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Rocca MS, Honig EL, Tran A, Kolevar MP, Kaveeshwar S, Aneizi A, Leong NL, Packer JD, Henn RF, Meredith SJ. Preoperative Opioid Use is Associated with Worse Preoperative Patient Reported Outcomes in Hip Arthroscopy Patients. J ISAKOS 2024:S2059-7754(24)00086-5. [PMID: 38692433 DOI: 10.1016/j.jisako.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/08/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES The purpose of this study was to define the rate of preoperative opioid use among patients undergoing hip arthroscopy, ascertain which clinical factors are associated with opioid use, and assess the effect of preoperative opioid usage on preoperative patient-reported outcome (PRO) measures. METHODS A single institution orthopaedic registry was retrospectively analyzed for patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAI) with or without labral tear between 2015 and 2022. Patients completed Patient-Reported Outcomes Measurement Information System (PROMIS) in six domains, Numeric Pain Scores (NPS), and Musculoskeletal Outcomes Data Evaluation and Management System expectations domain preoperatively. Patients' charts were reviewed to determine demographic factors and identify any active opioid prescription within 6 weeks before surgery. Bivariate analysis was used to determine associations between preoperative opioid use and baseline PROs. Statistically significant bivariate associations were further tested by multivariate analysis to determine independent predictors. RESULTS A total of 123 patients were included (age 39.7 ± 12.0 years; 87 females; body mass index 27.4 ± 5.7 kg/m2). There were 21 patients (17%) using opioids preoperatively. Prior orthopaedic or other surgery and lower education level was associated with preoperative opioid use. Patients with preoperative opioid use scored statistically significantly worse compared to those without preoperative opioid use on baseline PROMIS Physical Function (38.6 vs 40.5, p = 0.01), Pain Interference (65.9 vs 60.2, p = 0.001), Fatigue (60.7 vs 51.6, p = 0.005), Social Satisfaction (38.2 vs 43.2, p = 0.007), and Depression (54.2 vs 48.8, p = 0.01). Preoperative opioid use was also associated with statistically significantly worse pre-operative NPS for both the operative hip (6.3 vs 4.6, p = 0.003) and whole body (3.0 vs 1.4, p = 0.008). Preoperative opioid use was an independent predictor of worse baseline PROMIS Pain Interference, Fatigue, Social Satisfaction, and NPS for the operative hip. CONCLUSION Patients using opioids preoperatively had worse baseline PROs for physical function, pain, social satisfaction, and depression than those not using opioids preoperatively. When controlling for confounding variables, preoperative opioid use was independently predictive of worse baseline pain, fatigue, and social satisfaction. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Michael S Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
| | - Evan L Honig
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
| | - Andrew Tran
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
| | - Matthew P Kolevar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
| | - Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207.
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Weber A, O'Hara NN, Slobogean GP, Henn RF, O'Toole RV, Sciadini MF. Can an Orthopedic Hip Fracture Simulator Advance Orthopedic Residents' Hip Fracture Fixation Skills to an Expert Level? J Surg Educ 2024; 81:288-294. [PMID: 38160109 DOI: 10.1016/j.jsurg.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 10/12/2023] [Accepted: 11/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study was undertaken to evaluate hip fracture simulator training and orthopedic resident skill attainment. We hypothesized that after 6 training sessions, improvement in post-training scores in junior residents would exceed that of senior residents and that senior residents would attain expert level proficiency sooner. DESIGN Thirty orthopedic residents from a single institution completed 6 training sessions. Sessions included a pretest, 9 training modules, and post-test. An expert score was obtained from the average scores of 8 trauma fellows and attending orthopedic traumatologists. The primary outcome measure was overall score. SETTING A single academic institution. PARTICIPANTS Orthopedic residents (postgraduate years [PGYs] 1-5). RESULTS Twenty-six residents completed the study. The mean overall post-training score was 87% of the expert level. Factors associated with post-training score changes were additional training sessions (4.2% improvement [p < 0.01]), time between training sessions (0.3% decrease [p = 0.05]) and PGY5 class (12.1% improvement [p = 0.03]). Fifty-four percent of residents attained the expert overall score. Expert score attainment was not associated with an additional year of training or case log volume. Post-training scores plateaued for the PGY1s and showed linear improvement for the PGY5s. CONCLUSIONS Differences in trends between training levels suggest this simulator is a useful adjunct to a 5-year orthopedic residency training program.
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Affiliation(s)
- Annie Weber
- Atrium Health Wake Forest Baptist, Wake Forest, Winston-Salem, North Carolina; R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gerard P Slobogean
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Marcus F Sciadini
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
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Zhang T, Wahl A, Schneider M, Xu D, Hahn A, Meredith SJ, Packer JD, Leong NL, Zhang LQ, Henn RF, Jauregui JJ. Biomechanical Comparison of Four- versus Six-Strand Transosseous Suture Repair for Patellar Tendon Rupture. J Knee Surg 2024; 37:193-197. [PMID: 37023764 DOI: 10.1055/s-0043-1766094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Surgical repair is indicated for patellar tendon ruptures that result in loss of knee extensor mechanism function. However, biomechanical studies report conflicting results when comparing transosseous suture versus suture anchor repair techniques. This discrepancy may be due to inconsistencies in experimental design as these studies use various numbers of suture strands. Therefore, the main objective of this study is to compare the ultimate load of four- versus six-strand transosseous suture repair. Secondary objectives are to compare gap formation after cyclical loading and mode of failure. METHODS Six pairs of fresh-frozen cadaveric specimen were randomly allocated to either four- or six-strand transosseous suture repair. Specimen underwent preconditioning cyclical loading and then load to failure. RESULTS The six-strand repair had a significantly higher maximum load to failure compared with the four-strand repair (mean difference = 319.3 N [57.9%], p = 0.03). There was no significant difference in gap length after cyclical loading or at max load. There were no significant differences in mode of failure. CONCLUSION Utilizing a six-stand transosseous patella tendon repair construct with one additional suture increases overall construct strength by over 50% compared with a four-strand construct.
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Affiliation(s)
- Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alexander Wahl
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Matheus Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Dali Xu
- Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, Maryland
| | - Alexander Hahn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Li-Qun Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
- Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Kevas Y, Kaveeshwar S, Pitsenbarger L, Hughes M, Schneider MB, Hahn A, Honig EL, Pensy RA, Langhammer CG, Henn RF. Preoperative Factors Associated With Worse PROMIS Pain Interference 2 Years After Hand and Wrist Surgery. Hand (N Y) 2023:15589447231218301. [PMID: 38156464 DOI: 10.1177/15589447231218301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND The purpose of this study was to identify preoperative factors associated with worse postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores 2 years after hand and wrist surgery. We hypothesized that older age, more comorbidities, increased substance use, and lower socioeconomic status would correlate with worse 2-year PROMIS PI scores. METHODS This study was a retrospective review of prospectively acquired data on 253 patients. Surveys were administered within 1 week of surgery and 2 years postoperatively. Bivariate and multivariable analyses were conducted to identify significant predictors of worse 2-year PROMIS PI scores and change in PROMIS PI scores. RESULTS Older age, higher body mass index, more comorbidities, lower preoperative expectations, more prior surgeries, unemployment, smoking, higher American Society of Anesthesiologists (ASA) score, and multiple other socio-demographic factors were correlated with worse 2-year PROMIS PI scores (P ≤ .018). Similar factors were also correlated with less improvement in 2-year PROMIS PI scores (P ≤ .048). Worse scores on all preoperative patient-reported outcome measures correlated with worse 2-year PROMIS PI scores (P ≤ .007). Multivariable analysis identified smoking history, less frequent alcohol consumption, worse preoperative PROMIS social satisfaction and Numeric Pain Scale whole body scores, and higher ASA scores as independent predictors of worse 2-year PROMIS PI. The same factors in addition to better baseline PROMIS PI were predictive of less improvement in 2-year PROMIS PI. CONCLUSION Numerous preoperative factors were predictive of worse postoperative 2-year PROMIS PI and less improvement in 2-year PROMIS PI for patients undergoing hand and wrist surgery.
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Affiliation(s)
- Yanni Kevas
- University of Maryland School of Medicine, Baltimore, USA
| | | | | | - Meghan Hughes
- University of Maryland School of Medicine, Baltimore, USA
| | | | - Alexander Hahn
- University of Maryland School of Medicine, Baltimore, USA
| | - Evan L Honig
- University of Maryland School of Medicine, Baltimore, USA
| | | | | | - R Frank Henn
- University of Maryland School of Medicine, Baltimore, USA
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Kung JE, Kaveeshwar S, Rocca M, Rivkin D, Hartline J, Packer JD, Meredith SJ, Leong NL, Henn RF. PROMIS cluster analysis predicts two-year outcomes in knee surgery patients. J Orthop 2023; 39:59-65. [PMID: 37125017 PMCID: PMC10139851 DOI: 10.1016/j.jor.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/26/2023] [Accepted: 04/05/2023] [Indexed: 05/02/2023] Open
Abstract
Aims & objectives Meaningful clinical interpretation of orthopaedic patient-reported outcome scores remains challenging. Grouping scores may be more meaningful than individual score analysis. The purpose of this study was to determine if grouping knee surgery patients into four preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) clusters would have prognostic value for two-year postoperative outcomes. Materials & methods 488 of 697 (70%) patients undergoing elective knee surgery at a single urban institution were enrolled in an orthopaedic registry and completed two-year follow up. Patients were administered questionnaires for PROMIS, International Knee Documentation Committee Score (IKDC), Marx Activity Rating Scale (MARS), and Surgical Satisfaction (SSQ-8). A k-means cluster analysis was performed to identify preoperative PROMIS clusters. Chi-square or Kruskal-Wallis tests were conducted for bivariate analyses. Least-squares multiple linear regression models were performed to identify if cluster group was an independent predictor. Results Cluster analysis revealed four clusters of patients. Psychological distress was most significant in determining classification. More impaired clusters were associated with higher rates of arthroplasty, African American race, preoperative opioid use, lower income, higher comorbidity index, and other sociodemographic and operative factors. Worse preoperative cluster status was associated with higher chance of achieving minimally clinically important change (MCID) on all metrics except PROMIS Pain Interference (PI), IKDC, and MARS. Multivariable analysis confirmed better preoperative cluster as predictive of better PROMIS Physical Function (PF), PI, IKDC scores, and satisfaction. Worse preoperative cluster was predictive of greater improvement on PF and PI but not IKDC. Conclusion Preoperative PROMIS clusters have prognostic value in predicting outcomes for knee surgery patients. Better preoperative cluster function predicts superior outcomes. While worse preoperative cluster predicts worse outcome, all clusters still significantly improve, so worse preoperative cluster is not a contraindication to surgery.
