scholarly journals Decreased Hip Labral Width Measured via Preoperative MRI is Associated with Inferior Outcomes for Arthroscopic Labral Repair

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0038
Author(s):  
Samuel Baron ◽  
Mohammed Samim ◽  
Christopher Burke ◽  
Robert Meislin ◽  
Thomas Youm, Daniel Kaplan
Keyword(s):  
Polynomial Regression ◽  
A Priori ◽  
Correlation Coefficients ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Future Research ◽  
Interclass Correlation ◽  
Number Of Patients ◽  
A Priori Power Analysis

Objectives: There are few pre-operative prognostic factors for hip labral repair outcomes. The objective of this study was to determine if hip labrum width measured on MRI was predictive of outcomes Methods: A retrospective review of prospectively gathered hip arthroscopy patients from 2010 to 2017 was performed. Inclusion criteria was defined as: patients >18 years old with radiographic evidence of femoroacetabular impingement who underwent a primary labral repair with >2 years of follow-up. Exclusion criteria was defined as: inadequate imaging, prior hip surgery, Tonnis grade ≥2 or lateral central edge angle <25 degrees. An a-priori power analysis was performed. MRI measurements of labral width were conducted by two blinded musculoskeletal fellowship-trained radiologists at standardized “clockface” locations using a previously validated technique. Outcomes were assessed using the Harris Hip Score (HHS), Modified HHS (mHSS), and NonArthritic Hip Score (NAHS). For mHHS, a minimal clinically important difference (MCID) and Patient Acceptable Symptomatic State (PASS) of 8 and 74 were used, respectively. Patients were divided into groups by labral width of ≤4mm and >4mm. Statistical analysis was performed using: linear and polynomial regression, Mann-Whitney U, Fischer exact, and interclass-correlation coefficients (ICC) testing Results: One hundred and three patients (107 hips) met criteria (mean age 39.4years+/-17, BMI 25.0+/-4, 51%right-sided, 68%female). Mean labrum measurements and number of patients with ≤4mm labrums at the 12:00 (indirect rectus), 3:00 (Psoas U), and 1:30 (point ½ between) positions were 7.1mm+/-2.2; 15 labrums≤4mm, 7.0 mm+/-2.0;13 labrums≤4mm, and 5.5+/-1.9; 27 labrums≤4mm, respectively. ICC agreements were good to excellent between readers at all positions (0.83-0.91,p<0.001). Pre-operative HHS, mHHS, and NAHS were not statistically different (p>0.05). Sex, laterality, and BMI had no significant effect on outcomes (p>0.05).HHS, mHHS, and NAHS scores were found to be significantly lower in the ≤4mm group at each location tested (p<0.001); including mHHS at the 12:00 (67vs87), 3:00, (69vs87) and 1:30 (74vs88) positions. The proportion of ≤4mm patients that reached MCID was significantly lower(p<0.001) at the 12:00 (47%vs91%), 3:00 (54%vs89%) and 1:30 (63%vs93%) positions. The proportion of ≤4mm patients above PASS was significantly lower (p<0.001) at the 12:00 (40%vs84%), 3:00 (31%vs84%) and 1:30 (52%vs86%) positions.Linear regression modelling was not significant at any position (p>0.05). Polynomial regression was significant at the 12:00 (R2=0.23,p<0.001), 3:00 (R2=0.17,p<0.001), and 1:30 (R2=0.26,p<0.001). Conclusion: A non-linear relationship may exist between labral width and patient outcomes following labral repair. Labrum width of ≤4mm measured via MRI may negatively impact labral repair outcomes. Future research may determine if torn labrums ≤4mm should be reconstructed instead of repaired.

scholarly journals Incisional hernia formation in hepatobiliary surgery using transverse and hybrid incisions: a systematic review and meta-analysis

2020 ◽  
Vol 102 (9) ◽  
pp. 663-671
Author(s):  
S Davey ◽  
N Rajaretnem ◽  
D Harji ◽  
J Rees ◽  
D Messenger ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Meta Analysis ◽  
A Priori ◽  
Primary Outcome Measure ◽  
Future Research ◽  
Hepatobiliary Surgery ◽  
Weighted Mean ◽  
Hernia Formation ◽  
Hepatopancreatobiliary Surgery

