scholarly journals Μελέτη της κλινικής αποτελεσματικότητας (αντικειμενική - ιατροκεντρική εκτίμηση) της λειτουργικής αποκατάστασης και της ποιότητας ζωής (υποκειμενικές -ασθενοκεντρικές εκτιμήσεις) μετά από αναθεώρηση αρθροπλαστικών ισχίου

2021 ◽  
Author(s):  
Αντώνιος Κουτάλος
Keyword(s):  
Los Angeles ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
University Of California ◽  
Harris Hip Score ◽  
Functional Scale ◽  
Timed Up And Go ◽  
Patient Reported ◽  
Oxford Hip Score ◽  
Lower Extremity Functional Scale

Η αξιολόγηση των αποτελεσμάτων μετά από μία χειρουργική επέμβαση ανακατασκευής της άρθρωσης του ισχίου γίνεται συνήθως με αντικειμενικές κλίμακες και ανάλυση επιβίωσης. Στη διεθνή βιβλιογραφία υπάρχει αυξημένο ενδιαφέρον από τους μελετητές για την υποκειμενική αξιολόγηση των αποτελεσμάτων αυτών. Βασικό πρόβλημα στην αξιολόγηση και κατανόηση των αποτελεσμάτων αυτών των χειρουργικών επεμβάσεων είναι η ανομοιομορφία των χρησιμοποιούμενων τεχνικών και εμφυτευμάτων, και οι διαφορετικές αιτίες αποτυχίας (συγχυτικοί παράγοντες). Μακροχρόνια αποτελέσματα μετά από αναθεώρηση ολικής αρθροπλαστικής ισχίου είναι σχετικά σπάνια στην βιβλιογραφία. Ιδιαίτερα, δεν υπάρχουν πολλές μελέτες όπου μελετάται συγκριτικά το κλινικό αποτέλεσμα, η λειτουργικότητα των ασθενών και η ποιότητα ζωής μετά από τέτοιες επεμβάσεις. Στη μελέτη αυτή συμπεριελήφθησαν εκατό είκοσι δύο ασθενείς (130 ισχία) που υπεβλήθησαν σε αναθεώρηση χωρίς τη χρήση οστικού τσιμέντου λόγω άσηπτης χαλάρωσης χρησιμοποιώντας συγκεκριμένη τεχνική και υλικά (TMT cup, Wagner SL stem, Zimmer Biomet) (ομάδα Α). Οι ασθενείς αυτοί συγκρίθηκαν με εκατό ασθενείς (100 ισχία) με παρόμοια χαρακτηριστικά οι οποίοι υπεβλήθησαν σε πρωτογενή αρθροπλαστική (ομάδα Β). Στην τελική επίσκεψη οι ασθενείς μελετήθηκαν με:•Αντικειμενικές μετρήσεις βάδισης, οι οποίες περιελάμβαναν την ταχύτητα βάδισης και το Timed-up-and-Go τεστ.•Την αντικειμενική κλίμακα αξιολόγησης της άρθρωσης του ισχίου Harris hip score.•Υποκειμενικές κλίμακες λειτουργικής αποκατάστασης, συμπληρούμενες από τον ίδιο τον ασθενή (patient reported outcome measures, PROMs) οι οποίες περιελάμβαναν την ειδική για οστεοαρθρίτιδα κλίμακα Western Ontario and McMaster Universities Arthritis Index (WOMAC), την ειδική για την άρθρωση του ισχίου Oxford hip score (OHS), όπως επίσης και την ειδική για τα κάτω άκρα υποκειμενική κλίμακα Lower Extremity Functional Scale (LEFS).•Υποκειμενικές κλίμακες δραστηριότητας, οι οποίες περιελάμβαναν την κλίμακα Parker mobility σκορ και την κλίμακα University of California at Los Angeles activity σκορ (UCLA).•Υποκειμενικές κλίμακες ποιότητας ζωής, οι οποίες περιελάμβαναν την κλίμακα 12 (SF-12) και την κλίμακα EuroQol (EQ-5D-5L).Μετά από ένα μέσο χρόνο παρακολούθησης 11.1 χρόνων (εύρος, 7-16) 96% (95% CI; 96-99%) των ισχίων παρέμενε χωρίς αναθεώρηση για οποιοδήποτε λόγο στην ομάδα Α και 98% (95% CI; 97-99%) στην ομάδα Β. Στατιστικώς σημαντική διαφορά ανάμεσα στις δύο ομάδες βρέθηκε για το WOMAC (Mann-Whitney U test, p= 0.014), το OHS (Mann-Whitney U test, p= 0.020) και το σκέλος της φυσικής δραστηριότητας του SF-12 (Mann-Whitney U test, p= 0.029). Η ομάδα Α των αναθεωρήσεων, προεγχειρητικά, είχε καλύτερη φυσική δραστηριότητα και λειτουργία από την ομάδα Β των πρωτογενών αρθροπλαστικών. Παρόλα αυτά, η ομάδα Β βελτιώθηκε περισσότερο από την ομάδα Α των αναθεωρήσεων, με αποτέλεσμα η ομάδα Α να έχει στατιστικώς και κλινικώς σημαντικά χαμηλότερες τιμές στις λειτουργικές κλίμακες από την ομάδα Β των πρωτογενών αρθροπλαστικών.Στην ομάδα Α, στην πολυπαραγοντική ανάλυση βρέθηκε ότι η νοητική λειτουργία (p=0.001), το ΒΜΙ (p=0.007) και ο μετεγχειρητικός πόνος (p=0.022) ανεξάρτητα επηρέαζαν την λειτουργικότητα των ασθενών όπως μετρήθηκε με το WOMAC σκορ. Παράλληλα, στην πολυπαραγοντική ανάλυση βρέθηκε πως ο μετεγχειρητικός πόνος (p=0.03) επηρέαζε την ποιότητα ζωής των ασθενών αυτών όπως αυτή αξιολογήθηκε με το EQ-5D-5L.Συμπερασματικά, σε μακροχρόνια βάση, η αναθεώρηση ολικής αρθροπλαστικής ισχίου έχει ικανοποιητικά αλλά κατώτερα λειτουργικά αποτελέσματα από την πρωτογενή αρθροπλαστική ισχίου, σύμφωνα με υποκειμενικές κλίμακες αξιολόγησης συμπληρωμένα από τον ίδιο τον ασθενή. Η λειτουργία του ισχίου και κινητικότητα σύμφωνα με αντικειμενικές κλίμακες συμπληρωμένες από τους μελετητές παρουσιάζεται επίσης βελτιωμένη μετά από την αναθεώρηση αλλά όχι σε τέτοιο βαθμό όπως στις πρωτογενείς αρθροπλαστικές. Τέλος, η ποιότητα ζωής, όπως μετρήθηκε με το SF-12 ήταν φτωχότερη στην ομάδα των αναθεωρήσεων. Ο εμμένων πόνος, ο αυξημένος δείκτης σώματος (BMI) και η επηρεασμένη νοητική λειτουργεία έχουν αρνητική επιρροή στους παραπάνω δείκτες. Οι ασθενείς θα πρέπει κατά την προεγχειρητική συζήτηση να ενημερώνονται επαρκώς σύμφωνα με τα παραπάνω δεδομένα, για τη βέλτιστη διαχείριση των προσδοκιών τους και για να μην εγείρονται ιατρονομικά ζητήματα.