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Affiliation(s)
- Justin E. Kung
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- Orthopedic Surgery, Prisma Health Midlands/University of South Carolina, Columbia, SC, USA
| | - Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel Rivkin
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jacob Hartline
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan D. Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sean J. Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie L. Leong
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Livesey MG, Weir TB, Addona JL, Curto RA, Apte A, Hughes M, Enobun B, Henn RF, Hasan SA, Gilotra MN. The Effect of Patients' Understanding of Sling Necessity and Home Assistance on Sling Wear After Shoulder Surgery. Am J Sports Med 2023; 51:179-186. [PMID: 36349935 DOI: 10.1177/03635465221131984] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Perioperative education and socioeconomic factors influence patient behavior. Recent evidence has suggested that sling compliance is associated with improved outcomes after shoulder surgery; it is important to investigate factors that influence sling compliance. PURPOSE To determine the associations between postoperative sling wear and patients' understanding of sling necessity, postoperative home assistance, and social deprivation. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 66 patients were prospectively enrolled from 2018 to 2020 if they were ≥18 years of age and undergoing shoulder surgery requiring a sling for at least 1 month postoperatively. Sling wear was measured using a temperature-sensing device. At 6 weeks postoperatively, patients' understanding for sling necessity was determined by their response to a question on the Medical Adherence Measure questionnaire, "Why did you have to wear a shoulder sling?" The Patient Understanding Grading Scale (PUGS) was developed to quantify patient responses. PUGS was graded 1 to 3, with grade 1 corresponding to the least technical knowledge. Patient characteristics, social deprivation (Area Deprivation Index [ADI]), and home assistance were additionally analyzed. RESULTS There were no significant differences in baseline characteristics between patients when stratified by PUGS grade. Multivariable linear regression analysis for total hours of sling wear per week showed that patients with PUGS grade 2 (β, 48.2 hours; P = .007) and grade 3 (β, 59.5 hours; P = .003) wore their slings significantly more than grade 1 patients. Patients with home assistance had significantly greater day hours (73.5 ± 33.0 vs 44.0 ± 24.5 hours; P = .037) of sling wear per week, but there was no difference in night sling hours. Patients older than 60 years wore their slings significantly more, while men and those with a higher body mass index (BMI) wore their slings significantly less. ADI was not significantly associated with sling wear. CONCLUSION This study demonstrates that patients with greater understanding for sling necessity, those with home assistance, and patients >60 years have greater sling wear, while male patients and those with a higher BMI have lower sling compliance. ADI was not a significant contributor.
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Affiliation(s)
- Michael G Livesey
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jacqueline L Addona
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ryan A Curto
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anuj Apte
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marcus Hughes
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Blessing Enobun
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Kaveeshwar S, Rocca MP, Oster BA, Schneider MB, Tran A, Kolevar MP, Adib F, Henn RF, Meredith SJ. Depression and anxiety are associated with worse baseline function in hip arthroscopy patients. Knee Surg Sports Traumatol Arthrosc 2022; 30:3563-3569. [PMID: 35416491 DOI: 10.1007/s00167-022-06963-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to analyze the correlation between baseline depression and anxiety and preoperative functional status in hip arthroscopy patients. METHODS A prospective, institutional review board-approved orthopaedic registry was used to retrospectively study 104 patients undergoing hip arthroscopy. Enrolled patients were administered baseline questionnaires for Patient-Reported Outcomes Measurement Information System (PROMIS) domains, Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) preoperative expectations, and Numeric Pain Scale (NPS). RESULTS The average baseline PROMIS Depression and Anxiety scores were 49.9 ± 9.8 and 55.5 ± 9.3, respectively. Bivariate analysis demonstrated that greater baseline PROMIS Anxiety correlated with worse preoperative PROMIS PI (p < 0.001), Fatigue (p < 0.001), Social Satisfaction (p < 0.001), and NPS score (p = 0.013). Bivariate analysis showed that greater PROMIS Depression correlated with worse preoperative PROMIS PF (p = 0.001), PI (p < 0.001), Fatigue (p < 0.001), SS (p < 0.001), and NPS score (p = 0.004). After controlling for confounders, multivariable analysis confirmed increased PROMIS Depression as an independent predictor of worse preoperative PROMIS PF (p = 0.009), MODEMS Expectations (p = 0.025), and NPS score (p = 0.002). Increased PROMIS Anxiety was predictive of worse baseline PROMIS PI (p < 0.001), Fatigue (p < 0.001), and Social Satisfaction (p < 0.001). A previous clinical diagnosis of depression or anxiety was only an independent predictor of worse baseline PROMIS Fatigue (p = 0.002) and was insignificant in all other models. CONCLUSION Increasing severity of depression and anxiety correlated with and predicted worse functional status at baseline in hip arthroscopy patients. As compared to clinical diagnosis of anxiety and depression, PROMIS metrics have superior utility in recognizing potentially modifiable mental health concerns that predict worse preoperative status. Ultimately, the study identifies an at-risk population undergoing hip arthroscopy that requires particular attention and potential mental health intervention in the preoperative setting. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Michael P Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Brittany A Oster
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Andrew Tran
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matthew P Kolevar
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Farshad Adib
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Henn RF, Hasan SA, Gilotra MN, Weir TB. To Drive or Not to Drive?: Commentary on an article by Ariel E. Badger, MS, et al.: "Patients Who Undergo Rotator Cuff Repair Can Safely Return to Driving at 2 Weeks Postoperatively". J Bone Joint Surg Am 2022; 104:e81. [PMID: 36129677 DOI: 10.2106/jbjs.22.00736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Fisher KJ, Livesey MG, Sax OC, Gilotra MN, O'Hara NN, Henn RF, Hasan SA. Are Outcomes After Fixation of Distal Humerus Coronal Shear Fractures Affected by Surgical Approach? A Systematic Review and Meta-analysis. JSES Int 2022; 6:1054-1061. [DOI: 10.1016/j.jseint.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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10
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Aneizi A, Gelmann D, Ventimiglia DJ, Sajak PMJ, Nadarajah V, Foster MJ, Weir TB, Akabudike NM, Pensy RA, Henn RF. Preoperative Opioid Use in Patients Undergoing Common Hand Surgeries. Hand (N Y) 2022; 17:905-912. [PMID: 33467941 PMCID: PMC9465804 DOI: 10.1177/1558944720974122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The objectives of this study were to determine the baseline patient characteristics associated with preoperative opioid use and to establish whether preoperative opioid use is associated with baseline patient-reported outcome measures in patients undergoing common hand surgeries. METHODS Patients undergoing common hand surgeries from 2015 to 2018 were retrospectively reviewed from a prospective orthopedic registry at a single academic institution. Medical records were reviewed to determine whether patients were opioid users versus nonusers. On enrollment in the registry, patients completed 6 Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), the Brief Michigan Hand Questionnaire (BMHQ), a surgical expectations questionnaire, and Numeric Pain Scale (NPS). Statistical analysis included multivariable regression to determine whether preoperative opioid use was associated with patient characteristics and preoperative scores on patient-reported outcome measures. RESULTS After controlling for covariates, an analysis of 353 patients (opioid users, n = 122; nonusers, n = 231) showed that preoperative opioid use was associated with higher American Society of Anesthesiologists class (odds ratio [OR], 2.88), current smoking (OR, 1.91), and lower body mass index (OR, 0.95). Preoperative opioid use was also associated with significantly worse baseline PROMIS scores across 6 domains, lower BMHQ scores, and NPS hand scores. CONCLUSIONS Preoperative opioid use is common in hand surgery patients with a rate of 35%. Preoperative opioid use is associated with multiple baseline patient characteristics and is predictive of worse baseline scores on patient-reported outcome measures. Future studies should determine whether such associations persist in the postoperative setting between opioid users and nonusers.
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Affiliation(s)
- Ali Aneizi
- University of Maryland School of
Medicine, Baltimore, USA
| | | | | | | | | | | | | | | | | | - R. Frank Henn
- University of Maryland School of
Medicine, Baltimore, USA
- University of Maryland School of
Medicine and University of Maryland Rehabilitation & Orthopaedic Institute,
Baltimore, USA
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Hamaker M, Enobun B, Kaveeshwar S, Hasan SA, Shiu B, Henn RF, Kilcoyne K, Srikumaran U, Gasbarro G, R. Zimmer Z, Gilotra MN. Reliability, validity, and responsiveness of a novel subscapularis outcome score: The Baltimore Orthopedic Subscapularis Score. JSES Int 2022; 6:957-962. [PMID: 36353434 PMCID: PMC9637793 DOI: 10.1016/j.jseint.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Available surveys that evaluate shoulder strength and pain often combine rotator cuff muscles making the test unable to differentiate subscapularis tears from other pathology including concomitant supraspinatus, infraspinatus tears. The purpose of this study was to validate a subscapularis-specific shoulder survey (Baltimore Orthopedic Subscapularis Score) as a viable clinical outcome assessment through analysis of psychometric properties. Methods A 5-question survey was given to a study population of 390 patients, 136 of whom had full thickness rotator cuff tears with a minimum score of 5 (better) and a maximum score of 25 (worse). Surveys were given during the initial consultation, preoperative visit, and postoperative visit. Content validity, construct validity, test-retest reliability, responsiveness to change, internal consistency, and minimal clinically important difference using distribution and anchor-based methods were determined for our subscapularis function survey. Results A high correlation was reported on test-retest reliability (intraclass correlation coefficient = 0.89). An acceptable internal consistency was reported for all patients surveyed (Cronbach alpha = 0.91). Floor and ceiling effects for patients with rotator cuff pathology were minimized (1% for both). Patients with an isolated subscapularis tear scored worse than supraspinatus/infraspinatus tears and exhibited similar dysfunction as patients with a supraspinatus/infraspinatus/subscapularis tear. An acceptable construct validity was reported with subscapularis-involved tears demonstrating higher scores with significance (P < .05). There was excellent responsiveness to change with a standardized response mean of 1.51 and effect size of 1.27 (large > 0.8). The minimal clinically important difference using a distribution and anchor-based method was 4.1 and 4.6, respectively. Among patients with rotator cuff tears in this population, a score of 22 or higher predicts a subscapularis tear 75% of the time, in spite of its low overall prevalence. Conclusion The subscapularis shoulder score demonstrated acceptable psychometric performance for outcomes assessment in patients with rotator cuff disease. This survey can be used as an effective clinical tool to assess subscapularis function.
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Affiliation(s)
- Max Hamaker
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Blessing Enobun
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S. Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brian Shiu
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelly Kilcoyne
- Department of Orthopedics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Gregory Gasbarro
- Orthopaedic Specialty Hospital Mercy Medical Center, Baltimore, MD, USA
| | - Zachary R. Zimmer
- Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mohit N. Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- Corresponding author: Mohit N. Gilotra, MD, MS, Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn St, Room 540D Baltimore, MD 21201, USA.
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12
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Song X, Sajak PMJ, Aneizi A, Alqazzaz A, Burt CI, Ventimiglia DJ, Meredith SJ, Leong NL, Packer JD, Henn RF. Impact of Postoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients. J Knee Surg 2022; 35:1106-1118. [PMID: 33618400 DOI: 10.1055/s-0040-1722326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purposes of this study were to identify the patient characteristics associated with refilling a postoperative opioid prescription after knee surgery and to determine whether refilling opioids is associated with 2-year patient-reported outcomes. We hypothesized that postoperative refill of opioids would be associated with worse 2-year patient-reported outcomes. We studied 192 patients undergoing knee surgery at a single urban academic institution. Patients completed multiple patient-reported outcome measures preoperatively and 2 years postoperatively, including six Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale scores for the operative knee and the rest of the body, Marx Activity Rating Scale, as well as measures of met expectations, improvement, and satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Patients who refilled a postoperative opioid prescription were compared with those who did not, and TMEs were calculated for those who refilled (Refill TMEs). One hundred twenty-nine patients (67%) refilled at least one postoperative opioid prescription. Black race, older age, higher average body mass index (BMI), smoking, greater medical comorbidities, preoperative opioid use, lower income, government insurance, and knee arthroplasty were associated with refilling opioids. Greater Refill TMEs was associated with black or white race, older age, higher average BMI, smoking, greater medical comorbidities, preoperative opioid use, government insurance, and unemployment. Refilling opioids and greater Refill TMEs were associated with worse postoperative scores on most patient-reported outcome measures 2 years after knee surgery. However, refilling opioids and greater Refill TMEs did not have a significant association with improvement after surgery. Multivariable analysis controlling for potential confounding variables confirmed that greater postoperative Refill TMEs independently predicted worse 2-year PROMIS Physical Function, 2-year PROMIS Pain Interference, and 2-year IKDC knee function scores. Postoperative refill of opioids was associated with worse 2-year patient-reported outcomes in a dose-dependent fashion. These findings reinforce the importance of counseling patients regarding opioid use and optimizing opioid-sparing pain management postoperatively.
