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Yim THJYZ, Tan KY. Functional Outcomes after Abdominal Surgery in Older Adults - How concerned are we about this? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108347. [PMID: 38657374 DOI: 10.1016/j.ejso.2024.108347] [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: 03/12/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
Amidst trends of a rapidly ageing population with better surgical outcomes for geriatric patients, it is imperative to consider outcome measures beyond mortality and morbidity rates. In fact, the preservation of one's postoperative function has been cited as a key priority for older adults and is a crucial determinant of postoperative independence and survival. This review aims to examine the prevalence of perioperative function reporting amongst older surgical patients undergoing elective major abdominal surgery for cancer. We systematically reviewed studies from inception to December 2023 for studies which focused on the outcomes of older surgical patients undergoing elective major abdominal surgery for cancer. Relevant citations were screened (title, abstract and full article review) based on the inclusion and exclusion criteria. 103 studies were included, of which only 31 studies consisting of 20885 participants reported perioperative function. While the nominal number of studies which report perioperative function has been on a steady rise since 2018, the proportion of studies which do so remains low. Postoperative function is three times less likely to be reported than preoperative function, suggesting that functional recovery is not sufficiently assessed. This suggests that there is still a poor uptake of functional recovery as an outcome measure amongst surgeons, and any increase in perioperative function reporting is likely due to the increased administration of frailty assessments. These findings should urge greater efforts in quantifying and enabling functional recovery to improve the clinical outcomes and quality of care for older surgical patients.
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Affiliation(s)
| | - Kok Yang Tan
- Department of General Surgery, Khoo Teck Puat Hospital, 90 Yishun Central Singapore 768828.
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Vatandoost S, Kowalski K, Lanting B, Ng KCG, Soltanabadi S, Rushton A. Association between physical measures of spinopelvic alignment and physical functioning with patient reported outcome measures (PROMs) after total hip arthroplasty: Protocol for systematic review and meta-analysis. PLoS One 2024; 19:e0304382. [PMID: 38787884 PMCID: PMC11125517 DOI: 10.1371/journal.pone.0304382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Prevalence of total hip arthroplasty (THA) has trended upwards over past decades and is projected to increase further. Optimizing outcomes after surgery is essential to avoid surgical revision and maximize outcomes. Low back pain is reported as a problem post THA. Patient-reported outcome measures (PROMs) are commonly used to evaluate THA outcomes but have limitations (e.g., ceiling effects). It is therefore important to assess a comprehensive range of outcomes. Physical outcome measures of spinopelvic alignment and physical functioning demonstrate potential value, but no evidence synthesis has investigated their association with PROMs. The objectives of this systematic review are to evaluate the association between spinopelvic alignment and physical outcome measures of physical functioning with PROMs and characteristics of low back pain after THA. METHODS AND ANALYSIS This protocol is aligned with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Cross-sectional and longitudinal cohort studies evaluating the association between the physical outcome measures and PROMs (any outcome measures reported) following THA by any approach/implant will be included except surface replacement and revision THA. Studies investigating THA for developmental pathology and inflammatory conditions will be excluded. A systematic search in MEDLINE (Ovid), Embase (Ovid), Scopus, Web of Science, CINAHL, and the grey literature will be carried out from inception to July 31, 2023. Two independent reviewers will evaluate eligibility of retrieved articles, extract data and assess risk of bias (NIH quality assessment tool) of included studies. A third reviewer will mediate disagreements. Random-effects meta-analyses will be conducted if studies are sufficiently homogeneous in design, population, physical measures and PROMs; reporting odds ratios and 95% confidence intervals. Where meta-analyses are not possible, a narrative synthesis will be conducted. Confidence in cumulative evidence will be assessed using a modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation). PROSPERO REGISTRATION NUMBER PROSPERO Registration number CRD42023412744.
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Affiliation(s)
- Sima Vatandoost
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Katie Kowalski
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Brent Lanting
- Department of Surgery, Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - K. C. Geoffrey Ng
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Alison Rushton
- School of Physical Therapy, Western University, London, Ontario, Canada
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Harada S, Hamai S, Shiomoto K, Kawahara S, Hara D, Harada T, Nakashima Y. Predictors of physical activity recovery after total hip arthroplasty: a prospective observational study. INTERNATIONAL ORTHOPAEDICS 2024; 48:753-760. [PMID: 37923880 DOI: 10.1007/s00264-023-06022-2] [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: 08/30/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Little is known about the changes and the factors in physical activity as following total hip arthroplasty (THA). There are potential discrepancies between subjective and objective measurements of physical activity. Thus, our porpose is to compare objective and subjective measurements of activity levels in patients undergoing THA preoperatively, three months and one year following surgery, and investigated the factors that predicts the objective activity level after THA. METHODS This prospective observational study included 42 patients with unilateral symptomatic hip osteoarthritis who underwent THA. The objective activity level (step counts, sit-to-stands, and upright time) by using a tri-axial accelerometer, PRO (Oxford hip score; OHS and University of California, Los Angeles activity score; UCLA score), and muscle volume around the hip joint by using preoperative computed tomography were measured. RESULTS The number of steps, OHS, and UCLA score before, at three months, and one year after THA averaged 5092, 6532, and 6545 steps, 30.3, 43.0, and 44.2 points, and 3.4, 4.8, and 4.6 points, respectively, with significant postoperative increases (P < 0.05). No significant difference was found between three months and one year postoperatively. In multivariate analysis, younger age and higher preoperative contralateral gluteal medius volume were the predictors of higher postoperative step counts (P < 0.05). CONCLUSIONS Physical activity, including step counts, OHS, and UCLA score increased significantly until three months after unilateral THA. Early surgical intervention before contralateral muscle declines and preoperative rehabilitation including contralateral side may additionally improve postoperative activity levels.
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Affiliation(s)
- Satoru Harada
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
- Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tetsunari Harada
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Ishimoto R, Mutsuzaki H, Shimizu Y, Yoshikawa K, Koseki K, Takeuchi R, Matsumoto S, Hada Y. Association between Obesity and Short-Term Patient-Reported Outcomes following Total Knee Arthroplasty: A Retrospective Cohort Study in Japan. J Clin Med 2024; 13:1291. [PMID: 38592115 PMCID: PMC10932041 DOI: 10.3390/jcm13051291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background: This study investigated the association between obesity and short-term patient-reported outcomes after total knee arthroplasty (TKA). Methods: The primary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index's (WOMAC) pain and function scores. Data were collected preoperatively and 2 and 4 weeks after surgery. Patients were stratified into three groups based on body mass index (BMI): normal weight (BMI < 24.99 kg/m2), overweight (25 ≤ BMI < 29.99 kg/m2), and obese (BMI ≥ 30 kg/m2). The associations between BMI and the WOMAC pain and function scores were assessed using generalized linear mixed models. Results: Among the 102 patients (median age: 75.0, women [85.3%]), 29.4%, 48.0%, and 22.5% were normal weight, overweight, and obese, respectively. The mean pain and function scores at baseline were similar across the BMI-stratified groups (p = 0.727 and 0.277, respectively). The pain score significantly improved 2 weeks post-surgery (p = 0.001). The function score improved significantly 4 weeks post-surgery (p < 0.001). The group and group-by-time interaction effects lacked statistical significance. Conclusions: All patients statistically and clinically showed relevant pain reduction and functional improvement shortly after TKA, irrespective of their obesity status. These data may help healthcare professionals discuss the expectations of pain amelioration and functional improvement with TKA candidates.
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Affiliation(s)
- Ryu Ishimoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8575, Japan;
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Ryoko Takeuchi
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Shuji Matsumoto
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
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Prüfer F, Pavlović M, Matko Š, Löfler S, Fischer MJ, Šarabon N, Grote V. Responsiveness of Isokinetic Dynamometry in Patients with Osteoarthritis after Knee and Hip Arthroplasty: A Prospective Repeated-Measures Cohort Study. Healthcare (Basel) 2024; 12:314. [PMID: 38338199 PMCID: PMC10855832 DOI: 10.3390/healthcare12030314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Functional assessments are crucial for the evaluation of rehabilitation after total knee (TKA) and hip (THA) arthroplasty. Muscle strength, a key determinant of physical function (PF), is often measured with isokinetic dynamometry (ID), which is considered the gold standard. However, studies lack evaluations of responsiveness-the ability to detect changes over time. This study aims to determine the responsiveness of ID in measuring PF in TKA and THA rehabilitation-is muscle strength a valid indicator for assessing improvement in rehabilitation processes? The pre- and post-surgery PF of 20 osteoarthritis patients (age 55-82) was assessed, using ID, performance-based and self-reported measures. Responsiveness was evaluated by comparing the observed relationship of changes in ID and PF scores with the a priori defined expected relationship of change scores. While the performance-based and self-reported measures showed significant improvements post-surgery (Cohen's d [0.42, 1.05] p < 0.05), ID showed no significant differences. Moderate correlations were found between changes in some ID parameters and selected functional tests (r ≈|0.5|, p < 0.05). Responsiveness was solely found for the peak torque of knee extension at 180°/s on the operated side. Responsiveness is an often-overlooked psychometric property of outcome measurements. The findings suggest that ID may not be fully responsive to the construct of PF after TKA and THA, raising questions about its role and usefulness in this context and the need for more appropriate assessment methods.
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Affiliation(s)
- Ferdinand Prüfer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Monika Pavlović
- Faculty of Health Sciences, University of Ljubljana, SI-1000 Ljubljana, Slovenia;
| | - Špela Matko
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Vamed Rehabilitation Center Kitzbühel, A-6370 Kitzbühel, Austria
| | - Nejc Šarabon
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Faculty of Health Sciences, University of Primorska, SI-6310 Izola, Slovenia
- Innorenew CoE, SI-6310 Izola, Slovenia
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
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Redfern RE, Crawford DA, Lombardi AV, Tripuraneni KR, Van Andel DC, Anderson MB, Cholewa JM. Outcomes Vary by Pre-Operative Physical Activity Levels in Total Knee Arthroplasty Patients. J Clin Med 2023; 13:125. [PMID: 38202132 PMCID: PMC10780185 DOI: 10.3390/jcm13010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/13/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
Physical activity (PA) is suggested to reduce osteoarthritis pain; however, it may be avoided by patients requiring arthroplasty. Our goal was to investigate objective and patient-reported outcomes as a function of pre-operative PA levels in patients undergoing total knee arthroplasty (TKA). A total of 1941 patients enrolled in a multicenter prospective cohort study investigating a smartphone-based care management platform for self-directed rehabilitation underwent TKA and were included in the analysis. Activity was categorized based on the cohort's step count quartiles into low, moderate, and high pre-operative PA. Pre-operative and post-operative pain, EQ5D5L, KOOS JR, and step counts were compared by ANOVA according to activity group. Pre-operative pain scores increased with the decreasing activity level (all, p < 0.05) and were most improved post-operatively in the low PA group. High PA patients demonstrated the smallest improvements in EQ-5D-5L and KOOS JR. Low and moderate PA patients increased physical activity by three months, reaching 176% and 104% of pre-operative steps; high PA patients did not return to full step counts by one year post-operatively. Patients undergoing TKA who present with higher levels of physical activity report lower levels of pain and higher function pre-operatively but appreciate less improvement up to one year post-operatively. These results may be helpful in appropriate counseling of patient expectations before TKA.
