scholarly journals Total knee arthroplasty using patient-specific instrumentation for osteoarthritis of the knee: a meta-analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Kazuha Kizaki ◽  
Ajaykumar Shanmugaraj ◽  
Fumiharu Yamashita ◽  
Nicole Simunovic ◽  
Andrew Duong ◽  
...  
Keyword(s):  
Blood Loss ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Mean Difference ◽  
Patient Specific ◽  
Osteoarthritis Of The Knee ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Patient Specific Instrumentation ◽  
Patient Reported

Abstract Background Total knee arthroplasty using patient-specific instrumentation (TKA-PSI), which are disposable cutting block guides generated to fit each patient’s 3-dimensional knee anatomy, has been developed to treat patients with end-stage osteoarthritis of the knee. Surrogate markers such as radiographic malalignment have been well investigated, however, patient-important outcomes are not well examined to elucidate the efficacy of TKA-PSI. The aim of this review is to determine if TKA-PSI improves patient-reported outcome measures (PROM), surgery time, blood loss, transfusion and complications (e.g. surgical site infection, deep venous thrombosis, and revision TKA). Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and ongoing clinical trials. For PROMs, surgery time, blood loss, and transfusion rate, we included randomized controlled trials (RCT) comparing TKA-PSI and standard TKA to treat osteoarthritis of the knee. For complications, we also included non-randomized comparative studies (non-RCT). Results This review includes 38 studies, 24 of which were RCT and 14 of which were non-RCT. These included a total of 3487 patients. The predominant population in the included studies highly reflected the general population, with 62% being female, aged over 60 and having end-stage osteoarthritis of the knee. TKA-PSI did not improve PROMs as compared to standard TKA for less than 1-year (mean difference 0.48, 95% confidence interval (CI) -1.92–0.97 in the Oxford knee score, mean 3-month follow-up) and for 1-year or more (mean difference 0.25, 95%CI − 4.39–4.89 in the WOMAC score, mean 29-month follow-up). TKA-PSI did not reduce surgery time (mean difference − 3.09 min, 95%CI -6.73–0.55). TKA-PSI decreased blood loss with a small effect size corresponding to a 0.4 g/dl hemoglobin decrease (95%CI 0.18–0.88), but did not decrease transfusion rate (risk difference − 0.04, 95%CI -0.09–0.01). TKA-PSI did not reduce complication rates (risk difference 0.00, 95%CI − 0.01–0.01 in the composite outcome). Conclusions TKA-PSI does not improve patient-reported outcome measures, surgery time, and complication rates as compared to standard TKA. TKA-PSI decreases blood loss with a small effect, which is not enough to reduce transfusion rate.

scholarly journals 3D printing and unicompartmental knee arthroplasty

2018 ◽  
Vol 3 (5) ◽  
pp. 248-253 ◽  
Author(s):  
Gareth G. Jones ◽  
Susannah Clarke ◽  
Martin Jaere ◽  
Justin Cobb
Keyword(s):  
3D Printing ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Specific ◽  
Unicompartmental Knee ◽  
Patient Specific Instrumentation ◽  
Patient Reported ◽  
Total Knee

In suitable patients, unicompartmental knee arthroplasty (UKA) offers a number of advantages compared with total knee arthroplasty. However, the procedure is technically demanding, with a small tolerance for error. Assistive technology has the potential to improve the accuracy of implant positioning. This review paper describes the concept of detailed UKA planning in 3D, and the 3D printing technology that enables a plan to be delivered intraoperatively using patient-specific instrumentation (PSI). The varying guide designs that enable accurate registration are discussed and described. The system accuracy is reported. Future studies need to ascertain whether accuracy for low-volume surgeons can be delivered in the operating theatre using PSI, and reflected in improved patient reported outcome measures, and lower revision rates.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.180001

scholarly journals 280 The Use of Telemedicine in Plastics Surgery During COVID-19: A Single-Centre Correlation Study with Patient Reported Outcome Measures

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Rojoa ◽  
F Raheman ◽  
A Ibrahim ◽  
N Patel
Keyword(s):  
Wound Care ◽  
Fold Increase ◽  
Wound Complication ◽  
Patient Reported Outcome Measures ◽  
Correlation Study ◽  
Patient Reported Outcome ◽  
Complication Rates ◽  
Face To Face ◽  
Patient Reported ◽  
The Impact