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Affiliation(s)
- Xuyang Song
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Patrick M J Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aymen Alqazzaz
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cameran I Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Dominic J Ventimiglia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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13
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Ventimiglia DJ, Chrencik M, Schneider MB, Zhang T, Munn M, Kolakowski L, Gilotra MN, Hasan SA, Henn RF. Preoperative Factors Associated with Patient Satisfaction Two Years After Elective Shoulder Surgery. JSES Int 2022; 6:649-654. [PMID: 35813145 PMCID: PMC9264137 DOI: 10.1016/j.jseint.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Purpose Patient satisfaction has become an increasingly important component of quality measures for both hospital reimbursement and quality assessment. Additionally, patient satisfaction influences patient behavior and patient follow-up. The purpose of this study was to identify preoperative factors associated with patient satisfaction 2 years after shoulder surgery. Methods Electronic surveys were used to collect patient information including demographic, surgical, and social history, as well as outcome data. Satisfaction was measured 2 years after surgery using the Surgical Satisfaction Questionnaire. Results Multivariable linear regression identified preoperative Patient-Reported Outcomes Measurement Information System Pain Interference, annual income, and American Society of Anesthesiologists score as independent predictors of lower patient satisfaction, while total shoulder arthroplasty was an independent predictor of greater patient satisfaction. The model accounted for 15% of the variance in satisfaction scores (R2 = 0.15). Conclusion Patient satisfaction 2 years after shoulder surgery is associated with preoperative patient-reported outcome scores. Lower patient satisfaction is independently predicted by greater preoperative PROMIS PI, income less than $70,000, and ASA score >1, while higher patient satisfaction is predicted by total shoulder arthroplasty.
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14
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Aneizi A, Sajak PMJ, Alqazzaz A, Weir T, Burt CI, Ventimiglia DJ, Leong NL, Packer JD, Henn RF. Impact of Preoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients. J Knee Surg 2022; 35:511-520. [PMID: 32898898 DOI: 10.1055/s-0040-1716358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objectives of this study are to assess perioperative opioid use in patients undergoing knee surgery and to examine the relationship between preoperative opioid use and 2-year postoperative patient-reported outcomes (PROs). We hypothesized that preoperative opioid use and, more specifically, higher quantities of preoperative opioid use would be associated with worse PROs in knee surgery patients. We studied 192 patients undergoing knee surgery at a single urban institution. Patients completed multiple PRO measures preoperatively and 2-year postoperatively, including six patient-reported outcomes measurement information system (PROMIS) domains; the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale (NPS) scores for the operative knee and the rest of the body, Marx's knee activity rating scale, Tegner's activity scale, International Physical Activity Questionnaire, as well as measures of met expectations, overall improvement, and overall satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Eighty patients (41.7%) filled an opioid prescription preoperatively, and refill TMEs were significantly higher in this subpopulation. Opioid use was associated with unemployment, government insurance, smoking, depression, history of prior surgery, higher body mass index, greater comorbidities, and lower treatment expectations. Preoperative opioid use was associated with significantly worse 2-year scores on most PROs, including PROMIS physical function, pain interference, fatigue, social satisfaction, IKDC, NPS for the knee and rest of the body, and Marx's and Tegner's scales. There was a significant dose-dependent association between greater preoperative TMEs and worse scores for PROMIS physical function, pain interference, fatigue, social satisfaction, NPS body, and Marx's and Tegner's scales. Multivariable analysis confirmed that any preoperative opioid use, but not quantity of TMEs, was an independent predictor of worse 2-year scores for function, activity, and knee pain. Preoperative opioid use and TMEs were neither independent predictors of met expectations, satisfaction, patient-perceived improvement, nor improvement on any PROs. Our findings demonstrate that preoperative opioid use is associated with clinically relevant worse patient-reported knee function and pain after knee surgery.
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Affiliation(s)
- Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Patrick M J Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Aymen Alqazzaz
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tristan Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cameran I Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Dominic J Ventimiglia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Schneider MB, Kung JE, Zhang T, Rocca MS, Foster MJ, Meredith SJ, Leong NL, Packer JD, Henn RF. Patient Perception of Being "Completely Better" After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2022; 50:1215-1221. [PMID: 35225001 DOI: 10.1177/03635465221074331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Contextualizing patient-reported outcomes (PROs) by defining clinically relevant differences is important. Considering that anterior cruciate ligament reconstruction (ACLR) ideally results in the restoration of normal knee function, an assessment of patients' perception of being "completely better" (CB) may be of particular value. PURPOSE The purpose of this study was to assess the prevalence and characteristics of patients who self-report a CB status after ACLR. Additionally, we aimed to determine whether PROs were associated with a CB status after ACLR as well as to determine CB status thresholds for 2-year and change in values. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS We retrospectively analyzed data from an orthopaedic registry at a single institution. Patients were administered the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), PROMIS Pain Interference (PI), and International Knee Documentation Committee (IKDC) Subjective Knee Form preoperatively and at 2 years after ACLR. Additionally, patients completed a CB anchor question at 2 years after ACLR. Thresholds for 2-year and change in PRO scores associated with achieving a CB status were identified with 90% specificity. RESULTS Overall, 95 of the 136 patients (69.9%) considered their condition to be CB at 2 years after surgery. The 2-year and change in PROMIS PF, PROMIS PI, and IKDC scores were significantly better in the CB group than in the non-CB group. Thresholds associated with a CB status for 2-year PROMIS PF, PROMIS PI, and IKDC scores were more reliable than those for changes in scores and were ≥63, ≤44, and ≥80, respectively. Thresholds for the change in PROMIS PF, PROMIS PI, and IKDC scores were ≥19, ≤-16, and ≥44, respectively. CONCLUSION The majority of patients reported that they were CB at 2 years after ACLR. This study may serve as a reference for orthopaedic surgeons and researchers when considering outcomes after ACLR.
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Affiliation(s)
- Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Justin E Kung
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael S Rocca
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael J Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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16
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Kung JE, Zhang T, Weir TB, Schneider MB, Aneizi A, Leong NL, Packer JD, Meredith SJ, Henn RF. Correlation of Press Ganey Scores With Early Patient Satisfaction After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221083704. [PMID: 35386839 PMCID: PMC8977719 DOI: 10.1177/23259671221083704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Patient satisfaction metrics are commonly used to assess the quality of
health care and affect reimbursement. The Press Ganey Ambulatory Surgery
(PGAS) is a satisfaction survey that has emerged as a prominent quality
assessment tool; however, no data exist on whether PGAS scores correlate
with early postsurgical satisfaction during the PGAS survey administration
period in patients who underwent anterior cruciate ligament reconstruction
(ACLR). Purpose: To determine if PGAS scores correlate with measures of satisfaction and
patient-reported outcomes (PROs) at 2 weeks postoperatively in ACLR
patients. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A retrospective review of patients who underwent ACLR at a single institution
was performed. Patients who completed the PGAS survey and PROs at 2 weeks
postoperatively were included in the study. Surgical satisfaction was
measured with the Surgical Satisfaction Questionnaire (SSQ-8), and PROs
included 6 Patient-Reported Outcomes Measurement Information System domains.
Bivariate analysis between PGAS and PRO scores was conducted using the
Spearman rank correlation coefficient (rS). Results: Of the 716 patients who received the PGAS survey after ACLR, 81 patients
completed the survey, and 39 patients also completed PROs and were included
in the study. Total converted (mean scaled score) and “top box” (percentages
of questions with highest rating selected) PGAS scores showed no significant
correlations with the SSQ-8 (rS =–0.24; P = .14). There were no significant
correlations between SSQ-8 and PGAS domain scores except for a negative
correlation with Facility domain top box scores (rS =–0.33; P = .04), meaning that patients with
higher surgical satisfaction had lower PGAS Facility scores. Total PGAS
(converted and top box scores) and PGAS domain scores showed no significant
correlation with any of the other PROs. Conclusion: PGAS scores showed no significant positive correlation with surgical
satisfaction, function, pain, mental health, activity, or expectations of
surgery in patients 2 weeks after ACLR. This suggests little to no
relationship between PGAS score and surgical satisfaction in the early
recovery period after ACLR.
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Affiliation(s)
- Justin E. Kung
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tristan B. Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matheus B. Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie L. Leong
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jonathan D. Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sean J. Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Hunt D, Zhang T, Koenig S, Aneizi A, Perraut G, Shasti K, Wahl AJ, Meredith SJ, Henn RF. Predictors of PROMIS Physical Function at 2 Years following Knee Surgery. J Knee Surg 2022; 35:521-528. [PMID: 32898902 DOI: 10.1055/s-0040-1716360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) 2 years following knee surgery, and identify preoperative factors associated with postoperative PROMIS PF. Three hundred and sixty-five patients, age 17 years and older, undergoing knee surgery at one institution were studied. Patients completed multiple questionnaires prior to surgery and again 2 years postoperatively including PROMIS PF, International Knee Documentation Committee (IKDC), joint and body numeric pain scales (NPS), Tegner's activity scale (TAS), and Marx's activity rating scale (MARS). Mean PROMIS PF improved from 41.4 to 50.9 at 2 years postoperatively (p < 0.001) and was strongly correlated with 2-year IKDC scores. Older age, female gender, non-Hispanic ethnicity, unemployment, lower income, government insurance, smoking, preoperative opioid use, having a legal claim, comorbidities, previous surgeries, higher body mass index (BMI), and knee arthroplasty were associated with worse 2-year PROMIS PF. Multivariable analysis confirmed that lower BMI, less NPS body pain, and higher MARS were independent predictors of greater 2-year PROMIS PF and better improvement in PROMIS PF. In this large, broad cohort of knee surgery patients, multiple preoperative factors were associated with PROMIS PF 2 years postoperatively. PROMIS PF scores improved significantly, but worse 2 year PROMIS PF scores and less improvement from baseline were independently predicted by higher BMI, greater NPS body pain, and lower MARS activity level. PROMIS PF can be implemented as an efficient means to assess outcomes after knee surgery.
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Affiliation(s)
- Darius Hunt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Scott Koenig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gregory Perraut
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Keyan Shasti
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alexander J Wahl
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Abstract
AIMS The purpose of this study was to assess the prevalence of depression and anxiety symptoms in patients undergoing shoulder surgery using the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety computer adaptive tests, and to determine the factors associated with more severe symptoms. Additionally, we sought to determine whether PROMIS Depression and Anxiety were associated with functional outcomes after shoulder surgery. METHODS This was a retrospective analysis of 293 patients from an urban population who underwent elective shoulder surgery from 2015 to 2018. Survey questionnaires included preoperative and two-year postoperative data. Bivariate analysis was used to identify associations and multivariable analysis was used to control for confounding variables. RESULTS Mean two-year PROMIS Depression and Anxiety scores significantly improved from preoperative scores, with a greater improvement observed in PROMIS Anxiety. Worse PROMIS Depression and Anxiety scores were also significantly correlated with worse PROMIS Physical Function (PF) and American Shoulder and Elbow Surgeons scores (ASES). After controlling for confounding variables, worse PROMIS Depression was an independent predictor of worse PROMIS PF, while worse PROMIS Anxiety was an independent predictor of worse PROMIS PF and ASES scores. CONCLUSION Mean two-year PROMIS Depression and Anxiety scores improved after elective shoulder surgery and several patient characteristics were associated with these scores. Worse functional outcomes were associated with worse PROMIS Depression and Anxiety; however, more severe two-year PROMIS Anxiety was the strongest predictor of worse functional outcomes. Cite this article: Bone Joint J 2022;104-B(4):479-485.
