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Wahl Z, Courbon C, Macindo JRB, Torres GCS, Lecoultre C. Surgical Patient Preoperative Readiness: Translation into French, Cultural Adaptation for Switzerland and Cross-Sectional Exploratory Study in a Tertiary Hospital. J Perianesth Nurs 2024:S1089-9472(24)00051-0. [PMID: 38819361 DOI: 10.1016/j.jopan.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Preoperative evaluation of elective surgery patients traditionally focuses on somatic and organizational aspects of the situation. Patient feelings of readiness, called preoperative readiness (PR), impacts postoperative outcomes, and yet is rarely evaluated. The Preoperative Assessment Tool (PART) is a validated and reliable 15-item questionnaire available in Filipino and English. A reliable tool is essential for evaluating PR within the Swiss health context to offer optimized and comprehensive perioperative care. The aim of this study was to both translate into French and adapt culturally the Preoperative Assessment Tool for Switzerland's francophone population, and to explore patient PR in the preoperative consultation within a Swiss tertiary hospital. DESIGN A mixed design with methodologic phases and descriptive study. METHODS A mixed design in two phases with a methodologic phase with (1) translation and (2) cultural adaptation for Romandie of the PART, following Wild's 10 steps methodology (n = 11) and (3) a cross-sectional exploratory descriptive study with pilot testing of the translated version in a general elective preoperative consultation in a tertiary hospital in Romandie (N = 88). FINDINGS Translation and cultural adaptations are well accepted and understood by the participants (n = 9/11), modifications are accepted by the authors and deemed adequate by the participants (n = 11/11). Time of completion is short (m = 69.06 seconds) and adapted to clinical context. The translated version has a Cronbach (α = 0.85) comparable to the original validated scale (α = 0.86). CONCLUSIONS The translation and cultural adaptation for Switzerland of the PART was achieved, and PR was explored. Further psychometric testing of the PART-FrenCH must be conducted to assess fully the tool before its use in a clinical setting. Including PR in preoperative evaluations could enhance patient-centered approaches and lead to improvement in the quality of care.
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Affiliation(s)
- Zoé Wahl
- Department of Nursing, Haute Ecole de Santé Vaud (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Vaud, Switzerland; College of Nursing, Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Vaud, Switzerland.
| | - Cécile Courbon
- Department of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Vaud, Switzerland
| | | | - Gian Carlo S Torres
- College of Nursing, University of Santo Tomas, Manila, Philippines; College of Nursing, University of the Philippines, Manila, Philippines
| | - Claudia Lecoultre
- Department of Surgery and Cardio-Vascular, University Hospital of Lausanne (CHUV), Lausanne, Vaud, Switzerland
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Fontalis A, Yasen AT, Kayani B, Luo TD, Mancino F, Magan A, Plastow R, Haddad FS. Two-Dimensional Versus Three-Dimensional Preoperative Planning in Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00526-6. [PMID: 38810812 DOI: 10.1016/j.arth.2024.05.054] [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: 12/04/2023] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Preoperative planning in total hip arthroplasty (THA) involves utilizing radiographs or advanced imaging modalities, including computerized tomography scans, for precise prediction of implant sizing and positioning. This study aimed to compare 3-dimensional (3D) versus 2-dimensional (2D) preoperative planning in primary THA with respect to key surgical metrics, including restoration of the horizontal and vertical center of rotation (COR), combined offset, and leg length. METHODS This study included 60 patients undergoing primary THA for symptomatic hip osteoarthritis (OA), randomly allocated to either robotic arm-assisted or conventional THA. Digital 2D templating and 3D planning using the robotic software were performed for all patients. All measurements to evaluate the accuracy of templating methods were conducted on the preoperative computerized tomography scanogram, using the contralateral hip as a reference. Sensitivity analyses explored differences between 2D and 3D planning in patients who had superolateral or medial OA patterns. RESULTS Compared to 2D templating, 3D templating was associated with less medialization of the horizontal COR (-1.2 versus -0.2 mm, P = .002) and more accurate restoration of the vertical COR (1.63 versus 0.3 mm, P < .001) with respect to the contralateral side. Furthermore, 3D templating was superior for planned restoration of leg length (+0.23 versus -0.74 mm, P = .019). Sensitivity analyses demonstrated that in patients who had medial OA, 3D planning resulted in less medialization of horizontal COR and less offset reduction. Conversely, in patients who had superolateral OA, there was less lateralization of horizontal COR and less offset increase using 3D planning. Additionally, 3D planning showed superior reproducibility for stem, acetabular cup sizes, and neck angle, while 2D planning often led to smaller stem and cup sizes. CONCLUSIONS Our findings indicated higher accuracy in the planned restoration of native joint mechanics using 3D planning. Additionally, this study highlights distinct variances between the 2 planning methods across different OA pattern subtypes, offering valuable insights for clinicians employing 2D planning.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Adam T Yasen
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tianyi David Luo
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; Orthopaedics Northeast, Fort Wayne, Indiana
| | - Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
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Yoo SW, Kim T, Seo J, Oh H, Lee JH. Comparing quality of recovery and satisfaction between spinal anesthesia and nerve block in orthopedic below-knee surgery: A prospective controlled trial. Medicine (Baltimore) 2024; 103:e37573. [PMID: 38579041 PMCID: PMC10994455 DOI: 10.1097/md.0000000000037573] [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: 01/13/2024] [Accepted: 02/21/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Postoperative quality of recovery (QoR) and patient satisfaction have gained increasing significance in medical services. This study aimed to compare these 2 parameters between 2 types of regional anesthetics (spinal anesthesia and combined sciatic-femoral nerve block) in orthopedic lower knee surgery. METHODS A total of 101 patients were classified into 2 groups (combined sciatic-femoral nerve block, group N; spinal anesthesia, group S) according to patient preference. In group N, sciatic and femoral nerve blocks were performed on the popliteal and groin regions, respectively, under ultrasound guidance. Spinal anesthesia was performed in group S. The primary outcomes were QoR and patient satisfaction. QoR was measured using the Korean translation of the QoR-15K. Patient satisfaction was assessed using an 11-point Likert scale (0-10) and a dichotomous question addressing anesthesia preferences for future surgeries. RESULTS The physical independence of the postoperative QoR-15K was significantly higher in group N than in group S (14.2 vs 12.0, P = .04). On the 11-point Likert scale, group N scored 8.8, and group S scored 7.8 (P = .001). In the dichotomous question, 93.8% of the group N and 52.8% of the group S answered that they would like to choose the same anesthesia method for the next surgery (P < .001). In addition, fewer participants in group N complained of backache than those in group S, and the time to first urination after anesthesia was shorter in group N than in group S (P = .004, <.001, respectively). CONCLUSION Combined sciatic-femoral nerve block may provide better physical independence and satisfaction than spinal anesthesia in orthopedic below-knee surgeries.
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Affiliation(s)
- Seon Woo Yoo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Taehoon Kim
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Jongmin Seo
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Hyunji Oh
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
| | - Jun Ho Lee
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
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Stanworth JO, Hsu RS, Stanworth PA, Kemp JM, Tzen R, Wu HH. When Culture Matters: Using Compliments and Complaints to Define and Influence Chinese Patients' Satisfaction. HEALTH COMMUNICATION 2024; 39:136-147. [PMID: 36572566 DOI: 10.1080/10410236.2022.2160098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Despite patients' cultural background influencing their satisfaction with medical care the majority of studies draw on assumptions and models from the Western world. We move attention to the East Asian world by investigating the attributes of Chinese patients' satisfaction with their hospital in-patient care. Our research design is an exploratory qualitative study of 577 incidents of Chinese hospital in-patients' complaints and compliments. The data were drawn from a sample of reports of patients' satisfaction with their care in a district general hospital over a five-year period. Analysis focused on satisfactory and dissatisfactory events to derive attributes involved. We find patients in Chinese culture evaluate satisfaction with their care using eight attributes: professionalism, efficiency, chīn-chièh, respect, patience, responsibility, value and ethics. We explore how Chinese patients' values and beliefs toward medicine and care-giving construct distinct meanings around these attributes. By synthesizing our findings with those in the literature we propose generic attributes which can form the basis of measures of Chinese patient satisfaction and inform training in cultural competence.
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Affiliation(s)
- James O Stanworth
- Department of Business Administration, National Changhua University of Education
| | - Ryan Shuwei Hsu
- Department of Business Administration, National Chengchi University
| | - Peter A Stanworth
- Department of Neurosurgery, University Hospitals Coventry and Warwickshire NHS Trust
| | | | | | - Hsin-Hung Wu
- Department of Business Administration, National Changhua University of Education
- Department of M-Commerce and Multimedia Applications, Asia University
- Faculty of Education, State University of Malang
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Koutp A, Hauer G, Leitner L, Kaltenegger L, Fischerauer S, Clar C, Reinbacher P, Schittek G, Leithner A, Sadoghi P. Less Induction Time and Postoperative Pain Using Spinal Anesthesia Versus General Anesthesia With or Without the Use of Peripheral Nerve Blocks in Total Knee Arthroplasty. J Arthroplasty 2024; 39:904-909. [PMID: 37852447 DOI: 10.1016/j.arth.2023.10.018] [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: 04/02/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Our aim was to analyze anesthetic induction time and postoperative pain using spinal anesthesia versus general anesthesia with or without the use of peripheral nerve blocks (PNBs) in total knee arthroplasty. The hypothesis was that spinal anesthesia would be beneficial with respect to induction time and postoperative pain and that PNBs would complement this effect. METHODS Patients were stratified according to demographics, American Society of Anesthesiologists physical status classification system (ASA), and opioid intake and divided into: (A) general anesthesia without PNB; (B) general anesthesia with PNB; (C) spinal anesthesia without PNB; and (D) spinal anesthesia with PNB. Endpoints were anesthetic induction time, opioid consumption, and pain. Of 559 patients, 348 (62.3%) received general anesthesia (consisting of group A with 46 and group B with 302 patients), and 211 (37.7%) spinal anesthesia (consisting of group C with 117 and group D with 94 patients). RESULTS We observed significantly lower total opioid intake 48 hours postoperative when applying spinal anesthesia by 2.08 mg (P < .05) of intravenous morphine-equivalent, and a reduction of 7.0 minutes (P < .05) until skin incision. The application of a PNB achieved a reduction of piritramide intake of 3.59 mg (P < .05) 48 hours postoperative and lengthened induction time by 8.5 minutes (P < .05). CONCLUSIONS Statistically shorter anesthetic induction times without clinical relevance, but lower postoperative opioid dosages with clinical relevance were observed for patients undergoing total knee arthroplasty with spinal anesthesia. The additional application of PNBs led to a lower need for opioids and lower pain levels in the early postoperative phase.
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Affiliation(s)
- Amir Koutp
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lucas Kaltenegger
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Stefan Fischerauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Clemens Clar
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Gregor Schittek
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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Wallace DT, Ohly NE, Allen DJ, Baines J. Long-term Outcomes of Revision Total Hip Arthroplasty Using a Modular Fluted Conical Femoral Stem. J Arthroplasty 2024; 39:1048-1053. [PMID: 37871856 DOI: 10.1016/j.arth.2023.10.031] [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: 05/26/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND This study presents minimum 6-year follow-up data on the survival and satisfaction of an uncemented modular revision femoral system, following on from our previously published earlier results. METHODS We retrospectively reviewed all revision hip arthroplasties performed at our institution between January 2005 and October 2012, using a single modular femoral revision system. Patient-reported outcomes were collected (satisfaction score and Oxford Hip Score). Preoperative and postoperative radiographs were reviewed for stem subsidence, and Kaplan-Meier analysis was performed for survival. A total of 115 femoral revisions were performed in 106 patients. RESULTS All-cause survival was 82% (95% confidence interval 74 to 91%) at 10.8 years, and 96% (95% confidence interval 90 to 100%) excluding septic failure. Of the 19 cases requiring reoperation, 16 were for infection, 2 for aseptic loosening, and 1 for mechanical failure. At final follow-up, 88.5% of patients were "satisfied" or "very satisfied". CONCLUSIONS This study showed excellent clinical results of a commonly used revision hip stem with at least 10 years follow-up. Satisfaction rates were high, with few aseptic failures. Stem subsidence was more common in revisions for infection, but did not correlate with lower satisfaction scores.
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Affiliation(s)
- David T Wallace
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Nicholas E Ohly
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland
| | - David J Allen
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland
| | - Joe Baines
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Scotland
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Angelini E, Wolf A, Wijk H, Brisby H, Baranto A. Evaluating a targeted person-centred pain management intervention programme in lumbar spine surgery - a controlled segment-specific before-and-after interventional design. BMC Health Serv Res 2024; 24:315. [PMID: 38459528 PMCID: PMC10921751 DOI: 10.1186/s12913-024-10769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Postoperative pain management in lumbar spine surgery care remains a challenge. The aim of this study was to evaluate the impact of a person-centred postoperative pain management intervention programme on lumbar spine surgery patients on postoperative pain, shared decision-making, and satisfaction with postoperative pain management. METHODS The study was performed with a controlled before-and-after interventional design in an orthopaedic unit at a university hospital. Person-centred pain management for patients undergoing spine surgery was developed in co-creation by a multi-professional team and implemented throughout the care pathway. The usual care group (pre-intervention) served as a comparison to the intervention group. Pain intensity, shared decision-making in pain management, and patient satisfaction with results of pain management, served as patient-reported measures, collected using the International Pain Outcomes questionnaire and analysed using descriptive statistics. RESULTS The intervention showed no benefit for patients' pain and satisfaction, while shared decision-making in pain management was significant lower in the intervention group than in the conventional group. The per-protocol analysis showed no significant differences between groups. CONCLUSION The initial assumption of the study, that the implementation of a co-created structured person-centred care pathway would improve patient-reported outcomes, was not confirmed. The periodically low fidelity to the intervention due to organizational constraints (due to sub-optimal organizational conditions and managerial support) may have affected the results.