Abstract Aim With enforcement of social distancing measures during the COVID-19 pandemic, face-to-face patient contact was shifted to telemedicine consultations. There is limited evidence evaluating patient experience of follow-ups and expectations into quality metrics. Our aim was to perform a service evaluation by prospectively evaluating the management and outcomes of plastic surgery patients. Method Patients were consecutively assessed over the COVID-19 lockdown period, from March to May 2020. They ranged from urgent cancer cases to burns and trauma. We used a questionnaire to evaluate initial treatment, wound care, complications, and overall service. A validated health-related quality of life (HRQL) survey was used to assess the impact of injury or wound on lifestyle and we also assessed patient enablement. Correlation analysis determined relationships between outcomes, service evaluations and HRQL variables. Results 77 patients were consecutively treated in our unit, of which 46 completed the questionnaire. 42.2% used multimedia as mode of follow-up, including smart phones for messages and videocalls, and trust e-mails. There was a 3-fold increase in number of infections for non-face-to-face consultations, with a correlation significance of 0.043. We found no correlation between age and wound complication rates. 72.7% of patients found overall service very good or excellent. Although overall service satisfaction was similar for multimedia use and face-to-face consultations (p = 0.02), less patients were confident looking after their wound without face-to-face follow-ups. Conclusions COVID-19 has brought upon an unprecedented change in practice in our department. Implementing multimedia use and educating patients on wound care can significantly improve efficiency and service provision.

scholarly journals Revision Surgery in Total Joint Replacement Is Cost-Intensive

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Markus Weber ◽  
Tobias Renkawitz ◽  
Florian Voellner ◽  
Benjamin Craiovan ◽  
Felix Greimel ◽  
...  
Keyword(s):  
Infection Rate ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Revision Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Complication Rates ◽  
Joint Replacements ◽  
Patient Reported ◽  
One Year

Revisions after total joint replacement increase constantly. In the current study, we analyzed clinical outcome, complication rates, and cost-effectiveness of revision arthroplasty. In a retrospective analysis of 162 revision hip and knee arthroplasties from our institutional joint registry responder rate, patient-reported outcome measures (EQ-5D, WOMAC), complication rates, and patient-individual charges in relation to reimbursement were compared with a matched control group of primary total joint replacements. Positive responder rate one year postoperatively was lower for revision arthroplasties with 72.9% than for primary arthroplasties with 90.1% (OR=0.30, 95%CI=0.18–0.59, p=0.001). Correspondingly, improvement in patient-reported outcome measures one year after surgery was lower in revision than in primary joint arthroplasty with EQ-5D 0.19±0.25 to 0.30±0.24 (p<0.001) and WOMAC 24.3±30.3 to 41.2±21.3 (p<0.001). Infection rate was higher in revision (6.8%) compared to primary replacements (0%, p=0.001). Mean charges in revision arthroplasty were 76.0% higher than in matched primary joint replacements (7110.8±2249.4$ to 4041.1±975.7$, p<0.001), whereas reimbursement was only 23.6% higher (9243.3±2258.4$ in revision and 7477.9±703.1$ in primary arthroplasty, p<0.001). Revision arthroplasty is associated with lower outcome and higher infection rate compared to primary replacements. The high financial expense of revision arthroplasty is only partly covered by a higher reimbursement.

scholarly journals Varying Association of Extended Hours Dialysis with Quality of Life

2019 ◽  
Vol 14 (12) ◽  
pp. 1751-1762 ◽  
Author(s):  
Brendan Smyth ◽  
Oliver van den Broek-Best ◽  
Daqing Hong ◽  
Kirsten Howard ◽  
Kris Rogers ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Short Form ◽  
Health Utility ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Mean Difference ◽  
Baseline Score ◽  
Patient Reported ◽  
Quality Adjusted Life

