | | - Yogen Thever
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Wei Sheng Foong
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | | | - Ngai-Nung Lo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Seng-Jin Yeo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
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Goh GS, Zeng GJ, Chen JY, Lo NN, Yeo SJ, Liow MHL. Ten-Year Results of Unicompartmental Knee Arthroplasty in Patients With Psychological Distress. J Arthroplasty 2020; 35:2830-2836.e1. [PMID: 32475784 DOI: 10.1016/j.arth.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/18/2020] [Accepted: 05/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the influence of psychological distress on the outcomes of total knee arthroplasty has been described extensively, its effect on unicompartmental knee arthroplasty (UKA) is poorly defined. Furthermore, most studies in arthroplasty literature had short follow-ups of ≤1 year. We investigated the influence of psychological distress on long-term patient-reported outcomes and analyzed the change in mental health after UKA in a cohort with minimum 10 years of follow-up. METHODS Prospectively collected data of 269 patients undergoing UKA in 2004-2007 were reviewed. Patients were stratified into those with psychological distress (36-item Short-Form health survey [SF-36] Mental Component Summary [MCS] <50, n = 111) and those without (SF-36 MCS ≥50, n = 158). Clinical outcomes were obtained preoperatively, at 2 years, and 10 years. Multiple regression was used to control for age, gender, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists class, and baseline scores. The rate of expectation fulfillment and satisfaction was compared. RESULTS Psychologically distressed patients had poorer Knee Society Knee Score, Function Score, Oxford Knee Score, and SF-36 Physical Component Summary preoperatively, at 2 years, and 10 years. However, an equal proportion in each group attained the minimal clinically important difference for each score. Distressed patients had a comparable rate of satisfaction (91% vs 95%, P = .136) but lower fulfillment of expectations (89% vs 95%, P = .048). The percentage of distressed patients declined from 41% to 35% at follow-up. The mean SF-36 MCS improved by 6.9 points. CONCLUSION Although psychologically distressed patients had relatively greater pain and poorer function preoperatively and up to 10 years after UKA, a similar proportion of them experienced a clinically meaningful improvement in patient-reported outcomes.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Gerald J Zeng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Y Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Goh GS, Liow MHL, Chen JY, Tay DKJ, Lo NN, Yeo SJ. Do Patients With Psychological Distress Have Poorer Patient-Reported Outcomes After Total Hip Arthroplasty? J Arthroplasty 2020; 35:2465-2471. [PMID: 32446627 DOI: 10.1016/j.arth.2020.04.077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with psychological distress are likely to have poorer short-term functional outcomes after total knee arthroplasty. However, the influence of psychological distress on the outcomes of total hip arthroplasty (THA) is relatively understudied. Previous studies also had short follow-ups of 1 year or less. We examined the influence of psychological distress on patient-reported outcomes and satisfaction, and analyzed the change in mental health after THA at a minimum of 2 years. METHODS Prospectively collected data of 1384 patients undergoing primary THA in 2001-2015 were reviewed. Patients were assessed using the Oxford Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and 36-item Short-Form health survey Physical Component Summary and Mental Component Score (MCS). Patients were stratified into those with psychological distress (MCS < 50, n = 720) and those without (MCS ≥ 50, n = 664). Multiple regression analysis was used to control for age, gender, body mass index, and baseline scores. The rate of satisfaction and expectation fulfillment was also analyzed. RESULTS Distressed patients had a poorer Physical Component Summary at 6 months. However, there was no difference in patient-reported outcomes at 2 years. A higher proportion of distressed patients attained the minimal clinically important difference for Oxford Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index, while 92.2% of distressed patients and 92.9% of nondistressed patients were satisfied at 2 years (P = .724). There was no difference in MCS after 6 months. The percentage of distressed patients also declined from 41.8% to 27.3%. CONCLUSION Patients with psychological distress achieved a comparable level of function, quality of life, and satisfaction 2 years after THA. Undergoing THA may also lead to mental health improvement in a subgroup of distressed patients.