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Affiliation(s)
- Mitchell Baker
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Fernando Albelo
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Tina Zhang
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, USA
| | | | - Michael J Foster
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Ali Aneizi
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, USA
| | - S Ashfaq Hasan
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Mohit N Gilotra
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, USA
| | - R Frank Henn
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, Maryland, USA
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19
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DePalma BJ, Costales TG, Schneider MB, Henn RF. Bilateral Extensor Mechanism Allograft Reconstruction in Native Knees: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00031. [PMID: 35081064 DOI: 10.2106/jbjs.cc.21.00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 66-year-old man presented with chronic bilateral extensor mechanism dysfunction and profound patella baja after failed revision surgery for bilateral quadriceps tendon ruptures. Staged bilateral reconstruction with complete extensor mechanism allograft resulted in excellent two-year satisfaction and clinical outcomes. CONCLUSION Complete extensor mechanism reconstruction can be a successful treatment for chronic quadriceps tendon rupture with profound patella baja.
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Affiliation(s)
- Brian J DePalma
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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20
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Zhang T, Jauregui JJ, Foster M, Packer JD, Meredith SJ, Leong NL, Henn RF. Outcomes of Partial Meniscectomy in Obese Patients: A Systematic Review and Meta-Analysis. Cartilage 2021; 13:216S-227S. [PMID: 32432486 PMCID: PMC8808876 DOI: 10.1177/1947603520923025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Arthroscopic partial meniscectomy (APM) is one of the most commonly performed surgical procedures. However, the indications for APM are controversial and obese patients may have worse outcomes. This study's primary purpose was to investigate differences in outcome after APM associated with elevated body mass index (BMI). Secondary objectives included differences in pathophysiology, surgical complications/failures, or osteoarthritis development. DESIGN MEDLINE, EMBASE, and OVID databases were systematically searched for eligible studies reporting on APM outcomes at a minimum of 1 year postoperatively. Studies that did not include BMI categorization were excluded. Meta-analysis was conducted with random-effects modeling where data from at least 2 studies was available. RESULTS A total of 16 articles were included. Overweight/obese BMI was associated with worse preoperative Lysholm (mean difference, -6.06 [95% CI, -11.70 to -0.42]) and visual analogue scale pain scores (0.43 [0.07 to 0.79]). Worse postoperative normalized knee-specific patient-reported outcome scores were also associated with obese BMI (-4.57 [-5.33 to -3.81]). There were no significant differences in clinical improvement or osteoarthritis progression among BMI groups. Two studies found higher complication/failure rates, 3 articles associated medial meniscus posterior root tears, and 1 article found differences in gene transcript expression with increased BMI. CONCLUSIONS Obesity is associated with worse knee function after APM, and patients with elevated BMI have worse preoperative knee pain and function. However, there is no difference in amount of improvement between elevated and normal BMI patients. Further prospective research is necessary to determine the comparative effectiveness of APM in patients with elevated BMI.
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Affiliation(s)
- Tina Zhang
- Department of Orthopaedics, University
of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J. Jauregui
- Department of Orthopaedics, University
of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Foster
- Department of Orthopaedics, University
of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan D. Packer
- Department of Orthopaedics, University
of Maryland School of Medicine, Baltimore, MD, USA
| | - Sean J. Meredith
- Department of Orthopaedics, University
of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie L. Leong
- Department of Orthopaedics, University
of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University
of Maryland School of Medicine, Baltimore, MD, USA,R. Frank Henn III, University of Maryland
Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive, Baltimore, MD
21207, USA.
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21
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Henry LE, Zhang T, Aneizi A, Weir TB, Schneider MB, Meredith SJ, Leong NL, Packer JD, Henn RF. Perioperative opioid use and Press Ganey patient satisfaction scores after anterior cruciate ligament reconstruction. J Orthop 2021; 27:84-91. [PMID: 34588743 DOI: 10.1016/j.jor.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/12/2021] [Indexed: 11/29/2022] Open
Abstract
Background Satisfaction measures such as Press Ganey (PG) scores are increasingly used to determine reimbursement. Purpose To investigate the relationship between PG satisfaction scores and perioperative opioid use in patients undergoing anterior cruciate ligament reconstruction (ACLR). Methods Patients undergoing ACLR were retrospectively identified. Perioperative opioid prescription data were collected using the electronic medical record. Results Positive correlations existed between immediate preoperative total morphine equivalents (TMEs) and PG scores. There was a negative correlation between "Pain Control" and preoperative TMEs. Conclusion PG scores were correlated with preoperative and intraoperative opioid administration but not postoperative opioid administration.
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Affiliation(s)
- Leah E Henry
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tristan B Weir
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matheus B Schneider
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sean J Meredith
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie L Leong
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan D Packer
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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22
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Chrencik MT, Ventimiglia DJ, Schneider MB, Zhang T, Fisher KJ, Hahn A, Gilotra MN, Hasan SA, Henn RF. Preoperative characteristics predictive of PROMIS Pain Interference two years after shoulder surgery. J Orthop 2021; 27:49-55. [PMID: 34483550 DOI: 10.1016/j.jor.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/28/2021] [Accepted: 08/15/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction The objective of this study was to identify preoperative characteristics associated with worse Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) two years after shoulder surgery. Methods This was a retrospective analysis of prospectively collected data on 293 patients who underwent elective shoulder surgery. Survey questionnaires were collected within one week of surgery and then two years postoperatively. Bivariate analysis was used to identify associations and multivariable analysis was used to control for confounding variables. Results Worse two-year PROMIS PI was significantly correlated with older age, higher BMI, greater comorbidities, more prior surgeries, and multiple socio-demographic factors. Less improvement in PROMIS PI was significantly correlated with greater comorbidities, more previous surgeries, unemployment, prior orthopaedic surgery on the operative joint, and a higher American Society of Anesthesiologists (ASA) score. Better scores on all preoperative patient-reported outcome measures correlated with better two-year PROMIS PI. Multivariable analysis demonstrated that worse two-year PROMIS PI was independently predicted by the following preoperative factors: Workers' Compensation claim, opioid use, worse whole body Numeric Pain Score, and worse PROMIS PI. Less improvement in two-year PROMIS PI was predicted by the same preoperative factors. Conclusion Worse PROMIS PI after shoulder surgery was associated with older age, greater comorbidities, mental health impairment, and lower socioeconomic status. Preoperative predictors of worse pain interference two years after shoulder surgery included Workers' Compensation, opioid use, worse whole body pain, and worse PROMIS PI. Level of evidence III.
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Affiliation(s)
- Matthew T Chrencik
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dominic J Ventimiglia
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matheus B Schneider
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kalin J Fisher
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexander Hahn
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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23
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Weir TB, Zhang T, Jauregui JJ, Aneizi A, Schneider MB, Sajak PMJ, Gilotra MN, Abzug JM, Akabudike NM, Henn RF. Press Ganey Surveys in Patients Undergoing Upper-Extremity Surgical Procedures: Response Rate and Evidence of Nonresponse Bias. J Bone Joint Surg Am 2021; 103:1598-1603. [PMID: 33988529 DOI: 10.2106/jbjs.20.01467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient satisfaction surveys are important measures of the patient experience that provide data for quality improvement. The purpose of this study was to establish the response rate and the factors associated with the completion of the Press Ganey (PG) Ambulatory Surgery Survey (PGAS) in patients who underwent ambulatory upper-extremity surgical procedures. METHODS A prospective orthopaedic registry at a single academic ambulatory surgical center was retrospectively reviewed for patients who underwent an upper-extremity surgical procedure from 2015 to 2019. The institutional PG database was queried to determine the patients who completed the PGAS postoperatively. The response rate was calculated, and baseline characteristics and patient-reported outcome measures were compared between responders and nonresponders. RESULTS Of the 1,489 patients included, 201 (13.5%) were responders and 1,288 (86.5%) were nonresponders. Differences existed in baseline characteristics between groups, with responders being significantly older (p = 0.004) and having significantly higher proportions of White race (p < 0.001), college education (p = 0.011), employment (p = 0.005), marriage (p = 0.006), and higher income earners (p < 0.001). Responders had significantly better baseline Patient-Reported Outcomes Measurement Information System scores across multiple domains (p < 0.05), but these differences were not clinically meaningful. CONCLUSIONS PGAS response rates were low (13.5%), and differences between responders and nonresponders may be utilized by hospitals to target feedback from underrepresented patient populations. Surgeons, policymakers, and health-care administrators should use caution with the interpretation of PGAS results because responders may not be representative of all patients.
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Affiliation(s)
- Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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24
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Jauregui JJ, Tran A, Kaveeshwar S, Nadarajah V, Chaudhri MW, Henn RF, Gilotra MN, Hasan SA. Diagnosing a periprosthetic shoulder infection: A systematic review. J Orthop 2021; 26:58-66. [PMID: 34305349 DOI: 10.1016/j.jor.2021.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/11/2021] [Indexed: 01/16/2023] Open
Abstract
Introduction The aim of this study was to systematically review the literature regarding accurate shoulder prosthetic joint infection (PJI) diagnosis. Methods Using PRISMA guidelines, we analyzed 25 studies reporting on 5535 patients and 646 infections. Results Cutibacterium acnes (C. acnes) cultures were positive in 60% of patients. Serum markers WBC, CRP, ESR, and IL-6 appear to lack diagnostic reliability. Synovial IL-6 and alpha-defensin may be more accurate in detecting infections. Conclusion Synovial IL-6 and alpha-defensin appear to have greater utility than serum markers. These may be incorporated into new criteria to accurately diagnose shoulder PJI. Level of evidence IV.
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Affiliation(s)
- Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Tran
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Moiuz W Chaudhri
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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25
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Kung JE, Zhang T, Aneizi A, Koenig S, Shasti K, Wahl AJ, Packer JD, Meredith SJ, Henn RF. Predictors of two-year patient satisfaction following elective knee surgery. J Clin Orthop Trauma 2021; 20:101486. [PMID: 34277340 PMCID: PMC8267497 DOI: 10.1016/j.jcot.2021.101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/16/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Patient satisfaction metrics are increasingly being utilized as tools to evaluate the quality of healthcare and affect reimbursements. The objectives of this study were to (1) identify factors associated with two-year patient satisfaction after elective knee surgery, (2) compare the Surgical Satisfaction Questionnaire-8 (SSQ-8) and a numeric satisfaction scale (NSS), and (3) determine if two-year patient satisfaction can be predicted based on preoperative factors. METHODS A total of 365 patients undergoing elective knee surgery at a single center were administered questionnaires to assess demographics, medical history, and various patient-reported outcomes preoperatively and at two years postoperatively. Patient satisfaction was measured at two years postoperatively with SSQ-8 and NSS. Bivariate and multivariate statistical analyses were performed to identify significant associations and independent predictors of satisfaction. RESULTS SSQ-8 and NSS scores were significantly correlated (rs = 0.68, P < 0.0001). Lower SSQ-8 and NSS scores were associated with black race, higher BMI, more comorbidities, unemployment, smoking, higher ASA score, and greater Met Expectations (P < 0.05). Better scores on patient-based outcome measures and better improvement from baseline were significantly correlated with higher satisfaction on both SSQ-8 and NSS. Multivariable analysis identified greater Met Expectations and higher two-year Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scores as independent predictors of greater SSQ-8 scores (adjusted r2 = .52). Greater Met Expectations and better two-year PROMIS Social Satisfaction scores were independent predictors of NSS score (adjusted r2 = .41). In contrast, when only preoperative variables were considered, the multivariable regression model accounted for only 14% of the variance in SSQ-8 and 6% of the variance in NSS. CONCLUSION While there are multiple preoperative factors that are associated with two-year patient satisfaction after knee surgery, those factors contribute relatively little to satisfaction. Meeting expectations and better patient-based outcomes at two years are more important.
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Affiliation(s)
| | | | | | | | | | | | | | | | - R. Frank Henn
- Corresponding author. Chief of Sports Medicine University of Maryland School of Medicine 2200 Kernan Drive Baltimore, MD 21207, USA.
