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Vogel N, Kaelin R, Rychen T, Wendelspiess S, Müller-Gerbl M, Arnold MP. Comparison of Responsiveness of Patient-Reported Outcome Measures After Total Knee Arthroplasty. J Arthroplasty 2024; 39:1487-1495.e2. [PMID: 38043745 DOI: 10.1016/j.arth.2023.11.029] [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: 06/28/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the responsiveness of different patient-reported outcome measures in patients with primary total knee arthroplasty (TKA). METHODS In this prospective observational study, we assessed patients with TKA before the surgery, after 4 months, after 1 year, and after 2 years. Measures were the objective Knee Society Score (KSS) and the following patient-reported outcome measures: Knee injury and Osteoarthritis Outcome Score (KOOS), KOOS-12, Forgotten Joint Score (FJS-12), High-Activity Arthroplasty Score, and EQ-5D-3L. Responsiveness was determined by effect size (ES), standardized response mean (SRM), area under the receiver operating characteristics curve, floor and ceiling effects, and hypothesis testing. RESULTS We analyzed data from 309 TKAs (272 patients, 56% female). The ES and SRM for the change in KSS, KOOS, KOOS-12, FJS-12, and EQ-5D-3L from baseline to each follow-up were large (>0.8). The largest responsiveness from baseline to follow-up was found for the KSS, KOOS/KOOS-12 quality of life, KOOS-12 summary, KOOS-12 pain, and FJS-12 (2.0 > ES <3.9, 1.4 > SRM <2.4). The area under the curve from baseline to each follow-up was ≥0.7 for KOOS, KOOS-12, and FJS-12 (range 0.71 to 0.95) and <0.7 for KSS and EQ-5D-3L (range 0.65 to 0.74). We found floor or ceiling effects in the KOOS, KOOS-12, and EQ-5D-3L, but not in the KSS, FJS-12, and High-Activity Arthroplasty Score. CONCLUSIONS Our study demonstrated that responsiveness differed between the various measures. The KOOS-12 and FJS-12 showed the greatest internal and external responsiveness, although ceiling effects occurred in the KOOS-12.
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Affiliation(s)
- Nicole Vogel
- Practice MEIN KNIE, Hirslanden Klinik Birshof, Münchenstein, Switzerland; Practice LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Kaelin
- Practice LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Thomas Rychen
- Practice LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Séverin Wendelspiess
- Practice LEONARDO, Hirslanden Klinik Birshof, Münchenstein, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Markus P Arnold
- Practice MEIN KNIE, Hirslanden Klinik Birshof, Münchenstein, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
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Wan D, Cao S, Li X, Zan Q, Yao S, Ma J, Shang L, Xu C. Translation, Cross-Cultural Adaptation and Validation of the Chinese Version of the High Activity Arthroplasty Score. Patient Relat Outcome Meas 2024; 15:121-130. [PMID: 38706693 PMCID: PMC11069113 DOI: 10.2147/prom.s451710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Background The High Activity Arthroplasty Score (HAAS) is a validated score that assesses functional outcomes after lower limb arthroplasty, with fewer ceiling effects than other scores. The aim is to translate and cross-culturally adapt the HAAS into a Chinese version (HAAS-C) and to evaluate the psychometric properties of HAAS-C in patients after primary total knee arthroplasty (TKA). Methods A total of 104 patients diagnosed with knee osteoarthritis who had undergone TKA at least 12 months prior were recruited. A forward and backward translation procedure was performed for developing a culturally acceptable HAAS-C. Internal consistency was assessed using Cronbach's α, and test-retest reliability was measured using the intraclass correlation coefficient (ICC) within a 10-day interval. Construct validity was assessed by examining the correlations between HAAS-C and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQoL Group's five-dimension questionnaire (EQ-5D-5L), and Oxford knee score (OKS). Results HAAS-C demonstrated adequate Internal consistency reliability, as indicated by Cronbach's α coefficient of 0.75. Test-retest reliability yielded excellent results, with an ICC value of 0.98. Content validity indices were high, with a scale-level validity index of 0.9 and item-level validity indices greater than or equal to 0.8. HAAS-C showed a strong correlation with WOMAC (r = 0.69), a moderate correlation with EQ-5D-5L (r = 0.43), and OKS (r = 0.53) while exhibiting no floor or ceiling effects. Conclusion The validated HAAS-C questionnaire is a valid instrument for assessing patients undergoing TKA in mainland China.