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Chen Y, Fang X, Huang Z, Li W, Zhang W. Factors affecting the clinical outcomes including patient satisfaction after Oxford unicompartmental knee arthroplasty: a retrospective study. ARTHROPLASTY 2020; 2:19. [PMID: 35236452 PMCID: PMC8796461 DOI: 10.1186/s42836-020-00038-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Oxford unicompartmental knee arthroplasty (UKA) is widely used for treating patients with unicompartmental knee diseases. However, the factors affecting the outcomes of and patients’ satisfaction with Oxford UKA remain controversial. The aims of this study were to evaluate the clinical and radiological outcomes, including patient satisfaction, after Oxford UKA and identify the influencing factors related to patients’ satisfaction. Methods We retrospectively analyzed the data of patients who underwent UKA in our medical institution from 2013 to 2018. Demographic information, clinical scores, patient satisfaction and imaging findings were recorded. The patients were followed up for at least 1 year. Multivariate Logistic regression analysis was performed to identify influencing factors related to clinical outcomes including patient satisfaction. Results A total of 80 patients (involving 87 knees) were included. The Numerical Rating Scale (NRS) scores and Knee Society Scores (KSS) were significantly improved after operation as compared to preoperative scores (6.0 vs. 1.0, P < 0.001; 113.0 ± 27.2 vs. 167.2 ± 23.9, P < 0.001), and the varus deformity was corrected (181.0 vs. 176.0, P < 0.05). Six patients (7.5%) developed postoperative complications, and no case suffered from prosthesis loosening. The time since operation (TSO) and angle E were found to be predictors of KSS improvement (P = 0.009; P = 0.024). The postoperative KSS and angle E were found to be predictors of patient satisfaction (P = 0.001; P = 0.032). Conclusion Oxford UKA can improve the NRS score and KSS and correct varus deformities. A shorter TSO and smaller angle E are indicators of a greater KSS improvement. A higher KSS and smaller angle E are indicative of higher patient satisfaction.
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Liow MHL, Goh GS, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ. Should patients aged 75 years or older undergo medial unicompartmental knee arthroplasty? A propensity score-matched study. Arch Orthop Trauma Surg 2020; 140:949-956. [PMID: 32306091 DOI: 10.1007/s00402-020-03440-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION With increasing life expectancies worldwide, more elderly patients with isolated medial compartment osteoarthritis may become suitable UKA candidates. However, there is a paucity of literature comparing outcomes between older patients (≥ 75 years) and younger patients undergoing UKA. The aim of this study was to determine if there were differences in functional and HRQoL measures between older patients (≥ 75 years) and younger controls (< 75 years) undergoing primary UKA. MATERIALS AND METHODS Prospectively collected registry data of 1041 patients who underwent primary, cemented, fixed-bearing medial UKA at a single institution from 2002-2013 were reviewed. Propensity scores generated using logistic regression was used to match older patients (≥ 75 years, n = 94) to controls (< 75 years, n = 188) in a 1:2 ratio. Knee Society Scores, Oxford Knee Score, Short Form-36, satisfaction/expectation scores, proportion of patients attaining OKS/SF-36 PCS MCID and survivorship were analysed. RESULTS Patients ≥ 75 years had significantly lower KSFS (67.1 ± 17.9 vs 79.4 ± 18.2, p < 0.001) and SF-36 PCS (47.3 ± 10.1 vs 50.4 ± 9.1, p = 0.01) as compared to the control group. In addition, a significantly lower proportion of patients ≥ 75 years attained MCID for SF-36 PCS when compared to the controls (50.0% vs 63.8%, p = 0.04). Survival rates at mean 8.3 ± 3.0 years were 98.9% (95% CI, 96.7-100) in the older group versus 92.8% (95% CI, 86.8-98.8) in the younger group (p = 0.31). CONCLUSIONS Our findings highlight the need to counsel older patients regarding potentially reduced improvements in functional outcomes, despite advantages of lower revision. However, UKA in older patients continues to be a viable option for isolated medial compartment osteoarthritis LEVEL OF EVIDENCE: Level III Propensity score matched study.