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Affiliation(s)
| | - David A. Crawford
- Joint Implant Surgeons, Inc., New Albany, OH 43054, USA; (D.A.C.); (A.V.L.J.)
| | - Adolph V. Lombardi
- Joint Implant Surgeons, Inc., New Albany, OH 43054, USA; (D.A.C.); (A.V.L.J.)
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Fary C, Cholewa J, Abshagen S, Van Andel D, Ren A, Anderson MB, Tripuraneni K. Stepping Beyond Counts in Recovery of Total Hip Arthroplasty: A Prospective Study on Passively Collected Gait Metrics. SENSORS (BASEL, SWITZERLAND) 2023; 23:6538. [PMID: 37514832 PMCID: PMC10383890 DOI: 10.3390/s23146538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
Gait quality parameters have been used to measure recovery from total hip arthroplasty (THA) but are time-intensive and previously could only be performed in a lab. Smartphone sensor data and algorithmic advances presently allow for the passive collection of qualitative gait metrics. The purpose of this prospective study was to observe the recovery of physical function following THA by assessing passively collected pre- and post-operative gait quality metrics. This was a multicenter, prospective cohort study. From six weeks pre-operative through to a minimum 24 weeks post-operative, 612 patients used a digital care management application that collected gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-sample t-test. Recovery was defined as the post-operative week when the respective gait metric was no longer statistically inferior to the pre-operative value. To control for multiple comparison error, significance was set at p < 0.002. Walking speeds and step length were lowest, and timing asymmetry and double support percentage were greatest at week two post-post-operative (p < 0.001). Walking speed (1.00 ± 0.14 m/s, p = 0.04), step length (0.58 ± 0.06 m/s, p = 0.02), asymmetry (14.5 ± 19.4%, p = 0.046), and double support percentage (31.6 ± 1.5%, p = 0.0089) recovered at 9, 8, 7, and 10 weeks post-operative, respectively. Walking speed, step length, asymmetry, and double support all recovered beyond pre-operative values at 13, 17, 10, and 18 weeks, respectively (p < 0.002). Functional recovery following THA can be measured via passively collected gait quality metrics using a digital care management platform. The data suggest that metrics of gait quality are most negatively affected two weeks post-operative; recovery to pre-operative levels occurs at approximately 10 weeks following primary THA, and follows a slower trajectory compared to previously reported step count recovery trajectories.
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Affiliation(s)
- Camdon Fary
- Epworth Foundation, Richmond, VIC 3121, Australia
- Department of Orthopaedics, Western Hospital, Melbourne, VIC 3011, Australia
| | | | | | | | - Anna Ren
- Zimmer Biomet, Warsaw, IN 46580, USA
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John S, Esch M, Steinert M, Witte K. Relationship Between Self-Reported Function, Functional Tests and Biomechanical Parameters in Patients 12 Months After Total Hip Arthroplasty: A Preliminary Cross-Sectional Study. Indian J Orthop 2023; 57:1032-1040. [PMID: 37384004 PMCID: PMC10293490 DOI: 10.1007/s43465-023-00887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/30/2023] [Indexed: 06/30/2023]
Abstract
Background/Purpose Several methods are used to evaluate the outcome of total hip arthroplasty (THA), however, their relationship at different time points after surgery is unclear. The purpose of this exploratory study was to investigate correlations between self-report function, performance-based tests (PBTs) and biomechanical parameters in patients 12 months after THA. Methods Eleven patients were included in this preliminary cross-sectional study. Hip disability and Osteoarthritis Outcome Score (HOOS) was completed for self-reported function. As PBTs, the Timed-up-and-Go test (TUG) and 30-Second-Chair-Stand test (30CST) were used. Biomechanical parameters were derived from analyses of hip strength, gait and balance. Potential correlations were calculated using Spearman correlation coefficient r. Results HOOS scores and parameters of PBTs showed moderate to strong correlations (0.3 < r < 0.7). Correlation analysis between HOOS scores and biomechanical parameters revealed moderate to strong correlations for hip strength whereas correlations with gait parameters and balance were rather weak (r < 0.3). Moderate to strong correlations were also found between parameters of hip strength and 30CST. Conclusion For THA outcome assessment 12 months after surgery, our first results indicate that self-report measures or PBTs could be used. Analysis of hip strength also appears to be reflected in HOOS and PBT parameters and may be considered as an adjunct. Given the weak correlations with gait and balance parameters, we suggest that gait analysis and balance testing should be performed in addition to PROMs and PBTs as they may provide supplementary information, especially for THA patients that are at risk for falls.
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Affiliation(s)
- Stefanie John
- Department of Sports Science, Faculty of Humanities, Otto-von-Guericke-University, Magdeburg, Germany
| | - Michael Esch
- Department of Biomechanics, Faculty of Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg, Germany
| | - Marvin Steinert
- Department of Sports Science, Faculty of Humanities, Otto-von-Guericke-University, Magdeburg, Germany
| | - Kerstin Witte
- Department of Sports Science, Faculty of Humanities, Otto-von-Guericke-University, Magdeburg, Germany
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Mooiweer Y, Seeber GH, Brütt AL, Eleveld R, Ulitzka R, Lazovic D, Ansmann L, Stevens M. Influence of health system and patient characteristics on expectations and outcome in total hip arthroplasty patients in the Dutch-German border region: protocol for a mixed-methods prospective observational comparative study (hip across). BMJ Open 2023; 13:e067499. [PMID: 37105704 PMCID: PMC10151850 DOI: 10.1136/bmjopen-2022-067499] [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: 04/29/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) is the treatment of choice for end-stage osteoarthritis of the hip. Management of THA differs between countries, and it is hypothesised that this can influence patients' expectations and self-efficacy. Using Chen's intervening mechanism evaluation approach, this study aims to explore how structure of care influences expectations and self-efficacy of patients undergoing THA, and how expectations and self-efficacy in turn influence outcome in terms of perceived physical function and satisfaction. METHODS AND ANALYSIS A mixed-methods study will be conducted in two German and two Dutch hospitals near the Dutch-German border. In the quantitative part, patients will complete questionnaires at three timepoints: preoperatively and at 3 and 6 months postoperatively. Data analysis will include multiple regression analysis and structural equation modelling. In the qualitative part, interviews will be held with patients (preoperatively and 3 months postoperatively) and healthcare providers. Analysis will be performed using structured qualitative content analysis. ETHICS AND DISSEMINATION The study is approved by the Institutional Review Boards of both Carl von Ossietzky University Oldenburg (2021-167) and University Medical Center Groningen (METc 2021/562 and METc 2021/601). The results will be disseminated in the international scientific community via publications and conference presentations. TRIAL REGISTRATION NUMBER The study is registered in the German Clinical Trials Registry (DRKS: DRKS00026744).
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Affiliation(s)
- Yvet Mooiweer
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | - Gesine H Seeber
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Germany
| | - Anna Levke Brütt
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Rienk Eleveld
- Department of Orthopedics, Ommelander Ziekenhuis Groningen, Scheemda, The Netherlands
| | - Raimund Ulitzka
- Department of Orthopedics and Trauma Surgery, Klinikum Leer gGmbH, Leer, Germany
| | - Djordje Lazovic
- University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University Oldenburg, Oldenburg, Germany
| | - Lena Ansmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
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Hill BG, Shah S, Moschetti W, Schilling PL. Do Patient Reported Outcomes Reflect Objective Measures of Function? Implications for Total Knee Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00405-9. [PMID: 37105330 DOI: 10.1016/j.arth.2023.04.049] [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: 12/01/2022] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Patient Reported Outcomes (PROs) are used in research, clinical practice, and by federal reimbursement models to assess outcomes for patients who have knee osteoarthritis (OA) and total knee arthroplasty (TKA). We examined a large cohort of patients to determine if commonly used PROs reflect observed evaluation as measured by standardized functional tests (SFTs). METHODS We used data from the Osteoarthritis Initiative, a ten-year observational study of knee osteoarthritis patients. Two cohorts were examined: 1) participants who received TKA (n=281) and 2) participants who have native OA (n=4,687). The PROs included Western Ontario and McMaster Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), 12-Item Short Form Health Survey (SF-12), and Intermittent and Constant Pain Score (ICOAP). The SFTs included 20 and 400 meter (M) walks and chair stand pace. Repeated measures correlation coefficients were used to determine the relationship between PROs and SFTs. RESULTS The PROs and SFTs were not strongly correlated in either cohort. The magnitude of the repeated measures correlation (rrm) between KOOS, WOMAC, SF-12, and ICOAP scores and SFT measurements in native knee OA patients ranged as follows: 400 M walk pace (0.08 to 0.20), chair stand pace (0.05 to 0.12), and 20 M pace (0.02 to 0.21), all with P<0.05. In the TKA cohort, values ranged as follows: 400 M walk pace (0.00 to 0.29), chair stand time (0.02 to 0.23), and 20 M pace (0.03 to 0.30). Due to the smaller cohort size, the majority, but not all had P values <0.05. CONCLUSION There is not a strong association between PROs and SFTs among patients who have knee OA or among patients who received a TKA. Therefore, PROs should not be used as a simple proxy for observed evaluation of physical function. Rather, PROs and SFTs are complementary and should be used in combination for a more nuanced and complete characterization of outcome.
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Affiliation(s)
- Brandon G Hill
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03766
| | - Shivesh Shah
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
| | - Wayne Moschetti
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03766; The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755
| | - Peter L Schilling
- Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03766; The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755.
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Goetz J, Maderbacher G, Gerg A, Leiss F, Dullien S, Zeman F, Meyer M, Reinhard J, Grifka J, Greimel F. Isokinetic knee muscle strength comparison after enhanced recovery after surgery (ERAS) versus conventional setup in total knee arthroplasty (TKA): a single blinded prospective randomized study. J Exp Orthop 2023; 10:44. [PMID: 37060486 PMCID: PMC10105813 DOI: 10.1186/s40634-023-00604-0] [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: 11/03/2022] [Accepted: 03/30/2023] [Indexed: 04/16/2023] Open
Abstract
PURPOSE Total knee arthroplasty (TKA) combined with the concept of enhanced recovery is of continued worldwide interest, as it is reported to improve early functional outcome and treatment quality without increasing complications. The aim of the study was to investigate isokinetic knee muscle strength after cemented TKA in combination with an enhanced recovery after surgery (ERAS) compared to a conventional setup. METHODS In the single blinded prospective randomized study, 52 patients underwent navigated primary cemented TKA within an ERAS (n = 30) or a conventional setup (n = 22). Preoperatively, five days and four weeks after surgery isokinetic knee muscle strength with BIODEX-type measuring device (peak torque in Nm, work in Joules and power in Watt) and subjective patient-related outcome measures (PROMs) were investigated. RESULTS The ERAS group showed significantly better outcomes in knee flexion at 180°/s (peak torque (Nm) p = 0.047, work (J) p = 0.040 and power (W) p = 0.016) 5 days postoperatively. The isokinetic measuring at knee extension 60°/s and 180°/s demonstrated no significant difference. The PROMs showed that patients were satisfied with the postoperative results in both groups. After 4 weeks, there was no longer a significant difference in isokinetic measuring at knee extension and flexion between the ERAS and conventional group. CONCLUSIONS TKA with the concept of ERAS improves excellent isokinetic outcome and patient satisfaction. The isokinetic muscle strength measurement can help patients and surgeons to modify expectations and improve patient satisfaction.