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Affiliation(s)
- Dongping Wan
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
| | - Shihang Cao
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
| | - Xinrui Li
- Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, Xi’an, People’s Republic of China
- School of Medicine, Northwest University, Xi’an, People’s Republic of China
| | - Qiang Zan
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, People’s Republic of China
| | - Shuxin Yao
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Jianbing Ma
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Lei Shang
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Chao Xu
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, Xi’an, People’s Republic of China
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Pai SN, Jeyaraman M, Maffulli N, Jeyaraman N, Migliorini F, Gupta A. Evidence-based informed consent form for total knee arthroplasty. J Orthop Surg Res 2023; 18:156. [PMID: 36864403 PMCID: PMC9979493 DOI: 10.1186/s13018-023-03647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure about obtaining informed consent for total knee arthroplasty (TKA). We developed a solution for this need for a pre-designed, evidence-based informed consent form for patients undergoing TKA. MATERIALS AND METHODS We extensively reviewed the literature on the medico-legal aspects of TKA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in TKA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had undergone TKA in the previous year. Based on all of the above, we developed an evidence-based informed consent form. The form was then reviewed by a legal expert, and the final version was used for 1 year in actual TKA patients operated at our institution. RESULTS Legally sound, evidence-based Informed Consent Form for Total Knee Arthroplasty. CONCLUSION The use of legally sound, evidence-based informed consent for total knee arthroplasty would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary.
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Affiliation(s)
- Satvik N Pai
- Department of Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, 600116, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, Faculty of Medicine - Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, 600095, India
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX, 78045, USA
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084, Fisciano, Italy
- San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, 84124, Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke-On-Trent, ST5 5BG, UK
| | - Naveen Jeyaraman
- Department of Orthopaedics, Atlas Hospitals, Tiruchirappalli, Tamil Nadu, 620002, India
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Ashim Gupta
- South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX, 78045, USA
- BioIntegrate, Lawrenceville, GA, 30043, USA
- Future Biologics, Lawrenceville, GA, 30043, USA
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Legally Sound, Evidence-Based Informed Consent Form for Total Hip Arthroplasty. Indian J Orthop 2023; 57:421-428. [PMID: 36825266 PMCID: PMC9941394 DOI: 10.1007/s43465-023-00824-7] [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: 09/27/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
Introduction Informed consent documentation is often the first area of interest for lawyers and insurers when a medico-legal malpractice suit is concerned. However, there is a lack of uniformity and standard procedure for obtaining informed consent for total hip arthroplasty (THA). We aimed to develop a solution for this need for a pre-designed, evidence-based informed consent form for THA cases. Materials and Methods We extensively reviewed the literature on the medico-legal aspects of THA, medico-legal aspects of informed consent, and medico-legal aspects of informed consent in THA. We then conducted semi-structured interviews with orthopaedic surgeons and patients who had previously undergone THA in the previous year. Based on all of the above, we developed an informed consent form that was evidence-based. We then had the form reviewed by a legal expert. The final form was utilised for THA cases at our institution for 1 year. Results Legally sound, evidence-based Informed Consent Form for Total Hip Arthroplasty is given in Form A. Conclusion The use of legally sound, evidence-based informed consent for total hip arthroplasty cases would be beneficial to orthopaedic surgeons and patients alike. It would uphold the rights of the patient, and promote open discussion and transparency. In the event of a lawsuit, it would be a vital document in the defence of the surgeon and withstand the scrutiny of lawyers and the judiciary.