Introduction Evidence suggests that midline incisions should be closed with the small-bite technique to reduce IH formation. No recommendations exist for the closure of transverse incisions used in hepatobiliary surgery. This work systematically summarises rates of IH formation and associated technical factors for these transverse incisions. Methods A systematic search was undertaken. Studies describing the incidence of IH were included. Incisions were classified as transverse (two incision types) or hybrid (transverse with midline extension, comprising five incision types). The primary outcome measure was the pooled proportion of IH. Subgroup analysis based on minimum follow-up of two years and a priori definition of IH with clinical and radiological diagnosis was undertaken. Findings Thirteen studies were identified and included 5,427 patients; 1,427 patients (26.3%) underwent surgery for benign conditions, 3,465 (63.8%) for malignancy and 535 (9.9%) for conditions that were not stated or classified as ‘other’. The pooled incidence of IH was 6.0% (2.0–10.0%) at a weighted mean follow-up of 17.5 months in the transverse group, compared with 15.0% (11.0–19.0%) at a weighted mean follow-up of 42.0 months in the hybrid group (p = 0.045). Subgroup analysis did not demonstrate a statistical difference in IH formation between the hybrid versus transverse groups. Conclusion Owing to the limitations in study design and heterogeneity, there is limited evidence to guide incision choice and methods of closure in hepatopancreatobiliary surgery. There is an urgent need for a high-quality prospective cohort study to understand the techniques used and their outcomes, to inform future research.

scholarly journals Standardising the measurement of physical activity in people receiving haemodialysis: considerations for research and practice

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Hannah M. L. Young ◽  
Mark W. Orme ◽  
Yan Song ◽  
Maurice Dungey ◽  
James O. Burton ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sample Size ◽  
Repeated Measures ◽  
A Priori ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Future Research ◽  
Wear Time ◽  
Minimum Number ◽  
The Uk

Abstract Background Physical activity (PA) is exceptionally low amongst the haemodialysis (HD) population, and physical inactivity is a powerful predictor of mortality, making it a prime focus for intervention. Objective measurement of PA using accelerometers is increasing, but standard reporting guidelines essential to effectively evaluate, compare and synthesise the effects of PA interventions are lacking. This study aims to (i) determine the measurement and processing guidance required to ensure representative PA data amongst a diverse HD population, and; (ii) to assess adherence to PA monitor wear amongst HD patients. Methods Clinically stable HD patients from the UK and China wore a SenseWear Armband accelerometer for 7 days. Step count between days (HD, Weekday, Weekend) were compared using repeated measures ANCOVA. Intraclass correlation coefficients (ICCs) determined reliability (≥0.80 acceptable). Spearman-Brown prophecy formula, in conjunction with a priori ≥  80% sample size retention, identified the minimum number of days required for representative PA data. Results Seventy-seven patients (64% men, mean ± SD age 56 ± 14 years, median (interquartile range) time on HD 40 (19–72) months, 40% Chinese, 60% British) participated. Participants took fewer steps on HD days compared with non-HD weekdays and weekend days (3402 [95% CI 2665–4140], 4914 [95% CI 3940–5887], 4633 [95% CI 3558–5707] steps/day, respectively, p < 0.001). PA on HD days were less variable than non-HD days, (ICC 0.723–0.839 versus 0.559–0.611) with ≥ 1 HD day and ≥  3 non-HD days required to provide representative data. Using these criteria, the most stringent wear-time retaining ≥ 80% of the sample was ≥7 h. Conclusions At group level, a wear-time of ≥7 h on ≥1HD day and ≥ 3 non-HD days is required to provide reliable PA data whilst retaining an acceptable sample size. PA is low across both HD and non- HD days and future research should focus on interventions designed to increase physical activity in both the intra and interdialytic period.

scholarly journals The utility of hip arthroscopy for patients with painful borderline hip dysplasia

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092316
Author(s):  
Deuk-Soo Hwang ◽  
Chan Kang ◽  
Jeong-Kil Lee ◽  
Jae-Young Park ◽  
Long Zheng ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hip Arthroscopy ◽  
Hip Dysplasia ◽  
Reoperation Rate ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Control Group ◽  
The Mean ◽  
Tönnis Grade