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Affiliation(s)
- Julia Goetz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Günther Maderbacher
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Anna Gerg
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Franziska Leiss
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Silvia Dullien
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Matthias Meyer
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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12
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Lawrie CM, Hannon CP, Jo S, King J, Riegler V, Nunley RM, Barrack RL. Tourniquet use does not impact trajectory of total knee arthroplasty early recovery: A prospective, randomized controlled trial. J Arthroplasty 2023; 38:S7-S13. [PMID: 37019311 DOI: 10.1016/j.arth.2023.03.081] [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] [Received: 03/14/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The impact of tourniquet use on recovery after total knee arthroplasty (TKA) remains controversial. The purpose of this prospective, single blinded, randomized controlled trial, was to investigate the effect of tourniquet use on early recovery after TKA using a smartphone app-based patient engagement platform (PEP) with a wrist-based activity monitor to obtain more robust data on early recovery. METHODS There were 107 patients undergoing primary TKA for osteoarthritis who were enrolled (54 tourniquet [TQ+]; 53 no tourniquet [TQ-]). All patients utilized a PEP and wrist-based activity sensor for two weeks preoperatively and 90 days postoperatively to collect Visual Analog Scale (VAS) pain scores and opioid consumption, as well as weekly Oxford Knee Score (OKS) and monthly Forgotten Joint Score (FJS). There was no difference in demographics between groups. Formal physical therapy assessments were performed preoperatively and 3 months postoperatively. Independent sample t-tests were used for continuous data and Chi-squared and Fisher's exact tests were used for discrete data. RESULTS Tourniquet use did not have a statistically significant impact on daily VAS pain or opioid consumption during the first 30 days postoperatively (P > 0.05). Tourniquet use did not have a significant impact on OKS or FJS at 30 or 90 days postoperatively (P> 0.05), or on performance of formal physical therapy testing at 3 months postoperatively (P> 0.05). CONCLUSIONS Using a digital technology to collect daily patient data, we found that tourniquet use has no clinically significant negative impact on pain and function in the first 90 days after primary TKA.
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Affiliation(s)
- Charles M Lawrie
- Baptist Health Orthopedic Care, Baptist Health South Florida, Miami, FL.
| | - Charles P Hannon
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Sally Jo
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jacqueline King
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Venessa Riegler
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
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13
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Babaei N, Hannani N, Dabanloo NJ, Bahadori S. A Systematic Review of the Use of Commercial Wearable Activity Trackers for Monitoring Recovery in Individuals Undergoing Total Hip Replacement Surgery. CYBORG AND BIONIC SYSTEMS (WASHINGTON, D.C.) 2022; 2022:9794641. [PMID: 36751476 PMCID: PMC9636847 DOI: 10.34133/2022/9794641] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Abstract
The innovation of wearable devices is advancing rapidly. Activity monitors can be used to improve the total hip replacement (THR) patients' recovery process and reduce costs. This systematic review assessed the body-worn accelerometers used in studies to enhance the rehabilitation process and monitor THR patients. Electronic databases such as Cochrane Database of Systematic Reviews library, CINAHL CompleteVR, Science Citation Index, and MedlineVR from January 2000 to January 2022 were searched. Due to inclusion criteria, fourteen eligible studies that utilised commercial wearable technology to monitor physical activity both before and after THR were identified. Their evidence quality was assessed with RoB 2.0 and ROBINS-I. This study demonstrates that wearable device technology might be feasible to predict, monitor, and detect physical activity following THR. They could be used as a motivational tool to increase patients' mobility and enhance the recovery process. Also, wearable activity monitors could provide a better insight into the individual's activity level in contrast to subjective self-reported questionnaires. However, they have some limitations, and further evidence is needed to establish this technology as the primary device in THR rehabilitation.
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Affiliation(s)
- Nasibeh Babaei
- Department of Biomedical Engineering, Science And Research Branch, Islamic Azad University, Tehran, Iran
| | - Negin Hannani
- Department of Biomedical Engineering, Science And Research Branch, Islamic Azad University, Tehran, Iran
| | - Nader Jafarnia Dabanloo
- Department of Biomedical Engineering, Science And Research Branch, Islamic Azad University, Tehran, Iran
| | - Shayan Bahadori
- Faculty of Health and Social Science, Bournemouth University, Bournemouth, UK
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14
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Yeung S, Kim HK, Carleton A, Munro J, Ferguson D, Monk AP, Zhang J, Besier T, Fernandez J. Integrating wearables and modelling for monitoring rehabilitation following total knee joint replacement. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107063. [PMID: 35994872 DOI: 10.1016/j.cmpb.2022.107063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/24/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Wearable inertial devices integrated with modelling and cloud computing have been widely adopted in the sports sector, however, their use in the health and medical field has yet to be fully realised. To date, there have been no reported studies concerning the use of wearables as a surrogate tool to monitor knee joint loading during recovery following a total knee joint replacement. The objective of this study is to firstly evaluate if peak tibial acceleration from wearables during gait is a good surrogate metric for computer modelling predicted functional knee loading; and secondly evaluate if traditional clinical patient related outcomes measures are consistent with wearable predictions. METHODS Following ethical approval, four healthy participants were used to establish the relationship between computer modelling predicted knee joint loading and wearable measured tibial acceleration. Following this, ten patients who had total knee joint replacements were then followed during their 6-week rehabilitation. Gait analysis, wearable acceleration, computer models of knee joint loading, and patient related outcomes measures including the Oxford knee score and range of motion were recorded. RESULTS A linear correlation (R2 of 0.7-0.97) was observed between peak tibial acceleration (from wearables) and musculoskeletal model predicted knee joint loading during gait in healthy participants first. Whilst patient related outcome measures (Oxford knee score and patient range of motion) were observed to improve consistently during rehabilitation, this was not consistent with all patient's tibial acceleration. Only those patients that exhibited increasing peak tibial acceleration over 6-weeks rehabilitation were positively correlated with the Oxford knee score (R2 of 0.51 to 0.97). Wearable predicted tibial acceleration revealed three patients with a consistent knee loading, five patients with improving knee loading, and two patients with declining knee loading during recovery. Hence, 20% of patients did not present with satisfactory joint loading following total knee joint replacement and this was not detected with current patient related outcome measures. CONCLUSIONS The use of inertial measurement units or wearables in this study provided additional insight into patients who were not exhibiting functional improvements in joint loading, and offers clinicians an 'off-site' early warning metric to identify potential complications during recovery and provide the opportunity for early intervention. This study has important implications for improving patient outcomes, equity, and for those who live in rural regions.
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Affiliation(s)
- S Yeung
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - H K Kim
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; School of Kinesiology, Louisiana State University, United States
| | - A Carleton
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - J Munro
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - D Ferguson
- Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - A P Monk
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - J Zhang
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - T Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - J Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Engineering Science, University of Auckland, Auckland, New Zealand.
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15
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Boekesteijn R, Smolders J, Busch V, Keijsers N, Geurts A, Smulders K. Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures. PeerJ 2022; 10:e14054. [PMID: 36193431 PMCID: PMC9526408 DOI: 10.7717/peerj.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/24/2022] [Indexed: 01/20/2023] Open
Abstract
Background Inertial sensors hold the promise to objectively measure functional recovery after total knee (TKA) and hip arthroplasty (THA), but their value in addition to patient-reported outcome measures (PROMs) has yet to be demonstrated. This study investigated recovery of gait after TKA and THA using inertial sensors, and compared results to recovery of self-reported scores of pain and function. Methods PROMs and gait parameters were assessed before and at two and fifteen months after TKA (n = 24) and THA (n = 24). Gait parameters were compared with healthy individuals (n = 27) of similar age. Gait data were collected using inertial sensors on the feet, lower back, and trunk. Participants walked for two minutes back and forth over a 6m walkway with 180° turns. PROMs were obtained using the Knee Injury and Osteoarthritis Outcome Scores and Hip Disability and Osteoarthritis Outcome Score. Results Gait parameters recovered to the level of healthy controls after both TKA and THA. Early improvements were found in gait-related trunk kinematics, while spatiotemporal gait parameters mainly improved between two and fifteen months after TKA and THA. Compared to the large and early improvements found in of PROMs, these gait parameters showed a different trajectory, with a marked discordance between the outcome of both methods at two months post-operatively. Conclusion Sensor-derived gait parameters were responsive to TKA and THA, showing different recovery trajectories for spatiotemporal gait parameters and gait-related trunk kinematics. Fifteen months after TKA and THA, there were no remaining gait differences with respect to healthy controls. Given the discordance in recovery trajectories between gait parameters and PROMs, sensor-derived gait parameters seem to carry relevant information for evaluation of physical function that is not captured by self-reported scores.
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Affiliation(s)
- Ramon Boekesteijn
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands,Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José Smolders
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Vincent Busch
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander Geurts
- Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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16
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Kim AG, Bernhard Z, Acuña AJ, Wu VS, Kamath AF. Use of intraoperative technology in total knee arthroplasty is not associated with reductions in postoperative pain. Knee Surg Sports Traumatol Arthrosc 2022; 31:1370-1381. [PMID: 35984446 DOI: 10.1007/s00167-022-07098-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Our systematic review and meta-analysis sought to assess how technology-assistance impacts (1) post-operative pain and (2) opioid use in patients undergoing primary total knee arthroplasty (TKA). METHODS Four online databases were queried for studies published up to October 2021 that reported on pain and opioid usage between technology-assisted and manual TKA (mTKA) patients. Mantel-Haenszel (M-H) models were utilized to calculate pooled mean difference (MDs) and 95% confidence interval (CIs). Subgroup analyses were conducted to isolate robotic-arm assisted (RAA) and computed-assisted navigation (CAN) cohorts. Risk of bias was assessed for all included non-randomized studies with the Methodological Index for Non-Randomized Studies (MINORS) tool. For the randomized control trials included in our study, the Detsky scale was applied. RESULTS Our analysis included 31 studies, reporting on a total of 761,300 TKAs (mTKA: n = 753,554; Computer-Assisted Navigation (CAN): n = 1,309; Robotic-Arm Assisted (RAA): n = 6437). No differences were demonstrated when evaluating WOMAC (MD: 0.00, 95% CI - 0.69 to 0.69; p = 1.00), KSS (MD: 0.01, 95% CI - 1.46 to 1.49; p = 0.99), KOOS (MD - 2.91, 95% CI - 6.17 to 0.34; p = 0.08), and VAS (MD - 0.54, 95% CI - 1.01 to - 0.007; p = 0.02) pain scores between cohorts. There was mixed evidence regarding how opioid consumption differed between TKA techniques. CONCLUSION The present analysis demonstrated no difference in terms of pain across a variety of utilized patient-reported pain measurements. However, there were mixed results regarding how opioid consumption varied between manual and technology-assisted cohorts, particularly in the immediate post-operative period. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Andrew G Kim
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Zachary Bernhard
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Victoria S Wu
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA. .,Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Mail Code A41, Cleveland, OH, 44195, USA.