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Similar rate of return to sports activity between posterior-stabilised and cruciate-retaining primary total knee arthroplasty in young and active patient. Knee Surg Sports Traumatol Arthrosc 2023; 31:551-558. [PMID: 36173439 PMCID: PMC9898351 DOI: 10.1007/s00167-022-07176-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/14/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Cruciate-retaining and posterior-stabilised implant designs are available for primary total knee arthroplasty. However, whether the implant design is associated with a difference in the level of activity still remains unclear. This clinical trial compared posterior-stabilised and cruciate-retaining implants in sport-related patient-reported outcome measures, range of motion, rate of return to sport, and weekly time dedicated to sport in active adults. It was also hypothesised that in young and active patients both implants lead to a similar rate of return to sport in terms of hours per week, type of sport, and joint mobility. METHODS All patients were evaluated preoperatively and for a minimum of 36 months follow-up. The University of California Los Angeles activity scores, High-Activity Arthroplasty Score, and Visual Analogue Scale were administered preoperatively and at the last follow-up. The range of motion was investigated at admission and the last follow-up. Data concerning the hours per week dedicated to sports and the type of sport practiced were also collected at admission and at the last follow-up. The Kaplan-Meier Curve was performed to compare implant survivorship. RESULTS Data from 227 procedures (cruciate-retaining: 109, posterior-stabilised: 118) were prospectively collected. At the last follow-up, no difference was reported in The University of California Los Angeles activity scores (p = 0.6), High-Activity Arthroplasty Score (p = 0.1), Visual Analogue Scale (p = 0.9), flexion (p = 0.7) and extension (p = 0.4). No difference was found in the rate of return (p = 0.1) and weekly hours dedicated to sport (p = 0.3). The Kaplan-Meier curve evidenced no statistically significant difference in implant survivorship (p = 0.6). CONCLUSIONS At approximately five years of follow-up, no difference was reported between cruciate-retaining and posterior-stabilised implants in active adults in sport-related patient-reported outcomes measures, range of motion, pain, weekly time dedicated to sport, rate of return to sport, and implant survivorship. LEVEL OF EVIDENCE Level II, prospective study.
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The German version of the High-Activity Arthroplasty Score is valid and reliable for patients after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:1204-1211. [PMID: 33770220 DOI: 10.1007/s00167-021-06531-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/04/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE The indications for a total knee arthroplasty (TKA) broadened to younger and more active patients. The High-Activity Arthroplasty Score (HAAS) is a self-administered instrument focussing on the wider range of functional abilities of more active patients. The HAAS was developed in English and is not available in German yet. This study aims to translate, cross-cultural adapt and assess the psychometric properties of the German HAAS in patients 12 months after primary TKA. METHODS After forward and backward translation, we examined the final version regarding its psychometric properties in patients 12 months after primary TKA. The HAAS was sent out to 70 patients together with routine questionnaires comprising the Knee injury and Osteoarthritis Outcome Score (KOOS), the Forgotten Joint Score (FJS-12), the EuroQol (EQ-5D-3L) and 2 numerical pain rating scales. Acceptability, reliability, responsiveness, content and construct validity as well as floor and ceiling effects were evaluated. RESULTS Fifty-two patients were recruited. The HAAS was well accepted with a mean time to completion of 2.4 min. Cronbach's alpha for internal consistency was 0.749, test-retest reliability was excellent with an Intraclass Correlation Coefficient (ICC) of 0.961. The smallest detectable change was 1.5. Good content validity was confirmed. A strong correlation was found between the HAAS and KOOS sport (r = 0.661) and a medium correlation for all other KOOS subscales (r = 0.324 to 0.453), the FJS-12 (r = 0.425), the EQ-5D-3L (r = 0.427) and pain (r = - 0.439 to - 0.308). The HAAS showed no floor and ceiling effects. CONCLUSIONS The German version of the HAAS provides good validity and reliability. It can be easily self-administered and is recommended to capture high-intensity activities in patients after TKA. LEVEL OF EVIDENCE Diagnostic study, Level I.