Purpose: We measured the width of the acetabular labra in, and the clinical outcomes of, patients with borderline hip dysplasia (HD) who underwent arthroscopy. Methods: A total of 1436 patients who underwent hip arthroscopy to treat symptomatic, acetabular labral tears were enrolled. From this cohort, we extracted a borderline HD group (162 cases). Lateral labral widths were evaluated using preoperative magnetic resonance imaging scans. Clinical data including the modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score–activity of daily living (HOS-ADL) score, visual analog scale (VAS) pain score, and Tönnis grade were collected. In addition, patient satisfaction with arthroscopy outcomes was rated. All complications and reoperations were noted. Results: The mean follow-up time was 87.4 months. The lateral labral width was 7.64 mm in those with normal hips and 7.73 mm in borderline HD patients, respectively ( p = 0.870). The Tönnis grade progressed mildly from 0.46 to 0.76 ( p = 0.227). At the last follow-up, clinical outcome scores (mHHS, NAHS, and HOS-ADL scores) and the VAS score were improved ( p < 0.001). The mean patient satisfaction was scored at 8.2. The reoperation rate was higher in those who underwent labral debridement (25.6%) than labral repair (4.1%). Conclusions: The lateral labral width did not differ significantly between the borderline HD group and the nondysplastic control group. Arthroscopy relieved the symptoms of painful borderline HD and did not accelerate osteoarthritis. Therefore, if such patients do not respond to conservative treatment, hip arthroscopy can be considered for further treatment.

scholarly journals Clinical outcomes of arthroscopic repair of acetabular labral tears

2018 ◽  
Vol 4 (1) ◽  
pp. e000328 ◽  
Author(s):  
Carlos César Vassalo ◽  
Antônio Augusto Guimarães Barros ◽  
Lincoln Paiva Costa ◽  
Euler de Carvalho Guedes ◽  
Marco Antônio Percope de Andrade
Keyword(s):  
Clinical Outcomes ◽  
Arthroscopic Repair ◽  
Final Evaluation ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Senior Surgeon ◽  
Labral Tears ◽  
Significant Difference ◽  
The Mean

PurposeTo evaluate the primary clinical outcomes of arthroscopic labral repair.MethodsAll patients who underwent arthroscopic repair of the acetabular labrum performed by a senior surgeon between October 2010 and December 2013 were invited to participate in this prospective study. Patients included were those who had a preoperative diagnosis of labral tears, a lateral centre edge greater than 25° and a labral tear believed to be suturable during the intraoperative evaluation. Patients with Tönnis grade 2 or grade 3 hip osteoarthritis and those who had undergone a previous hip surgery were excluded. All patients were evaluated using the modified Harris Hip Score (mHHS) during the final appointment before surgery, 4 months after surgery and at the final evaluation. Interviews were conducted by the senior surgeon.ResultsEighty-four patients (90 hips) underwent arthroscopic repair. The mean age was 44.2 years and the mean follow-up period was 43.0 months (minimum of 25 months and maximum of 59 months). The mean mHHS was 80.4 preoperatively, 95.0 at 4 months postoperatively and 96.6 at final evaluation. A statistically significant difference existed among these scores (p<0.001).ConclusionArthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up.Level of evidenceLevel IV, therapeutic case series.

Acetabular Labral Reconstruction: Development of a Tool to Predict Outcomes

2018 ◽  
Vol 46 (13) ◽  
pp. 3119-3126 ◽  
Author(s):  
George F. Lebus ◽  
Karen K. Briggs ◽  
Grant J. Dornan ◽  
Shannen McNamara ◽  
Marc J. Philippon
Keyword(s):  
Arthroscopic Surgery ◽  
Joint Space ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Secondary Outcome ◽  
Factors Associated ◽  
Female Sex ◽  
Outcome Scores ◽  
Prior Surgery