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17
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Paton M, Lane R, Paul E, Linke N, Shehabi Y, Hodgson CL. Correlation of patient-reported outcome measures to performance-based function in critical care survivors: PREDICTABLE. Aust Crit Care 2022:S1036-7314(22)00070-4. [PMID: 35810078 DOI: 10.1016/j.aucc.2022.05.006] [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: 02/13/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Establishing sequela following critical illness is a public health priority; however, recruitment and retention of this cohort make assessing functional outcomes difficult. Completing patient-reported outcome measures (PROMs) via telephone may improve participant and researcher involvement; however, there is little evidence regarding the correlation of PROMs to performance-based outcome measures in critical care survivors. OBJECTIVES The objective of this study was to assess the relationship between self-reported and performance-based measures of function in survivors of critical illness. METHODS This was a nested cohort study of patients enrolled within a previously published study determining predictors of disability-free survival. Spearman's correlation (rs) was calculated between four performance-based outcomes (the Functional Independence Measure [FIM], 6-min walk distance [6MWD], Functional Reach Test [FRT], and grip strength) that were collected during a home visit 6 months following their intensive care unit admission, with two commonly used PROMs (World Health Organization Disability Assessment Scale 2.0 12 Level [WHODAS 2.0] and EuroQol-5 Dimension-5 Level [EQ-5D-5L]) obtained via phone interview (via the PREDICT study) at the same time point. RESULTS There were 38 PROMs obtained from 40 recruited patients (mean age = 59.8 ± 16 yrs, M:F = 24:16). All 40 completed the FIM and grip strength, 37 the 6MWD, and 39 the FRT. A strong correlation was found between the primary outcome of the WHODAS 2.0 with all performance-based outcomes apart from grip strength where a moderate correlation was identified. Although strong correlations were also established between the EQ-5D-5L utility score and the FIM, 6MWD, and FRT, it only correlated weakly with grip strength. The EQ-5D overall global health rating only had very weak to moderate correlations with the performance-based outcomes. CONCLUSION The WHODAS 2.0 correlated stronger across multiple performance-based outcome measures of functional recovery and is recommended for use in survivors of critical illness.
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Affiliation(s)
- Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia; Department of Physiotherapy, Monash Health, Clayton, VIC, 3168, Australia
| | - Rebecca Lane
- College of Health and Biomedicine, Victoria University, Footscray, VIC, 3011, Australia
| | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Natalie Linke
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Yahya Shehabi
- Department of Intensive Care, Monash Health School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia; Department of Physiotherapy, Alfred Hospital, Melbourne, VIC, 3004, Australia.
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18
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Constantinescu D, Pavlis W, Rizzo M, Vanden Berge D, Barnhill S, Hernandez VH. The role of commercially available smartphone apps and wearable devices in monitoring patients after total knee arthroplasty: a systematic review. EFORT Open Rev 2022; 7:481-490. [PMID: 35900191 PMCID: PMC9297050 DOI: 10.1530/eor-21-0115] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Commercially available smartphone apps and wearable devices have proven valuable in a variety of clinical settings, yet their utility in measuring physical activity and monitoring patient status following total knee arthroplasty (TKA) remains unclear. Methods A systematic review was performed to assess the evidence supporting the use of smartphone apps and wearable devices to assist rehabilitation interventions following TKA. A search was conducted in the PubMed, Cochrane, Medline, and Web of Science databases in September 2021. Results One hundred and seventy-six studies were retrieved, of which 15 met inclusion criteria, including 6 randomized control trials. Four of these studies utilized smartphone apps, seven utilized wearable devices, and four utilized a combination of both. A total of 1607 TKA patients participated in the included studies. For primary outcomes, three reported on device accuracy, three on recovery prediction, two on functional recovery, two on physical activity promotion, two on patient compliance, two on pain control, and one on healthcare utilization. Conclusion Commercially available smartphone apps and wearable devices were shown to capably monitor physical activity and improve patient engagement following TKA, making them potentially viable adjuncts or replacements to traditional rehabilitation programs. Components of interventions such as step goals, app-based patient engagement platforms, and patient-specific benchmarks for recovery may improve effectiveness. However, future research should focus on the economics of implementation, long-term outcomes, and optimization of compliance and accuracy when using these devices.
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Affiliation(s)
| | - William Pavlis
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Rizzo
- Department of Orthopaedics, University of Miami, Miami, Florida, USA
| | | | - Spencer Barnhill
- Department of Orthopaedics, University of Miami, Miami, Florida, USA
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Can Patient-Reported Outcome Measurement Information System Measures Differentiate Patients Who Will Undergo Hip and Knee Total Joint Arthroplasty: A Retrospective Case-Control Study. J Arthroplasty 2022; 37:S56-S62. [PMID: 35196566 DOI: 10.1016/j.arth.2022.02.053] [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: 07/30/2021] [Revised: 01/31/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Patient-Reported Outcome Measurement Information System (PROMIS) can be used to monitor patients in population-health-based programs. However, it is unknown which measures are most appropriate to differentiate patients who will undergo hip or knee total joint arthroplasty (TJA) in a cohort of patients with osteoarthritis. METHODS A retrospective cohort of new patients consulting for treatment from November 17, 2017 to April 20, 2020 (cases: hip: n = 157, knee: n = 112; randomly selected nonsurgical controls: hip: n = 314, knee: n = 224) was extracted from the electronic health record. We recorded demographics, comorbidity, and PROMIS scores for 8 domains (physical function, pain interference, pain intensity, anxiety, depression, sleep disturbance, ability to participate in social roles and activities, and fatigue). We performed descriptive statistics to characterize the cohorts and baseline PROMIS scores and conducted logistic regression models to determine which PROMIS domains differentiated patients undergoing hip and knee TJA. RESULTS In univariate comparisons of PROMIS domains, the hip and knee surgical cohorts differed from controls in physical function (P < .01), pain interference (P < .01), and ability to participate in social roles and activities (P < .02). In logistic regression models informed by univariate analyses, PROMIS physical function was the only PROMIS measure to differentiate undergoing surgery in both hip and knee cohorts (P < .01). CONCLUSION PROMIS physical function can differentiate TJA cases from nonsurgical controls in both hip and knee patients. These findings have implications for considering which PROMIS measures to administer in patients with hip and knee osteoarthritis.
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20
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Evaluation of consistency of patient-satisfaction score in the 2011 Knee Society Score to other patient-reported outcome measures. J Orthop Sci 2022; 27:652-657. [PMID: 33896681 DOI: 10.1016/j.jos.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/21/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are important aspects of evaluating clinical outcomes after total knee arthroplasty (TKA). The patient-satisfaction score in the 2011 Knee Society Score (KSS) is one of the most frequently used questionnaires; however, patient satisfaction is a subjective assessment and is affected by multiple factors. Therefore, we evaluated correlations between the patient-satisfaction score in the 2011 KSS and that of other categories of the 2011 KSS as well as other PROMs. Furthermore, the ceiling effects of each PROMS were also investigated. METHODS We enrolled 85 patients aged ≥65 years who underwent cruciate retaining TKA. Patients completed various questionnaires, including the 2011 KSS, Forgotten Joint Score-12 (FJS-12), EuroQol 5 Dimension (EQ-5D), and Geriatric Locomotive Function Scale (GLFS-25), one year after TKA. Simple linear regression analysis was used to evaluate correlations between each PROM and the patient-satisfaction score in the 2011 KSS. Ceiling effects of the patient-satisfaction score in the 2011 KSS, FJS-12, EQ-5D and GLFS-25 were evaluated by comparing the number of patients categorized into the top 10% with each PROM. RESULTS All scores were significantly correlated (p < 0.001) with the patient-satisfaction score in the 2011 KSS (symptoms: r = 0.69, functional activities: r = 0.69, patient expectations: r = 0.73, FJS-12: r = 0.72, EQ-5D: r = 0.67, GLFS-25: r = -0.74). The patient-satisfaction score in the 2011 KSS and GLFS-25 showed a ceiling effect. On the other hand, this effect was not observed in the results of the FJS-12 and EQ-5D. CONCLUSIONS The patient-satisfaction score in the 2011 KSS correlated with other PROMs, and the indicated level of satisfaction was consistent. The results of the FJS-12 and EQ-5D had good positive correlation to patient satisfaction without ceiling effect.
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21
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Soffin EM, Wainwright TW. Hip and Knee Arthroplasty. Anesthesiol Clin 2022; 40:73-90. [PMID: 35236584 DOI: 10.1016/j.anclin.2021.11.003] [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: 06/14/2023]
Abstract
Variation in care is associated with variation in outcomes after total joint arthroplasty (TJA). Accordingly, much research into enhanced recovery efficacy for TJA has been devoted to linking standardization with better outcomes. This article focuses on recent advances suggesting that variation within a set of core protocol elements may be less important than providing the core elements within enhanced recovery pathways for TJA. Provided the core elements are associated with benefits for patients and health care system outcomes, variation in the details of their provision may contribute to a pathway's success. This article provides an updated review of the literature.
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Affiliation(s)
- Ellen M Soffin
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
| | - Thomas W Wainwright
- Orthopaedic Research Institute, Bournemouth University, 89 Holdenhurst Road, Bournemouth, Dorset BH8 8FT, UK
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22
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Tomar L, Govil G, Dhawan P. Physiotherapeutic assistance verse home care assistance in the early rehabilitation of total knee arthroplasty during COVID-19 lockdown. ARTHROPLASTY 2022; 3:6. [PMID: 34977466 PMCID: PMC7920634 DOI: 10.1186/s42836-020-00067-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this retrospective comparison study was to assess early functional recovery of total knee arthroplasty with home care assistance during COVID-19 lockdown. Methods A total of 16 patients (27 knees involved) were divided into a pre-lockdown group (10 patients; 17 knees) and a post-lockdown group (6 patients, 10 knees) in terms of the time of surgeries performed before and after lockdown, respectively, due to COVID-19 pandemic. Patients of pre-lockdown group underwent rehabilitation under the guidance of trained physiotherapists for at-home sessions and under assisted physiotherapy. Patients of post-lockdown group followed the rehabilitation protocol of at-home sessions and under home-care assistance during COVID-19 lockdown. Functional recovery of the knee was assessed against the Knee Injury and Osteoarthritis Outcome Score, Junior. A p < 0.05 was considered statistically significant. Results The pre- and postoperative mean KOOS Junior of pre-lockdown group were 48.73 ± 2.64 and 64.91 ± 2.74, respectively (p < 0.001). The pre- and postoperative scores of post-lockdown group were 48.83 ± 2.83 and 67.84 ± 4.31 (p < 0.001), respectively. Intergroup comparison between pre- and postoperative KOOS Jr. revealed no significant differences (p > 0.05). Conclusion Although the COVID-19 lockdown affected the routine postoperative rehabilitation after total knee arthroplasty, the coordination among the surgeon, therapists, and home caregivers can provide sustained assistance in rehabilitation. The guidelines for practitioners and physiotherapists can benefit functional recovery of the knee.