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D'Ambrosi R, Ursino C, Mariani I, Corona K, Dahmen J, Sciarretta FV, Valli F, Ursino N. No difference in return to amateur sports after medial and lateral unicompartmental knee arthroplasty in patients younger than 65 years. Knee Surg Sports Traumatol Arthrosc 2022; 30:1050-1056. [PMID: 33751156 DOI: 10.1007/s00167-021-06526-7] [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: 01/08/2021] [Accepted: 03/01/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to assess the return to amateur sports of patients under 65 years, following medial unicompartmental knee arthroplasty (mUKA) versus lateral unicompartmental knee arthroplasty (lUKA). It was hypothesized that patients younger than 65 years who underwent lateral or medial unicondylar knee replacement will result in similar rates to amateur sports, at a minimum follow-up of 2 years. METHOD Patients who underwent medial or lateral UKA participated in a 2-year follow-up program, where they were clinically evaluated for their return to amateur sports, using the University of California, Los Angeles (UCLA) activity scale and the High-Activity Arthroplasty Score (HAAS). Furthermore, subgroup analyses by gender and age were performed. Power analysis was performed to ensure sample size considering that lUKA is implanted ten times less frequently than its medial counterpart. RESULTS There were 85 patients who completed the entire minimum 2-year follow-up of which 73 belonged to the mUKA group and 12 to the lUKA group. No preoperative differences were found between the groups regarding the gender, the affected side, age, and mean follow-up. Both groups showed statistically significant improvement (p < 0.05) in their return to amateur sports in all parameters (UCLA and HAAS). No differences among the two groups were found at T0 and T1 (n.s.). All subgroups showed a statistically significant improvement (p < 0.05) with respect to the preoperative value, except for UCLA for lUKA with less than 60 years and HAAS for males in the lUKA group (n.s.). No differences were found among subgroups both at To and T1 (n.s.). CONCLUSION Both mUKA and lUKA procedures enabled all young and active patients a certain return to amateur sports 2 years after surgery, regardless of age and gender. UKA, medial or lateral, should always be considered for the treatment of isolated osteoarthritis in young and active patients with high functional demands. LEVEL OF EVIDENCE Cohort Study, Level of Evidence III. REGISTRATION Researchregistry6221 - Research Registry www.researchregistry.com .
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Affiliation(s)
| | - Chiara Ursino
- Clinica Ortopedica, IRCCS Policlinico San Martino, Genova, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Katia Corona
- Dipartimento Di Medicina E Scienze Della Salute Vincenzo, Università Degli Studi del Molise, Campobasso, Tiberio, Italy
| | - Jari Dahmen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc, IOC Research Center, Amsterdam, The Netherlands
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D'Ambrosi R, Anghilieri FM, Corona K, Mariani I, Valli F, Ursino N, Hirschmann MT. Similar rates of return to sports and BMI reduction regardless of age, gender and preoperative BMI as seen in matched cohort of hypoallergenic and standard Cobalt Chromium medial unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:890-898. [PMID: 33550449 DOI: 10.1007/s00167-021-06467-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the rate of return to sports and body mass index (BMI) reduction in patients who underwent surgery for unicompartmental knee arthroplasty (UKA) with either Cobalt-Chromium (CoCr) alloy UKA or with hypoallergenic UKA, stratified by age, gender and BMI. METHODS Two consecutive cohorts of patients with a total of 172 UKA and a minimum 2-year follow-up period were prospectively included in this comparative study. The first cohort consisted of 136 consecutive series of standard Cobalt-Chromium (CoCr Group). The second cohort consisted of 36 consecutive mobile-bearing hypoallergenic Titanium Niobium Nitride UKA, (TiNbN Group). The clinical evaluation was based on the University of California, Los Angeles (UCLA) activity scores and the High-Activity Arthroplasty Score (HAAS) evaluated on the day before surgery (T0) and after a minimum follow-up of 12 months (T1) and 24 months (T2). Radiographic evaluation performed at T2 included the femoral component position in varus/valgus, the tibial component in varus/valgus and the anteroposterior slope. RESULTS No statistical differences were found between the groups at each follow-up, as shown by the UCLA and HAAS score (n.s.). Both groups showed a statistically significant improvement (p < 0.05) at each follow-up.. Both groups showed a statistically significant BMI reduction between T0 and T2 (p < 0.05). Radiographic analysis revealed no statistical differences between the two groups in terms of the three measures after the final follow-up (n.s.). All the subgroups showed a significant (p < 0.05) rate of return to sport if compared with the preoperative value (T2 versus T0), except for male in TiNbN group. CONCLUSIONS Both TiNbN and CoCr medial mobile-bearing UKA enabled patients to return to sports after the final follow-up, regardless of age, BMI, gender and metal sensitivity. These findings inform shared decision making and can help to manage patient expectations after surgery, in particular, in active patients with an overt metal allergy, a specific hypoallergenic implant should be considered the gold standard implant in partial knee replacement surgery. LEVEL OF EVIDENCE Cohort Study, Level III. REGISTRATION researchregistry6250- www.researchregistry.com .