Background: Acetabular labral reconstruction has demonstrated good results for labral lesions not amenable to labral repair. Purpose: To determine the predictors of outcomes at a minimum 2 years after labral reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Patients included in the study underwent labral reconstruction with a minimum 2-year follow-up. The primary outcome variable was the Hip Outcome Score–Activities of Daily Living (HOS-ADL). Secondary outcome measures included the 12-item Short Form Health Survey physical component summary (SF-12 PCS) and patient satisfaction with surgical outcomes. Preoperative and intraoperative variables assessed included demographics, prior surgery, chronicity of symptoms, radiographic measurements, preoperative outcome scores, and findings at arthroscopic surgery. Predictors were assessed using logistic regression with restricted cubic splines. Bivariate statistics assessed risk factors for reoperation including revision arthroscopic surgery and total hip arthroplasty (THA). Results: Three hundred seventeen of 368 labral reconstructions were available for follow-up (86.1%). Of these, 42 were converted to THA (13.2%) and 35 required revision arthroscopic surgery after labral reconstruction (11.0%). Factors associated with THA included older age, ≥2 previous surgeries, ≤2 mm of joint space, and lateral center edge angle (LCEA) <25°. Factors associated with revision included female sex, ≥2 previous surgeries, and LCEA <25°. Six patients refused to participate (1.9%), leaving 234 with a minimum follow-up of 2 years (mean, 3.7 years [range, 2.0-11.3 years]). These patients had significant improvement in HOS-ADL (71 to 90; P < .001), HOS-Sport (47 to 75; P < .001), Western Ontario and McMaster Universities Osteoarthritis Index (27 to 9; P < .001), modified Harris Hip Score (65 to 85; P < .001), and SF-12 PCS scores (41.6 to 53.1; P < .001). Median postoperative satisfaction was 9. Predictors of improvement for the HOS-ADL included higher preoperative HOS-ADL scores ( P < .001), joint space >2 mm ( P = .004), and no prior surgery ( P = .039). Predictors of improvement for the SF-12 PCS included higher preoperative SF-12 PCS scores ( P < .001), subacute chronicity (3 months to 1 year) of symptoms ( P = .013), and joint space >2 mm ( P = .046). Joint space >2 mm ( P < .001) and higher preoperative SF-12 scores (PCS: P = .034; mental component summary: P = .039) predicted higher satisfaction. Conclusion: At a minimum 2 years’ follow-up, patients who did not undergo conversion to THA (13.2%) or require revision (11.0%), reported significant improvement in outcome scores and high satisfaction with outcomes. Predictors of revision or THA included ≥2 previous surgeries, low LCEA, female sex for revision, and narrowed joint space for THA. Higher preoperative outcome scores were the most significant predictors of improvement after labral reconstruction. Lower preoperative scores, joint space narrowing, and history of surgery were predictive of an inferior result and decreased postoperative satisfaction.

scholarly journals Prospective Randomized Comparison of Capsule Management Techniques During Hip Arthroscopy

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0020 ◽  
Author(s):  
Kostas John Economopoulos ◽  
Christopher Y. Kweon
Keyword(s):  
Activities Of Daily Living ◽  
Hip Arthroscopy ◽  
Daily Living ◽  
Alpha Angle ◽  
Labral Repair ◽  
Harris Hip Score ◽  
Outcome Score ◽  
Patient Reported ◽  
Management Techniques

Objectives: Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients. The purpose of this study was to perform a prospective randomized trial to comparatively assess three commonly performed capsule management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes compared to non-closing capsulotomy management techniques. Methods: Patients undergoing hip arthroscopy were randomly assigned into three groups at the time of surgery: 1) T-capsulotomy without closure (TC), 2) interportal capsulotomy without closure (IC), and 3) interportal capsulotomy with closure (CC). Inclusion criteria included patients with labral tear on advanced imaging, cam lesion with alpha angle greater than 55 degrees, center-edge angle less than 40 degrees, and Tönnis grade 0 or 1. Patients younger than 18, older than 55, or those with signs of clinical hip hypermobility or radiographic dysplasia were excluded from the trial. All patients underwent labral repair and femoral osteoplasty. Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS) was obtained preoperatively and at intervals up to 2 years. Other outcomes obtained included need for future hip surgery. Results: 50 patients were randomly allocated into each group. Patient demographics, preoperative patient-reported outcomes (PROs) and radiographic measures of impingement were similar between all three groups. Revision hip arthroscopy was performed in 5 TC patients, 2 IC patients and 0 CC patients (p=0.17). Conversion to hip arthroplasty occurred in 4 patients in the TC group, none in the IC or CC groups (p=0.48). All three groups showed increased PRO scores postoperatively compared to preoperative values (p<0.01). The CC group when compared to the TC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (74.4 vs 65.3) at the final 2 year follow up (p<0.001). The IC group demonstrated more modest improvements in outcomes compared to the TC group. The CC group showed greater improvement in HOS-SSS compared to the IC group at early follow up (65.6 vs 55.1, p>.001) that was not maintained at 2 years (74.4 vs 71.4, p=.28). Conclusion: Patients undergoing capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes compared to those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsule management technique, especially in respect to optimizing postoperative activities of daily living.

Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction With Nested Matched-Pair Benchmarking Against a Labral Repair Control Group

2019 ◽  
Vol 47 (9) ◽  
pp. 2045-2055 ◽  
Author(s):  
Benjamin G. Domb ◽  
Muriel R. Battaglia ◽  
Itay Perets ◽  
Ajay C. Lall ◽  
Austin W. Chen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Labral Repair ◽  
Matched Pair ◽  
Harris Hip Score ◽  
Control Group ◽  
Analog Scale ◽  
Labral Tears ◽  
Point Increase ◽  
Modified Harris Hip Score

Background: Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for midterm outcomes of this treatment. Hypotheses: Arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Second, primary labral reconstruction (PLRECON) would result in similar improvement in PROs at minimum 5-year follow-up when compared with a matched-pair primary labral repair (PLREPAIR) control group. Study Design: Cohort study; Level of evidence, 3. Methods: Data from February 2008 to April 2013 were retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoroacetabular impingement, with minimum 5-year follow-up for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, patient satisfaction, and visual analog scale for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or workers’ compensation claims. PLRECON cases were matched in a 1:3 ratio to a PLREPAIR control group based on age ±5 years, sex, and body mass index ±5 kg/m2. Results: Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. The authors found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in modified Harris Hip Score ( P = .002), 22-point increase in Nonarthritic Hip Score ( P < .001), 25.4-point increase in Hip Outcome Score–Sports Specific Subscale ( P = .003), and a 2.9-point decrease in visual analog scale pain ratings ( P < .001). Mean patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 patients who underwent PLRECON were matched to a control group of 51 patients who underwent PLREPAIR. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction (6.7 vs 8.5, P = .04). Conclusion: Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared with a benchmark PLREPAIR control group but demonstrated lower patient satisfaction at latest follow-up.

Characterization of Emergency Department Rabies Post-Exposure Prophylaxis Procedures with an Infectious Diseases Clinic Referral Process

2020 ◽  
pp. 001857872097388
Author(s):  
Jessica J. Frederickson ◽  
Alexandra K. Monroe ◽  
Gregory A. Hall ◽  
Kyle A. Weant
Keyword(s):  
Emergency Department ◽  
Retrospective Chart Review ◽  
Future Research ◽  
Post Exposure Prophylaxis ◽  
Referral Process ◽  
Post Exposure ◽  
Care Plans ◽  
Number Of Patients ◽  
Exposure Prophylaxis

Purpose: Rabies post-exposure prophylaxis (rPEP) in the emergency department (ED) is associated with high costs, complicated administration protocols, and a time-sensitive vaccination series that often requires ED follow-up visits for subsequent vaccine administration. This study sought to characterize the number of redirected vaccine administrations in those patients referred to ID Clinic, guideline compliance, and opportunities for improvement. Methods: Retrospective chart review of adult and pediatric patients presenting to the ED from 2016 to 2019 and prescribed rabies immunoglobulin. Results: Of the 89 patients included, 66.3% were referred to ID Clinic. Those referred to clinic had significantly fewer average visits to the ED for repeat vaccination ( P < .001). Of the 177 vaccinations prescribed for patients referred, 105 were administered in clinic. Overall, having insurance significantly increased the odds of completing the prescribed vaccination series (Odds Ratio (OR) = 4.34, 95% Confidence Interval (CI) = 1.34 to 15.52). Among those patients referred to clinic, having insurance significantly increased the odds of receiving any follow-up doses in clinic (OR = 6.00, 95% CI = 1.48 to 25.98), receiving all of their prescribed follow-up doses in clinic (OR = 10.00, 95% CI = 1.72 to 190.80), and completing the entirety of their vaccination series (OR = 5.89, 95% CI = 1.50 to 26.21). Conclusions: The use of an ID Clinic referral process for rPEP resulted in a significant reduction in the average number of visits to the ED for repeat vaccination, hence avoiding 105 ED visits. Insurance status was a significant factor in both the utilization of the ID Clinic referral system and overall completion of the vaccination series. Future research should explore workflows inclusive of both ED care and outpatient follow-up, care plans for the uninsured, and mechanisms to limit the number of patients that fail to complete the recommended vaccination series.