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Affiliation(s)
- Eva Angelini
- Dept of Orthopaedics, Institute of Clinical Sciences, at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Institute of Health and Care Sciences, at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Axel Wolf
- Institute of Health and Care Sciences, at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Dept of Anaesthesia, Operation & Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Dept. of Quality Improvement, Sahlgrenska University Hospital, Gothenburg, Sweden
- Architecture, Chalmers University of Technology, Gothenburg, Sweden
| | - Helena Brisby
- Dept of Orthopaedics, Institute of Clinical Sciences, at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Dept. of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adad Baranto
- Dept of Orthopaedics, Institute of Clinical Sciences, at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Dept. of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Momtaz D, Okpara S, Martinez A, Cushing T, Ghali A, Gonuguntla R, Kotzur T, Duruewuru A, Harris M, Seifi A, Harrington M. A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty. ARTHROPLASTY 2024; 6:7. [PMID: 38310263 PMCID: PMC10838456 DOI: 10.1186/s42836-024-00232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION This study aimed to develop a modified frailty index (MFI) to predict the risks of revision total hip arthroplasty (THA). METHODS Data from the American College of Surgeons - National Surgical Quality Improvement Program were analyzed for patients who underwent revision THA from 2015 to 2020. An MFI was composed of the risk factors, including severe obesity (body mass index > 35), osteoporosis, non-independent function status prior to surgery, congestive heart failure within 30 days of surgery, hypoalbuminemia (serum albumin < 3.5), hypertension requiring medication, type 1 or type 2 diabetes, and a history of chronic obstructive pulmonary disease or pneumonia. The patients were assigned based on the MFI scores (MFI0, no risk factor; MFI1, 1-2 risk factors; MFI2, 3-4 risk factors; and MFI3, 5+ risk factors). Confidence intervals were set at 95% with a P value less than or equal to 0.05 considered statistically significant. RESULTS A total of 17,868 patients (45% male, 55% female) were included and had an average age of 68.5 ± 11.5 years. Odds of any complication, when compared to MFI0, were 1.4 (95% CI [1.3, 1.6]) times greater for MFI1, 3.2 (95% CI [2.8, 3.6]) times greater for MFI2, and 10.8 (95% CI [5.8, 20.0]) times greater for MFI3 (P < 0.001). Odds of readmission, when compared to MFI0, were 1.4 (95% CI [1.3, 1.7]) times greater for MFI1, 2.5 (95% CI [2.1, 3.0]) times greater for MFI2, and 4.1 (95% CI [2.2, 7.8]) times greater for MFI3 (P < 0.001). CONCLUSION Increasing MFI scores correlate with increased odds of complication and readmission in patients who have undergone revision THA. This MFI may be used to predict the risks after revision THA.
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Affiliation(s)
- David Momtaz
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Shawn Okpara
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Armando Martinez
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Tucker Cushing
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Abdullah Ghali
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Rishi Gonuguntla
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Travis Kotzur
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Anthony Duruewuru
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Madison Harris
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ali Seifi
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Melvyn Harrington
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, 77030, USA
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Perry M, LeDuc R, Stakenas S, Wozniak A, Francois A, Evans D. Adductor Canal Nerve Block versus Intra-articular Anesthetic in Knee Arthroscopy: A Single-Blinded Prospective Randomized Trial. J Knee Surg 2024; 37:220-226. [PMID: 36807102 DOI: 10.1055/a-2037-6418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Effective perioperative pain control following knee arthroscopy allows patients to reduce narcotic intake, avoid side effects of these medications, and recover more quickly. Adductor canal nerve blockade (ACB) and intra-articular injection of local anesthetic have been described as adjuvant treatments for postoperative pain control following surgery of the knee. This study directly compares the effect of each of these treatment modalities. Patients undergoing knee arthroscopy were blinded and randomized to receive either an ACB (n = 60) or intra-articular injection of local anesthetic (IAB, n = 64). Outcome measures included patient reported visual analog scale (VAS) scores at 1, 2, 4, 8, 16, 24, 36, 48 hours and 1 week and total narcotic consumption at 12, 24, and 48 hours postoperatively. Student's t-tests were used to compare unadjusted VAS scores at each time point and use of postoperative pain medication between treatment groups. Adjusted VAS scores were estimated in a multivariable general linear model with interaction of time and treatment group and other relevant covariates. There were no statistically significant differences between the two groups in terms of gender, age, body mass index, and insurance type. ACB patients had significantly higher pain scores than IAB patients at hours 1 and 2 (hour 1: 4.02 [2.99] vs. 2.59 [3.00], p = 0.009; hour 2: 3.12 [2.44] vs. 2.17 [2.62], p = 0.040). ACB patients had higher pain scores than IAB patients up to hour 16, though hours 4 to 16 were not significantly different. Adjusted covariate analyses demonstrate an additional statistically significant reduction in pain score in the IAB group at hour 4. There were no differences in narcotic consumption. Intraoperative local anesthetic and regional ACB each provides adequate pain control following knee arthroscopy, and intraoperative local anesthetic may provide enhanced pain control for up to 4 hours postoperatively. LEVEL OF EVIDENCE: : Level 1 evidence, randomized control trial.
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Affiliation(s)
- Michael Perry
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Ryan LeDuc
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Steven Stakenas
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Amy Wozniak
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Audrice Francois
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Douglas Evans
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
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Clement ND, Clement R, Clement A. Predicting Functional Outcomes of Total Hip Arthroplasty Using Machine Learning: A Systematic Review. J Clin Med 2024; 13:603. [PMID: 38276109 PMCID: PMC10816364 DOI: 10.3390/jcm13020603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this review was to assess the reliability of machine learning (ML) techniques to predict the functional outcome of total hip arthroplasty. The literature search was performed up to October 2023, using MEDLINE/PubMed, Embase, Web of Science, and NIH Clinical Trials. Level I to IV evidence was included. Seven studies were identified that included 44,121 patients. The time to follow-up varied from 3 months to more than 2 years. Each study employed one to six ML techniques. The best-performing models were for health-related quality of life (HRQoL) outcomes, with an area under the curve (AUC) of more than 84%. In contrast, predicting the outcome of hip-specific measures was less reliable, with an AUC of between 71% to 87%. Random forest and neural networks were generally the best-performing models. Three studies compared the reliability of ML with traditional regression analysis: one found in favour of ML, one was not clear and stated regression closely followed the best-performing ML model, and one showed a similar AUC for HRQoL outcomes but did show a greater reliability for ML to predict a clinically significant change in the hip-specific function. ML offers acceptable-to-excellent discrimination of predicting functional outcomes and may have a marginal advantage over traditional regression analysis, especially in relation to hip-specific hip functional outcomes.
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Affiliation(s)
- Nick D. Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK
- Southwest of London Orthopaedic Elective Centre, Epsom KT18 7EG, UK
| | - Rosie Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK
| | - Abigail Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SA, UK
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Feingold JD, Ryan R. T, Maniar A, Mitrasinovic S, Menta SV, Ranawat A. Intraoperative traction has a negligible time-dependent influence on patient-reported outcomes after hip arthroscopy: a cohort study. J Hip Preserv Surg 2024; 11:38-43. [PMID: 38606333 PMCID: PMC11005777 DOI: 10.1093/jhps/hnad034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/17/2023] [Accepted: 09/26/2023] [Indexed: 04/13/2024] Open
Abstract
The aim of this study is to determine if post-operative patient-reported outcome measures (PROMs) are influenced by hip arthroscopy traction duration. Patients from a local prospective hip arthroscopy database were retrospectively analyzed. Four hip-specific PROMs were utilized: modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Specific (HOS-SS), and international Hip Outcome Tool (iHOT). PROMs were collected pre-operatively and 6 months, 1 year and 2 years post-operatively. Two cohorts were created based on a cut-off corresponding to the 66th percentile for our patient cohort. Analyses were completed for each PROM at each post-operative interval with univariable statistics. Multivariable statistics were examined to identify the variables that were predictive of achieving post-operative minimal clinically important difference (MCID) at the 2-year follow-up. Overall, 222 patients met the inclusion criteria. The mean age was 32.4 ± 9.4 years, and 116 (52.3%) were female. The average traction time of the study population was 46.1 ± 12.9 min. A total of 145 patients were included in the short traction cohort (65%) with traction times of <50 min (66th percentile). No significant differences were found regarding PROM scores or MCID achievement rates between both cohorts at any post-operative period. In multivariable analyses, achievement of MCID was predicted by a decrease in traction time for all PROMs and pincer-type resection for mHSS, HOS-ADL and iHOT. There was no difference in PROMs and MCID achievement between longer and shorter traction time cohorts. On multivariable analysis, a decrease in traction time is predictive of MCID for all PROM scores and pincer-type resection was predictive of MCID for most PROM scores. Level of evidence: Level III, cohort study.
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Affiliation(s)
- Jacob D Feingold
- Sports Medicine Institute, The Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Thacher Ryan R.
- Sports Medicine Institute, The Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Adit Maniar
- Department of Orthopaedics, London Health Sciences Centre, 339 Windermere, London, ON N6B, Canada
| | - Stefan Mitrasinovic
- Sports Medicine Institute, The Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Samarth Venkata Menta
- Sports Medicine Institute, The Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
| | - Anil Ranawat
- Sports Medicine Institute, The Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
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Green A, Walsh A, Al-Dadah O. Comparison of clinical outcomes between total hip replacement and total knee replacement. World J Orthop 2023; 14:853-867. [PMID: 38173808 PMCID: PMC10758591 DOI: 10.5312/wjo.v14.i12.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND Total hip replacements (THR) and total knee replacements (TKR) are effective treatments for severe osteoarthritis (OA). Some studies suggest clinical outcomes following THR are superior to TKR, the reason for which remains unknown. This study compares clinical outcomes between THR and TKR. AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures (PROMs). METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre- and post-operatively. RESULTS A total of 131 patients were included in the study which comprised the THR group (68 patients) and the TKR group (63 patients). Both groups demonstrated significant post-operative improvements in all PROM scores (P < 0.001). There were no significant differences in post-operative PROM scores between the two groups: Hip and Knee Osteoarthritis Outcome scores (P = 0.140), Western Ontario and McMaster Universities Osteoarthritis Index pain (P = 0.297) stiffness (P = 0.309) and function (P = 0.945), Oxford Hip and Knee Score (P = 0.076), EuroQol-5D index (P = 0.386) and Short-Form 12-item survey physical component score (P = 0.106). Subgroup analyses showed no significant difference (P > 0.05) between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference (P > 0.05) between cemented and uncemented fixation in the THR group. Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR. CONCLUSION Contrary to some literature, THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs. The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome. Obesity had a greater influence on the outcome following TKR than that of THR.
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Affiliation(s)
- Alexander Green
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside NE34 0PL, United Kingdom
| | - Alex Walsh
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside NE34 0PL, United Kingdom
| | - Oday Al-Dadah
- Department of Trauma and Orthopaedic Surgery, South Tyneside District Hospital, South Tyneside NE34 0PL, United Kingdom
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4HH, United Kingdom
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Shrestha P, Karmacharya RM, Dhakal P, Bade S, Dahal S, Bhandari N, Bade S. Predicting factors of patient satisfaction after varicose vein surgery at a university hospital in Nepal. JOURNAL OF VASCULAR NURSING 2023; 41:180-185. [PMID: 38072570 DOI: 10.1016/j.jvn.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Varicose veins are a common vascular problem with a high prevalence, yet they are often neglected. The main objective of this study was to explore the patient satisfaction after varicose vein surgery, along with its predicting factors. To our knowledge, no similar study has been conducted in Nepal to date. METHODOLOGY This retrospective cross-sectional study included patients who underwent varicose vein surgery at Dhulikhel Hospital from September 2019 to February 2020. The satisfaction level after the surgery was assessed using a 10-point Likert scale questionnaire during a telephone interview with their verbal consent. Descriptive statistics and linear regression were performed to identify the predicting factors of patient satisfaction. RESULTS Among a total of 84 patients interviewed, 53.6% were male. The mean age of the participants was 43.13 ± 13.62 years. The mean patient satisfaction score was 42 ± 5.5, with nursing service, discharge teaching and hospital service being the highest scoring items in terms of patient satisfaction. Linear regression revealed age ≤40 years as a predictor of higher patient satisfaction (β=0.258, p=0.015) while early stage of varicose veins (β=-0.233, p=0.026) and duration of post-operative follow-up (β=-0.25, p=0.021) were negative predictors of patient satisfaction. This means that patients with C2-C3 venous disease and longer duration of postoperative follow-up tended to have lower satisfaction scores. CONCLUSION The overall patient satisfaction following varicose vein surgery was very good, and the major predictors of better satisfaction were age ≤40 years, C4-C6 clinical classification of venous disease and the shorter duration of follow-up after surgery.