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Affiliation(s)
- Lavindra Tomar
- Department of Orthopaedics, Max Super Speciality Hospital, Patparganj, Delhi, A-702 Vardhman apartment, Mayur Vihar Phase1extension, Delhi, 110091 India
| | - Gaurav Govil
- Department of Orthopaedics, Max Super Speciality Hospital, Patparganj, Delhi, D101, Sunshine Helios, Sector 78, Noida, Uttar Pradesh 201305 India
| | - Pawan Dhawan
- Department of Orthopaedics, Max Super Speciality Hospital, Patparganj, Delhi, House no 37, Sukh Vihar, Delhi, 110051 India
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Patients' perceived walking abilities, daily-life gait behavior and gait quality before and 3 months after total knee arthroplasty. Arch Orthop Trauma Surg 2022; 142:1189-1196. [PMID: 33956227 PMCID: PMC9110478 DOI: 10.1007/s00402-021-03915-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/13/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Functional outcome and patients' daily-life activities after total knee arthroplasty are becoming more important with a younger and more active patient population. In addition to patient-reported outcome measures (PROMs), trunk-based accelerometry has shown to be a promising method for evaluating gait function after total knee arthroplasty. The aim of this study was to evaluate daily-life perceived walking abilities, gait behavior and gait quality before and 3 months after total knee arthroplasty, using PROMs and trunk-based accelerometry. MATERIALS AND METHODS A cohort of 38 patients completed questionnaires including the Oxford Knee Score and modified Gait Efficacy Scale before and 3 months after primary unilateral total knee arthroplasty. At both time points, they wore a tri-axial accelerometer at the lower back for seven consecutive days and nights. Gait behavior was calculated using gait quantity and walking speed, and multiple gait quality parameters were calculated. RESULTS Significant improvements were seen after 3 months in the Oxford Knee Score [median (interquartile range) 29 (10) vs 39 (8), p < 0.001] and modified Gait Efficacy Scale [median (interquartile range) 67 (24) vs 79 (25), p = 0.001]. No significant changes were observed in gait behavior (quantity and speed) or gait quality variables. CONCLUSIONS In contrast to the significant improvements in patients' perception of their walking abilities and PROMs, patients did not show improvements in gait behavior and gait quality. This implies that after 3 months patients' perceived functional abilities after total knee arthroplasty do not necessarily represent their actual daily-life quantity and quality of gait, and that more focus is needed on postoperative rehabilitation to improve gait and functional behavior.
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Jelsma J, Van Kuijk S, Buil I, Heyligers I, Grimm B, Schotanus M. Only limited correlations between patient-reported outcomes and objectively monitored physical activity 10-years after THA. Acta Orthop Belg 2021; 87:593-599. [PMID: 35172425 DOI: 10.52628/87.4.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In orthopaedics, patient reported outcomes (PROMs) are designed to quantify changes in pain and to assess physical function, most often after joint arthroplasty. However, PROMs have some disadvantages, most important is their subjective nature. The aim was to investigate how patient-self-reported-outcomes of general health, disease-specific outcome and physical function, joint-awareness and self-perceived activity- levels are correlated with objectively-measured physical-activity (PA) parameters derived from wearable activity-monitors (AM) in subjects with a hip-arthroplasty. A prospective cohort study was conducted in a group of 32 patients, with a mean follow-up of 10 years after total hip arthroplasty. To assess different domains, the SF-36 (general health), HOOS-PS (pain/functional outcome), FJS-12 (joint awareness) and SQUASH (physical activity) were chosen. Activity-monitoring was performed using a 3-axis accelerometer, gyroscope and magnetometer. No significant correlations between PA-parameters and the FJS-12 and SQUASH were found. The HOOS- PS was significant correlated with BMI, the daily time walking and total-time active and the amount of daily steps. The physical functioning-subscale of the SF-36 was significant negative correlated with BMI and time sitting, but significant positive correlated with time walking, total-time active and the amount of daily steps. Considering the value of PA for maintaining general health, the value of using sensor-based AMs to assess efficacy of treatments in this health related dimension or use it as a tool for patient education, awareness and communication, seems very high.
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Van Egmond JC, Hesseling B, Verburg H, Mathijssen NMC. Short-term functional outcome after fast-track primary total knee arthroplasty: analysis of 623 patients. Acta Orthop 2021; 92:602-607. [PMID: 33977863 PMCID: PMC8519557 DOI: 10.1080/17453674.2021.1925412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Early functional outcome after total knee arthroplasty (TKA) has been described before, but without focus on the presence of certain functional recovery patterns. We investigated patterns of functional recovery during the first 3 months after TKA and determined characteristics for non-responders in functional outcome.Patients and methods - All primary TKA in a fast-track setting with complete patient-reported outcome measures (PROMs) preoperatively, at 6 weeks, and 3 months postoperatively were included. Included PROMs were Oxford Knee Score (OKS), Knee disability and Osteoarthritis Outcome Score Physical Function Short-Form (KOOS-PS), and EuroQol 5 dimensions (EQ-5D) including the self-rated health Visual Analogue Scale (VAS). Patients with improvement on OKS less than the minimal clinically important difference (MCID) were determined as non-responders at that time point. Characteristics between groups of responders and non-responders in functional recovery were tested for differences: we defined 4 groups a priori, based on the responder status at each time point.Results - 623 patients were included. At 6 weeks OKS, KOOS-PS, and EQ-5D self-rated health VAS were statistically significant improved compared with preoperative scores. The mean improvement was clinically relevant at 6 weeks for KOOS-PS and at 3 months for OKS. Patient characteristics in non-responders were higher BMI and worse scores on EQ-5D items: mobility, self-care, usual activities, and anxiety/depression.Interpretation - Both statistically significant and clinically relevant functional improvement were found in most patients during the first 3 months after primary TKA. Presumed modifiable patient characteristics in non-responders on early functional outcome were BMI and anxiety/depression.
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Affiliation(s)
- Jeroen C Van Egmond
- Department of Orthopaedics, Reinier Haga Orthopedisch Centrum, Zoetermeer, the Netherlands,Correspondence:
| | - Brechtje Hesseling
- Department of Orthopaedics, Reinier Haga Orthopedisch Centrum, Zoetermeer, the Netherlands
| | - Hennie Verburg
- Department of Orthopaedics, Reinier Haga Orthopedisch Centrum, Zoetermeer, the Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedics, Reinier Haga Orthopedisch Centrum, Zoetermeer, the Netherlands
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Bolam SM, Batinica B, Yeung TC, Weaver S, Cantamessa A, Vanderboor TC, Yeung S, Munro JT, Fernandez JW, Besier TF, Monk AP. Remote Patient Monitoring with Wearable Sensors Following Knee Arthroplasty. SENSORS (BASEL, SWITZERLAND) 2021; 21:5143. [PMID: 34372377 PMCID: PMC8347411 DOI: 10.3390/s21155143] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022]
Abstract
(Background) Inertial Measurement Units (IMUs) provide a low-cost, portable solution to obtain functional measures similar to those captured with three-dimensional gait analysis, including spatiotemporal gait characteristics. The primary aim of this study was to determine the feasibility of a remote patient monitoring (RPM) workflow using ankle-worn IMUs measuring impact load, limb impact load asymmetry and knee range of motion in combination with patient-reported outcome measures. (Methods) A pilot cohort of 14 patients undergoing primary knee arthroplasty for osteoarthritis was prospectively enrolled. RPM in the community was performed weekly from 2 up to 6 weeks post-operatively using wearable IMUs. The following data were collected using IMUs: mobility (Bone Stimulus and cumulative impact load), impact load asymmetry and maximum knee flexion angle. In addition, scores from the Oxford Knee Score (OKS), EuroQol Five-dimension (EQ-5D) with EuroQol visual analogue scale (EQ-VAS) and 6 Minute Walk Test were collected. (Results) On average, the Bone Stimulus and cumulative impact load improved 52% (p = 0.002) and 371% (p = 0.035), compared to Post-Op Week 2. The impact load asymmetry value trended (p = 0.372) towards equal impact loading between the operative and non-operative limb. The mean maximum flexion angle achieved was 99.25° at Post-Operative Week 6, but this was not significantly different from pre-operative measurements (p = 0.1563). There were significant improvements in the mean EQ-5D (0.20; p = 0.047) and OKS (10.86; p < 0.001) scores both by 6 weeks after surgery, compared to pre-operative scores. (Conclusions) This pilot study demonstrates the feasibility of a reliable and low-maintenance workflow system to remotely monitor post-operative progress in knee arthroplasty patients. Preliminary data indicate IMU outputs relating to mobility, impact load asymmetry and range of motion can be obtained using commercially available IMU sensors. Further studies are required to directly correlate the IMU sensor outputs with patient outcomes to establish clinical significance.
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Affiliation(s)
- Scott M. Bolam
- Department of Orthopaedics, Auckland City Hospital, Auckland 1023, New Zealand; (S.M.B.); (T.C.V.); (J.T.M.)
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand;
| | - Bruno Batinica
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand;
| | - Ted C. Yeung
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand; (T.C.Y.); (S.W.); (S.Y.); (J.W.F.); (T.F.B.)
| | - Sebastian Weaver
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand; (T.C.Y.); (S.W.); (S.Y.); (J.W.F.); (T.F.B.)
| | - Astrid Cantamessa
- Laboratory of Biological and Bioinspired Materials, University of Liège, 4000 Liège, Belgium;
| | - Teresa C. Vanderboor
- Department of Orthopaedics, Auckland City Hospital, Auckland 1023, New Zealand; (S.M.B.); (T.C.V.); (J.T.M.)
| | - Shasha Yeung
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand; (T.C.Y.); (S.W.); (S.Y.); (J.W.F.); (T.F.B.)
| | - Jacob T. Munro
- Department of Orthopaedics, Auckland City Hospital, Auckland 1023, New Zealand; (S.M.B.); (T.C.V.); (J.T.M.)
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand;
| | - Justin W. Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand; (T.C.Y.); (S.W.); (S.Y.); (J.W.F.); (T.F.B.)
- Department of Engineering Science, University of Auckland, Auckland 1010, New Zealand
| | - Thor F. Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand; (T.C.Y.); (S.W.); (S.Y.); (J.W.F.); (T.F.B.)
- Department of Engineering Science, University of Auckland, Auckland 1010, New Zealand
| | - Andrew Paul Monk
- Department of Orthopaedics, Auckland City Hospital, Auckland 1023, New Zealand; (S.M.B.); (T.C.V.); (J.T.M.)
- Department of Surgery, University of Auckland, Auckland 1023, New Zealand;
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand; (T.C.Y.); (S.W.); (S.Y.); (J.W.F.); (T.F.B.)