Characterisation of Molecular Relapse Profiles after Tyrosine Kinase Inhibitor Cessation in Patients Eligible for Treatment-Free Remission Strategies in Chronic Phase CML

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1893-1893 ◽  
Author(s):  
Franck E Nicolini ◽  
Vincent Alcazer ◽  
Stephanie Dulucq ◽  
Marie Balsat ◽  
Helene Labussiere ◽  
...  
Keyword(s):  
Tyrosine Kinase ◽  
Polynomial Regression ◽  
Residual Disease ◽  
Chronic Phase ◽  
Disease Free Survival ◽  
Cardiac Insufficiency ◽  
Rank Test ◽  
Number Of Patients ◽  
Kinetics Of

Abstract Background & aims Tyrosine kinase inhibitors (TKI) still in a majority of cases do not cure chronic phase CML (CP-CML) and leave patients in a minimal residual disease state, requiring the indefinite continuation of TKI. However, in some patients, these agents are able to induce prolonged disease undetectability leading to TKI-cessation strategies and successful treatment-free remissions (TFR) in some. Stable (≥2 years) undetectability can be observed after Imatinib (IM), Nilotinib (NIL) and Dasatinib (DAS) and TKI-cessation strategies have been developed in these 3 settings. In most studies, the overall molecular relapse rate [defined as a loss of MMR, >0.1% BCR-ABL/ABLIS] is ~30-50% requiring the re-initiation of a TKI. The aim of this study is to characterize and compare the molecular relapse profiles in 3 cohorts of patients undergoing IM, NIL or DAS-cessation. Methods This is a bicentric observational retrospective analysis on a selected cohort of CP-CML patients fulfilling the following criteria: CP-CML since diagnosis; ≥2 years stable undetectable BCR-ABL (with ≥32,000 ABL copies/sample) evaluated on 4-6 consecutive follow-up samples, on IM, NIL, or DAS; first cessation whatever the reason for TKI prescription was; molecular relapse after TKI cessation defined as MMR loss on 1 occasion. Molecular analyses were performed in 2 reference laboratories belonging to the EUTOS/ELN quality control system. Relevant clinical data were extracted from the 2 databases of these centres, following the rules of our country regulations. Results We identified 29 patients relapsing after IM, 15 after NIL and 14 after DAS cessation with a median age at TKI cessation of 57, 63, and 62.5 respectively (p=0.80). Interestingly, the male/female ratios were 1.41, 0.87 and 0.55 (p=0.38). Sokal score were respectively (L/I/H/NA): 10/12/6/2 for IM, 3/6/6/0 for NIL, 5/4/4/1 for DAS groups (overall p=0.78). Pre-TKI IFN-awas administered in 6 patients in the IM, 4 in the NIL and 1 in the DAS groups (p=0.42). ACA were present at diagnosis in 2, 1 and 1 patients respectively. Two patients had NIL and 7 DAS, in first-line. MR4.5 duration was 37 months for IM, 24.5 months for NIL and 33 months for DAS. Overall TKI duration until TKI cessation were 86 months for IM, 85 months for NIL and 70 months for DAS (p=0.28). The median interval between MR4.5 and TKI cessation was shorter for NIL (25 Months) than for DAS (33 months, p=0.041). The kinetics of relapse are shown in Figure 1 where the evolution of the BCR-ABL ratio by TKI has been smoothed with a polynomial regression. Relapses occurred after a median of 3.94 (0.89-7.2) for IM, 5 (0.69-7.6) for NIL and 4 (2.87-7.52) months for DAS (p=0.86). Kaplan-Meier analysis of the molecular disease-free survival (DFS) according to TKI and since TKI cessation is surprisingly not different (log-rank test p=0.95) between the 3 TKI, suggesting that TKI2 do not slow down the kinetics of relapse. When looking at the KM estimates of molecular DFS since stable MR4.5, it seems longer with DAS than with NIL (long-rank test p=0.018), despite the fact that the duration of MR4.5 before cessation was significantly longer with NIL than with DAS. This might suggest a differential effect of these 2 compounds on the BCR-ABL+ stem cell compartment. TKI were re-initiated after a median of 0.9, 0.8 and 0.75 months after relapse for IM, NIL and DAS. After relapse 6 patients switched from IM to NIL, 1 from NIL to Peg-IFN-a, 4 from NIL to DAS, whereas all DAS restarted the same TKI. MR4.5 was regained after 6.5, 3.9 and 7.41 months in the IM, NIL and DAS groups with a median follow-up of 43, 23.75 and 25 months after relapse respectively. Two patients died, 1 in the IM group from terminal cardiac insufficiency and 1 in the DAS group from metastatic secondary tumor. At last follow-up, patients regained ≥ MMR in all groups except 1 (0.16% at 3 months DAS rechallenge). Conclusion Despite its obvious limitations (relatively low number of patients, retrospective non randomized study) this study characterizes the kinetics of molecular relapse after TKI cessation for TFR and might point out differences suggesting that in these patients the BCR-ABL+ cells responsible for relapse might be different, or that the differential kinase inhibition profile by each TKI induces a different behaviour at relapse. However, these data need to be confirmed ideally in a prospective setting. Figure 1. Kinetics of BCR-ABL/ABL ratio after TKI cessation in patients who relapse Figure 1. Kinetics of BCR-ABL/ABL ratio after TKI cessation in patients who relapse. Disclosures Nicolini: Ariad, BMS: Consultancy, Speakers Bureau; Novartis: Speakers Bureau. Dulucq:Novartis: Speakers Bureau. Mahon:Pfizer: Honoraria; Ariad: Honoraria; Novartis: Honoraria, Research Funding; BMS: Honoraria. Etienne:BMS: Speakers Bureau; Pfizer: Speakers Bureau; ARIAD: Speakers Bureau; novartis: Consultancy, Speakers Bureau.