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Affiliation(s)
- P Shrestha
- Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Nepal.
| | - R M Karmacharya
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal.
| | - P Dhakal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
| | - S Bade
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
| | - S Dahal
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
| | - N Bhandari
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
| | - S Bade
- Department of Surgery, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Kavrepalanchowk, Dhulikhel, Bagmati Province, Nepal
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Ghobrial PG, Eikani CK, Schmitt DR, Brown NM, Pinzur MS, Schiff AP. Safety and Efficacy of Tranexamic Acid in Total Ankle Arthroplasty. Foot Ankle Spec 2023:19386400231207276. [PMID: 37916469 DOI: 10.1177/19386400231207276] [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] [Indexed: 11/03/2023]
Abstract
Tranexamic acid has been shown to significantly reduce blood loss in patients undergoing total knee arthroplasty and total hip arthroplasty. However, there is a paucity of data regarding its safety and efficacy in total ankle arthroplasty. The purpose of this study was to determine whether tranexamic acid use in patients with total ankle arthroplasty affects blood loss or overall complication rate. A retrospective chart review was conducted for 64 patients who underwent total ankle arthroplasty with (n = 32) and without (n = 32) intraoperative tranexamic acid from 2014 to 2023 at a single academic medical center. Recorded blood loss, pre-to-postoperative hemoglobin changes, hidden blood loss, and complication rates were recorded and compared. There was no statistically significant difference in recorded blood loss, total calculated blood loss, pre-to-postoperative hemoglobin difference, hidden blood loss, or overall complications between the groups (all, P > .05). A lower rate of wound complications was observed in the tranexamic acid group, but the difference between each group was not statistically significant (P > .05). Tranexamic acid did not decrease blood loss during total ankle arthroplasty, as measured in our study. Tranexamic acid was not associated with any increase in overall complications. Based on our findings, tranexamic acid may be a safe intervention in total ankle arthroplasty, but further studies are needed to better elucidate its clinical impact.Level of Evidence: Level 3.
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Affiliation(s)
- Philip G Ghobrial
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Carlo K Eikani
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Daniel R Schmitt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Michael S Pinzur
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Adam P Schiff
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
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15
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Bekmuratova S, Bahle-Lampe A, Pflaster T. Physical therapists' experience using focus on therapeutic outcome in outpatient clinics: A qualitative study. Health Serv Manage Res 2023; 36:240-248. [PMID: 35943297 DOI: 10.1177/09514848221118749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While patient-reported outcomes measures (PROMs) are used in many practice settings as a standardized system of outcome measures, various factors may impact the meaningful use of PROMs by clinicians operating in various settings. Very limited research exists that focused on examining the use of FOTO® in outpatient rehabilitation settings. This study aimed to explore the barriers and facilitators in achieving FOTO® treatment completion rates and patient functional outcomes among physical therapists. Additionally, the study aimed to explore the internal acceptance of FOTO as a useful tool in rehabilitation from the perspectives of physical therapists. Qualitative data were collected through four focus group interviews with physical therapists at outpatient rehabilitation clinics. The interviews were audio-recorded and transcribed, and transcribed, and qualitative content analysis was applied for data analysis. Four major themes emerged from qualitative data analyses including (a) use of FOTO® in clinical practice, (b) reasons why the FOTO® process may not be followed, (c), therapists' perceptions of FOTO®, and (d) perceived barriers and enablers related to FOTO®. The study concluded that multi-level determinants impact the successful use of FOTO® by therapists in outpatient rehabilitation settings. The findings have important implications for clinical practice, organizational leaders, and PROM developers.
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Osmanski-Zenk K, Ellenrieder M, Mittelmeier W, Klinder A. Net Promoter Score: a prospective, single-centre observational study assessing if a single question determined treatment success after primary or revision hip arthroplasty. BMC Musculoskelet Disord 2023; 24:849. [PMID: 37891529 PMCID: PMC10605956 DOI: 10.1186/s12891-023-06981-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Our study aimed to identify the relationship between treatment outcome assessed by patient-reported outcomes (PROMs) and satisfaction measured by calculation of the Net Promoter Score (NPS), which identifies promoters, following total hip arthroplasty (THA). The aim was to evaluate this association separately in primary and revision THA and to determine thresholds based on PROMs that identify detractors of the surgical procedure or the centre. METHODS A total of 1,243 patients who underwent primary or revision THA at our hospital were asked to complete questionnaires of the Oxford Hip Score (OHS), Euroquol-5D (EQ-5D) and information on pain intensity preoperatively, three and 12 months after surgery. Postoperatively, the patients were additionally asked about their satisfaction with the procedure and the hospital by using three different NPS questions. The association between PROMs and NPS was evaluated based on group comparisons of primary or revision THA and receiver operating characteristics analysis (ROC) to determine threshold values. RESULTS At 12 months the NPS of all three questions were invariably linked to treatment outcome in patients after primary THA and patients with a single revision. In these two treatment groups, promoters always showed significantly better PROM scores than detractors. The NPS score was always higher in the primary group in comparison to the single revision group, e.g. 66.4% would undergo the procedure again in the first group, while only 33.0% would opt for this in the latter group. The high thresholds for the PROMs at 12 months, that were calculated by ROC analysis to identify promoter/detractors, indicate that patients` satisfaction required very good joint function and pain relief. However, the NPS was not a suitable tool to identify patients who need further care in an early phase after surgery. CONCLUSIONS With NPS already a single question or a single parameter provides the desired information regarding patient satisfaction and also treatment success. TRIAL REGISTRATION The study was approved by the Ethics Committee at the Medical Faculty of the University Rostock: "Ethikkommission an der Medizinischen Fakultät der Universität Rostock", Address: St.-Georg Str. 108 18055 Rostock, Germany, reference number: A2015-0055.
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Affiliation(s)
- Katrin Osmanski-Zenk
- Orthopaedische Klinik und Poliklinik, Medizinischen Fakultät, Universitaetsmedizin Rostock, Universität Rostock, Doberaner Strasse 142, D-18057, Rostock, Deutschland.
| | - Martin Ellenrieder
- Orthopaedische Klinik und Poliklinik, Medizinischen Fakultät, Universitaetsmedizin Rostock, Universität Rostock, Doberaner Strasse 142, D-18057, Rostock, Deutschland
| | - Wolfram Mittelmeier
- Orthopaedische Klinik und Poliklinik, Medizinischen Fakultät, Universitaetsmedizin Rostock, Universität Rostock, Doberaner Strasse 142, D-18057, Rostock, Deutschland
| | - Annett Klinder
- Orthopaedische Klinik und Poliklinik, Medizinischen Fakultät, Universitaetsmedizin Rostock, Universität Rostock, Doberaner Strasse 142, D-18057, Rostock, Deutschland
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17
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Hamilton DF, Gaston P, Macpherson GJ, Simpson P, Clement ND. Nexus Evaluation Primary Trident II UNcemented shEll (NEPTUNE). Bone Jt Open 2023; 4:782-790. [PMID: 37848192 PMCID: PMC10581835 DOI: 10.1302/2633-1462.410.bjo-2023-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Aims The primary aim of this study is to assess the survival of the uncemented hydroxyapatite (HA) coated Trident II acetabular component as part of a hybrid total hip arthroplasty (THA) using a cemented Exeter stem. The secondary aims are to assess the complications, joint-specific function, health-related quality of life, and radiological signs of loosening of the acetabular component. Methods A single-centre, prospective cohort study of 125 implants will be undertaken. Patients undergoing hybrid THA at the study centre will be recruited. Inclusion criteria are patients suitable for the use of the uncemented acetabular component, aged 18 to 75 years, willing and able to comply with the study protocol, and provide informed consent. Exclusion criteria includes patients not meeting study inclusion criteria, inadequate bone stock to support fixation of the prosthesis, a BMI > 40 kg/m2, or THA performed for pain relief in those with severely restricted mobility. Results Implant survival, complications, functional outcomes and radiological assessment up to ten years following index THA (one, two, five, seven, and ten years) will be performed. Functional assessment will include the Oxford Hip Score, Forgotten Joint Score, 12-Item Short Form Health Survey, EuroQol five-dimension health questionnaire, and pain and patient satisfaction. Radiological assessment with assess for acetabula lucent lines, lysis, and loosening according to DeLee and Charnley zones. Conclusion This study is part of a stepwise introduction of a new device to orthopaedic practice, and careful monitoring of implants should be carried out as part of the Beyond Compliance principles. The results of this study will provide functional, radiological, and survival data to either support the ongoing use of the HA acetabulum or highlight potential limitations of this new implant before wide adoption.
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Affiliation(s)
- David F. Hamilton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
| | - Paul Gaston
- Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gavin J. Macpherson
- Department of Orthopaedics, University of Edinburgh, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Philip Simpson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D. Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Lützner C, Beyer F, David L, Lützner J. Fulfilment of patients' mandatory expectations are crucial for satisfaction: a study amongst 352 patients after total knee arthroplasty (TKA). Knee Surg Sports Traumatol Arthrosc 2023; 31:3755-3764. [PMID: 36740633 PMCID: PMC10435619 DOI: 10.1007/s00167-022-07301-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/18/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Patient satisfaction with the results of their total knee arthroplasty (TKA) is one of the primary goals of this elective procedure. Furthermore, the association between the fulfilment of patients' expectations and their satisfaction is well known. The aim of this study was to identify the key expectations of patients awaiting a TKA, evaluate their fulfilment, and compare the outcomes between very and not fully satisfied patients. METHODS A prospective cohort study of patients with knee OA scheduled for primary TKA was performed. Pre- and one-year postoperatively patient-reported outcome measures (PROMs) were assessed. Expectations and their fulfilment were evaluated via a questionnaire encompassing 31 expectations. Preoperatively, expectations were indicated as mandatory, desirable and not important. Postoperatively, fulfilment was rated as exceeded, fulfilled, partially or not fulfilled, and not applicable. Satisfaction with the results of TKA was measured with a numeric rating scale (NRS) of 0-10. Discrimination between not fully satisfied and very satisfied patients was set at ≥ 8, as has been proposed recently. To identify independent predictors of this discrimination, a multivariate logistic regression analysis was performed. RESULTS Complete data sets of 352 patients were analysed. A set of 17 key expectations was identified. Relief of knee pain was fulfilled the most, and improvement of physical function was fulfilled the least. When asked about overall fulfilled expectations, 40% of patients rated them as exceeded, 34% as fulfilled and 26% as less fulfilled than expected. Not fully satisfied patients showed significantly lower PROMs pre- and postoperatively and less fulfilled key expectations. Higher numbers of exceeded and fulfilled mandatory expectations, higher overall fulfilment and better range of motion (ROM) were significant predictors for satisfaction ≥ 8. CONCLUSION Patients' expectations of TKA outcomes were high with equal emphasis on knee-related and general health-related aspects. Their fulfilment was positively associated with satisfaction. Surgeons should ask patients about mandatory expectations for successful TKA and counsel them about the likelihood of their fulfilment to avoid unrealistic expectations. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Cornelia Lützner
- Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Ludwig David
- Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Lützner
- Department for Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Gustafsson K, Kvist J, Eriksson M, Rolfson O. What Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes After THA? A Register-based Study. Clin Orthop Relat Res 2023; 481:1732-1742. [PMID: 37159269 PMCID: PMC10427049 DOI: 10.1097/corr.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Some patients report long-term pain or no improvement in health-related quality of life (HRQoL) or are dissatisfied after THA. However, factors associated with these poorer patient-reported outcomes after surgery are inconsistent and have typically been studied in the late phase of hip osteoarthritis (OA) among patients already eligible for surgery. Earlier identification of risk factors would provide time to address modifiable factors, helping to improve patients' pain, HRQoL, and satisfaction after surgery and reduce the burden on orthopaedic clinics by referring patients who are better prepared for surgery. QUESTIONS/PURPOSES We analyzed data from patients with hip OA referred to a first-line OA intervention program in primary healthcare at a stage when they had not been referred for THA, and asked: (1) What percentage of patients who proceed to THA report lack of improvement in pain, lack of improvement in HRQoL as measured by the EQ-5D, or are not satisfied with surgery 1 year after THA? (2) What associations exist between baseline factors at referral to this first-line OA intervention program and these poorer patient-reported outcomes 1 year after THA? METHODS We included 3411 patients with hip OA (mean age 67 ± 9 years, 63% [2160 of 3411] women) who had been referred for first-line OA interventions between 2008 and 2015 and subsequently underwent THA for OA. All patients were initially identified through the Swedish Osteoarthritis Register, which follows and evaluates patients in a standardized national first-line OA intervention program. Then, we identified those who were also registered in the Swedish Arthroplasty Register with a THA during the study period. We included only those with complete patient-reported outcome measures for pain, HRQoL, and satisfaction preoperatively and 1-year postoperatively, representing 78% (3411 of 4368) of patients, who had the same baseline characteristics as nonrespondents. Multiple logistic regression was used to assess the associations between 14 baseline factors and the aforementioned patient-reported outcomes of pain, HRQoL, and satisfaction 1 year after THA, adjusted for all included factors. RESULTS Five percent (156 of 3411) of the study population lacked improvement in pain, 11% (385 of 3411) reported no improvement in HRQoL, and 10% (339 of 3411) reported they were not satisfied with surgery 1 year after THA. Charnley Class C (multiple-joint OA or another condition that affects the ability to walk) was associated with all outcomes: lack of improvement in pain (OR 1.84 [95% CI 1.24 to 2.71]; p = 0.002), lack of improvement in HRQoL (OR 1.83 [95% CI 1.42 to 2.36]; p < 0.001), and not being satisfied (OR 1.40 [95% CI 1.07 to 1.82]; p = 0.01). Older age was associated with a lack of improvement in pain (OR per year 1.03 [95% CI 1.01 to 1.05]; p = 0.02), lack of improvement in HRQoL (OR per year 1.04 [95% CI 1.03 to 1.06]; p < 0.001), and not being satisfied (OR per year 1.03 [95% CI 1.01 to 1.05]; p < 0.001). Depression was associated with a lack of improvement in pain (OR 1.54 [95% CI 1.00 to 2.35]; p = 0.050) and with not being satisfied (OR 1.50 [95% CI 1.11 to 2.04]; p = 0.01) but not with a lack of improvement in HRQoL (OR 1.04 [95% CI 0.76 to 1.43]; p = 0.79). Having four or more comorbidities was associated with a lack of improvement in HRQoL (OR 2.08 [95% CI 1.39 to 3.10]; p < 0.001) but not with a lack of improvement in pain and not being satisfied. CONCLUSION The results of this study showed that older age, Charley Class C, and depression in patients with first-line OA interventions were risk factors associated with poorer outcomes regarding pain, HRQoL, and satisfaction after THA. Screening patients with hip OA for depression early in the disease course would provide increased time to optimize treatments and may contribute to better patient-reported pain, HRQoL, and satisfaction after future THA. Further research should focus on identifying the optimal time for surgery in patients with depression, as well as what targeted interventions for depression can improve outcome of surgery in these patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Kristin Gustafsson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Marit Eriksson
- Futurum - the Academy for Health and Care, Region Jönköping County, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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Luger M, Schopper C, Krottenthaler ES, Mahmoud M, Heyse T, Gotterbarm T, Klasan A. Not all questions are created equal: the weight of the Oxford Knee Scores questions in a multicentric validation study. J Orthop Traumatol 2023; 24:44. [PMID: 37592170 PMCID: PMC10435438 DOI: 10.1186/s10195-023-00722-6] [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: 03/27/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The Oxford Knee Score (OKS) has been designed for patients with knee osteoarthritis and has a widespread use. It has 12 questions, with each question having the same weight for the overall score. Some authors have observed a significant ceiling effect, especially when distinguishing slight postoperative differences. We hypothesized that each questions' weight will depend significantly on the patient's sociodemographic data and lifestyle. METHODS In this international multicentric prospective study, we included patients attending a specialist outpatient knee clinic. Each patient filled out 3 questionnaires: (a) demographic data and data pertaining to the OKS, (b) the standard OKS, and (c) the patient gave a mark on the weight of the importance of each question, using a 5-point Likert scale (G OKS). Linear regression models were used for the analysis. RESULTS In total 203 patients (106 female and 97 male) with a mean age of 64.5 (±12.7) years and a mean body mass index (BMI) of 29.34 (±5.45) kg/m2 were included. The most important questions for the patients were the questions for pain, washing, night pain, stability, and walking stairs with a median of 5. In the regression models, age, gender, and driving ability were the most important factors for the weight of each of the question. CONCLUSION The questions in the OKS differ significantly in weight for each patient, based on sociodemographic data, such as age, self-use of a car, and employment. With these differences, the Oxford Knee Score might be limited as an outcome measure. Adjustment of the OKS that incorporates the demographic differences into the final score might be useful if the ceiling effect is to be mitigated. LEVEL OF EVIDENCE Level II prospective prognostic study.