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Deckey DG, Rosenow CS, Verhey JT, Brinkman JC, Mayfield CK, Clarke HD, Bingham JS. Robotic-assisted total knee arthroplasty improves accuracy and precision compared to conventional techniques. Bone Joint J 2021; 103-B:74-80. [PMID: 34053292 DOI: 10.1302/0301-620x.103b6.bjj-2020-2003.r1] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS Robotic-assisted total knee arthroplasty (RA-TKA) is theoretically more accurate for component positioning than TKA performed with mechanical instruments (M-TKA). Furthermore, the ability to incorporate soft-tissue laxity data into the plan prior to bone resection should reduce variability between the planned polyethylene thickness and the final implanted polyethylene. The purpose of this study was to compare accuracy to plan for component positioning and precision, as demonstrated by deviation from plan for polyethylene insert thickness in measured-resection RA-TKA versus M-TKA. METHODS A total of 220 consecutive primary TKAs between May 2016 and November 2018, performed by a single surgeon, were reviewed. Planned coronal plane component alignment and overall limb alignment were all 0° to the mechanical axis; tibial posterior slope was 2°; and polyethylene thickness was 9 mm. For RA-TKA, individual component position was adjusted to assist gap-balancing but planned coronal plane alignment for the femoral and tibial components and overall limb alignment remained 0 ± 3°; planned tibial posterior slope was 1.5°. Mean deviations from plan for each parameter were compared between groups for positioning and size and outliers were assessed. RESULTS In all, 103 M-TKAs and 96 RA-TKAs were included. In RA-TKA versus M-TKA, respectively: mean femoral positioning (0.9° (SD 1.2°) vs 1.7° (SD 1.1°)), mean tibial positioning (0.3° (SD 0.9°) vs 1.3° (SD 1.0°)), mean posterior tibial slope (-0.3° (SD 1.3°) vs 1.7° (SD 1.1°)), and mean mechanical axis limb alignment (1.0° (SD 1.7°) vs 2.7° (SD 1.9°)) all deviated significantly less from the plan (all p < 0.001); significantly fewer knees required a distal femoral recut (10 (10%) vs 22 (22%), p = 0.033); and deviation from planned polyethylene thickness was significantly less (1.4 mm (SD 1.6) vs 2.7 mm (SD 2.2), p < 0.001). CONCLUSION RA-TKA is significantly more accurate and precise in planning both component positioning and final polyethylene insert thickness. Future studies should investigate whether this increased accuracy and precision has an impact on clinical outcomes. The greater accuracy and reproducibility of RA-TKA may be important as precise new goals for component positioning are developed and can be further individualized to the patient. Cite this article: Bone Joint J 2021;103-B(6 Supple A):74-80.
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Affiliation(s)
- David G Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Jens T Verhey
- Alix School of Medicine, Mayo Medical School, Scottsdale, Arizona, USA
| | - Joseph C Brinkman
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Cory K Mayfield
- Department of Orthopedics, University of Southern California, Los Angeles, California, USA
| | - Henry D Clarke
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.,Alix School of Medicine, Mayo Medical School, Scottsdale, Arizona, USA
| | - Joshua S Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.,Alix School of Medicine, Mayo Medical School, Scottsdale, Arizona, USA
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Hendrickx R, van der Avoird T, Pilot P, Kerkhoffs G, Schotanus M. Exergaming as a Functional Test Battery in Patients Who Received Arthroscopic Ankle Arthrodesis: Cross-sectional Pilot Study. JMIR Rehabil Assist Technol 2021; 8:e21924. [PMID: 33949311 PMCID: PMC8135032 DOI: 10.2196/21924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/06/2021] [Accepted: 04/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recently, movement-based videogames (exergames) have gained popularity in improving the rehabilitation process after surgery. During exergaming, participants are physically challenged as the game component stimulates adherence to the training program. There is no literature on the effect of exergame training interventions in patients who received arthroscopic ankle arthrodesis. OBJECTIVE This pilot study assessed the potency of an existing exergaming tool for the rehabilitation program of patients who received arthroscopic ankle arthrodesis. METHODS A cross-sectional pilot study was performed, in which patients who received arthroscopic ankle arthrodesis (n=8) were subjected to an exergaming protocol. Gait analysis was performed with a treadmill system. A healthy age-matched control group (n=10) was used as the control group. RESULTS The patient group was capable of performing exergaming exercises and they showed no floor or ceiling effect. Only in case of the overall stability, the patient group performed significantly less better than the control group (P=.03). Gait analysis showed equal step length with increased external rotation of the affected limb. CONCLUSIONS Exergaming seems to be a valuable tool for measuring the ability of patients who received AAA to perform activities of daily living and it has the potential to individualize rehabilitation programs. When exergaming is systematically integrated with patient-reported outcome measures and activity tracking, it has the potential to improve the quality of care.
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Affiliation(s)
| | | | | | - Gino Kerkhoffs
- Amsterdam University Medical Centers, Amsterdam, Netherlands
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29
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Dantas LO, Salvini TDF, McAlindon TE. Knee osteoarthritis: key treatments and implications for physical therapy. Braz J Phys Ther 2021; 25:135-146. [PMID: 33262080 PMCID: PMC7990728 DOI: 10.1016/j.bjpt.2020.08.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a chronic progressive disease that imparts a substantial socioeconomic burden to society and healthcare systems. The prevalence of knee OA has dramatically risen in recent decades due to consistent increases in life expectancy and obesity worldwide. Patient education, physical exercise, and weight loss (for overweight or obese individuals) constitute the first-line knee OA treatment approach. However, less than 40% of patients with knee OA receive this kind of intervention. There is an unmet need for healthcare professionals treating individuals with knee OA to understand the current recommended treatment strategies to provide effective rehabilitation. OBJECTIVE To guide physical therapists in their clinical decision making by summarizing the safest and most efficacious treatment options currently available, and by delineating the most traditional outcome measures used in clinical research for knee OA. CONCLUSION There is a need for healthcare providers to abandon low-quality and ineffective treatments and educate themselves and their patients about the current best evidence-based practices for knee OA.
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Affiliation(s)
- Lucas Ogura Dantas
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, SP, Brazil; Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA
| | | | - Timothy E McAlindon
- Division of Rheumatology, Allergy and Immunology, Tufts Medical Center, Boston, MA, USA.
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Mark-Christensen T, Thorborg K, Kallemose T, Bandholm T. Physical rehabilitation versus no physical rehabilitation after total hip and knee arthroplasties: Protocol for a pragmatic, randomized, controlled, superiority trial (The DRAW1 trial). F1000Res 2021; 10:146. [PMID: 34316356 PMCID: PMC8276181 DOI: 10.12688/f1000research.50814.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 05/13/2024] Open
Abstract
Background: Following total hip- and knee arthroplasty (THA and TKA), post-discharge physical rehabilitation is common practice, but varies significantly regarding content, duration, intensity and mode of delivery. Recent systematic reviews have found home-based rehabilitation to be as good as outpatient rehabilitation in terms of pain and physical function. We therefore wonder if physical rehabilitation "works" at all when compared to no physical rehabilitation after THA and TKA - "no rehabilitation" defined as no prescribed therapeutic rehabilitation exercises. The purpose of this trial is to compare the effectiveness of home-based telerehabilitation, home-based rehabilitation and no physical rehabilitation following THA and TKA. Methods: This pragmatic, randomized controlled trial will include 168 patients following discharge after THA or TKA, in Bornholm Denmark. Patients will be randomized into one of the three 6-week rehabilitation strategies: home-based telerehabilitation, home-based rehabilitation or no physical rehabilitation. The trial is designed as a superiority trial to test the hypothesis that rehabilitation (home-based telerehabilitation and home-based rehabilitation) is superior to no physical rehabilitation. The primary outcome will be the hip disability and osteoarthritis outcome score (HOOS)/ the knee injury and osteoarthritis outcome score (KOOS)-subscale: function of daily living at first follow-up (end of the 6-weeks' intervention). Additional follow-ups are scheduled at 3 and 12 months. Outcome assessors and data analysts are blinded to group allocation. Conclusions: Knowledge about the effectiveness of the three investigated rehabilitation strategies will help guide the future organization of post-discharge rehabilitation after THA and TKA. Trial registration: Clinicaltrials.gov NCT03750448 (23/11/2018).
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Affiliation(s)
- Troels Mark-Christensen
- Department of Rehabilitation, Centre of Health, Regional Municipality of Bornholm, Rønne, Bornholm, Denmark
| | - Kristian Thorborg
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Physical Therapy and Occupational, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital – Amager and Hvidovre, Copenhagen, Denmark
| | - Thomas Bandholm
- Physical Medicine and Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Physical Therapy and Occupational, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Copenhagen University Hospital – Amager and Hvidovre, Copenhagen, Denmark
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Thilak J, Babu BC, Thadi M, Mohan V, Arun Kumar T, Mane PP, Ravindran GC. Accuracy in the Execution of Pre-operative Plan for Limb Alignment and Implant Positioning in Robotic-arm Assisted Total Knee Arthroplasty and Manual Total Knee Arthroplasty: A Prospective Observational Study. Indian J Orthop 2021; 55:953-960. [PMID: 34194653 PMCID: PMC8192671 DOI: 10.1007/s43465-020-00324-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/28/2020] [Indexed: 02/04/2023]
Abstract
AIM The objective of the study is to compare the accuracy of implant positioning and limb alignment achieved in robotic-arm assisted total knee arthroplasty(RATKA) and manual total knee arthroplasty(MTKA) to their respective preoperative plan. PATIENTS AND METHODS This was a prospective observational study conducted in a tertiary care centre between August 2018 and January 2020. 143 consecutive RATKA(105 patients) and 151 consecutive MTKA(111 patients) performed by two experienced arthroplasty surgeons were included. Two independent observers evaluated the accuracy of implant positioning by measuring the radiological parameters according to the Knee-Society-Roentgenographic-Evaluation-System and limb alignment from postoperative weight-bearing scanogram. Outcomes were defined, based on the degree of deviation of measurements from the planned position and alignment, as excellent(0-1.99°), acceptable(2.00-2.99°) and outlier(≥ 3.00°). RESULTS There were no systematic differences in the demographic and baseline characteristics between RATKA and MTKA. Statistically significant outcomes were observed favouring robotic group for postoperative mechanical axis (p < .001), coronal inclination of the femoral component (p < 0.001), coronal inclination of tibial component (p < 0.001), and sagittal inclination of tibial component (p < 0.001). There was no significant difference in the sagittal inclination of the femoral component (p = 0.566). The percentage of knees in the 'excellent' group were higher in RATKA compared to MTKA. There was absolutely no outlier in terms of limb alignment in the RATKA group versus 23.8% (p < 0.001) in the MTKA group. All the measurements showed high interobserver and intraobserver reliability. CONCLUSION Robotic-arm assisted TKA executed the preoperative plan more accurately with respect to limb alignment and implant positioning compared to manual TKA, even when the surgeons were more experienced in the latter. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-020-00324-y.
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Affiliation(s)
- Jai Thilak
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Balu C. Babu
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Mohan Thadi
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Vipin Mohan
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - T. Arun Kumar
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Prajwal P. Mane
- grid.427788.60000 0004 1766 1016Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Greeshma C. Ravindran
- grid.411370.00000 0000 9081 2061Department of Biostatistics, Amrita School of Medicine, Kochi, Kerala India
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Houts CR, Patrick-Lake B, Clay I, Wirth RJ. The Path Forward for Digital Measures: Suppressing the Desire to Compare Apples and Pineapples. Digit Biomark 2020; 4:3-12. [PMID: 33442577 DOI: 10.1159/000511586] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
Digital measures are becoming more prevalent in clinical development. Methods for robust evaluation are increasingly well defined, yet the primary barrier for digital measures to transition beyond exploratory usage often relies on a comparison to the existing standards. This article focuses on how researchers should approach the complex issue of comparing across assessment modalities. We discuss comparisons of subjective versus objective assessments, or performance-based versus behavioral measures, and we pay particular attention to the situation where the expected association may be poor or nonlinear. We propose that, rather than seeking to replace the standard, research should focus on a structured understanding of how the new measure augments established assessments, with the ultimate goal of developing a more complete understanding of what is meaningful to patients.