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Affiliation(s)
- Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
| | - Hee-Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: a comparative case-control study. Arch Orthop Trauma Surg 2020; 140:231-237. [PMID: 31686181 PMCID: PMC6989597 DOI: 10.1007/s00402-019-03296-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of this study was to provide a matched cohort comparison of clinical and functional outcome scores, range of motion and quality of life following unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). The hypothesis was that patients receiving UKA report better results than comparable patients who receive conventional TKA. METHODS Clinical and functional results of 35 patients with medial end-stage osteoarthritis who had received a fixed-bearing UKA were compared with the results of 35 matched patients who had received a TKA from the same manufacturer by the same surgeon. Outcome scores were measured before surgery and at final follow-up using Tegner Activity Scale (TAS), range of motion (ROM) and Short Form 36 Health Survey (SF-36). The Knee Society Score (KSS) was assessed at final follow-up. The mean observation period was 2.3 years in both groups. RESULTS The preoperative knee scores had no statistically significant differences between the two groups. Postoperatively, however, UKAs performed significantly better regarding TAS and ROM (4 vs. 3 and 118.4 vs. 103.7, respectively). The results of the SF-36 showed significantly better results for the UKA group in the mental component summary score and in the subscale of social function. CONCLUSIONS The present study suggests that UKA is associated with higher activity level, higher quality of life, and greater ROM when compared with TKA on comparable patients. Prolonged clinical follow-up in a larger patient cohort with a randomised-controlled study design would be beneficial to confirm these findings. LEVEL OF EVIDENCE III.
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Poor Baseline Mental Health Does Not Influence Improvement in Patient-reported Outcomes, Satisfaction, and Return to Work Two Years After Single-level Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2019; 44:839-847. [PMID: 30540718 DOI: 10.1097/brs.0000000000002960] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study using prospectively collected registry data. OBJECTIVE The authors examine the influence of preoperative mental health on outcomes after anterior cervical discectomy and fusion (ACDF) and determine the impact of ACDF on postoperative mental health. SUMMARY OF BACKGROUND DATA While studies have reported a negative correlation between preoperative mental health and outcomes following lumbar spine surgery, the influence on outcomes following cervical spine surgery remains relatively understudied. METHODS Prospectively collected registry data of 104 patients who underwent single-level ACDF for cervical spondylotic myelopathy were reviewed. Patients were dichotomized into top and bottom halves based on preoperative SF-36 MCS (Mental Component Summary) using a cutoff of 48. Outcomes assessed were visual analogue scale for neck pain, arm pain, AAOS Neck Pain and Disability, Neurogenic Symptoms, Neck Disability Index, Short-Form 36, Japanese Orthopaedic Association myelopathy score, return to work, return to function, satisfaction and expectation fulfilment up to 2 years postoperatively. RESULTS The preoperative MCS was 37.5 ± 8.1 and 57.4 ± 6.3 in the Low and High MCS groups respectively (P < 0.001). The Low MCS group had poorer preoperative scores (P < 0.05). There was no significant difference in length of stay or comorbidities (P > 0.05). The High MCS group had less neck pain (P = 0.002) and showed a trend towards lower Neck Disability Index (P = 0.062) at 2 years. The Low MCS group demonstrated greater improvement in Japanese Orthopaedic Association (P = 0.007) and similar improvement in other scores (P > 0.05). There was no significant difference in proportion that achieved minimal clinically important difference for each score (P > 0.05). Both groups had similar rates of return to work, return to function, expectation fulfilment, and satisfaction (P > 0.05). Lower preoperative MCS was predictive of greater improvement in MCS (r = -0.477, P < 0.001). CONCLUSION Despite relatively greater pain and disability at 2 years, patients with poor baseline mental health experienced similar improvement in clinical outcomes, return to work, and satisfaction rates. LEVEL OF EVIDENCE 3.