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
- Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
| | - Clemens Schopper
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Eliana S Krottenthaler
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Mahmoud Mahmoud
- Red Cross Hospital Frankfurt Germany, Königswarterstraße 16, 60316, Frankfurt am Main, Germany
| | - Thomas Heyse
- Red Cross Hospital Frankfurt Germany, Königswarterstraße 16, 60316, Frankfurt am Main, Germany
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Antonio Klasan
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
- AUVA UKH Steiermark, Göstinger Strasse 14, 8020, Graz, Austria
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21
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Yu B, Xiao Y, Dai H, Yu Y, Lin Y, Xu J. Spinal intradural extramedullary tumors: microscopic keyhole resection with the focus on intraoperative neurophysiological monitoring and long-term outcome. J Orthop Surg Res 2023; 18:598. [PMID: 37574567 PMCID: PMC10424432 DOI: 10.1186/s13018-023-04074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE Spinal schwannomas (SS) and spinal meningiomas (SM) account for most intradural extramedullary (IDEM) tumors. These tumors are usually benign lesions, which generally respond favorably to surgical excision. Few studies up to now tried to determine the long-term outcome after minimally invasive surgery (MIS) with multimodal intraoperative neurophysiological monitoring (IONM) for IDEM tumors. The aim of this study was to present one of the largest case series with special regard to IONM findings and long-term outcome after MIS-keyhole surgery with a tubular retractor system. METHODS Between January 2013 and August 2018, 87 patients with IDEM tumors who underwent tumor removal surgery via MIS-keyhole approach under multimodal IONM were retrospectively reviewed. The neurological status was assessed using a modified McCormick grading scale pre- and postoperatively. Multimodal IONM consisted of motor evoked potentials (MEP), somatosensory evoked potentials (SEP), and electromyography (EMG). Both short-term and long-term clinical evaluations as well as patients' medical files were retrospectively analyzed. RESULTS Surgeries were performed for resection of SS in 49 patients and SM in 38 patients. Tumor locations were cervical in 16.1%, thoracic in 48.3%, thoracolumbar in 4.6%, lumbar 31%. Critical IONM changes were detected in 9 operations (10.3%) in which there were 2 SEPs, 5 MEPs, and 2 EMG events. Three IONM changes (2 MEPs, 1 EMG) were turned out to be transient change in nature since they were resolved in a short time when immediate corrective actions were initiated. Six patients with permanent IONM changes (2SEPs, 3MEPs, 1EMG event), all deficits had resolved during hospitalization or on short -term follow-up evaluation. Sensitivity, specificity, and positive and negative predicted values of IONM were 100, 96, 67, and 100%, respectively. Gross total resection rate was 100%, and a stable or improved McCormick grade exhibited in all patients. No tumor recurrence and no spinal instability were found in the long-term follow-up evaluation (mean 5.2 ± 2.9 years postoperatively). Overall, 94% of patients were either satisfied or very satisfied with their operation, and 93% patients reported excellent or good general clinical outcome according to Odom's criteria. CONCLUSION MIS-keyhole surgery with multimodal IONM for IDEM tumors enables a high level of satisfaction and a satisfying long-term clinical and surgical outcome.
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Affiliation(s)
- Bofei Yu
- Division of Spine Surgery and Electrophysiological Center, Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, Fujian, China
| | - Yuhua Xiao
- Division of Spine Surgery and Electrophysiological Center, Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, Fujian, China
| | - Hanhao Dai
- Division of Spine Surgery and Electrophysiological Center, Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, Fujian, China
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Yunlong Yu
- Division of Spine Surgery and Electrophysiological Center, Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, Fujian, China
| | - Yuan Lin
- Division of Spine Surgery and Electrophysiological Center, Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, Fujian, China
| | - Jie Xu
- Division of Spine Surgery and Electrophysiological Center, Department of Orthopedics, Fujian Provincial Hospital, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, Fujian, China.
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22
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Reinbacher P, Schittek GA, Draschl A, Hecker A, Leithner A, Klim SM, Brunnader K, Koutp A, Hauer G, Sadoghi P. Local Periarticular Infiltration with Dexmedetomidine Results in Superior Patient Well-Being after Total Knee Arthroplasty Compared with Peripheral Nerve Blocks: A Randomized Controlled Clinical Trial with a Follow-Up of Two Years. J Clin Med 2023; 12:5088. [PMID: 37568489 PMCID: PMC10420252 DOI: 10.3390/jcm12155088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This study aimed to compare local periarticular infiltration (LIA) with ultra-sound guided regional anesthesia (USRA) with ropivacaine and dexmedetomidine as an additive agent in primary total knee arthroplasty (TKA). METHODS Fifty patients were randomized into two groups in a 1:1 ratio. Patients in the LIA group received local periarticular infiltration into the knee joint. The USRA group received two single-shot USRA blocks. Functional outcomes and satisfaction (range of movement, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Knee Score, and Forgotten Joint Score), including well-being, were analyzed preoperatively and at five days, six weeks, and one and two years postoperatively. RESULTS Functional outcomes did not significantly differ between the two groups at six weeks and one and two years after the implementation of TKA. A moderate correlation was observed in the LIA group regarding well-being and pain on day five. Six weeks postoperatively, the LIA group showed significantly superior well-being but worse pain scores. No differences between the groups in well-being and functional outcomes could be observed one and two years postoperatively. CONCLUSION Patients treated with LIA had superior postoperative well-being in the early postoperative phase of up to six weeks. Furthermore, LIA patients had similar functionality compared to patients treated with USRA but experienced significantly more pain six weeks postoperatively. LIA leads to improved short-term well-being, which is potentially beneficial for faster knee recovery. We believe that LIA benefits fast-track knee recovery with respect to improved short-term well-being, higher practicability, and faster application.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Gregor A. Schittek
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Andrzej Hecker
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- COREMED—Centre for Regenerative Medicine and Precision Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Sebastian Martin Klim
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Kevin Brunnader
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Amir Koutp
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Georg Hauer
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
| | - Patrick Sadoghi
- Department of Orthopaedics & Traumatology, Medical University of Graz, 8036 Graz, Austria; (P.R.); (P.S.)
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23
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Manjunath AK, Bloom DA, Fried JW, Bieganowski T, Slover JD, Macaulay WB, Schwarzkopf R. Pain-management protocol aimed at reducing opioids following total knee arthroplasty does not negatively impact patient satisfaction. Knee 2023; 43:106-113. [PMID: 37385111 DOI: 10.1016/j.knee.2023.06.003] [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: 08/16/2022] [Revised: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Prior research has demonstrated that the prescription of opioid medications may be associated with the desire to treat pain in order to achieve favorable patient satisfaction. The purpose of the current study was to investigate the effect of decreased opioid prescribing following total knee arthroplasty (TKA) on survey-administered patient satisfaction scores. METHOD This study is a retrospective review of prospectively collected survey data for patients who underwent primary elective TKA for the treatment of osteoarthritis (OA) between September 2014 and June 2019. All patients included had completed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) survey information. Patients were stratified into two cohorts based on whether their surgery took place prior to or subsequent to the implementation of an institutional-wide opioid-sparing regimen. RESULTS Of the 613 patients included, 488 (80%) were in the pre-protocol cohort and 125 (20%) in the post-protocol cohort. Rate of opioid refills (33.6% to 11.2%; p < 0.001) as well as length of stay (LOS, 2.40 ± 1.05 to 2.13 ± 1.13 days; p = 0.014) decreased significantly after protocol change while rate of current smokers increased significantly (4.1% to 10.4%; p = 0.011). No significant difference was observed in "top box" percentages for satisfaction with pain control (Pre: 70.5% vs Post: 72.8%; p = 0.775). CONCLUSIONS Protocols calling for reduced prescription of opioids following TKA resulted in significantly lower rates of opioid refills, and were associated with significantly shorter LOS, while causing no statistically significant deleterious changes in patient satisfaction, as measured by HCAPS survey. LOE: III. CLINICAL RELEVANCE This study suggests that HCAPS scores are not negatively impacted by a reduction in postoperative opioid analgesics.
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Affiliation(s)
- Amit K Manjunath
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA
| | - David A Bloom
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA
| | - Jordan W Fried
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA
| | | | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA
| | | | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA.
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24
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Arraut J, Thomas J, Oakley C, Umeh UO, Furgiuele DL, Schwarzkopf R. Peripheral Nerve Catheter Reduces Postoperative Opioid Consumption and Pain in Revision Total Knee Arthroplasty. Arthroplast Today 2023; 22:101155. [PMID: 37663072 PMCID: PMC10472143 DOI: 10.1016/j.artd.2023.101155] [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: 12/28/2022] [Revised: 03/22/2023] [Accepted: 05/08/2023] [Indexed: 09/05/2023] Open
Abstract
Background Patients undergoing revision total knee arthroplasty (rTKA) have historically received high doses of opioids during the perioperative period. As awareness of opioid use has heightened, opioid administration has continuously decreased. This study aimed to evaluate if peripheral nerve catheter (PNC) use in rTKA reduces opiate consumption while maintaining similar pain control and postoperative function levels. Methods A retrospective review of 354 patients who underwent rTKA between July 2019 and January 2022 was conducted. Fifty total patients who received an adductor canal PNC were propensity-matched 1:1 to a control group of 50 patients that did not receive a PNC. To assess the primary outcome of opiate consumption, nursing documented opiate administration events were converted into morphine milligram equivalents per 24-hour interval. Postoperative pain and functional status were assessed using the verbal rating scale for pain and the Activity Measure for Post-Acute Care scores, respectively. Results Compared to the control group, the PNC group demonstrated significantly lower overall inpatient opiate consumption (98.68 ± 117.03 vs 176.69 ± 203.47 morphine milligram equivalents; 44.15% decrease, P = .021) and lower verbal rating scale pain scores at 60 to 72 hours postoperatively (4.85 ± 1.24 vs 5.83 ± 1.35; 16.81% decrease, P = .038). There was no significant difference in Activity Measure for Post-Acute Care scores postoperatively (raw score: 19.41 ± 3.61 vs 19.46 ± 3.18; 0.26% decrease, P = .952). Finally, the PNC cohort was significantly less likely to be readmitted within 90 days after surgery (0.0% vs 12.0%; P = .012). Conclusions In rTKA patients, PNC can significantly reduce inpatient opioid consumption while maintaining a comparable functional recovery and superior pain control. Level III Evidence Retrospective Cohort Study.