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Affiliation(s)
- Carrie R Houts
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
| | | | - Ieuan Clay
- Evidation Health, Inc., San Mateo, California, USA
| | - R J Wirth
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
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Luna IE, Kehlet H, Olsen RM, Wede HR, Hoevsgaard SJ, Aasvang EK. Hypoxemia following hospital discharge after fast-track hip and knee arthroplasty - A prospective observational study subanalysis. Acta Anaesthesiol Scand 2020; 64:1405-1413. [PMID: 32659852 DOI: 10.1111/aas.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Post-operative hypoxemia is prevalent in hospitalized patients and may adversely affect recovery. However, little data exist on the post-discharge phase or details on duration, severity and potential risk factors. Thus, we investigated the incidence and risk factors for severe desaturation during the first post-operative week after THA/TKA by continuous nocturnal oxygen saturation monitoring. METHODS The study was a secondary analysis of a prospective cohort study of 112 patients undergoing fast-track THA/TKA. Patients with known sleep apnoea were excluded. Oxygen saturation and heart rate were recorded by a wireless wrist-worn pulse oximeter 2 nights before and 7 nights after surgery. Data on demographics, opioid consumption and cognitive function were collected from medical charts, patient diaries and clinical testing respectively. The primary outcome was occurrence of severe desaturation defined as periods with saturation <85% lasting ≥10 minutes. Secondary outcomes included description of various saturation levels and relevant risk factors. RESULTS Severe oxygen desaturation occurred in 35% of the patients during the first post-operative week. Duration and severity of hypoxemic episodes increased after the first post-operative day. Pre-operative episodes of hypoxemia significantly increased the risk of post-operative hypoxemic events (OR 2.4-4.4, CI 0.4-46), while pre- and post-operative opioid use, age, gender, ASA classification, type of surgery or anaesthesia were significantly related to the development of post-operative hypoxemia. CONCLUSIONS One third of the patients suffered from increased and prolonged episodes of severe nocturnal hypoxemia during the first week after THA/TKA discharge. Increased risk for severe hypoxemic episodes was related to pre-operative hypoxemia.
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Affiliation(s)
- I. E. Luna
- The Lundbeck Centre for fast‐track Hip and Knee Arthroplasty Copenhagen Denmark
| | - H. Kehlet
- The Lundbeck Centre for fast‐track Hip and Knee Arthroplasty Copenhagen Denmark
- Section of Surgical Pathophysiology Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - R. M. Olsen
- Biomedical Engineering Department of Electrical Engineering Technical University of Denmark Lyngby Denmark
| | - H. R. Wede
- The Lundbeck Centre for fast‐track Hip and Knee Arthroplasty Copenhagen Denmark
- Department of Orthopaedics Gentofte‐Herlev Hospital University of Copenhagen Copenhagen Denmark
| | - S. J. Hoevsgaard
- The Lundbeck Centre for fast‐track Hip and Knee Arthroplasty Copenhagen Denmark
- Department of Orthopaedics Vejle Hospital Vejle Denmark
| | - E. K. Aasvang
- The Lundbeck Centre for fast‐track Hip and Knee Arthroplasty Copenhagen Denmark
- Section of Surgical Pathophysiology Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Anaesthesia Center for Cancer and Organ Failure Rigshospitalet University of Copenhagen Copenhagen Denmark
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Schwartz AM, Wilson JM, Farley KX, Bradbury TL, Guild GN. Concomitant Malnutrition and Frailty Are Uncommon, but Significant Risk Factors for Mortality and Complication Following Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:2878-2885. [PMID: 32576431 DOI: 10.1016/j.arth.2020.05.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) demand continues to rise, but we are also gaining greater insight into patient risk factors for postoperative complications and excess resource utilization. There has been growing interest in frailty and malnutrition as risk factors, although they are often mistakenly used interchangeably. We aimed at identifying the incidence of their coexistence, and the magnitude of risk they confer to TKA patients. METHODS We queried the American College of Surgeons-National Surgery Quality Improvement Program database to identify 4 patient cohorts: healthy/normal serum albumin, healthy/hypoalbuminemic patients, normoalbuminemic/medically frail patients (defined by modified frailty index), and hypoalbuminemic/frail patients. We performed both univariate and multivariate analyses to quantify the risk conferred by each condition in isolation, and in coexistence. RESULTS Of 179,702 elective TKA cases from 2006 to 2018, 18.6% of patients were frail only, 3.0% were hypoalbuminemic -only, and just 1.2% were both frail and hypoalbuminemic. The raw rate of any complication was highest in frail/hypoalbuminemic patients (8.7%), 5.2% in hypoalbuminemic patients, 4.8% in frail patients, and just 3.4% in healthy patients (P < .001); the multivariate model revealed odds ratio of a complication in frail/hypoalbuminemic group of 2.40 (95% confidence interval = 1.27-1.63; P < .001). Mortality within 30 days was highest in the frail/hypoalbuminemic cohort (1.0%), and just 0.1% in healthy patients, and the multivariate model noted an odds ratio of 9.43 for these patients (95% confidence interval = 5.92-14.93; P < .001). The odds of all studied complications were highest in the frail/hypoalbuminemic group. CONCLUSION Frailty and hypoalbuminemia represent distinct conditions and are independent risk factors for a complication after TKA. Their coexistence imparts a synergistic association with the risk of post-TKA complications.
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Bahadori S, Collard S, Williams JM, Swain I. Why Do People Undergo THR and What Do They Expect to Gain-A Comparison of the Views of Patients and Health Care Professionals. J Patient Exp 2020; 7:1778-1787. [PMID: 33457643 PMCID: PMC7786753 DOI: 10.1177/2374373520956735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Little concerted effort has been made to understand why individuals undergo total hip replacement (THR) surgery and their rehabilitation goals. Similarly, insight of views and perspective of health care professionals’ (HCPs) regarding surgery and what objective measures help them with decision-making is lacking. This patient and public involvement report aimed to explore both patients’ and HCPs’ perspectives of THR surgery. Twenty patients, 10 pre-THR, 10 post-THR, 9 physiotherapists, and 6 surgeons took part. Results suggest a consensus among patients and HCPs on pain reduction being the main reason for undergoing THR. The inability to carry out simple daily activities such as dog walking and sleep deprivation had a significant effect on patients’ mental and physical well-being. This article is the first to explore the views of THR patients and HCPs on reasons behind THR surgery amalgamated into a single report. As walking is important, wearable activity monitors are suggested as a possible motivator to enhance patient compliance to self-care rehabilitation and increase quality of life. A future research project on the use of such wearable activity monitors in enhancing mobility post-THR is therefore planned.
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Affiliation(s)
- Shayan Bahadori
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset, United Kingdom
| | - Sarah Collard
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, United Kingdom
| | - Jonathan Mark Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, United Kingdom
| | - Ian Swain
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset, United Kingdom
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Kaiser U, Liedgens H, Meissner W, Weinmann C, Zahn P, Pogatzki-Zahn E. Developing consensus on core outcome domains and measurement instruments for assessing effectiveness in perioperative pain management after sternotomy, breast cancer surgery, total knee arthroplasty, and surgery related to endometriosis : The IMI-PainCare PROMPT protocol for achieving a consensus on core outcome domains. Trials 2020; 21:773. [PMID: 32912288 PMCID: PMC7488037 DOI: 10.1186/s13063-020-04665-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/09/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Evidence synthesis of clinical trials requires consistent outcome assessment. For pain management after surgery, inconsistency of effectiveness assessment is still observed. A subproject of IMI-PainCare (Innovative Medicine Initiatives, www.imi-paincare.eu ) aims for identifying core outcome domains and measurement instruments for postoperative pain in four surgical fields (sternotomy, breast cancer surgery, total knee arthroplasty, and surgery related to endometriosis) in order to harmonize outcome assessment for perioperative pain management. METHODS A multifaceted process will be performed according to existing guidelines (Core Outcome Measures in Effectiveness Trials (COMET), COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)). In a first step, outcome domains will be identified via systematic literature review and consented on during a 1-day consensus meeting by 10 stakeholder groups, including patient representatives, forming an IMI PROMPT consensus panel. In a second step, outcome measurement instruments regarding the beforehand consented core outcome domains and their psychometric properties will be searched for via systematic literature review and approved by COSMIN checklist for study quality and scale quality separately. In a three-step online survey, the IMI PROMPT consensus panel will vote for most suitable measurement instruments. The process is planned to be conducted between 11/2017 (systematic literature review on common outcome domains) and 3/2022 (final voting on core outcome measurement).