scholarly journals The Impact of Depression on Patient Outcomes in Hip Arthroscopic Surgery

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880649 ◽  
Author(s):  
RobRoy L. Martin ◽  
John J. Christoforetti ◽  
Ryan McGovern ◽  
Benjamin R. Kivlan ◽  
Andrew B. Wolff ◽  
...  
Keyword(s):  
Rating Scale ◽  
Arthroscopic Surgery ◽  
Severe Depression ◽  
Outcome Data ◽  
Labral Repair ◽  
Initial Assessment ◽  
Symptoms Of Depression ◽  
Number Of Patients ◽  
The Impact

Background: Mental health impairments have been shown to negatively affect preoperative self-reported function in patients with various musculoskeletal disorders, including those with femoroacetabular impingement. Hypothesis: Those with symptoms of depression will have lower self-reported function, more pain, and less satisfaction on initial assessment and at 2-year follow-up than those without symptoms of depression. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who were enrolled in a multicenter hip arthroscopic surgery registry and had 2-year outcome data available were included in the study. Patients completed the 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and 12-item Short-Form Health Survey (SF-12) when consenting for surgery. At 2-year follow-up, patients were emailed the iHOT, the VAS, and a rating scale of surgical satisfaction. Initial SF-12 mental component summary (MCS) scores <46.5 and ≤36 were used to qualify symptoms of depression and severe depression, respectively, as previously described and validated. Repeated-measures analysis of variance was performed to compare preoperative and 2-year postoperative iHOT-12, VAS, and satisfaction scores between those with and without symptoms of depression. Results: A total of 781 patients achieved the approximate 2-year milestone (mean follow-up, 735 ± 68 days), with 651 (83%) having 2-year outcome data available. There were 434 (67%) female and 217 (33%) male patients, with a mean age of 35.8 ± 13.0 years and a mean body mass index of 25.4 ± 8.8 kg/m2. The most common procedures were femoroplasty (83%), followed by synovectomy (80%), labral repair (76%), acetabuloplasty (58%), acetabular chondroplasty (56%), femoral chondroplasty (23%), and labral reconstruction (19%). The mean initial SF-12 MCS score was 51.5 ± 10.3, with cutoff scores indicating symptoms of depression and severe depression in 181 (28%) and 71 (11%) patients, respectively. Patients with symptoms of depression scored significantly ( P < .05) lower on the initial iHOT-12 and VAS and 2-year follow-up iHOT-12, VAS, and rating scale of surgical satisfaction. Conclusion: A large number of patients who underwent hip arthroscopic surgery presented with symptoms of depression, which negatively affected self-reported function, pain levels, and satisfaction on initial assessment and at 2-year follow-up. Surgeons who perform hip arthroscopic surgery may need to identify the symptoms of depression and be aware of the impact that depression can have on surgical outcomes.

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