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Affiliation(s)
- Jerry Arraut
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Jeremiah Thomas
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Christian Oakley
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Uchenna O. Umeh
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital for Special Surgery, New York, NY, USA
| | - David L. Furgiuele
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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25
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Boretto JG. CORR Insights®: Treatment Invasiveness and Illness Perceptions Are Strongly Associated With Outcome Expectations in Patients Treated for Hand or Wrist Conditions: A Cross-sectional Study. Clin Orthop Relat Res 2023; 481:1006-1007. [PMID: 36790436 PMCID: PMC10097536 DOI: 10.1097/corr.0000000000002590] [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] [Received: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Jorge G Boretto
- Head of the Hand and Upper Extremity Surgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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26
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Hewson DW, Scott CEH, Macfarlane AJR. Regional analgesia for total hip arthroplasty and Schwartz's paradox. Br J Anaesth 2023; 130:650-654. [PMID: 37105898 DOI: 10.1016/j.bja.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Enhanced recovery after total hip arthroplasty aims to facilitate return to function and early hospital discharge, but the role of novel fascial plane block techniques in such pathways is uncertain. A randomised trial by Kukreja and colleagues describes superior quality of recovery after hip arthroplasty in patients receiving a pericapsular nerve group (PENG) block. We discuss the trial findings in the context of ongoing uncertainty regarding best analgesic practice for this surgical procedure.
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Affiliation(s)
- David W Hewson
- Department of Anaesthesia and Critical Care Medicine, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Department of Anaesthesia, Queen's Medicine Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Chloe E H Scott
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK; Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Alan J R Macfarlane
- Department of Anaesthetics, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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27
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Yapp LZ, Scott CEH, MacDonald DJ, Howie CR, Simpson AHRW, Clement ND. Primary knee arthroplasty for osteoarthritis restores patients' health-related quality of life to normal population levels. Bone Joint J 2023; 105-B:365-372. [PMID: 36924161 DOI: 10.1302/0301-620x.105b4.bjj-2022-0659.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This study investigates whether primary knee arthroplasty (KA) restores health-related quality of life (HRQoL) to levels expected in the general population. This retrospective case-control study compared HRQoL data from two sources: patients undergoing primary KA in a university-teaching hospital (2013 to 2019), and the Health Survey for England (HSE; 2010 to 2012). Patient-level data from the HSE were used to represent the general population. Propensity score matching was used to balance covariates and facilitate group comparisons. A propensity score was estimated using logistic regression based upon the covariates sex, age, and BMI. Two matched cohorts with 3,029 patients each were obtained for the adjusted analyses (median age 70.3 (interquartile range (IQR) 64 to 77); number of female patients 3,233 (53.4%); median BMI 29.7 kg/m2 (IQR 26.5 to 33.7)). HRQoL was measured using the three-level version of the EuroQol five-dimension questionnaire (EQ-5D-3L), and summarized using the Index and EuroQol visual analogue scale (EQ-VAS) scores. Patients awaiting KA had significantly lower EQ-5D-3L Index scores than the general population (median 0.620 (IQR 0.16 to 0.69) vs median 0.796 (IQR 0.69 to 1.00); p < 0.001). By one year postoperatively, the median EQ-5D-3L Index score improved significantly in the KA cohort (mean change 0.32 (SD 0.33); p < 0.001), and demonstrated no clinically relevant differences when compared to the general population (median 0.796 (IQR 0.69 to 1.00) vs median 0.796 (IQR 0.69 to 1.00)). Compared to the general population cohort, the postoperative EQ-VAS was significantly higher in the KA cohort (p < 0.001). Subgroup comparisons demonstrated that older age groups had statistically better EQ-VAS scores than matched peers in the general population. Patients awaiting KA for osteoarthritis had significantly poorer HRQoL than the general population. However, within one year of surgery, primary KA restored HRQoL to levels expected for the patient's age-, BMI-, and sex-matched peers.
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Affiliation(s)
- Liam Z Yapp
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E H Scott
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Deborah J MacDonald
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Colin R Howie
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Hamish R W Simpson
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.,Bone & Joint Research , London, UK
| | - Nick D Clement
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.,Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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28
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Quinn J, Jones P, Randle R. Assessment of patient satisfaction following revision total knee arthroplasty. ANZ J Surg 2023; 93:995-1000. [PMID: 36881523 DOI: 10.1111/ans.18375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/27/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Patient satisfaction is becoming an increasingly important measure of healthcare quality. Satisfaction following RTKA is poorly described within the literature, resulting in difficulty for clinicians to manage patient expectations and obtain informed consent. METHODS We investigated postoperative satisfaction of RTKA patients by a single surgeon, using a single prosthesis, at a single institution. Patient satisfaction was assessed using structured telephone assessment questionnaires and review of orthopaedic/hospital records. The effect of patient and surgical characteristics on satisfaction was assessed using correlation coefficients and binary logistic regression in SPSS. RESULTS Two hundred and two RTKAs were performed in 178 patients between 2004 and 2015 inclusive. One hundred and twenty-four patients (143 RTKAs) were contactable to complete satisfaction assessment. Eighty-five percent of patients were satisfied and would have the RTKA again, 8% were unsure, 7% would not. Mean reported satisfaction on a numerical scale (1-10) was 8.17 (range 1-10), with 74% of patients scoring 8 or above, and 35% of patients scoring 10. The Mahomed Satisfaction Scale outcomes demonstrated a mean score of 87.7. High positive correlation was found between assessment tools. Logistic regression analysis identified factors contributing to satisfaction included ROM, OKS, BMI, and surgical time. CONCLUSION This cohort demonstrated high patient satisfaction rate following RTKA, utilizing simple and reliable outcome measurement tools. We found a high positive correlation between methods of assessment, and moderate positive correlation between satisfaction and functional outcomes. These results contribute to the understanding of satisfaction in RTKA patients, which may assist in informing patients of expected post-operative outcomes.
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Affiliation(s)
- Jonathan Quinn
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Peter Jones
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Ray Randle
- Gold Coast Centre for Bone and Joint Surgery, Gold Coast, Queensland, Australia
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29
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Alemu ME, Worku WZ, Berhie AY. Patient satisfaction and associated factors towards surgical service among patients undergoing surgery at referral hospitals in western Amhara Regional State, Ethiopia. Heliyon 2023; 9:e14266. [PMID: 36938460 PMCID: PMC10015238 DOI: 10.1016/j.heliyon.2023.e14266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
Background Patient satisfaction is a growing concern in all aspects of healthcare. Assessing patient satisfaction has paramount importance for measuring the level of care provided by a health system. The present study aimed to measure the levels of satisfaction among patients undergoing invasive surgery in the referral hospitals of the Western Amhara Regional State. Methods A cross-sectional study design was employed. The data were collected from 422 study participants from February 6 to April 6, 2020. The participants were selected using systematic random sampling technique. Interviewer administered questionnaire and chart review were used for data collection. A binary logistic regression model was used to identify the association between independent variables and patient satisfaction. Level of significance was considered at p value less than 0.05 with 95% confidence level. Result Of the total participants, 290 (68.7%, 95% CI: 64.5-73.5) were found to be satisfied with surgical service. Factors such as age >58 years [AOR = 3.80, 95% CI (1.53-9.46)], 47-58 years [AOR = 2.47, 95%CI (1.07-5.71)], those with no formal education [AOR = 2.73, 95% CI (1.18-6.32)], primary school education [AOR = 3.89, 95%CI (1.65-9.17)] and secondary school education [AOR = 3.37, 95%CI (1.38-8.23)], no history of previous surgical admission [AOR = 2.09, 95%CI (1.07-4.08)], length of stay in the hospital <7 days [AOR = 2.13,95%CI(1.21-3.75)] and elective admission for surgery [AOR = 1.75, 95%CI (1.03-2.99)] were significantly associated with patient satisfaction towards surgical service. Conclusion The proportion of patient satisfaction towards surgical service was found to be low. Factors including age, educational status, history of previous surgical admission, length of stay in the hospital and elective admission for surgery were associated with patient satisfaction. This suggests that healthcare organizations should focus on providing patients with respectful and compassionate patient care approach while paying close attention to how patients are treated.Moreover, in order to provide patient-focused care, health care providers should strengthen their usage of patient characteristics including age, educational level, and type of surgery while developing patient focused care plan.
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Key Words
- AOR, adjusted odd ratio
- CI, confidence interval
- COR, Crud Odd Ratio
- DMRH, debremarkos referral hospital
- Ethiopia
- FHRH, felege hiwot referral hospital
- GURH, gondar university referral hospital
- GYN&OBS, gynecology and obstetrics ward
- OPHTA, ophthalmology ward
- OW, orthopedic ward
- Patient satisfaction
- SW, surgical ward
- Surgical patients
- Surgical service
- TGRH, tibebe ghion referral hospital
- UK, united kingdom
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Affiliation(s)
- Mekides Engeda Alemu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Workie Zemene Worku
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Ethiopia
| | - Alemshet Yirga Berhie
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
- Corresponding author.
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Rubio-Morales M, Miralles-Muñoz FA, Gonzalez-Parreño S, Ruiz-Lozano M, Lizaur-Utrilla A, Vizcaya-Moreno MF. A relevant number of patients do not increase their engagement in physical, social and leisure activities at the medium-term after total knee arthroplasty: a prospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:1011-1017. [PMID: 36114843 DOI: 10.1007/s00167-022-07165-2] [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: 07/09/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to investigate the changes in engagement in physical, leisure and social activities in older adults following primary TKA. METHODS A prospective study of 106 patients with a mean age of 72.6 (SD 7.4) years undergoing primary TKA was performed. Physical, social and leisure activities performed by the patients preoperatively and postoperatively at 3-year were recorded. Activities were selected according to the age, and grouped as passive, moderate and high intensity. The energy spent in each activity was expressed in Metabolic Equivalent of Task (MET) units. Charlson Comorbidity Index, Mini-mental test and Western Ontario and McMaster Universities (WOMAC) scores were also used. Multivariate analysis was used to identify predictors of active patients. RESULTS Mean WOMAC significantly improved from preoperative (34.8, SD 11.8) to final follow-up (74.4, SD 11.1) (p = 0.001), and the mean energy spent increased from 10.7 (SD 13.6) to 28.2 (SD 16.2) MET-hour weekly (p = 0.001) with a decrease in the passive activities and increase in the moderate activities. However, the participation in high-intensity activities according to age was negligible. Only 65 (61.3%) patients were considered active postoperatively (weekly spending ≥ 40 MET), although the WOMAC scores were not significantly different between active and sedentary patients. Active patients compared with sedentary patients had a significant increase in engagement in physical, social and leisure activities, and a decrease in passive activities. Female gender (p = 0.037), less preoperatively participation in passive activities (p = 0.042), and greater participation in social activities (p = 0.027) were significant predictors of active patients at the final follow-up. CONCLUSION Overall, most patients increased their activity level postoperatively. However, 38.6% of patients had no increased engagement in moderate physical, social or leisure activities at the medium-term despite improvements in pain and function provided by TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Marta Rubio-Morales
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Santiago Gonzalez-Parreño
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain.,Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain
| | - Matias Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, Elda, 03600, Alicante, Spain. .,Department of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, San Juan de Alicante, 03202, Alicante, Spain.
| | - M Flores Vizcaya-Moreno
- Unit of Clinical Nursing Research, Faculty of Health Sciences, University of Alicante, Ctra S Vicente Raspeig s/n, 06390, Alicante, Spain
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Fuchs L, Givon A, Shweiki F, Hovav T. Arthroscopic knee debridement in osteoarthritis in the older age can be satisfactory. J Clin Orthop Trauma 2023; 38:102130. [PMID: 36860995 PMCID: PMC9969278 DOI: 10.1016/j.jcot.2023.102130] [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: 03/24/2022] [Revised: 01/19/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction Knee arthroscopy is one of the treatments for knee pain. In recent years, the use of knee arthroscopy in the treatment of osteoarthritis was challenged by several randomized-controlled trials, systematic reviews and meta-analyses. However, some design flaws are making the clinical decision harder. This study specifically explores the patient satisfaction from these surgeries to aid in clinical decision. Hypothesis Knee arthroscopy can relieve symptoms and delay further surgical treatment in the older age. Patients & methods Fifty patients accepted participation and were invited to a follow-up examination eight years post knee arthroscopy. All patients were above age 45 and diagnosed with degenerative meniscus tear and osteoarthritis. The patients filled follow-up questionnaires of function (WOMAC, IKDC, SF-12) and pain. The patients were asked to appreciate if they would have repeated the surgery retrospectively. The results were compared to a previous data base. Results Thirty-six patients (72%) reported satisfaction of 8 and above (scale of 0-10) from the surgery and would have repeated it. A higher SF-12 physical score pre-surgery predicted a higher satisfaction rate (p = 0.027). Patients who were more satisfied from the surgery improved post-surgery in all parameters compared with the less-satisfied group (p < 0.001). Patients above the age 60 had similar parameters pre- and post-surgery compared with patients under the age 60 (p > 0.05). Conclusions Patients between the ages 46-78 with degenerative meniscus tear and osteoarthritis felt they benefited from knee arthroscopy in an eight-year follow-up and would repeat the surgery. Our research may help with better patient selection and suggest knee arthroscopy can relive symptoms and delayed further surgical treatment for the older patient with clinical symptoms and signs of meniscus related pain, mild osteoarthritis, and failed conservative treatment. Level of evidence IV.