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26
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Sood A, Klein A, Kaveeshwar S, Jones DL, Duvall G, Hovis JP, Weir TB, Enobun B, Hasan SA, Henn RF, Packer JD, Gilotra MN. An accurate method of measuring shoulder sling compliance: a validation study. BMC Musculoskelet Disord 2021; 22:524. [PMID: 34098906 PMCID: PMC8186189 DOI: 10.1186/s12891-021-04396-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background The effect of postoperative shoulder sling compliance on surgical outcomes is unknown. The goal was to determine an accurate method to measure sling compliance. We compared volunteer recorded sling wear time with temperature-based sensors to monitor sling compliance. Methods Data loggers sutured at three locations measured heat generated in 15-minute intervals. Slings wearers logged sling wear to accurately cross-reference with temperature sensors. Secondary experiments analyzed whether surrounding ambient temperature can be discerned from actual sling wear. We created an algorithm to describe actual sling wear time as a function of heat recorded and calculated percent wear accuracy. Results The modified sling was worn for 172 h. The algorithm modeled sling on/off times by analyzing cutoff temperatures. Diagnostic accuracy was >99 % for the three locations, with no statistically significant differences among them. Compared with sling wear, ambient temperature took longer to reach critical temperature values determined by the algorithm, helping distinguish compliance from false positives. Conclusions The described algorithm can effectively quantify shoulder sling wear time based on heat-generated sensor readings. False positives from ambient temperature are minimal. This measurement method could be used to study the relationship between postoperative sling use and functional outcomes after shoulder surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04396-1.
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Affiliation(s)
- Anshum Sood
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - Ashley Klein
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - Derek L Jones
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - Grant Duvall
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - James Paul Hovis
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA.,Department of Orthopedics, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - Blessing Enobun
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, 100 Penn Street, Room 540D, Baltimore, Maryland, 21201, USA.
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27
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Nadarajah V, Meredith SJ, Jauregui JJ, Smuda MP, Medina S, Gilotra MN, Hasan SA, Henn RF. Preoperative opioid use in patients undergoing shoulder surgery. Shoulder Elbow 2021; 13:248-259. [PMID: 34659464 PMCID: PMC8512997 DOI: 10.1177/1758573219879689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioids are commonly used to manage pain from acute injury or chronic degenerative diseases. The objective of this study was to assess the prevalence of preoperative opioid use in patients undergoing shoulder surgery and the clinical factors associated with preoperative opioid use. METHODS This was an analytical cross-sectional study of 175 patients undergoing shoulder surgery at an urban hospital from June 2015 to June 2017. Multivariable regression models were used to determine independent associations. RESULTS Fifty-three patients reported preoperative opioid use, which was significantly associated with primary procedure performed (Current Procedural Terminology [CPT]), higher body mass index (BMI), unemployment, lower income, smoking, higher American Society of Anesthesiologists score, greater number of previous surgeries, higher comorbidity burden, and decreased expectations to exercise and do recreational activities (p < 0.05). Preoperative opioid use was independently associated with worse scores on the: Numeric Pain Scale, ASES, IPAQ, and PROMIS domains of Physical Function, Pain Interference, and Social Satisfaction (p < 0.05). CONCLUSION More than one in four patients reported preoperative opioid use. Several health measures, including worse pain, function, and social satisfaction were independently associated with preoperative opioid use. These findings suggest that orthopaedic surgeons need to identify patients using opioids preoperatively in order to effectively establish and execute a plan for pain management, which may include weaning off opioids prior to surgery, managing psychological distress, and optimizing coping strategies.Level of Evidence: III.
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Affiliation(s)
- Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery and
Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Shaun Medina
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of
Medicine, Baltimore, MD, USA
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28
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Albelo FD, Baker M, Zhang T, Schneider MB, Jauregui JJ, Nadarajah V, Meredith SJ, Packer JD, Henn RF. Impact of pre-operative recreational marijuana use on outcomes two years after orthopaedic surgery. Int Orthop 2021; 45:2483-2490. [PMID: 34052856 DOI: 10.1007/s00264-021-05069-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to investigate the relationship between recreational marijuana use and patient-reported outcomes two years after orthopaedic surgery. We hypothesized that pre-operative recreational marijuana use would be associated with less pain, better function, and better mental health measures two years after orthopaedic surgery. METHODS Patients were retrospectively analyzed from a prospective orthopaedic registry at a single urban institution. A total of 1710 patients completed the pre-operative assessment and 1103 patients (64.5%) completed the two-year follow-up questionnaires. The cohort was then divided into two groups based on reported preoperative recreational marijuana usage, and statistical analysis was performed to determine if marijuana use was associated with two-year outcomes. Multivariable analysis was used to control for confounding variables. RESULTS Marijuana use was reported by 47 (4.3%) patients. Significantly worse scores for two-year PROMIS Anxiety (53.2 vs. 49.2, p = 0.005), PROMIS Depression (51.1 vs. 46.5, p = 0.001), Met Expectations (63.1 vs. 74.4, p = 0.024), Surgical Satisfaction Questionnaire-8 (71.7 vs. 80.4, p = 0.005), and Numeric Satisfaction Scale (75.6 vs. 83.1, p = 0.041) were associated with marijuana use. Marijuana users also had less improvement of Numeric Pain Scores at the operative site (- 1.8 vs. - 2.7, p = 0.037) and greater decrease in Marx activity scores for lower extremities (- 12.3 vs. - 3.9, p = 0.024). Marijuana use was not an independent predictor of any outcome measure in the multivariable analysis. CONCLUSION Marijuana use was associated with worse mental health scores, lower activity level, less pain relief, and worse satisfaction two years after orthopaedic surgery. However, after controlling for confounding variables, marijuana use was not predictive of any two-year outcome measure. STUDY DESIGN Cross-sectional study.
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Affiliation(s)
- Fernando D Albelo
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Mitchell Baker
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA.,Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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29
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Thompson MM, Popp L, Foster MJ, Malik H, Henn RF. Opioid Prescribing Habits for Common Arthroscopic Procedures in Opioid Naïve Patients. Orthop J Sports Med 2021; 9:23259671211009263. [PMID: 34095328 PMCID: PMC8142003 DOI: 10.1177/23259671211009263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background: With the opioid epidemic and the increasing number of opioid-related deaths, there is growing awareness in the medical community regarding the dangers of opioid overprescription. As a result, there is a willingness among physicians to abandon old norms and adopt new data-driven prescribing practices. Purpose: To demonstrate patient-reported consumption data of opioid medications after anterior cruciate ligament (ACL) reconstructions (ACLRs), knee arthroscopies, and rotator cuff repairs to provide data-driven guidelines for prescribing opioids after these procedures. Study Design: Case series; Level of evidence, 4. Methods: Included in the study were 168 patients who underwent an ACLR, knee arthroscopy, or arthroscopic rotator cuff repair over a 17-month period. Patients were excluded if they had an opioid allergy, had preexisting opioid use, had an acute postoperative complication requiring further surgery, required hospitalization, exhibited drug-seeking behaviors, or were lost to follow-up. Medical records were reviewed to determine the number of opioid pills prescribed and the number of pills taken postoperatively. Prescribing was standardized in that 15 hydrocodone/acetaminophen pills (5/325 mg) were prescribed for all knee arthroscopy procedures and 40 hydrocodone/acetaminophen pills were prescribed for all ACL and rotator cuff procedures. The mean number of pills consumed and percentage of prescribed pills taken were analyzed in association with specific procedures and patient demographics. Results: Overall, the mean (±SD) reported opioid consumption overall was 13.5 ± 13.0 pills, with a utilization rate of 45.6% of the prescription. The mean reported opioid consumption for ACLRs, knee arthroscopies, and rotator cuff repairs was 19.1 ± 15.4, 7.2 ± 5.4, and 17.2 ± 14.3 pills, respectively (P < .001). This represented a utilization rate of 48%, 47%, and 41%, respectively. Conclusion: This study provides important information regarding opioid utilization after common arthroscopic procedures. For ACLRs, knee arthroscopies, and rotator cuff repairs, by respectively prescribing 20, 10, and 20 pills postoperatively, the amount of unused medications would decrease by 60%, 47%, and 64%, respectively. We recommend prescribing no more than 20, 10, and 20 hydrocodone/acetaminophen pills (5/325 mg) for ACLRs, knee arthroscopies, and arthroscopic rotator cuff repairs, respectively.
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Affiliation(s)
- Matthew M Thompson
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lucas Popp
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael J Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Hassan Malik
- Loyola University Maryland, Baltimore, Maryland, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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30
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Karsalia M, Zhang T, Aneizi A, Foster MJ, Schneider MB, Sajak PM, Nadarajah V, Meredith SJ, Henn RF. Predictors of postoperative pain using PROMIS pain interference two-years following knee surgery. J Orthop 2021; 25:271-277. [PMID: 34099956 DOI: 10.1016/j.jor.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/09/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction The purpose of this study was to identify preoperative factors associated with worse PROMIS Pain Interference (PI) two years following knee surgery. Methods Participants completed surveys preoperatively and two years postoperatively. Data collected included demographics, medical history, and multiple patient-reported outcomes measures, including PROMIS PI. Results After controlling for confounders, lower income, smoking, worse PROMIS Anxiety, worse Numeric Pain Score body pain, and worse Marx Activity Rating Scale were independent predictors for worse PROMIS PI two years after surgery. Conclusion Worse PROMIS PI two years after elective knee surgery is associated with multiple socio-demographic patient identifiers.
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Affiliation(s)
- Moli Karsalia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael J Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick Mj Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Abstract
There is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee surgery at an urban academic medical center. We utilized the Musculoskeletal Outcomes Data Evaluation and Management System to measure preoperative expectations. Multiple legacy PRO measures were recorded, as well as the new Patient-Reported Outcomes Measurement Information Systems (PROMIS) Computer Adaptive Testing. Nonparametric statistical analyses were performed to determine significance. Overall, patients undergoing knee surgery had high expectations, with a mean of 88.0 (95% confidence interval [CI], 86.7-89.3) and median of 91.7 (95% CI, 89.2-94.3). Greater preoperative expectations of knee surgery were associated with higher income, surgically naïve knee, lower Charlson Comorbidity Index, better PROMIS Depression and Anxiety scores, greater Marx knee activity scores, and lower total body pain (p < 0.05). Preoperative expectations of patients undergoing knee surgery are associated with a history of prior knee surgery, income, general and mental health, activity, and pain. Expectations were also found to be associated with PRO measures of function and psychological well-being. These findings may have implications for patient education and shared decision-making preoperatively. The level of evidence for the study is IV.
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Affiliation(s)
- Kali N Stevens
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate College of Medicine, Brooklyn, New York
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Xuyang Song
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shaun H Medina
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Lin BJ, Zhang T, Aneizi A, Henry LE, Mixa P, Wahl AJ, Shasti K, Meredith SJ, Henn RF. Predictors of met expectations two years after knee surgery. J Orthop 2021; 25:10-15. [PMID: 33897134 DOI: 10.1016/j.jor.2021.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/28/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The purpose of this study is to determine which patient factors predict two-year postoperative met expectations in a cohort of patients undergoing knee surgery. Additionally, this study aims to measure the association between met expectations and postoperative outcomes. Methods 319 patients undergoing knee surgery at one institution were studied. Patients completed patient-reported outcome questionnaires prior to surgery and again two years postoperatively. Preoperative Expectations and postoperative Met Expectations were measured using the Musculoskeletal Outcomes and Data Evaluation Management System (MODEMS) Expectations domain. Results The mean Met Expectations score was significantly lower than the preoperative Expectations Score. Worse two-year Met Expectations were associated with older age, higher BMI, greater comorbidities, more previous surgeries, black race, unemployment, lower income, government insurance, Worker's Compensation, smoking, and no injury prior to surgery. Greater Met Expectations were correlated with better scores on all two-year outcome measures as well as greater improvement on most outcome measures. Race, insurance status, function, mental health, and knee pain were found to be independent predictors of Met Expectations. Conclusion This study identified multiple patient factors and outcome measures that were associated with Met Expectations two years after knee surgery.