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Chua JL, Goh GSH, Liow MHL, Tay DKJ, Lo NN, Yeo SJ. Modern TKA implants are equivalent to traditional TKA implants in functional and patellofemoral joint-related outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:1116-1123. [PMID: 30269170 DOI: 10.1007/s00167-018-5161-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/24/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE To compare patient-reported outcomes measures, health-related quality of life and satisfaction rates between a new Modern TKA system (M-TKA) and an existing Traditional TKA system (T-TKA). METHODS Prospectively collected registry data of 65 patients who underwent T-TKA and 65 patients who underwent M-TKA at a single institution from 2014 to 2015 was reviewed. The range of motion, Knee Society Knee Score (KSKS), Function Score (KSFS), Oxford Knee Score (OKS), SF-36, satisfaction and expectation fulfilment were compared at Pre-op, 6 months and 2 years. Patellofemoral joint-related OKS subscores (3, 5, 7, 12) were also compared between the groups. Minimal clinically important difference (MCID) in OKS/SF-36 were analysed for both groups. Propensity scores generated using logistic regression were used to adjust for confounding variables, thus allowing matching of T-TKA to M-TKA in a 1:1 ratio. RESULTS Both groups showed a significant improvement in all measured variables at 6 month and 2 years (p < 0.001) when compared to baseline. There was no significant difference in KSKS, KSFS, OKS, SF-36 and Patellofemoral joint-related OKS subscores (3, 5, 7, 12) between the two groups (n.s.). At 2 years, there were high satisfaction rates of 89.2% and 92.2% in the T-TKA and M-TKA groups, respectively (n.s.). Similarly, both groups demonstrated high expectation fulfilment rates of 84.6% and 90.6% for the T-TKA and M-TKA groups, respectively (n.s.). CONCLUSION Using an extensive battery of standardized patient-reported, health-related quality of life and MCID assessments, our study demonstrated no difference in clinical outcomes between M-TKA and T-TKA that would justify the use of the newer and costlier M-TKA. Longer follow-up is necessary to evaluate the possible advantages of this new implant design. LEVEL OF EVIDENCE Level III, Retrospective Study.
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Affiliation(s)
- Jia Long Chua
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Graham Seow-Hng Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore.
| | - Darren Keng-Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia, Level 4, Singapore, 169865, Singapore
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Inpatient Versus Outpatient Hip and Knee Arthroplasty: Which Has Higher Patient Satisfaction? J Arthroplasty 2018; 33:3402-3406. [PMID: 30143333 DOI: 10.1016/j.arth.2018.07.025] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND More surgeons are offering patients the option of having adult reconstructive procedures performed as an outpatient at an ambulatory surgery center. However, it is unknown if these patients have higher or lower satisfaction with their care than patients having a traditional inpatient stay. The purpose of this study is to compare satisfaction between inpatients and outpatients undergoing hip or knee arthroplasty. METHODS Portions of the Health Consumer Assessment of Healthcare Providers and Systems survey, the Friends and Family Test, and 8 additional questions were administered to 174 consecutive patients. There were 8 non-responders (95.4% response rate) leaving 102 who underwent inpatient and 64 who had outpatient surgery. Responses were stratified using the "boxes" scoring approach as recommended by Health Consumer Assessment of Healthcare Providers and Systems and analyzed with a chi-squared or Fischer's exact test where appropriate. Power analysis determined that 38 patients per group were needed to detect a 1-point difference in overall satisfaction between groups with 80% power and alpha of 0.05 considered significant. RESULTS Outpatients responded with more top responses when asked about the staff's explanation of any medicines received (91.4% vs 77.5%, P = .026), the staff's assistance with their pain management (98.3% vs 88.0%, P = .022), the written health information they were given upon discharge (98.3% vs 90.1%, P = .05), and the courtesy and respect from the nurses (100.0% vs 92.2%, P = .022). Inpatients responded with more bottom responses when asked how prepared they felt for discharge home (8.9% vs 0.0%, P = .014). Top responses in overall satisfaction with the facility (87.1% vs 93.4%, P = .204) and overall experience (89.2% vs 95.2%, P = .177) were similar between inpatients and outpatients, respectively. Not surprisingly, inpatients were older (64.1 vs 59.2 years, P = .001), heavier (body mass index 32.7 vs 30.4, P = .035), and had higher Charlson comorbidity scores (2.6 vs 1.9, P = .002). CONCLUSION Although satisfaction was high in both groups, when differences were present they favored outpatient surgery in the ambulatory surgery center.
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