Background and objectivesLittle is known about the effect of changes in dialysis hours on patient-reported outcome measures. We report the effect of doubling dialysis hours on a range of patient-reported outcome measures in a randomized trial, overall and separately for important subgroups.Design, setting, participants, & measurementsThe A Clinical Trial of IntensiVE Dialysis trial randomized 200 participants to extended or standard weekly hours hemodialysis for 12 months. Patient-reported outcome measures included two health utility scores (EuroQOL-5 Dimensions-3 Level, Short Form-6 Dimension) and their derived quality-adjusted life year estimates, two generic health scores (Short Form-36 Physical Component Summary, Mental Component Summary), and a disease-specific score (Kidney Disease Component Score). Outcomes were assessed as the mean difference from baseline using linear mixed effects models adjusted for time point and baseline score, with interaction terms added for subgroup analyses. Prespecified subgroups were dialysis location (home- versus institution-based), dialysis vintage (≤6 months versus >6 months), region (China versus Australia, New Zealand, Canada), and baseline score (lowest, middle, highest tertile). Multiplicity-adjusted P values (Holm–Bonferroni) were calculated for the main analyses.ResultsExtended dialysis hours was associated with improvement in Short Form-6 Dimension (mean difference, 0.027; 95% confidence interval [95% CI], 0.00 to 0.05; P=0.03) which was not significant after adjustment for multiple comparisons (Padjusted=0.05). There were no significant differences in EuroQOL-5 Dimensions-3 Level health utility (mean difference, 0.036; 95% CI, −0.02 to 0.09; P=0.2; Padjusted=0.2) or in quality-adjusted life years. There were small positive differences in generic and disease-specific quality of life: Physical Component Summary (mean difference, 2.3; 95% CI, 0.6 to 4.1; P=0.01; Padjusted=0.04), Mental Component Summary (mean difference, 2.5; 95% CI, 0.5 to 4.6; P=0.02; Padjusted=0.05) and Kidney Disease Component Score (mean difference, 3.5; 95% CI, 1.5 to 5.5; P=0.001; Padjusted=0.005). The results did not differ among predefined subgroups or by baseline score.ConclusionsThe effect of extended hours hemodialysis on patient-reported outcome measures reached statistical significance in some but not all measures. Within each measure the effect was consistent across predefined subgroups. The clinical importance of these differences is unclear.

scholarly journals Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Michael Nunns ◽  
Joseph B. John ◽  
John S. McGrath ◽  
Liz Shaw ◽  
Simon Briscoe ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Enhanced Recovery ◽  
Evidence Synthesis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Complication Rates ◽  
Erp Implementation ◽  
Complex Needs ◽  
Patient Reported ◽  
Multicomponent Interventions

Abstract Multicomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns et al. considers the effectiveness and cost-effectiveness of all types of multicomponent interventions for older adults undergoing elective inpatient surgery. Enhanced recovery programmes (ERPs) were the most commonly evaluated intervention. An association between ERPs and decreased length of stay was observed, whilst complication rates and time to recovery were static or sometimes reduced. Important areas which lack research in the context of ERPs are patient-reported outcome measures, patients with complex needs and assessment of factors pertaining to successful ERP implementation. The next generation of ERP studies should seek to develop our understanding in these key areas.

scholarly journals Delta Xtend reverse shoulder arthroplasty – Results at a minimum of five years

2019 ◽  
Vol 12 (2) ◽  
pp. 114-123
Author(s):  
Craig M Ball
Keyword(s):  
Outcome Measures ◽  
Shoulder Arthroplasty ◽  
Reverse Shoulder Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
High Rate ◽  
Complication Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Patient Reported

Background Reverse shoulder arthroplasty provides predictable pain relief and improvements in function, but concerns remain regarding complication rates and there is little long-term outcome data. The aim of this study was to review the clinical and radiographic outcomes of the Delta Xtend reverse shoulder arthroplasty at a minimum of five years. Methods Ninety-six Delta Xtend reverse shoulder arthroplasty procedures were performed in 93 patients. There were 41 males and 52 females with an average age of 74.9 years. All available patients returned for clinical and radiographic analysis, including completion of patient reported outcome measures. Results The complication rate was 9.4%. There were three revisions (3.1%) and two other reoperations (2.1%). Fifty-nine shoulders were available for review at an average of 81 months. Average forward flexion was 142°. Average American Shoulder and Elbow Assessment Score improved from 27.6 to 78.5 (p<0.001). Radiolucent lines and/or proximal bone resorption was seen in 35.4%. Scapula notching was observed in 69.1%, with Grade III or IV notching in 20%. These findings had no effect on patient reported outcome measures. Discussion This study confirms the clinical benefits of reverse shoulder arthroplasty, with improvements maintained out to 10 years. The high rate of scapula notching remains a concern. Further study is needed to fully understand the clinical significance of notching, as well as the potential benefits of newer implant designs.