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Affiliation(s)
- Brian J Lin
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Leah E Henry
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick Mixa
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexander J Wahl
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Keyan Shasti
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Bennett CH, Nadarajah V, Moore MC, Jauregui JJ, Dubina AG, Burt C, Davis DL, Uppal A, Henn RF. Cartiform Implantation for focal cartilage defects in the knee: A 2-year clinical and magnetic resonance imaging follow-up study. J Orthop 2021; 24:135-144. [PMID: 33716418 PMCID: PMC7932855 DOI: 10.1016/j.jor.2021.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/14/2021] [Indexed: 01/18/2023] Open
Abstract
The purpose of this study was to evaluate clinical and magnetic resonance imaging (MRI) outcomes in patients who underwent cryopreserved viable osteochondral allograft (CVOCA) implantation for focal cartilage defects in the knee at a minimum of 2-years postoperatively. This is a retrospective follow-up study of twelve patients who underwent CVOCA implantation from 2013 to 2015 by a single surgeon for a International Cartilage Repair Society (ICRS) grade 3 or 4 chondral defect. Patient-reported outcome (PRO) measurements and MRI were obtained 2-years postoperatively. Collected PRO measures included: International Knee Documentation Committee (IKDC) form; Visual Analog Scale (VAS) pain score; Veterans RAND 12-Item Health Survey (VR-12); Knee Injury and Osteoarthritis Outcome Score (KOOS); and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Patients completed a standard return to work and sports/recreation survey. A blinded, fellowship-trained musculoskeletal radiologist independently evaluated each MRI to determine the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Mean follow-up was 2.1 years (2.0-2.3). There were 6 women and 6 men with a mean age of 46.2 ± 11.9 years. Mean PRO scores were: IKDC 72.6 ± 17.4; VAS 2.9 ± 2.8; WOMAC 84.2 ± 15.1; KOOS- Pain 83.8 ± 18.5, Symptoms 77.6 ± 16.0, ADL 88.0 ± 16.9, Sports/Rec 67.7 ± 33.3, QOL 54.8 ± 24.2; and VR-12 PCS 45.0 ± 8.5 and MCS 51.1 ± 9.5. The mean MOCART score was 59.5 ± 12.9. To our knowledge, this is the largest study to report clinical and MRI outcomes of CVOCA implantation in the knee. With positive functional outcomes and lack of failures at 2-year follow-up, CVOCA is a promising treatment option for focal chondral defects in the knee. STUDY DESIGN Retrospective case series, Level of evidence 4.
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Affiliation(s)
- Craig H. Bennett
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- LifeBridge Health Sports Medicine Institute, Owings Mills, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Health Sciences University, Brooklyn, NY, USA
| | - Michelle C. Moore
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J. Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew G. Dubina
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cameran Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Derik L. Davis
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Foster MJ, O'Hara NN, Weir TB, Aneizi A, Henn RF, Packer JD, Hasan SA, Slobogean GP, Gilotra MN. Difference in Resident Versus Attending Perspective of Competency and Autonomy During Arthroscopic Rotator Cuff Repairs. JB JS Open Access 2021; 6:JBJSOA-D-20-00014. [PMID: 33748637 PMCID: PMC7963494 DOI: 10.2106/jbjs.oa.20.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A noted deficiency in orthopaedic resident education is a lack of intraoperative autonomy; however, no studies exist evaluating this issue. The purpose of this study was to determine whether there is a difference between resident and attending perception of resident competency and autonomy during arthroscopic rotator cuff repairs and whether increased perceived competency leads to more autonomy.
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Affiliation(s)
- Michael J Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gerard P Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Meredith SJ, Foster MJ, Henn RF. Editorial Commentary: Suprascapular Nerve Decompression Can Be Effective, But Should You Have the Nerve to Do It? Arthroscopy 2021; 37:508-509. [PMID: 33546789 DOI: 10.1016/j.arthro.2020.12.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
Isolated suprascapular neuropathy that requires surgical decompression is rare. Arthroscopic suprascapular nerve decompression is an effective treatment for correctly indicated patients, but identifying which patients would benefit from decompression is challenging. While good outcomes and low complication rates after arthroscopic suprascapular nerve decompression have been reported by expert surgeons, this procedure has potential for neurovascular injury in inexperienced hands. Given the rarity of the condition, the difficulty with accurate diagnosis, and the potential risks from surgical intervention, we believe that these patients are best treated in a tertiary referral practice.
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Kator J, Aneizi A, Nadarajah V, Sajak PMJ, Zhan M, Gilotra MN, Akabudike NM, Packer JD, Henn RF. Predictors of early postoperative pain interference following orthopaedic surgery. J Orthop 2020; 22:579-583. [PMID: 33299270 DOI: 10.1016/j.jor.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/08/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Despite the increasing incidence of orthopaedic surgeries, there is a lack of data reporting on patient experience and recovery following surgery. As such, there is a need to better characterize the natural history of pain interference (PI) after orthopaedic surgery to better manage patients' expectations and recovery. Purpose To identify factors associated with greater pain interference two weeks following orthopaedic surgery. Methods All patients undergoing elective outpatient orthopaedic surgery at a single urban academic institution were evaluated preoperatively from August 2016 to March 2018. Patients completed a baseline assessment consisting of demographic information, PROMIS computer adaptive testing in 6 domains including Pain Interference (PI), Physical Function, Social Satisfaction, Fatigue, Anxiety, and Depression. Two weeks following surgery, patients completed the same questionnaires along with assessments of Improvement and Satisfaction. Bivariate and multivariable regression analyses were performed. Categorical data was compared with ANOVA and continuous data was compared with Spearman's correlation coefficient (rs). Results 435 patients (age = 41.1 ± 15.7, 47% female) were studied. Mean PI was 60.1 ± 7.0 prior to surgery and 61.7 ± 7.6 at 2 weeks postoperative. Worse 2 week PROMIS PI was associated with lower extremity surgery, prior surgery on the joint, preoperative opioid use, depression, lower income, lower education, and higher ASA score (p < 0.05). Better 2 week PROMIS PI was correlated with better baseline and better 2 week scores on all outcome measures. Multivariable analysis demonstrated that lower extremity surgery, worse preoperative pain scores, and worse preoperative pain interference were independent predictors of worse pain interference after surgery. Conclusion Early postoperative pain interference is associated with function, demographic, and psychosocial factors.
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Affiliation(s)
- Jamie Kator
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Patrick M J Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Zhan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ngozi M Akabudike
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Perraut G, Aneizi A, Nadarajah V, Sajak PMJ, Smuda MP, Jauregui JJ, Zhan M, Packer JD, Henn RF. PROMIS physical function two weeks following orthopaedic surgery. J Clin Orthop Trauma 2020; 11:S837-S843. [PMID: 32999565 PMCID: PMC7503061 DOI: 10.1016/j.jcot.2020.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022] Open
Abstract
UNLABELLED Many patients opt for elective orthopaedic procedures to regain physical function. However, little data exist about patient-reported early postoperative function. PURPOSE To characterize physical function two weeks postoperative from upper and lower extremity orthopaedic surgery and to determine pre-operative factors that are associated with physical function two weeks following surgery. METHODS Patients 17 years and older undergoing elective orthopaedic surgery at one institution were enrolled prospectively and completed questionnaires prior to surgery and again two weeks postoperatively. The questionnaires included: six of the PROMIS computer adaptive questionnaires: Physical Function (PF), Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression; a joint-specific function questionnaire, a joint numeric pain scale, and a body numeric pain scale. Physical activity levels were measured using Tegner, IPAQ, and Marx. Responses were analyzed using Spearman's correlation coefficient, ANOVA, and multivariate linear stepwise regression with two-week PF as the dependent variable. RESULTS 435 patients (47% female) with mean age 41.1 ± 15.7 were included in our final analysis. Mean baseline PF score was 42.1 and mean two-week PF score was 35.5 (p < .0001). Patients undergoing upper extremity surgery had higher PF at two weeks than those undergoing lower extremity surgery (39.1 vs 32.2, p < .0001). Younger age, Hispanic ethnicity, preoperative narcotic use, injury prior to surgery, and procedure all had a significant relationship with lower 2-week postoperative PF score (p < 0.05). Numerous baseline and 2-week measures were correlated with postoperative PF score, with 2-week Social Satisfaction demonstrating the strongest correlation (rs = 0.604, p < .0001). Multivariable regression confirmed that the better preoperative PF score and upper extremity surgery were independent preoperative predictors of better 2-week PF scores. CONCLUSIONS Patients have a significant decline in physical function following orthopaedic surgery, with those undergoing lower extremity surgery having a significantly greater decline. Many factors are associated with activity levels, including mental health, pain, and satisfaction. This information can be used to help manage patients' short-term expectations.
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Affiliation(s)
- Gregory Perraut
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick MJ. Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael P. Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J. Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Zhan
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan D. Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author. University of Maryland Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Henry LE, Aneizi A, Nadarajah V, Sajak PMJ, Stevens KN, Zhan M, Gilotra MN, Packer JD, Henn RF. Preoperative expectations and early postoperative met expectations of extremity orthopaedic surgery. J Clin Orthop Trauma 2020; 11:S829-S836. [PMID: 32999564 PMCID: PMC7503149 DOI: 10.1016/j.jcot.2020.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/05/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preoperative patient expectations and met expectations are likely associated with the outcome of treatment. However, there is a lack of data regarding the preoperative expectations and early postoperative met expectations of patients undergoing extremity orthopaedic surgery. The purpose of this study was to identify the predictors of early postoperative met expectations in a cohort of patients undergoing extremity orthopaedic surgery and to assess the relationship between patient expectations and patient-reported outcome (PRO) measures. We hypothesized that patients with higher preoperative expectation scores and higher postoperative met expectation scores would have better early postoperative outcomes. METHODS Four hundred thirty-five patients age seventeen and older who underwent extremity orthopaedic surgery at one institution were prospectively enrolled in this study. Each patient completed a preoperative questionnaire that included an assessment of demographics, pain, function, general health, treatment expectations, activity level, and Patient-Reported Outcome Measurement Information System (PROMIS) computer adaptive testing. Expectations were evaluated using the Expectations Domain of the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire. Patients completed a follow-up questionnaire two weeks after surgery that also assessed MODEMS met expectations and satisfaction (Surgical Satisfaction Questionnaire (SSQ-8)). RESULTS The mean preoperative expectation score was 86.95 ± 16.59, and the mean postoperative met expectation score was 55.02 ± 27.63 (0-100 scale with 100 representing the highest level of expectations). Greater met expectations were significantly associated with white race (p = 0.025), college degree (p = 0.011), and higher income (p = 0.002). Greater met expectations were also significantly associated with greater postoperative physical function, social satisfaction, activity level, and subjective improvement, as well as lower pain interference, joint pain, body pain, fatigue, anxiety, and depression (p < 0.01 for each). Multivariable analysis results found that less postoperative joint pain and greater postoperative social satisfaction, improvement, and physical function were all significant independent predictors of greater met expectations at two weeks postoperative (p < 0.01 for each). CONCLUSION Greater preoperative expectations are associated with better activity and less pain two weeks after surgery. Met expectations of extremity orthopaedic surgery were associated with postoperative physical function, social satisfaction, activity, pain, anxiety, depression, and subjective improvement. These results may have implications for preoperative counseling and risk factor modification.