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Affiliation(s)
- Lee Fuchs
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Assaf Givon
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Fadi Shweiki
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Tavor Hovav
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
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Lee SC, Chang CF, Wang JY, Liang PJ. Translation and validation of the Taiwanese SarQoL, a quality of life questionnaire specific to sarcopenia. J Formos Med Assoc 2023; 122:249-257. [PMID: 36198517 DOI: 10.1016/j.jfma.2022.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/06/2022] [Accepted: 09/19/2022] [Indexed: 10/06/2022] Open
Abstract
BACKGROUND The Sarcopenia Quality of Life (SarQoL) questionnaire has been translated into various languages. This study validated the Taiwanese version of the SarQoL (SarQoL-TW) questionnaire. METHODS Forward-backward translation was conducted, along with a test of the prefinal version of the translated questionnaire. To validate the psychometric properties of the questionnaire, 50 older adults with sarcopenia and 50 older adults without sarcopenia completed the SarQoL-TW, the Short Form12 Health Survey (SF-12), and the EQ-5D-3L questionnaire. Participants with sarcopenia were asked to complete the SarQoL-TW questionnaire once more after 2 weeks. Validating the psychometric properties of the SarQoL-TW questionnaire involved assessing its discriminative power, internal consistency, construct validity, test-retest reliability, and potential floor and ceiling effects. RESULTS The SarQoL-TW questionnaire was translated without major difficulties. The psychometric analysis revealed that older adults with sarcopenia scored significantly lower on the SarQoL-TW, both overall and in some of the domains. The Cronbach's alpha of 0.846 indicated high internal consistency. The SarQoL-TW questionnaire correlated well with similar constructs on the SF-12 and EQ-5D-3L for convergent validity and correlated weakly with distinct domains for divergent validity, confirming its favorable construct validity. The test-retest reliability was excellent (intraclass correlation coefficient: 0.970). Neither floor nor ceiling effects were observed. CONCLUSION The SarQoL-TW questionnaire is a reliable and valid questionnaire, useful for assessing quality of life in older adults with sarcopenia in clinical practice and research.
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Affiliation(s)
- Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Fen Chang
- Department of Healthcare Administration, College of Medical and Health Sciences, Asia University, Taichung, Taiwan; Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Sciences, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Pei-Jung Liang
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
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Dai Y, Diao N, Lin W, Yang G, Kang H, Wang F. Patient-Reported Outcomes and Risk Factors for Decreased Improvement after Patellofemoral Arthroplasty. J Knee Surg 2023; 36:382-388. [PMID: 34583395 DOI: 10.1055/s-0041-1735159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patellofemoral arthroplasty (PFA) is acknowledged as the method for the treatment of isolated patellofemoral osteoarthritis (PFOA). Few previous studies have assessed the patient-reported outcomes (PROs) and risk factors of less improvement of PROs in patients undergoing PFA. A retrospective analysis was performed, including all patients who had undergone PFA. Pre- and postoperative PROs included the Oxford Knee Score (OKS) and Kujala score. Univariate and multivariate statistical analyses were performed to assess influencing factors of less improvement of PROs including the demographic factors (gender, age, body mass index, smoking, opioid usage, and duration of symptoms [DOSs]), surgical factors (concomitant surgery), and imaging factors (trochlear dysplasia [TD], patellar height, the degree of PFOA). A total of 46 PFAs were analyzed with a mean follow-up of 37 ± 7 months. The mean age at surgery was 61.1 ± 7.7 years. Patients showed significant improvement in all PROs (p < 0.001). Patients with TD preoperatively have greater improvement in OKS and Kujala score postoperatively (19.2 ± 5.0 vs. 23.1 ± 3.6, p = 0.038). Longer DOSs (≥1 year) had a greater mean improvement in OKS and Kujala score (p = 0.011 and p = 0.000). According to the measurement of patella height, patients with patella alta (Caton-Deschamps index [CDI] ≥1.3) showed less improvement in both OKS and Kujala score (p = 0.000 and p = 0.002). PFA is a safe and efficient surgery with good PROs. Patella alta with a CDI ≥1.3 and duration of preoperative symptoms ≤ 1 year were risk factors for decreased OKS and Kujala score improvement, while the preoperative presence of TD was significantly predictive factors for increased OKS improvement.
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Affiliation(s)
- Yike Dai
- Department of Orthopaedic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Naicheng Diao
- Department of Orthopaedic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wei Lin
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Guangmin Yang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Huijun Kang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Fei Wang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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McCormick JR, Kruchten MC, Mehta N, Damodar D, Horner NS, Carey KD, Nicholson GP, Verma NN, Garrigues GE. Internet search analytics for shoulder arthroplasty: what questions are patients asking? Clin Shoulder Elb 2023; 26:55-63. [PMID: 36919508 PMCID: PMC10030990 DOI: 10.5397/cise.2022.01347] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/02/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Common questions about shoulder arthroplasty (SA) searched online by patients and the quality of this content are unknown. The purpose of this study is to uncover questions SA patients search online and determine types and quality of webpages encountered. METHODS The "People also ask" section of Google Search was queried to return 900 questions and associated webpages for general, anatomic, and reverse SA. Questions and webpages were categorized using the Rothwell classification of questions and assessed for quality using the Journal of the American Medical Association (JAMA) benchmark criteria. RESULTS According to Rothwell classification, the composition of questions was fact (54.0%), value (24.7%), and policy (21.3%). The most common webpage categories were medical practice (24.6%), academic (23.2%), and medical information sites (14.4%). Journal articles represented 8.9% of results. The average JAMA score for all webpages was 1.69. Journals had the highest average JAMA score (3.91), while medical practice sites had the lowest (0.89). The most common question was, "How long does it take to recover from shoulder replacement?" CONCLUSIONS The most common questions SA patients ask online involve specific postoperative activities and the timeline of recovery. Most information is from low-quality, non-peer-reviewed websites, highlighting the need for improvement in online resources. By understanding the questions patients are asking online, surgeons can tailor preoperative education to common patient concerns and improve postoperative outcomes.
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Affiliation(s)
| | - Matthew C Kruchten
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Dhanur Damodar
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nolan S Horner
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kyle D Carey
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Grant E Garrigues
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Arraut J, Thomas J, Oakley CT, Barzideh OS, Rozell JC, Schwarzkopf R. The AAHKS Best Podium Presentation Research Award: A Second Dose of Dexamethasone Reduces Postoperative Opioid Consumption and Pain in Total Joint Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00098-0. [PMID: 36775214 DOI: 10.1016/j.arth.2023.02.007] [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: 08/11/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND The optimal administration of dexamethasone for postoperative pain management and recovery following primary elective total joint arthroplasty (TJA) remains unclear. This study aimed to evaluate the effect of a second intravenous (IV) dose of dexamethasone on postoperative pain scores, inpatient opioid consumption, and functional recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS A retrospective review was conducted of 2,256 primary elective THAs and 1,951 primary elective TKAs between May 2020 and April 2021. Patients who received 2 perioperative doses (2D) of dexamethasone 10 mg IV were propensity-matched 1:1 to a control group who received 1 perioperative dose (1D). Primary outcomes were opiate consumption as morphine milligram equivalences (MMEs), postoperative pain as Verbal Rating Scale (VRS) pain scores, and functional status assessed by the Activity Measure for Post-Acute Care (AM-PAC) scores. RESULTS The 2D THA and 2D TKA cohorts consumed significantly less opiates at the 24 to 48-hour and 48 to 72-hour intervals. The 2D TKA cohort had significantly lower total opiate consumption compared to the 1D TKA cohort. Compared to the 1D cohorts, the 2D THA cohort and 2D TKA cohorts had significantly lower pain scores at the 48 to 60-hour interval; additionally, the 2D TKA cohort had significantly lower pain scores in the 36 to 48-hour interval. AM-PAC scores did not differ between cohorts for both TKA and THA at any interval. CONCLUSION The administration of a second perioperative dexamethasone dose significantly decreased opioid consumption in the immediate postoperative period. Inpatient opioid administration can be significantly reduced while maintaining comparable functional recovery and superior pain control. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Jerry Arraut
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Jeremiah Thomas
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Christian T Oakley
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Omid S Barzideh
- Department of Orthopedic Surgery, NYU Langone Health, Mineola, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Turnbull AE, Lee EM, Dinglas VD, Beesley S, Bose S, Banner-Goodspeed V, Hopkins RO, Jackson JC, Mir-Kasimov M, Sevin CM, Brown SM, Needham DM. Health Expectations and Quality of Life After Acute Respiratory Failure: A Multicenter Prospective Cohort Study. Chest 2023:S0012-3692(23)00120-4. [PMID: 36682611 DOI: 10.1016/j.chest.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Patients often have high expectations for recovery after critical illness, but the impact of these expectations on subsequent quality of life (QoL) after serious illnesses has not been evaluated empirically. RESEARCH QUESTION Among adult survivors of acute respiratory failure (ARF), are met vs unmet expectations for health associated with self-reported QoL 6 months after discharge? STUDY DESIGN AND METHODS Prospective longitudinal cohort study enrolling consecutive adult patients with ARF managed in ICUs at five academic medical centers. At hospital discharge, we evaluated participants' expected health 6 months in the future via a visual analog scale (VAS; range, 0-100), with higher scores representing better expected health. At the 6-month follow-up, perceived health was assessed using the EQ-5D VAS, and QoL was assessed using the WHOQOL-BREF instrument. Participants' health expectations were categorized as having been met when perceived health at 6 months was no more than eight points lower than their expectation at study enrollment. The primary analysis compared WHOQOL-BREF domain scores (range, 0-100) at 6 months after discharge in patients with met vs unmet health expectations using the nonparametric Mann-Whitney U test. Secondary analysis modeled WHOQOL-BREF domain scores using multivariate regression, and sensitivity analyses assessed QoL using EQ-5D-5L index values. RESULTS In the primary analysis, QoL was significantly better among participants with met vs unmet health expectations across all domains of the WHOQOL-BREF: physical health (estimated difference in scores: median, 19 [interquartile range (IQR), 12-15]; P < .001), psychological health (median, 12 [IQR, 6-18]; P < .001), social relationships (median, 6 [IQR, 0-13]; P = .02), and environmental health (median, 12 [IQR, 6-13]; P < .001). In multivariate regression, the difference between expected and perceived health remained associated significantly with the physical health domain score. INTERPRETATION Fulfillment of health expectations is associated with better QoL after ARF, suggesting a mechanism underpinning successful ICU recovery programs that incorporates normalization and expectation management.