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Affiliation(s)
| | - Filippo Maria Anghilieri
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Katia Corona
- Dipartimento di Medicina e Scienze della Salute Vincenzo Tiberio, Università degli Studi del Molise, Campobasso, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | - Michael Tobias Hirschmann
- Department of Orthopaedic Surgery and Traumatology Kantonsspital, Baselland (Bruderholz, Liestal, Laufen), Liestal, Switzerland
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Effect of an Innovative Biofeedback Insole on Patient Rehabilitation after Total Knee Arthroplasty. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Partial weight bearing is fundamental to rehabilitation in the early stages following lower limb surgery. However, it remains debated as to how to properly achieve partial weight bearing while avoiding complications from excessive or premature load. Of the devices currently on the market, instrumented insoles coupled with force-sensitive resistors (FSRs) are among the best options in today’s clinical practice. Still, although several of these systems have been developed in the last few years, only some have been validated, leaving insufficient information on their application in rehabilitation after total knee replacement (TKR). To address this research gap, we evaluated the performance of an innovative biofeedback insole system featuring an extremely low response time for real-time force feedback. We randomly recruited 30 patients who underwent total knee arthroplasty. All patients used the new programmable insole for partial weight bearing per post-operative rehabilitation protocol. Our results confirm their inability to perform a correct gait with low partial weight bearing (<30–50% of their bodyweight). Partial weight bearing with a correct gait in the post-operative period is not obtainable without a measuring system. This new biofeedback insole is thus one of the most indicated and can improve rehabilitation compliance, therefore allowing continual patient monitoring for faster discharge and fast-track rehabilitation.
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Thiebat G, Cucchi D, Spreafico A, Muzzi S, Viganò M, Visconti L, Facchini F, de Girolamo L. Italian version of the anterior cruciate ligament-return to sport after injury scale (IT ACL-RSI): translation, cross-cultural adaptation, validation and ability to predict the return to sport at medium-term follow-up in a population of sport patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:270-279. [PMID: 33620511 DOI: 10.1007/s00167-021-06498-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The timing of psychological and physical recovery after anterior cruciate ligament reconstruction represents an open issue in current orthopedic practice. Several tools have been developed to evaluate these factors, with the most recent being represented by the anterior cruciate ligament (ACL) return to sport injury scale (ACL-RSI). The aims of this study were to provide a validated Italian translation of the ACL-RSI in a population of sport patients, and to identify a possible correlation of the ACL-RSI score with the return to sport (RTS) time and the level of sport participation in comparison to the pre-injury one. METHODS The Italian translation and cultural adaptation of the scale were completed using a using the "translation-back translation" method. A total of 130 patients were enrolled and completed the study questionnaires 6 months after ACL reconstruction. Randomly, 65 of them were re-tested for the ACL-RSI within 2 weeks. The internal consistency, reliability, feasibility, and construct validity of the Italian version of ACL-RSI were assessed and compared to Italian version of the KOOS, the Lysholm Score, the AKPS and the IKDC subjective score. Responsiveness was tested comparing patients returning to sport at 6 and 12 months. The Tegner activity scale was collected at baseline, 6 and 12 months to identify the level of activity after return to sport, in relation to the ACL-RSI score. RESULTS The Italian adaptation of the ACL-RSI demonstrated excellent internal consistency (Cronbach's alpha = 0.953), reliability (test-retest ICC = 0.916) and feasibility, with no ceiling or floor effect. Construct validity was confirmed by the moderate to strong correlation with all the other scales (p < 0.0001). Slight and non-significant higher ACL-RSI score was shown by patients returned to sport at 6 or 12 months after surgery. Nevertheless, the ACL-RSI score at 6 months was significantly different between patients who returned and those who did not returned to the same level of sport activity 12 months after the procedure. CONCLUSIONS This study demonstrated that the Italian ACL-RSI is a reliable tool for evaluating the psychological readiness for return to sports of athletes who underwent ACL reconstruction, especially when collected at the end of the rehabilitation process. Since the IT ACL-RSI used in this study is a faithful translation of the original English version, this finding can be generalized to other cultural contexts and languages too. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Gabriele Thiebat
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Andrea Spreafico
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