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Affiliation(s)
- Leah E. Henry
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA,Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Patrick MJ. Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kali N. Stevens
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Zhan
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N. Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan D. Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author. University of Maryland School of Medicine, Department of Orthopaedics, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Howard B, Aneizi A, Nadarajah V, Sajak PM, Ventimiglia DJ, Burt CI, Zhan M, Akabudike NM, Henn RF. Early patient satisfaction following orthopaedic surgery. J Clin Orthop Trauma 2020; 11:S823-S828. [PMID: 32999563 PMCID: PMC7503134 DOI: 10.1016/j.jcot.2020.06.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/05/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The healthcare industry is shifting its focus from traditional clinical outcome measures to patient satisfaction metrics. This change has caused orthopaedic surgeons to become increasingly interested in factors influencing patient satisfaction, which would allow them to potentially modify these factors in an effort to increase postoperative satisfaction. The objective of this study was to identify factors associated with patient satisfaction two weeks following extremity orthopaedic surgery. METHODS Patients completed questionnaires preoperatively to assess demographics, activity, pain, expectations, and Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing for Physical Function, Pain Interference, Social Satisfaction, Depression, Anxiety, and Fatigue. Two weeks after their operation, patients completed the same questionnaires in addition to an Improvement Survey and Met Expectations. Satisfaction was assessed with the Surgical Satisfaction Questionnaire. RESULTS Greater surgical satisfaction two weeks following orthopaedic surgery was associated with higher education, alcohol use, better scores on all PROMIS domains at baseline and two weeks, greater activity levels at baseline and two weeks, less bodily pain at baseline and two weeks, less pain in the surgical site at two weeks, greater met expectations, and greater improvement (p < 0.05). CONCLUSION This study provides important information about patient satisfaction two weeks after orthopaedic surgery.
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Affiliation(s)
- Bailey Howard
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Patrick M.J. Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dominic J. Ventimiglia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cameran I. Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Zhan
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ngozi M. Akabudike
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- Corresponding author. University of Maryland Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive Baltimore, MD, 21207, USA.
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Kaveeshwar S, Duvall G, Jones DL, O'Hara NN, Klein A, Diedrich AM, Kolakowski L, Lai JK, Hasan SA, Henn RF, Gilotra MN. Risk factors for increased shoulder Cutibacterium acnes burden. JSES Int 2020; 4:464-469. [PMID: 32939469 PMCID: PMC7479048 DOI: 10.1016/j.jseint.2020.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Cutibacterium acnes is the primary cause of shoulder surgery infections, but the predisposition to larger skin counts and potentially higher risk for postoperative infection remains unclear. This study aimed to quantify risk factors influencing endogenous C. acnes burden and to compare counts among 4 shoulder sites. Methods C. acnes counts were quantified via a detergent scrub technique for 173 participants. Bivariate and multivariable stepwise linear regression statistical analyses were used to investigate the association of sex, age, ethnicity, degree of hirsutism, diabetes, smoking status, body mass index, and location with counts. A separate Wilcoxon rank-sum test was performed analyzing counts of East/Southeast Asians vs. all other ethnicities. Results Sex, age, degree of hirsutism, diabetes, smoking status, and body mass index were included in the multivariable stepwise linear regression analysis. The multiple regression analysis isolated individuals <40 years with the highest burden (P = .001). Males had a 191% increase in C. acnes counts compared with females (P = .001). Increased hirsutism was further indicated to be a risk factor for the male sex although not in a dose-dependent manner (P = .027). Wilcoxon rank-sum test results found that East/Southeast Asians had the lowest load (P = .019), although not significant in the multivariate model. Conclusion Surgical site C. acnes infections occur more frequently in younger males, and males <40 years with shoulder-specific hirsutism have the highest preoperative burden. East/Southeast Asians have lower raw counts of C. acnes compared with other ethnicities that may be related to less hirsutism.
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Affiliation(s)
- Samir Kaveeshwar
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Grant Duvall
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Derek L Jones
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Nathan N O'Hara
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Ashley Klein
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Aloise M Diedrich
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Logan Kolakowski
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Jim K Lai
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, MD, USA
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Nadarajah V, Glazier E, Miller K, Jauregui JJ, Smuda MP, Bennett CH, Packer JD, Henn RF. Evaluation of Preoperative Pain Using PROMIS Pain Interference in Knee Surgery Patients. J Knee Surg 2020; 33:875-883. [PMID: 31096280 DOI: 10.1055/s-0039-1688769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Given that pain relief is often the primary goal of orthopaedic surgery, an accurate assessment of pain is paramount. The objectives of this cross-sectional analytical study were to (1) compare how the Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) computer adaptive test (CT) performs against the Numeric Pain Scale (NPS) measure in evaluating pain, and (2) to determine demographic, clinical, and psychosocial correlates of PI in an urban population undergoing a variety of knee surgeries. We hypothesized that there would be a strong correlation between PI and NPS, with minimal floor and ceiling effects; and that a worse PI score would be associated with a worse general health profile. The sample consisted of 412 patients undergoing knee surgery at an urban academic center. Patients were preoperatively administered measures of health-related quality of life (HRQOL). Bivariate and multivariable statistical analyses were performed to identify significant independent predictors. The mean PI score was 60.3 ± 7.2 and had no floor or ceiling effects, whereas NPS demonstrated a greater percentage of patients scoring at the extremes of the measure. Worse PI scores were associated with older age, higher body mass index (BMI), greater comorbidity, lower income, smoking, female gender, Hispanic ethnicity, Black race, unemployment, opioid use, lower expectations, and greater American Society of Anesthesiologists score (p < 0.05). Compared with other procedures, total knee arthroplasty was associated with worse PI scores and anterior cruciate ligament reconstruction was associated with better PI scores. Furthermore, PI demonstrated significant associations with a wide range of HRQOL measures. After controlling for confounding variables, worse PI was independently associated with older age, lower income, higher BMI, and smoking.
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Affiliation(s)
- Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Elizabeth Glazier
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kenneth Miller
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Craig H Bennett
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Miles M, Nadarajah V, Jauregui JJ, Dubina AG, Smuda MP, Bennett CH, Packer JD, Henn RF. Evaluation of the PROMIS Physical Function Computer Adaptive Test in Patients Undergoing Knee Surgery. J Knee Surg 2020; 33:810-817. [PMID: 31067591 DOI: 10.1055/s-0039-1688691] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A cross-sectional analysis of data derived from patients undergoing knee surgery at a single institution was conducted. The objectives of the study were to (1) compare how the Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) computer adaptive test performs against the International Knee Documentation Committee (IKDC) Subjective Knee Form in evaluating functional status, and (2) to determine demographic, clinical, and psychosocial correlates of each outcome measure in an urban population undergoing a variety of knee surgeries. We hypothesized that there would be a strong correlation between PROMIS PF and IKDC, with minimal floor and ceiling effects, and similar clinical correlates. The sample consisted of 412 patients undergoing knee surgery. Bivariate and multivariable statistical analyses were performed to identify significant independent predictors. The PROMIS PF and IKDC scores were strongly correlated (r s = 0.71, p < 0.001), and neither exhibited floor nor ceiling effects. Lower body mass index, no preoperative opioid use, lower Charlson comorbidity index score, employment, and lower income were found to be significant independent predictors for better scores on both PROMIS PF and IKDC. Patients undergoing total knee arthroplasty had significantly lower PROMIS PF and IKDC scores (p < 0.05). Potential explanations for these findings are presented, and clinical implications are discussed.
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Affiliation(s)
- Megan Miles
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrew G Dubina
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Craig H Bennett
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Davis DL, Almardawi R, Henn RF, Zhuo J, Mulligan ME, Resnik CS, Abdullah SB, Al Khalifah H, Gilotra MN, Hasan SA, Gullapalli RP. Correlation of Quantitative Versus Semiquantitative Measures of Supraspinatus Intramuscular Fatty Infiltration to Shoulder Range of Motion and Strength: A Pilot Study. Curr Probl Diagn Radiol 2020; 50:629-636. [PMID: 32654835 DOI: 10.1067/j.cpradiol.2020.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The relationship of magnetic resonance imaging (MRI) measures of rotator cuff intramuscular fatty infiltration (FI) to shoulder range of motion (ROM) and strength are not well understood. Our purpose was to determine if supraspinatus quantitative Dixon fat fraction has superior correlation to shoulder ROM and strength as compared to semiquantitative Goutallier grade. METHODS Thirty-seven study subjects received shoulder MRI; and measurement of ipsilateral shoulder forward flexion ROM, abduction ROM and abduction strength. Supraspinatus Dixon fat fraction was measured on 6-point Dixon MRI by 2 diagnostic radiology residents. Supraspinatus Goutallier grade was assessed on T1-weighted MRI by 2 musculoskeletal radiologists. Questionnaires recorded demographics. Based on characteristics, study subjects were divided into 3 groups: Group 1, neither shoulder pain nor full-thickness supraspinatus tendon (SST) tear (n = 17; mean age, 63.0 ± 10.1 years); Group 2, positive complaint of shoulder pain but without full-thickness SST tear (n = 7; mean age, 57.4 ± 9.9 years); Group 3, positive complaint of shoulder pain and full-thickness SST tear (n = 13; mean age, 63.6 ± 8.1 years). One-way analysis of variance compared groups. Spearman (rho) rank order correlation was performed to determine correlation of supraspinatus Dixon fat fraction, or Goutallier grade, with measures of ROM and strength for the study population. Reliability analyses were performed for Dixon fat fraction and Goutallier grade. RESULTS No significant differences were present among groups for age. Significant differences existed among groups for forward flexion ROM (P= 0.001), abduction ROM (P < 0.001), Dixon fat fraction (P = 0.004) and Goutallier grade (P = 0.012). Dixon fat fraction showed statistically significant inverse correlations with forward flexion ROM (rho = -0.47; P = 0.005), abduction ROM (rho = -0.35, P = 0.041), and abduction strength (rho = -0.42; P = 0.013). Goutallier grade demonstrated weak inverse correlation that lacked statistical significance (P > 0.05) for the same measures. Dixon fat fraction showed strong interobserver and intraobserver reliability with intraclass correlation coefficients of 0.956 and 0.999, respectively. Goutallier grade showed poor interobserver (kappa, 0.188) and moderate intraobserver (kappa, 0.608) reliability. CONCLUSION Supraspinatus Dixon fat fraction has superior correlation to shoulder ROM and strength relative to Goutallier grade on MRI.
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Affiliation(s)
- Derik L Davis
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD..
| | - Ranyah Almardawi
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Jiachen Zhuo
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Michael E Mulligan
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Charles S Resnik
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Selwan B Abdullah
- Department of Radiology, RA-3, Brigham & Women's Hospital, Boston, MA
| | | | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Rao P Gullapalli
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
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Hertzberg ML, Zhang T, Dubina AG, Henn RF. Superior Patella Periosteal Sleeve Avulsion After Ipsilateral Tibial Tubercle Fracture Fixation: A Case Report. JBJS Case Connect 2020; 10:e2000155. [PMID: 32960021 DOI: 10.2106/jbjs.cc.20.00155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 14-year-old boy underwent open reduction and internal fixation (ORIF) of a tibial tubercle avulsion fracture. Seven weeks postoperatively, the patient slipped in the bathroom and was found to have a superior patellar pole periosteal sleeve avulsion injury. CONCLUSION We describe a rare case of periosteal sleeve avulsion fracture of the superior patella pole after tibial tubercle avulsion fracture ORIF in an adolescent male patient. The etiology of this injury pattern may be due to altered tensile forces transmitted through the extensor mechanism related to the previous surgery. Orthopaedic surgeons should be aware of this unusual sequela.