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Affiliation(s)
- Alison E Turnbull
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD.
| | - Emma M Lee
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD
| | - Sarah Beesley
- Division of Pulmonary and Critical Care Medicine, University of Utah; Division of Pulmonary and Critical Care Medicine; Center for Humanizing Critical Care
| | - Somnath Bose
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA; Division of Pulmonary and Critical Care Medicine
| | | | - Ramona O Hopkins
- Center for Humanizing Critical Care; Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT
| | - James C Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Mustafa Mir-Kasimov
- Division of Pulmonary and Critical Care Medicine, University of Utah; Intermountain Medical Center, the Salt Lake City Veterans Administration, Salt Lake City
| | - Carla M Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Samuel M Brown
- Division of Pulmonary and Critical Care Medicine, University of Utah; Center for Humanizing Critical Care
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Department of Physical Medicine and Rehabilitation, School of Medicine, , Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD
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Mardan-Dezfouli S, Reid OG, Fliss MD, Stevenson J, Harris D, Lyon MR, Koehle MS, Mitchell CJ. The Impact of Abdominal Body Contouring Surgery on Physical Function After Massive Weight Loss: A Pilot Prospective Matched Comparison. Aesthet Surg J 2023; 43:NP28-NP37. [PMID: 35946751 DOI: 10.1093/asj/sjac220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Many individuals develop excess skin (ES) following massive weight loss (MWL). Patient-reported outcomes demonstrate that abdominal ES negatively impacts perceived physical function which is improved by abdominal body contouring surgery (ABCS). However, the effect of ABCS on objective measures of physical function is unknown. OBJECTIVES The aim of this study was to examine the impact of ABCS on objective measures of physical function in individuals who have undergone MWL. METHODS Patients who have undergone MWL with abdominal ES (grade, ≥2) underwent the following physical function assessments: 9-item modified physical performance test (mPPT), chair stand, star excursion balance test (SEBT), timed up and go (TUG), modified agility T test, and 6-minute walk test (6-MWT). Perception of physical exertion and BODY-Q questionnaire scales were also collected. Nonsurgical controls (n = 21) and those who had undergone ABCS (n = 6) after the first visit performed a second physical function assessment 8 to 12 weeks later to allow for postoperative healing. RESULTS No ceiling or floor effect was detected for any physical function measure. The intraclass correlation coefficient was 0.78 (95% CI, 0.44, 0.91) for the mPPT and >0.80 for all other measures. The effect sizes were 0.74 (75% CI, 0.19, 1.28) for the mPPT, 0.54 (75% CI, 0.00, 1.08) for the SEBT, -0.63 (75% CI, -1.17, -0.09) for the modified agility T test, and 0.79 (75% CI, 0.24, 0.13) for the 6-MWT. CONCLUSIONS The mPPT and tests involving dynamic balance, agility, and walking were reliable and showed medium to large effect sizes, suggesting that these tests may be sensitive to change following ABCS. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | - Owen G Reid
- Division of Plastic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Matthew D Fliss
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Jordan Stevenson
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - David Harris
- Richmond Metabolic and Bariatric Surgery, Vancouver, BC, Canada
| | - Michael R Lyon
- Obesity Medicine and Diabetes Institute, Coquitlam, BC, Canada
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Cameron J Mitchell
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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Higher preoperative expectations predict better outcomes in shoulder surgery patients. Knee Surg Sports Traumatol Arthrosc 2023; 31:185-192. [PMID: 35780400 DOI: 10.1007/s00167-022-07053-9] [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: 02/18/2022] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study is to determine if preoperative expectations (PE) are an independent predictor of greater 2-year outcomes and greater improvement from baseline in shoulder surgery patients. METHODS Two-hundred and sixteen patients who underwent shoulder surgery at one institution were studied. Patients completed both preoperative and 2-year follow-up questionnaires including PROMIS (Patient-Reported Outcome Measurement Information System) computer-adaptive testing in six domains, American Shoulder and Elbow Surgeons (ASES) score, shoulder numeric pain scale (NPS), and the Marx Shoulder Activity Rating Scale (MARS). PE were measured using the Musculoskeletal Outcomes and Data Evaluation Management System (MODEMS) expectations domain, and satisfaction was measured via the Surgical Satisfaction Questionnaire (SSQ-8). RESULTS The mean PE score was 86.2 ± 17.8. Greater PE were associated with significantly better 2-year scores for ASES, NPS, MARS, SSQ8, and PROMIS domains of Physical Function, Fatigue, Pain Interference Fatigue and Social Satisfaction. Multivariable analyses demonstrated that greater PE were an independent predictor of both better 2-year scores and greater improvement for PROMIS SS (p < 0.001), ASES (p = 0.007), and shoulder NPS (p = 0.011). CONCLUSION Greater PE are positively associated with numerous patient-based outcomes 2 years after surgery. With regards to pain relief, shoulder function, and social satisfaction, higher PE are also predictive of better outcome scores and more improvement. This study suggests that preoperative assessment of shoulder surgery PE is important, and that counseling patients to optimize realistic expectations may lead to superior outcomes. LEVEL OF EVIDENCE III.
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Janhunen M, Katajapuu N, Paloneva J, Pamilo K, Oksanen A, Keemu H, Karvonen M, Luimula M, Korpelainen R, Jämsä T, Kautiainen H, Mäkelä K, Heinonen A, Aartolahti E. Effects of a home-based, exergaming intervention on physical function and pain after total knee replacement in older adults: a randomised controlled trial. BMJ Open Sport Exerc Med 2023; 9:e001416. [PMID: 36896366 PMCID: PMC9990686 DOI: 10.1136/bmjsem-2022-001416] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
Objectives To investigate the effects of 4 months of customised, home-based exergaming on physical function and pain after total knee replacement (TKR) compared with standard exercise protocol. Methods In this non-blinded randomised controlled trial, 52 individuals aged 60-75 years undergoing TKR were randomised into an exergaming (intervention group, IG) or a standard exercising group (control group, CG). Primary outcomes were physical function and pain measured before and after (2 months and 4 months) surgery using the Oxford Knee Score (OKS) and Timed Up and Go (TUG) test. Secondary outcomes included measures of the Visual Analogue Scale, 10m walking, short physical performance battery, isometric knee extension and flexion force, knee range of movement and satisfaction with the operated knee. Results Improvement in mobility measured by TUG was greater in the IG (n=21) at 2 (p=0.019) and 4 months (p=0.040) than in the CG (n=25). The TUG improved in the IG by -1.9 s (95% CI, -2.9 to -1.0), while it changed by -0.6 s (95% CI -1.4 to 0.3) in the CG. There were no differences between the groups in the OKS or secondary outcomes over 4 months. 100% of patients in the IG and 74% in the CG were satisfied with the operated knee. Conclusion In patients who have undergone TKR, training at home with customised exergames was more effective in mobility and early satisfaction and as effective as standard exercise in pain and other physical functions. In both groups, knee-related function and pain improvement can be considered clinically meaningful. Trial registration number NCT03717727.
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Affiliation(s)
- Maarit Janhunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Faculty of Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Niina Katajapuu
- Faculty of Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Healthcare District and University of Eastern Finland, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Orthopedics, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Airi Oksanen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Hannes Keemu
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko Karvonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika Luimula
- Faculty of Business and Engineering, Turku University of Applied Sciences, Turku, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eeva Aartolahti
- Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
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Sowers CB, Carrero AC, Cyrus JW, Ross JA, Golladay GJ, Patel NK. Return to Sports After Total Hip Arthroplasty: An Umbrella Review for Consensus Guidelines. Am J Sports Med 2023; 51:271-278. [PMID: 34668788 DOI: 10.1177/03635465211045698] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current recommendations on safe return to sports (RTS) after total hip arthroplasty (THA) are subjective and based on studies of varying quality. PURPOSE The aim of this study was to synthesize systematic reviews and meta-analyses on post-THA RTS to propose practice guidelines identifying which sports can be resumed, when they can be resumed, and what risks are present. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS This umbrella review followed the Joanna Briggs Institute (JBI) protocol and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Embase, Medline, and Cochrane databases were searched. Included studies were either systematic reviews or meta-analyses addressing primary or secondary outcomes. Outcomes of interest included safe sports after THA, time to RTS, prognostic indicators of RTS, reasons patients do not RTS, percentage of patients who RTS, implant complications, and objective classification of sports by impact level. Included reviews had data extracted and were assessed for methodological quality using the JBI protocol. The authors defined RTS as "returning to a sport the patient participated in at any point preoperatively." RESULTS Patients demonstrated a trend toward lower-impact sports postoperatively. Sports were classified as low (eg, walking), moderate (eg, downhill skiing), or high impact (eg, soccer). A total of 82% (range, 55%-104%) of patients were able to RTS at a mean time of 6 months (range, 4-7 months). The best prognostic indicator for RTS was previous experience in that sport. The main reason patients did not RTS was surgeon recommendation. Aseptic loosening was the most cited complication after RTS. CONCLUSION Most patients are able to return to preoperative levels of low- (eg, walking) and moderate-impact (eg, hiking) sports between 7 and 12 months after THA. Patients planning a return to high-impact (eg, singles tennis) sports should be counseled on the possible risks of traumatic injuries and aseptic loosening and monitored closely.
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Affiliation(s)
| | - Alberto C Carrero
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA
| | - John W Cyrus
- Virginia Commonwealth University, School of Medicine; Richmond, Virginia, USA
| | - Jeremy A Ross
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA
| | | | - Nirav K Patel
- Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA
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Gal R, Charest-Morin R, Verlaan JJ, Fisher CG, Wessels H, Verkooijen HM, Versteeg AL. Patient Expectations About Palliative Treatment for Symptomatic Spinal Metastases: A Qualitative Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:4-9. [PMID: 35672228 DOI: 10.1016/j.jval.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 04/14/2022] [Accepted: 05/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Patients with spinal metastases often receive palliative surgery or radiation therapy to maintain or improve health-related quality of life. Patients with unrealistic expectations regarding treatment outcomes have been shown to be less satisfied with their post-treatment health status. This study evaluated expectations of patients with spinal metastases scheduled for surgery and/or radiation therapy. METHODS Individual semistructured interviews were conducted with patients with symptomatic spinal metastases before and 6 weeks after surgery and/or radiation therapy. Expectations regarding treatment outcomes were discussed before treatment, and level of fulfillment of these pretreatment expectations was discussed after treatment. Interviews were recorded, transcribed and analyzed according to the thematic analysis method to identify themes. RESULTS Before treatment, patients thought they were not, or minimally, informed about (expected) treatment outcomes, but they felt well informed about treatment procedures and possible complications. Although patients expected pain relief and improvement in daily functioning, they found it difficult to describe any recovery timeline or the impact of these expected improvements on their daily life. Patients generally understood that treatment was not curative, but lacked insight into the impact of treatment on life expectancy given that this was hardly discussed by their surgeon and/or radiation oncologist. Pretreatment expectations regarding pain and daily functioning were only partially met in most patients post-treatment. CONCLUSIONS Patients thought they were not, or only minimally, informed about expected outcomes after surgery and/or radiation therapy for symptomatic spinal metastases. Improvements in patient-physician communication and counseling could help guide patients toward realistic pretreatment expectations.
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Affiliation(s)
- Roxanne Gal
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
| | - Raphäele Charest-Morin
- Division of Spine, Department of Orthopaedics, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Jorrit-Jan Verlaan
- Department of Orthopaedic Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Charles G Fisher
- Division of Spine, Department of Orthopaedics, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada
| | - Hester Wessels
- Department of Corporate Communications, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Anne L Versteeg
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
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Decision regret after primary hip and knee replacement surgery. J Orthop Sci 2023; 28:167-172. [PMID: 34838410 DOI: 10.1016/j.jos.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Decision regret (DR) is a recognised patient centered outcome measure following a therapeutic intervention. This study aimed to measure DR following primary total hip and knee arthroplasty (THA/TKA), to assess for differences between these patients and explore possible contributory factors. METHOD DR was measured using the DR scale in a group of THA and TKA patients, between February 2017 and December 2018, who had made a decision to have joint replacement surgery within the previous year and were able to reflect on their outcomes. RESULTS On analysis a significantly greater proportion of TKA patients reported moderate or severe (Mod/Sev) DR [17.1% (56/328)] compared to THA patients [4.8% (18/376)]. Conversely, a significantly reduced proportion of TKA patients reported having No DR [42.1% (138/328)] compared to THA patients [66.7% (251/376)]. On multivariate logistic regression analysis joint replacement type (TKA/THA) and change in Oxford score were significant predictors of DR with gender, age, BMI and ASA grade not significantly associated. TKA patients were more than twice as likely to have Mod/Sev DR compared THA patients (Odds Ratio = 2.33 (95% CI 1.24-4.39)). Patients with poorer improvements in pain and function 1-year post-operatively (measured by Oxford scores) reported greater levels of DR. CONCLUSION TKA patients were significantly more likely to report greater levels of DR 1-year following surgery compared to THA patients. For both TKA and THA patients, greater levels of DR were associated with poorer Oxford scores. The use of decision aids to reduce post-operative DR in joint replacement patients should be examined especially for knee replacement patients.
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Mantilla M, Stangl-Correa P, Stangl-Herrera W, Cantor E, Echeverry-Vélez A, Palacio JC. Validación al español del instrumento Self-Administered Patient Satisfaction Scale (SAPS) para reemplazo total de cadera o de rodilla. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.6.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Introducción: La satisfacción del paciente es un indicador importante al evaluar los resultados clínicos de un reemplazo total de cadera o rodilla. El objetivo de este estudio fue validar al idioma español el instrumento Self-Administered Patient Satisfaction Scale (SAPS) para reemplazo total de cadera o rodilla, y estudiar sus propiedades psicométricas.
Materiales y Métodos: Se realizó un estudio de validación de corte transversal para evaluar el contenido, la consistencia interna y la validez de criterio de la SAPS. Se incluyó a 105 pacientes con reemplazo total de cadera o rodilla. La validez de criterio fue valorada con las escalas WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) y SF-36 (36-Item Short Form Survey).
Resultados: Se analizó a 50 pacientes con reemplazo total de cadera y 55 con reemplazo total de rodilla y una mediana de seguimiento de 14 meses (rango intercuartílico, 11-19), con una edad de 71.3 ± 11.6 años; 73,3% (77) eran mujeres. El coeficiente alfa de Cronbach fue de 0,797 indicando una consistencia interna aceptable. La correlación entre las escalas SAPS y WOMAC fue moderada (coeficiente de Spearman 0,488; p <0,05), al igual que con el componente físico de la SF-36 (coeficiente de Spearman 0,525; p <0,05).