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Affiliation(s)
- Ulrike Kaiser
- Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | | | - Winfried Meissner
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Claudia Weinmann
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Peter Zahn
- Department of Anaesthesiology and Intensive Care Medicine, Palliative Care Medicine and Pain Management, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH Bochum, Ruhr University Bochum, Bochum, Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
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Bin sheeha B, Granat M, Williams A, Johnson DS, Jones R. Does free-living physical activity improve one-year following total knee arthroplasty in patients with osteoarthritis: A prospective study. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100065. [DOI: 10.1016/j.ocarto.2020.100065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022] Open
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Bahadori S, Collard S, Williams JM, Swain I. A review of current use of commercial wearable technology and smartphone apps with application in monitoring individuals following total hip replacement surgery. J Med Eng Technol 2020; 44:324-333. [DOI: 10.1080/03091902.2020.1797197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Shayan Bahadori
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
| | - Sarah Collard
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Jonathan Mark Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Ian Swain
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
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Schwartz AM, Farley KX, Guild GN, Bradbury TL. Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030. J Arthroplasty 2020; 35:S79-S85. [PMID: 32151524 PMCID: PMC7239745 DOI: 10.1016/j.arth.2020.02.030] [Citation(s) in RCA: 343] [Impact Index Per Article: 85.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/22/2020] [Accepted: 02/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND As the incidence of primary total joint arthroplasty rises in the United States, it is important to investigate how this will impact rates of revision arthroplasty. The purpose of this study was to analyze the incidence and future projections of revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) to 2030. Anticipating surgical volume will aid surgeons in designing protocols to efficiently and effectively perform rTHA/rTKA. METHODS The national inpatient sample was queried from 2002 to 2014 for all rTHA/rTKA. Using previously validated measures, Poisson and linear regression analyses were performed to project annual incidence of rTHA/rTKA to 2030, with subgroup analyses on modes of failure and age. RESULTS In 2014, there were 50,220 rTHAs and 72,100 rTKAs. From 2014 to 2030, rTHA incidence is projected to increase by between 43% and 70%, whereas rTKA incidence is projected to increase by between 78% and 182%. The 55-64 and 65-74 age groups increased in revision incidence during the study period, whereas 75-84 age group decreased in incidence. For rTKA, infection and aseptic loosening are the 2 most common modes of failure, whereas periprosthetic fracture and infection are most common for rTHA. CONCLUSION The incidence of rTHA/rTKA is projected to increase, particularly in young patients and for infection. Given the known risk factor profiles and advanced costs associated with revision arthroplasty, our projections should encourage institutions to generate revision-specific protocols to promote safe pathways for cost-effective care that is commensurate with current value-based health care trends. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andrew M. Schwartz
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA,Department of Orthopaedic Surgery, Emory University Orthopaedics & Spine Hospital, Tucker, GA,Reprint requests: Andrew M. Schwartz, MD, Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park Drive, SE, Atlanta, GA 30329
| | - Kevin X. Farley
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA
| | - George N. Guild
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA,Department of Orthopaedic Surgery, Emory University Orthopaedics & Spine Hospital, Tucker, GA
| | - Thomas L. Bradbury
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA,Department of Orthopaedic Surgery, Emory University Orthopaedics & Spine Hospital, Tucker, GA
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40
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A dynamic knee extension device improves flexion contracture before total knee arthroplasty: a randomized controlled trial. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kurkis G, Erwood A, Maidman SD, Manz WJ, Nazzal E, Bradbury TL, Bariteau JT. Mobility Limitation After Surgery for Degenerative Pathology of the Ankle, Hindfoot, and Midfoot vs Total Hip Arthroplasty. Foot Ankle Int 2020; 41:501-507. [PMID: 32129086 DOI: 10.1177/1071100720907034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgery for degenerative foot and ankle conditions often results in a lengthy recovery. Current outcome measures do not accurately assess postoperative mobility, especially in older patients. The Life-Space Assessment (LSA), a questionnaire quantifying patients' mobility after a medical event, was used in this study to assess perioperative mobility in total hip arthroplasty (THA) and foot and ankle surgery patients. We hypothesized that patients undergoing elective foot and ankle surgery would have greater postoperative mobility limitation than THA patients. METHODS Preoperative, 3-month, and 6-month postoperative LSA data were collected from THA and foot and ankle cohorts. Twelve-month postoperative data were obtained for the foot and ankle group as well. Patient demographics were recorded, and data were analyzed using a Mann-Whitney U test. RESULTS Twenty-eight degenerative foot and ankle operative patients and 38 THA patients met inclusion criteria. Only patients aged ≥60 years were included in this study. The mean preoperative LSA score was lower in the foot and ankle group (68.8) compared with THA (74.0), although the difference was not statistically significant (P = .602). THA patients showed a significant increase in LSA score from preoperative (74) to 6 months postoperation (95.9) (P = .003); however, foot and ankle patients showed no significant difference between preoperative (68.8) and 6-month (61.2) scores (P = .468). Twelve months postoperatively, foot and ankle patients showed improvement in LSA score (88.3) compared with preoperation (P = .065). CONCLUSION Compared with THA, recovery of mobility after foot and ankle surgery was slower. THA patients exhibited improved mobility as early as 3 months after surgery, whereas foot and ankle patients did not show full improvement until 12 months. This work will assist the foot and ankle specialist in educating patients about challenges in mobility during their recovery from surgery. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Gregory Kurkis
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University Orthopaedics and Spine Center, Atlanta, GA, USA
| | - Amalie Erwood
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University Orthopaedics and Spine Center, Atlanta, GA, USA
| | | | - Wesley J Manz
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Thomas Lane Bradbury
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University Orthopaedics and Spine Center, Atlanta, GA, USA
| | - Jason Tyler Bariteau
- Emory University School of Medicine, Atlanta, GA, USA.,Emory University Orthopaedics and Spine Center, Atlanta, GA, USA
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Vajapey SP, Morris J, Li D, Greco NG, Li M, Spitzer AI. Outcome Reporting Patterns in Total Hip Arthroplasty. JBJS Rev 2020; 8:e0197. [DOI: 10.2106/jbjs.rvw.19.00197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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CORR Insights®: Are TKA Kinematics During Closed Kinetic Chain Exercises Associated with Patient-reported Outcomes? A Preliminary Analysis. Clin Orthop Relat Res 2020; 478:264-265. [PMID: 31794481 PMCID: PMC7438133 DOI: 10.1097/corr.0000000000001061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Bloomfield RA, Williams HA, Broberg JS, Lanting BA, McIsaac KA, Teeter MG. Machine Learning Groups Patients by Early Functional Improvement Likelihood Based on Wearable Sensor Instrumented Preoperative Timed-Up-and-Go Tests. J Arthroplasty 2019; 34:2267-2271. [PMID: 31255408 DOI: 10.1016/j.arth.2019.05.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/13/2019] [Accepted: 05/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Wearable sensors permit efficient data collection and unobtrusive systems can be used for instrumenting knee patients for objective assessment. Machine learning can be leveraged to parse the abundant information these systems provide and segment patients into relevant groups without specifying group membership criteria. The objective of this study is to examine functional parameters influencing favorable recovery outcomes by separating patients into functional groups and tracking them through clinical follow-ups. METHODS Patients undergoing primary unilateral total knee arthroplasty (n = 68) completed instrumented timed-up-and-go tests preoperatively and at their 2-, 6-, and 12-week follow-up appointments. A custom wearable system extracted 55 metrics for analysis and a K-means algorithm separated patients into functionally distinguished groups based on the derived features. These groups were analyzed to determine which metrics differentiated most and how each cluster improved during early recovery. RESULTS Patients separated into 2 clusters (n = 46 and n = 22) with significantly different test completion times (12.6 s vs 21.6 s, P < .001). Tracking the recovery of both groups to their 12-week follow-ups revealed 64% of one group improved their function while 63% of the other maintained preoperative function. The higher improvement group shortened their test times by 4.94 s, (P = .005) showing faster recovery while the other group did not improve above a minimally important clinical difference (0.87 s, P = .07). Features with the largest effect size between groups were distinguished as important functional parameters. CONCLUSION This work supports using wearable sensors to instrument functional tests during clinical visits and using machine learning to parse complex patterns to reveal clinically relevant parameters.
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Affiliation(s)
- Riley A Bloomfield
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada; Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Harley A Williams
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jordan S Broberg
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Kenneth A McIsaac
- Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada
| | - Matthew G Teeter
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
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Kayani B, Konan S, Ayuob A, Onochie E, Al-Jabri T, Haddad FS. Robotic technology in total knee arthroplasty: a systematic review. EFORT Open Rev 2019; 4:611-617. [PMID: 31754467 DOI: 10.1302/2058-5241.4.190022] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Robotic total knee arthroplasty (TKA) improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment compared to conventional jig-based TKA.Robotic TKA does not have a learning curve effect for achieving the planned implant positioning. The learning curve for achieving operative times comparable to conventional jig-based TKA is 7-20 robotic TKA cases.Cadaveric studies have shown robotic TKA is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKA.Robotic TKA is associated with decreased postoperative pain, enhanced early functional rehabilitation, and decreased time to hospital discharge compared to conventional jig-based TKA. However, there are no differences in medium- to long-term functional outcomes between conventional jig-based TKA and robotic TKA.Limitations of robotic TKA include high installation costs, additional radiation exposure, learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs.Further higher quality studies are required to compare differences in conventional TKA versus robotic TKA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:611-617. DOI: 10.1302/2058-5241.4.190022.
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Affiliation(s)
- Babar Kayani
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Sujith Konan
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Atif Ayuob
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | | | | | - Fares S Haddad
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
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Mark-Christensen T, Kehlet H. Assessment of functional recovery after total hip and knee arthroplasty: An observational study of 95 patients. Musculoskeletal Care 2019; 17:300-312. [PMID: 31489996 DOI: 10.1002/msc.1409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND A significant proportion of patients experience functional limitations following total hip and knee arthroplasty (THA and TKA). The purpose of this study was to investigate prospectively the patient-reported and objectively assessed functional recovery following THA and TKA. METHODS Patients were recruited at a regional Danish hospital, using a prospective, observational hypothesis-generating cohort design. Primary outcome measures were performance-based function (30-s chair-stand test) and self-reported physical function measured by the Hip Disability and Osteoarthritis Outcome Score (HOOS) for those who had undergone THA, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) for those who had undergone TKA. In addition, patient expectations, the "forgotten joint" scale and pain catastrophizing were measured. Outcome measures were collected at baseline (preoperatively) and at follow-up (4 months postoperatively). RESULTS A total of 95 patients (59 who had undergone THA and 36 who had undergone TKA) were recruited. Performance-based function improved only slightly, with a mean difference of 2.9 (95% confidence interval [CI] 1.9, 4.0) for THAs and 1.6 (95% CI 0.4, 2.8) for TKAs. Self-reported physical function improved significantly, with a mean difference of 37.9 (95% CI 31.5, 44.3) for THAs and 28.6 (95% CI 22.7, 34.4) for TKAs. However, dividing the cohort into "improved" and "non-improved" groups based on changes in performance-based function, no clinically relevant predictors for poor performance-based outcome could be found. CONCLUSIONS Self-reported outcome measures improved significantly following THA and TKA, whereas performance-based function improved only slightly by the 4-month follow-up. The subgroup that did not improve in performance-based function still reported significant improvements in self-reported outcome measures, demonstrating the difficulty in predicting optimal rehabilitation strategies after THA and TKA.
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Affiliation(s)
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement, Copenhagen, Denmark
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Bendich I, Chung C, Hwang K, Patterson J, Mulvihill J, Barry J, Bini S. Changes in prospectively collected longitudinal patient-generated health data are associated with short-term patient-reported outcomes after total joint arthroplasty: a pilot study. Arthroplast Today 2019; 5:61-63. [PMID: 31020024 PMCID: PMC6470351 DOI: 10.1016/j.artd.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/07/2022] Open
Abstract
Data from wearable technology may correlate with patient-reported outcome measures (PROMs). The objective of this prospective pilot study of 22 total joint arthroplasty patients was to determine if sensor-generated data are predictive of short-term PROMs in total joint arthroplasty. Data on “average daily step count” and “average daily minutes active” were generated by the provided wearable sensor preoperatively and up to 6 weeks postoperatively. PROMs were collected preoperatively and at 6 weeks postoperatively. Changes in PROMs were calculated as “Δ”. Linear regression of the sensor data and PROMs generated R2 values. Changes in the average daily step count from preop to 6-week postop strongly associated with changes in Veterans Rand 12 Physical Component Score (R2 = 0.4532) from preop to 6 weeks. Changes in average daily minutes active from preop to 6-weeks postop were strongly associated with ΔHOOS/KOOS (R2 = 0.4858).
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Affiliation(s)
- Ilya Bendich
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Chris Chung
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Kevin Hwang
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Joseph Patterson
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Jeff Mulvihill
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Jeff Barry
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Stefano Bini
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
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Shah A, Bailey CR. Outcomes following surgery: are we measuring what really matters? Anaesthesia 2019; 74:696-699. [DOI: 10.1111/anae.14562] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 12/01/2022]
Affiliation(s)
- A. Shah
- Nuffield Department of Anaesthesia John Radcliffe Hospital OxfordUK
- Radcliffe Department of Medicine University of OxfordUK
| | - C. R. Bailey
- Department of Anaesthesia Guys and St. Thomas’ NHS Foundation Trust London UK
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