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Affiliation(s)
- Michelle L Hertzberg
- 1Department of Orthopaedics, New York Medical College, Valhalla, New York 2Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Nadarajah V, Stevens KN, Henry L, Jauregui JJ, Smuda MP, Ventimiglia DJ, Gilotra MN, Hasan SA, Henn RF. Patients undergoing shoulder surgery have high preoperative expectations. Knee Surg Sports Traumatol Arthrosc 2020; 28:2377-2385. [PMID: 31912166 DOI: 10.1007/s00167-019-05824-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/09/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The primary aims of this study were to (1) assess the preoperative expectations of patients undergoing shoulder surgery, and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. It was hypothesized that younger patients with worse function and worse health status had higher expectations of shoulder surgery. METHODS Data from a total of 319 patients (319 shoulders) from 2015-2018 were analyzed. Patients completed a series of questionnaires covering demographics and patient-reported outcome measures. Expectations of treatment were evaluated using the Musculoskeletal Outcomes Data Evaluation and Management System. Bivariate analyses were performed to determine the significance of identified associations. RESULTS The study population consisted of 186 males and 133 females. The mean age was 46.9 (± 17.2), and the mean BMI was 30.1 (± 6.8). Overall, patients had high expectations of shoulder surgery, with a mean score of 84.7 (± 19.3). The most commonly performed procedure in the study population was arthroscopic rotator cuff repair. There was a significant association between pre-treatment expectations and ethnicity, previous shoulder surgery, employment status, income level, tobacco use, preoperative opioid use, depression, and ASA score. CONCLUSION The findings suggest that patients undergoing shoulder surgery have high overall preoperative expectations, which were significantly associated with ethnicity, surgical history, opioid use, and employment status, and with multiple patient-reported outcome measures including physical function, pain interference, fatigue, and depression. Nevertheless, by discussing expectations preoperatively, orthopaedic surgeons can help patients develop high but realistic expectations to improve outcomes and satisfaction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Kali N Stevens
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Leah Henry
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael P Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dominic J Ventimiglia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA. .,University of Maryland Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Iyer SR, Scheiber AL, Yarowsky P, Frank Henn R, Otsuru S, Lovering RM. Exosomes Isolated From Platelet-rich Plasma And Mesenchymal Stem Cells Promote Functional Recovery After Muscle Injury. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000679516.67474.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Iyer SR, Scheiber AL, Yarowsky P, Henn RF, Otsuru S, Lovering RM. Exosomes Isolated From Platelet-Rich Plasma and Mesenchymal Stem Cells Promote Recovery of Function After Muscle Injury. Am J Sports Med 2020; 48:2277-2286. [PMID: 32543878 DOI: 10.1177/0363546520926462] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinical use of platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) has gained momentum as treatment for muscle injuries. Exosomes, or small cell-derived vesicles, could be helpful if they could deliver the same or better physiological effect without cell transplantation into the muscle. HYPOTHESIS Local delivery of exosomes derived from PRP (PRP-exos) or MSCs (MSC-exos) to injured muscles hastens recovery of contractile function. STUDY DESIGN Controlled laboratory study. METHODS In a rat model, platelets were isolated from blood, and MSCs were isolated from bone marrow and expanded in culture; exosomes from both were isolated through ultracentrifugation. The tibialis anterior muscles were injured in vivo using maximal lengthening contractions. Muscles were injected with PRP-exos or MSC-exos (immediately after injury and 5 and 10 days after injury); controls received an equal volume of saline. Histological and biochemical analysis was performed on tissues for all groups. RESULTS Injury resulted in a significant loss of maximal isometric torque (66% ± 3%) that gradually recovered over 2 weeks. Both PRP-exos and MSC-exos accelerated recovery, with similar faster recovery of contractile function over the saline-treated group at 5, 10, and 15 days after injury (P < .001). A significant increase in centrally nucleated fibers was seen with both types of exosome groups by day 15 (P < .01). Genes involved in skeletal muscle regeneration were modulated by different exosomes. Muscles treated with PRP-exos had increased expression of Myogenin gene (P < .05), whereas muscles treated with MSC-exos had reduced expression of TGF-β (P < .05) at 10 days after muscle injury. CONCLUSION Exosomes derived from PRP or MSCs can facilitate recovery after a muscle strain injury in a small-animal model likely because of factors that can modulate inflammation, fibrosis, and myogenesis. CLINICAL RELEVANCE Given their small size, low immunogenicity, and ease with which they can be obtained, exosomes could represent a novel therapy for many orthopaedic ailments.
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Affiliation(s)
- Shama R Iyer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Amanda L Scheiber
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul Yarowsky
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Satoru Otsuru
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Richard M Lovering
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Nadarajah V, Sood A, Kator JL, Foster MJ, Jauregui JJ, Gilotra MN, Hasan SA, Henn RF. Evaluation of preoperative pain in patients undergoing shoulder surgery using the PROMIS pain interference computer-adaptive test. J Clin Orthop Trauma 2020; 11:S539-S545. [PMID: 32774026 PMCID: PMC7394780 DOI: 10.1016/j.jcot.2020.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/12/2020] [Accepted: 04/24/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive testing Pain Interference (PROMIS PI) item bank in patients undergoing shoulder surgery. We hypothesized that PROMIS PI would exhibit a strong positive correlation with the numerical pain scale for the operative shoulder (shoulder NPS) with less floor and ceiling effects. Secondary study aims included assessing the relationships between patient characteristics and PROMIS PI. DESIGN Analytical cross-sectional study. SETTING Urban academic medical center. PATIENTS One-hundred and ninety-five patients undergoing shoulder surgery between June 2015 to June 2017. MAIN OUTCOME MEASURES All patients completed a series of patient-reported outcomes measures, including PROMIS PI and NPS. Non-parametric tests were used for bivariate analysis. Multivariable regression models were used to determine independent associations. RESULTS There was a moderate correlation between the PROMIS PI and shoulder NPS scores (rs = 0.53; p < 0.001). PROMIS PI had no ceiling or floor effects while shoulder NPS had 26 patients (13.3%) at either the floor or the ceiling. PROMIS PI demonstrated a strong correlation with PROMIS Physical Function (rs = -0.65; p < 0.001), ASES total score (rs = -0.67; p < 0.001), and PROMIS Fatigue (rs = 0.64; p < 0.001). CONCLUSIONS The strong association noted between PROMIS PI and psychosocial and behavioral factors, versus that of NPS, demonstrates that PROMIS Pain Interference may be a more appropriate choice as an outcome measure where the surgeon is concerned about a patient's improvement of functioning and decrease in the impact of pain in other aspects of wellbeing following shoulder surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Vidushan Nadarajah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Anshum Sood
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jamie L. Kator
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael J. Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julio J. Jauregui
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N. Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S. Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author. University of Maryland Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive, Baltimore, MD, 21207, USA.
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Meredith SJ, Matuszewski PE, Smuda MP, Taskoy E, Koenig S, Nadarajah V, Packer JD, Henn RF. Use of a custom website by orthopaedic sports medicine surgical patients: If you build it, will they come? J Clin Orthop Trauma 2020; 11:S383-S388. [PMID: 32523298 PMCID: PMC7275272 DOI: 10.1016/j.jcot.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/08/2020] [Accepted: 04/03/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Internet use is nearly ubiquitous, and orthopaedic patients are increasingly utilizing the Internet for medical information. The quality of resources available to patients is variable, and patients may benefit from physician guidance. A recent study showed only 11% of orthopaedic trauma patients accessed a custom-designed website developed by a physician. The purpose of this study was to determine whether orthopaedic sports medicine patients would use a custom-designed website and what factors would be associated with website use. METHODS A prospective study was conducted of patients undergoing eight common orthopaedic sports medicine procedures from April 2017 to December 2017.108 patients were enrolled and provided access to the website that allowed tracking of each patient's website use. The sports medicine cohort was compared to a previously published trauma cohort using the same methodology in a similar population at the same institution. The custom-designed website was replicated from the previous trauma study, but with the patient information now focused on sports medicine conditions and procedures. Patients' access to the website, tracking of website use, data collection, and analysis was identical to the previous trauma cohort. Bivariate and multivariate analyses were performed to determine which patient factors were associated with website use. RESULTS 33 orthopaedic sports medicine patients (31%) accessed the website, and of those, 96% found the website helpful or very helpful. Orthopaedic sports medicine patients were nearly 3 times more likely to use the designated website than orthopaedic trauma patients (31% vs. 11%; p = 0.0004). Higher education predicted website use (p = 0.006). Age, gender, race, employment status, and household income were not predictive of use (p = 0.49, 0.27, 0.23, 0.15, 0.58; respectively). Anterior cruciate ligament (ACL) reconstruction was associated with website use as compared to meniscus and cartilage surgery (42% vs. 20%; p = 0.037). Nominal logistic regression analysis confirmed higher level of education (p = 0.00001) and ACL reconstruction (p = 0.0005) independently predicted website use. CONCLUSION Orthopaedic sports medicine surgical patients are more likely to use a custom-designed informational website than orthopaedic trauma patients. However, only 31% of sports medicine patients accessed the website. Inherent differences between groups may account for the differences in website use. Higher level of education is predictive of website use, as is ACL reconstruction for knee surgery patients. Physicians should work to direct patients to high quality Internet resources given the vast amount of potentially unreliable information available.
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Affiliation(s)
- Sean J. Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, 110 S Paca St, 6th Floor Suite 300, Baltimore, MD, USA,Corresponding author. University of Maryland Orthopaedics, 110 S Paca St, 6th Floor, Suite 300, Baltimore, MD, 21201, USA.
| | - Paul E. Matuszewski
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky School of Medicine, 740 S Limestone, Suite K401, Lexington, KY, USA
| | - Michael P. Smuda
- Department of Orthopaedics, University of Maryland School of Medicine, 110 S Paca St, 6th Floor Suite 300, Baltimore, MD, USA
| | - Evin Taskoy
- Department of Orthopaedics, University of Maryland School of Medicine, 110 S Paca St, 6th Floor Suite 300, Baltimore, MD, USA
| | - Scott Koenig
- Department of Orthopaedics, University of Maryland School of Medicine, 110 S Paca St, 6th Floor Suite 300, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, MSC 30, Brooklyn, NY, USA
| | - Jonathan D. Packer
- Department of Orthopaedics, University of Maryland School of Medicine, 110 S Paca St, 6th Floor Suite 300, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, 110 S Paca St, 6th Floor Suite 300, Baltimore, MD, USA
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50
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Duvall G, Kaveeshwar S, Sood A, Klein A, Williams K, Kolakowski L, Lai J, Enobun B, Hasan SA, Henn RF, Gilotra MN. Benzoyl peroxide use transiently decreases Cutibacterium acnes load on the shoulder. J Shoulder Elbow Surg 2020; 29:794-798. [PMID: 31676186 DOI: 10.1016/j.jse.2019.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cutibacterium acnes is the most common pathogen in shoulder prosthetic joint infections. Short-contact benzoyl peroxide (BPO) solutions effectively reduce C acnes loads on the shoulder preoperatively. It is unknown how long the effect of BPO lasts. We evaluated C acnes counts 1 week after BPO application. We hypothesized that BPO would decrease C acnes burden with a rebound after 1 week. METHODS Screening of 102 healthy volunteers with no history of shoulder surgery or C acnes infection was performed to establish bacterial counts. Thirty-four participants were selected based on an established threshold. Each was given BPO 5% for 3 consecutive days of application on either the left or right shoulder as indicated by a random number generator. Deep sebaceous gland cultures were obtained with a detergent scrub technique before BPO application, after 3 days of use, and 1 week after BPO treatment commenced. RESULTS The differences between the logarithmic reduction and the logarithmic rebound at the anterior, lateral, and posterior sites were statistically significant. Anteriorly, the average log reduction was -0.44 and the average log rebound was 0.69 (P = .003). Laterally, reduction was -0.64 and rebound was 0.74 (P = .003). Posteriorly, reduction was -0.63 and rebound was 0.78 (P = .008). At the axilla, reduction was -0.40 and rebound was 0.31 (P = .10). The differences in C acnes burden between pretreatment and 1-week counts at all sites were not statistically significant. CONCLUSION A significant decrease in C acnes burden occurred after BPO application but was not permanent. Significant rebound occurred just 1 week later.
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Affiliation(s)
- Grant Duvall
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samir Kaveeshwar
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anshum Sood
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashley Klein
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katrina Williams
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Logan Kolakowski
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jim Lai
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Blessing Enobun
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
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