Conclusión: La versión en español de la SAPS es una herramienta válida y confiable para medir el grado de satisfacción de los pacientes sometidos a reemplazo total de cadera o rodilla, tiene propiedades psicométricas similares a las de la escala original.
Nivel de Evidencia: II
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Abdalla I, Robertson AP, Tippett V, Walsh TP, Platt SR. "I'd never have that operation again" - a mixed-methods study on how patients react to adverse outcomes following foot and ankle surgery. J Foot Ankle Res 2022; 15:85. [PMID: 36494742 PMCID: PMC9733247 DOI: 10.1186/s13047-022-00590-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adverse outcomes arising from foot and ankle surgery, including lack of pain relief, increased disability and perioperative complications are infrequent but inevitable. This mixed-methods study aims to explore the impact of adverse outcomes on patients following nonemergent foot and ankle surgery. METHODS Patients who underwent foot and ankle surgery over a two-year period were invited to participate in this study if they reported an adverse outcome. Qualitative assessment consisted of individual semi-structured interviews, designed to explore the decision they made to have surgery and the impact of the outcome after surgery. Quantitative assessment was performed using questionnaires on demographics, current analgesia, foot pain, health-related quality of life, psychological health, and regret. RESULTS Twelve participants (eight women) consented for inclusion in this study. Current foot pain was high in 10 participants, five met the criteria for central sensitisation syndrome and two had clinically significant pain catastrophising. Most participants regretted their decision to have surgery. The three major themes identified were expectations, communication, and alternatives. CONCLUSIONS Self-reported adverse outcomes following foot and ankle surgery were prevalent and participants in this study consistently complained of persistent pain. Regret was common and reasons cited for their adverse outcomes centred around the feelings of inadequate communication and failure to meet expectations.
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Affiliation(s)
- Israa Abdalla
- grid.1024.70000000089150953Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059 Australia
| | - Aaron P. Robertson
- grid.1024.70000000089150953Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059 Australia
| | - Vivienne Tippett
- grid.1024.70000000089150953Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059 Australia
| | - Tom P. Walsh
- grid.1024.70000000089150953Faculty of Health, School of Clinical Sciences, Queensland University of Technology (QUT), Kelvin Grove, Queensland 4059 Australia ,grid.413154.60000 0004 0625 9072Department of Orthopaedics, Gold Coast Hospital and Health Service, Southport, Queensland 4215 Australia
| | - Simon R. Platt
- grid.413154.60000 0004 0625 9072Department of Orthopaedics, Gold Coast Hospital and Health Service, Southport, Queensland 4215 Australia
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Total knee arthroplasty in post-traumatic osteoarthritis is more challenging, but results in similar patient satisfaction - An analysis of 1646 cases. Knee 2022; 39:116-123. [PMID: 36191398 DOI: 10.1016/j.knee.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with post-traumatic osteoarthritis (PTOA) present a variety of technical challenges to surgeons. Surgical parameters, complication rates and patient-reported outcomes (PROs) have been reported as detrimental in total knee arthroplasty (TKA) for PTOA. The purpose of this study was to compare these variables and satisfaction with the results of TKA in patients with post-traumatic osteoarthritis with a matched-pair cohort of primary osteoarthritis (POA). METHODS A registry-embedded prospective case-control study was performed. Of a total of 1646 TKAs, 155 were performed due to PTOA between 2012 and 2019. One-hundred and thirty-six could be one-to-one propensity score-matched to patients with POA undergoing primary TKA based on similar patient demographic variables. Outcomes investigated included operation time, estimated blood loss, types of implants, postoperative complications and PROs pre- and 1 year postoperatively as well as satisfaction with the results of surgery. Sub-cohort analysis was performed for patients with prior fracture and soft tissue trauma, respectively. RESULTS Surgical parameters were significantly different in disadvantages of PTOA: operation time (P < 0.001), estimated blood loss (P < 0.001), blood transfusions (P = 0.039), type of implants (P < 0.001). Manipulation under anaesthesia (MUA) was necessary more often in the PTOA fracture group (odds ratio 5.01, (95% confidence interval 1.04; 24.07). PRO demonstrated no substantial differences after 1 year. Satisfaction with the results of TKA was as equally high in all cohorts. CONCLUSIONS This study demonstrated that TKAs in patients with PTOA require higher surgical effort but can result in similar PROs and satisfaction compared to POA, regardless of the underlying trauma.
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Yapp LZ, Clement ND, Moran M, Clarke JV, Simpson AHRW, Scott CEH. The estimated lifetime risk of revision after primary knee arthroplasty is influenced by age, sex, and indication. Bone Joint J 2022; 104-B:1313-1322. [DOI: 10.1302/0301-620x.104b12.bjj-2021-1631.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Aims The aim of this study was to assess factors associated with the estimated lifetime risk of revision surgery after primary knee arthroplasty (KA). Methods All patients from the Scottish Arthroplasty Project dataset undergoing primary KA during the period 1 January 1998 to 31 December 2019 were included. The cumulative incidence function for revision and death was calculated up to 20 years. Adjusted analyses used cause-specific Cox regression modelling to determine the influence of patient factors. The lifetime risk was calculated as a percentage for patients aged between 45 and 99 years using multiple-decrement life table methodology. Results The estimated lifetime risk of revision ranged between 32.7% (95% confidence interval (CI) 22.6 to 47.3) for patients aged 45 to 49 years and 0.6% (95% CI 0.1 to 4.5) for patients aged over 90 years. At 20 years, the overall cumulative incidence of revision (6.8% (95% CI 6.6 to 7.0)) was significantly less than that of death (66.3% (95% CI 65.4 to 67.1)). Adjusted analyses demonstrated converse effect of increasing age on risk of revision (hazard ratio (HR) 0.5 (95% CI 0.5 to 0.6)) and death (HR 3.6 (95% CI 3.4 to 3.7)). Male sex was associated with increased risks of revision (HR 1.1 (95% CI 1.1 to 1.2); p < 0.001) and death (HR 1.4 (95% CI 1.3 to 1.4); p < 0.001). Compared to patients undergoing primary KA for osteoarthritis, patients with inflammatory arthropathy had a higher risk of death (HR 1.7 (95% CI 1.7 to 1.8); p < 0.001), but were less likely to be revised (HR 0.9 (95% CI 0.7 to 1.0); p < 0.001). Patients with a greater number of comorbidities (HR 1.4 (95% CI 1.3 to 1.4)) and greater levels of socioeconomic deprivation (HR 1.4 (95% CI 1.4 to 1.5)) were at increased risk of death, but neither increased the risk of revision. Conclusion The estimated lifetime risk of revision KA varied depending on patient sex, age, and underlying diagnosis. Patients aged between 45 and 49 years had a one in three risk of undergoing revision surgery within their lifetime, which decreased with age to one in 159 in those aged 90 years or more. Cite this article: Bone Joint J 2022;104-B(12):1313–1322.
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Affiliation(s)
- Liam Z. Yapp
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Arthroplasty Project, NHS Public Health Scotland, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D. Clement
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Matthew Moran
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Arthroplasty Project, NHS Public Health Scotland, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jon V. Clarke
- Scottish Arthroplasty Project, NHS Public Health Scotland, Edinburgh, UK
- Golden Jubilee University National Hospital, Clydebank, UK
| | - A. Hamish R. W. Simpson
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chloe E. H. Scott
- Department of Orthopaedics, Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Laoruengthana A, Rattanaprichavej P, Kositanurit I, Saenghirunvattana C, Samapath P, Pongpirul K. Adductor Canal Block Combined with Interspace between the Popliteal Artery and Capsule of the Knee (iPACK) versus Periarticular Injection for Total Knee Arthroplasty. Clin Orthop Surg 2022; 14:514-521. [PMID: 36518937 PMCID: PMC9715935 DOI: 10.4055/cios21108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The combination of the adductor canal block (ACB) and the infiltration of anesthetic solution into the interspace between the popliteal artery and capsule of the knee (iPACK) has become increasingly used to augment rapid recovery protocols in total knee arthroplasty (TKA). However, its efficacy in comparison with periarticular anesthetic injection (PAI) alone has yet to be evaluated. Hence, we conducted a retrospective study to compare PAI and ACB + iPACK for controlling pain after TKA. METHODS Propensity scores, incorporating American Society of Anesthesiologists scores, body mass index, age, and sex, were used to match the ACB + iPACK group with the PAI group. All patients received the identical surgical technique and postoperative care. Outcome measures were visual analog scale (VAS) for pain, morphine consumption, knee flexion angle, straight leg raising (SLR), postoperative nausea vomiting (PONV), and length of stay (LOS) after the surgery. RESULTS After matching by propensity score, there were 49 patients with comparable demographic data in each group. The VAS and morphine requirements of the PAI and ACB + iPACK groups were not different during the first 48 hours after TKA. At 72 hours postoperatively, the VAS of the ACB + iPACK was 0.97 higher than that of the PAI group (p = 0.020). Knee flexion angle, SLR, PONV, and LOS were not significantly different between groups. No procedure-related complications were identified in either group. CONCLUSIONS The anesthesiologist-administered ACB + iPACK was as effective as surgeon-administered PAI in controlling pain in the first 48 hours after TKA. However, the ACB + iPACK group had higher intensity of pain than did the PAI group at 72 hours after TKA.
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Affiliation(s)
- Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Inthiporn Kositanurit
- Department of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Chao Saenghirunvattana
- Department of Anesthesiology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Parin Samapath
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Aartolahti E, Janhunen M, Katajapuu N, Paloneva J, Pamilo K, Oksanen A, Keemu H, Karvonen M, Luimula M, Korpelainen R, Jämsä T, Mäkelä K, Heinonen A. Effectiveness of Gamification in Knee Replacement Rehabilitation: Protocol for a Randomized Controlled Trial With a Qualitative Approach. JMIR Res Protoc 2022; 11:e38434. [PMID: 36441574 DOI: 10.2196/38434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Exergames can provide encouraging exercise options. Currently, there is limited evidence regarding home-based exergaming in the postoperative phase of total knee replacement (TKR). OBJECTIVE This study aimed to investigate the effects of a 4-month postoperative home-based exergame intervention with an 8-month follow-up on physical function and symptoms among older persons undergoing TKR compared with home exercise using a standard protocol. In addition, a concurrent embedded design of a mixed methods study was used by including a qualitative component within a quantitative study of exergame effects. METHODS This was a dual-center, nonblinded, two-arm, parallel group randomized controlled trial with an embedded qualitative approach. This study aimed to recruit 100 patients who underwent their first unilateral TKR (aged 60-75 years). Participants were randomized to the exergame or standard home exercise arms. Participants followed a custom-made exergame program independently at their homes daily for 4 months. The primary outcomes at 4 months were function and pain related to the knee using the Oxford Knee Score questionnaire and mobility using the Timed Up and Go test. Other outcomes, in addition to physical function, symptoms, and disability, were game user experience, exercise adherence, physical activity, and satisfaction with the operated knee. Assessments were performed at the preoperative baseline and at 2, 4, and 12 months postoperatively. Exergame adherence was followed from game computers and using a structured diary. Self-reported standard exercise was followed for 4 months of intervention and physical activity was followed for 12 months using a structured diary. Qualitative data on patients' perspectives on rehabilitation and exergames were collected through laddering interviews at 4 and 12 months. RESULTS This study was funded in 2018. Data collection began in 2019 and was completed in January 2022. The COVID-19 pandemic caused an unavoidable situation in the study for recruitment, data collection, and statistical analysis. As of November 2020, a total of 52 participants had been enrolled in the study. Primary results are expected to be published by the end of 2022. CONCLUSIONS Our study provides new knowledge on the effects of postoperative exergame intervention among older patients with TKR. In addition, this study provides a new understanding of gamified postoperative rehabilitation, home exercise adherence, physical function, and physical activity among older adults undergoing TKR. TRIAL REGISTRATION ClinicalTrials.gov NCT03717727; https://clinicaltrials.gov/ct2/show/NCT03717727. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/38434.
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Affiliation(s)
- Eeva Aartolahti
- Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Maarit Janhunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Niina Katajapuu
- Faculty of Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Healthcare District and University of Eastern Finland, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Orthopedics, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Airi Oksanen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Hannes Keemu
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko Karvonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika Luimula
- Faculty of Business and Engineering, Turku University of Applied Sciences, Turku, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland.,Research Unit of Population Health, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Timmers T, van der Weegen W, Janssen L, Kremer J, Kool RB. Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics. JMIR Form Res 2022; 6:e39637. [PMID: 36326799 PMCID: PMC9672996 DOI: 10.2196/39637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients’ priorities. Objective In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app’s content. Conclusions In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app’s content from the patient’s perspective. Given the growing emphasis on patients’ self-management, it is crucial that the information they receive is not only relevant from a health care provider’s perspective but also aligns with what really matters to patients. Trial Registration Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295
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Affiliation(s)
- Thomas Timmers
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Interactive Studios, Den Bosch, Netherlands
| | | | | | - Jan Kremer
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rudolf Bertijn Kool
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Fuchs L, Kluska A, Novak D, Kosashvili Y. The influence of early virtual reality intervention on pain, anxiety, and function following primary total knee arthroplasty. Complement Ther Clin Pract 2022; 49:101687. [DOI: 10.1016/j.ctcp.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/29/2022] [Accepted: 10/29/2022] [Indexed: 11/07/2022]
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