scholarly journals Different collagenase delivery for Dupuytren disease in public hospitals

2020 ◽  
Vol 3 (2) ◽  
pp. 22-31
Author(s):  
Jessca A Paynter ◽  
Vicky Tobin ◽  
James CS Leong ◽  
Warren Matthew Rozen ◽  
David J Hunter-Smith
Keyword(s):  
Clinical Success ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Public Hospitals ◽  
Dupuytren’S Disease ◽  
Patient Specific ◽  
Extension Deficit ◽  
Dupuytren's Disease ◽  
Number Of Patients ◽  
Patient Reported

Background: The delivery protocol of collagenase Clostridium histolyticum (collagenase) injection for Dupuytren’s disease is variable, due to limited evidence for any one approach and widespread ‘off-label’ delivery occurring in Australia. As such, this preliminary study aimed to assess whether different collagenase delivery protocols for treating Dupuytren’s disease have an impact on effectiveness and safety. It was hypothesised that different collagenase delivery would affect outcomes. Methods: This preliminary, prospective study included a consecutive cohort of adult patients with Dupuytren’s disease being treated with collagenase within two Australian public hospitals to determine whether different collagenase delivery protocols impact on effectiveness and safety. The therapeutic effect was measured objectively using the total passive extension deficit (TPED), clinical success and clinical improvement. Three patient-reported outcome measures (PROMs) were used: Unité Rhumatologique des Affections de la Main (URAM), the Southampton Dupuytren’s Scoring Scheme and the Canadian Occupational Patient-Specific Functional Scale (PSFS). Results: The delivery of collagenase was variable at both clinics. The number of patients treated with collagenase at Institute I and Institute II was 49 and 18, respectively. Clinical success was achieved in 42 per cent of the Institute I and 35 per cent of the Institute II cohort. A statistically significant reduction in all three PROMs was observed for both cohorts. No significant differences between effectiveness or safety was found when comparing the two cohorts. Conclusion: The delivery of collagenase was variable at Institutes I and II, but these differences did not appear to impact the effectiveness or safety of collagenase delivery.

scholarly journals Long-term outcomes of patients who rate symptoms of rheumatoid arthritis as ‘satisfactory’

Rheumatology ◽  
2019 ◽  
Vol 59 (8) ◽  
pp. 1853-1861 ◽  
Author(s):  
James M Gwinnutt ◽  
Kimme L Hyrich ◽  
Mark Lunt ◽  
Anne Barton ◽  
Suzanne M M Verstappen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Mean Difference ◽  
Symptom Clusters ◽  
Random Effects Models ◽  
Early Ra ◽  
Patient Reported ◽  
General Functioning

Abstract Objectives To describe outcomes of patients with early RA in a patient acceptable symptom state (PASS) at treatment initiation and to identify clusters of symptoms associated with poor outcomes. Methods Data came from the Rheumatoid Arthritis Medication Study, a UK multicentre cohort study of RA patients starting MTX. The HAQ, DAS28 and other patient-reported outcome measures (PROMs) were collected at baseline, and at 6 and 12 months. Patients answering yes to the question ‘Is your current condition satisfactory, when you take your general functioning and your current pain into consideration?’ were defined as PASS; patients answering no were defined as N-PASS. Symptom clusters in the baseline PASS group were identified using K-medians cluster analysis. Outcomes of baseline PASS vs N-PASS patients and each cluster are compared using random effects models. Results Of 1127 patients, 572 (50.8%) reported being in PASS at baseline. Over one year, baseline PASS patients had lower DAS28 (mean difference = −0.71, 95% CI −0.83, −0.59) and HAQ scores (mean difference = −0.48, 95% CI −0.56, −0.41) compared with N-PASS patients. Within the baseline PASS group, we identified six symptom clusters. Clusters characterized by high disease activity and high PROMs, or moderate disease activity and high PROMs, had the worst outcomes compared with the other clusters. Conclusion Despite reporting their condition as ‘satisfactory’, early RA patients with high PROM scores are less likely to respond to therapy. This group may require increased vigilance to optimize outcomes.

Sign in / Sign up

Export Citation Format

Share Document