- Università Degli Studi Di Milano, Milano, Italy
| | - Stefano Muzzi
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
- Università Degli Studi Di Milano, Milano, Italy
| | - Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | | | - Francesca Facchini
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | - Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
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Monti L, Franchi E, Ursino N, Mariani I, Corona K, Anghilieri FM, D’Ambrosi R. Hypoallergenic unicompartmental knee arthroplasty and return to sport: comparison between Oxidized Zirconium and Titanium Niobium Nitride. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022160. [PMID: 35775764 PMCID: PMC9335424 DOI: 10.23750/abm.v93i3.12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The present study aims to compare the rate of return to sports in patients who underwent surgery for mobile-bearing UKA with either hypoallergenic TiNbN or with oxidized zirconium alloy implants. METHODS The records of two consecutive cohorts for a total of 90 hypoallergenic implants were prospectively analysed. The first cohort consisted of 41 consecutive series of medial mobile-bearing hypoallergenic TiNbN UKA, whereas the second cohort consisted of 49 consecutive medial fixed-bearing hypoallergenic Uni Oxinium.The clinical evaluation involved evaluating each patient's University of California, Los Angeles (UCLA) activity scoresand the High-Activity Arthroplasty Score(HAAS). Each patient was clinically evaluated on the day before surgery (T0), then after a minimum follow-up period of 12 months (T1), and finally after 24 months (T2). Results:The only pre-operative difference between the two groups involved pre-operative BMI with significantly higher BMI in TiNbN Group (p<0.001). Both groups reported significant improvement at each follow-up compared with the previous and also at the final follow up with respect to UCLA and HAAS (p<0.05), except for UCLA in TiNbN between T1 and T2(p>0.05). Moreover, BMI improved significantly at the final follow up, but only in TiNbN group (p<0.05). CONCLUSIONS Both TiNbN and Oxinium UKA procedures enabled patients to return to an acceptable level of sports activity with excellent radiographic outcomes after the final follow up regardless of the age, gender, BMI, and bearing type.
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Affiliation(s)
| | | | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” – Trieste, Italy
| | - Katia Corona
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute Vincenzo, Tiberio, Campobasso, Italy
| | - Filippo Maria Anghilieri
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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D'Ambrosi R, Nuara A, Mariani I, Corona K, Mogos S, Catellani F, Hantes M, Ursino N. Return to physical activity and change in body mass index after hypoallergenic medial mobile-bearing unicompartmental knee arthroplasty. J Orthop Traumatol 2021; 22:36. [PMID: 34536139 PMCID: PMC8449751 DOI: 10.1186/s10195-021-00598-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background The primary purpose of the present prospective study was to consecutively analyse the outcomes of the return to sports activity of patients with positive patch tests undergoing a medial mobile-bearing titanium niobium nitride (TiNbN) unicompartmental knee arthroplasty (UKA). The secondary purpose was to ascertain if a higher grade of physical activity leads to a reduction in the body mass index (BMI) of the patients. Material and methods Forty-one patients with positive skin patch tests were included in this prospective study. The clinical evaluation consisted of the University of California, Los Angeles (UCLA) activity scale and the High-Activity Arthroplasty Score (HAAS). Each patient was evaluated the day before surgery (T0), after 12.37 ± 0.70 months (T1), and on the day of the final follow-up, after 67.03 ± 18.2 months (T2). Furthermore, the BMI of each patient was analysed before surgery and during the final follow-up. Results The UCLA and HAAS mean preoperative values ranged from 3.68 ± 1.1.7 and 6.15 ± 0.76 to 6.1 ± 0.76 and 10.34 ± 1.3, respectively, at T1 (p < 0.0001) and to the final values of 6.34 ± 0.62 and 11.0 ± 8.9, respectively, at T2 (UCLA: T2 versus T1: p = 0.132; T2 versus T0: p < 0.0001; HAAS: T2 versus T1: p = 0.0027; T2 versus T0: p < 0.001). BMI ranged from a preoperative value of 27.97 ± 3.63 to a final value of 26.84 ± 3.11 (p < 0.0001). The only differences within the subgroups concerned patients with BMI ≥ 28, showing a superior HAAS at each follow-up (p < 0.05). A positive correlation was found between BMI and HAAS at T0 and T2 (p < 0.05). Conclusions This is the first study to evaluate the rate of the return to sports activities and change in BMI following hypoallergenic UKA. The majority of patients reduced their weight following UKA and improved their physical activity, showing outcomes that were comparable to the standard cobalt–chrome (CoCr) prostheses, regardless of gender, age, BMI and implant size. Level of evidence IV – Prospective Cohort Study. Trial registration researchregistry5978—Research Registry www.researchregistry.com Supplementary Information The online version contains supplementary material available at 10.1186/s10195-021-00598-4.
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Affiliation(s)
| | - Alessandro Nuara
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Milan, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Katia Corona
- Dipartimento Di Medicina E Scienze Della Salute Vincenzo Tiberio, Università Degli Studi del Molise, Campobasso, Italy
| | - Stefan Mogos
- Foișor Orthopaedics Hospital, Bucharest, Romania
| | | | - Michael Hantes
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, University Hospital of Larissa, Larissa, Greece
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Evaluation of the Efficacy and Safety of an Exercise Program for Persons with Total Hip or Total Knee Replacement: Study Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136732. [PMID: 34201439 PMCID: PMC8268118 DOI: 10.3390/ijerph18136732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
Total hip replacement (THR) and total knee replacement (TKR) are among the most common elective surgical procedures. There is a large consensus on the importance of physical activity promotion for an active lifestyle in persons who underwent THR or TKR to prevent or mitigate disability and improve the quality of life (QoL) in the long term. However, there is no best practice in exercise and physical activity specifically designed for these persons. The present protocol aims to evaluate the efficacy and safety of an exercise program (6 month duration) designed for improving quality of life in people who had undergone THR or TKR. This paper describes a randomized controlled trial protocol that involves persons with THR or TKR. The participant will be randomly assigned to an intervention group or a control group. The intervention group will perform post-rehabilitation supervised training; the control group will be requested to follow the usual care. The primary outcome is QoL, measured with the Short-Form Health Survey (SF-36); Secondary outcomes are clinical, functional and lifestyle measures that may influence QoL. The results of this study could provide evidence for clinicians, exercise trainers, and policymakers toward a strategy that ensures safe and effective exercise physical activity after surgery.
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Wang Y, Yin M, Zhu S, Chen X, Zhou H, Qian W. Patient-reported outcome measures used in patients undergoing total knee arthroplasty. Bone Joint Res 2021; 10:203-217. [PMID: 33734821 PMCID: PMC7998066 DOI: 10.1302/2046-3758.103.bjr-2020-0268.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Patient-reported outcome measures (PROMs) are being used increasingly in total knee arthroplasty (TKA). We conducted a systematic review aimed at identifying psychometrically sound PROMs by appraising their measurement properties. Studies concerning the development and/or evaluation of the measurement properties of PROMs used in a TKA population were systematically retrieved via PubMed, Web of Science, Embase, and Scopus. Ratings for methodological quality and measurement properties were conducted according to updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Of the 155 articles on 34 instruments included, nine PROMs met the minimum requirements for psychometric validation and can be recommended to use as measures of TKA outcome: Oxford Knee Score (OKS); OKS-Activity and Participation Questionnaire (OKS-APQ); 12-item short form Knee Injury and Osteoarthritis Outcome (KOOS-12); KOOS Physical function Short form (KOOS-PS); Western Ontario and McMaster Universities Arthritis Index-Total Knee Replacement function short form (WOMAC-TKR); Lower Extremity Functional Scale (LEFS); Forgotten Joint Score (FJS); Patient's Knee Implant Performance (PKIP); and University of California Los Angeles (UCLA) activity score. The pain and function subscales in WOMAC, as well as the pain, function, and quality of life subscales in KOOS, were validated psychometrically as standalone subscales instead of as whole instruments. However, none of the included PROMs have been validated for all measurement properties. Thus, further studies are still warranted to evaluate those PROMs. Use of the other 25 scales and subscales should be tempered until further studies validate their measurement properties. Cite this article: Bone Joint Res 2021;10(3):203-217.
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Affiliation(s)
- Yiou Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Meihua Yin
- Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Shibai Zhu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Xi Chen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Hongru Zhou
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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