scholarly journals Assessing responsiveness of the EQ-5D-3L, the Oxford Hip Score, and the Oxford Knee Score in the NHS patient-reported outcome measures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sujin Kang
Keyword(s):  
Outcome Measures ◽  
Knee Replacement ◽  
Oxford Knee Score ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Knee Score ◽  
Paired Data ◽  
Replacement Surgery ◽  
Patient Reported ◽  
Oxford Hip Score

Abstract Background The degree to which a validated instrument is able to detect clinically significant change over time is an important issue for the better management of hip or knee replacement surgery. This study examines the internal responsiveness of the EQ-5D-3L, the Oxford Hip Score (OHS), and the Oxford Knee Score (OKS) by various methods. Data from NHS patient-reported outcome measures (PROMs) linked to the Hospital Episodes Statistics (HES) dataset (2009–2015) was analysed for patients who underwent primary hip surgery (N = 181,424) and primary knee surgery (N = 191,379). Methods Paired data-specific univariate responsiveness was investigated using the standardized response mean (SRM), the standardized effect size (SES), and the responsiveness index (RI). Multivariate responsiveness was furthermore examined using the defined capacity of benefit score (i.e. paired data-specific MCID), adjusting baseline covariates such as age, gender, and comorbidities in the Box-Cox regression models. The observed and predicted percentages of patient improvement were examined both as a whole and by the patients' self-assessed transition level. Results The results showed that both the OHS and the OKS demonstrated great univariate and multivariate responsiveness. The percentages of the observed (predicted) total improvement were high: 51 (54)% in the OHS and 73 (58)% in OKS. The OHS and the OKS showed distinctive differences in improvement by the 3-level transition, i.e. a little better vs. about the same vs. a little worse. The univariate responsiveness of the EQ-5D-3L showed moderate effects in total by Cohen’s thresholds. The percentages of improvement in the EQ-5D-3L were moderate: 44 (48)% in the hip and 42 (44)% for the knee replacement population. Conclusions Distinctive percentage differences in patients’ perception of improvement were observed when the paired data-specific capacity of benefit score was applied to examine responsiveness. This is useful in clinical practice as rationale for access to surgery at the individual-patient level. This study shows the importance of analytic methods and instruments for investigation of the health status in hip and/or knee replacement surgery. The study finding also supports the idea of using a generic measure along with the disease-specific instruments in terms of cross-validation.

scholarly journals The Olympia anatomic polished cemented stem is associated with a high survivorship, excellent hip-specific functional outcome, and high satisfaction levels: follow-up of 239 consecutive patients beyond 15 years

2021 ◽  
Author(s):  
Gareth S. Turnbull ◽  
Claire Marshall ◽  
Jamie A. Nicholson ◽  
Deborah J. MacDonald ◽  
Nicholas D. Clement ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Femoral Stem ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
High Satisfaction ◽  
Age At Surgery ◽  
Patient Reported ◽  
Cemented Stem ◽  
Oxford Hip Score

Abstract Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3–17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen’s zones Results Mean patient age at surgery was 68.0 years (SD 10.9, 31–93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%–100%) and at 15 years was 97.5% (94.6%–100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%–100%) at 10 years and 95.9% (92.4%–99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7–11.3) follow-up, mean OHS was 39 (SD 10.3, range 7–48) and 94% of patients reported being very satisfied or satisfied with their THA. Conclusions The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.

scholarly journals Assessing the Attitudes, Awareness, and Behavioral Alterations of Patients Awaiting Total Hip Arthroplasty During the COVID-19 Crisis

2020 ◽  
Vol 11 ◽  
pp. 215145932096937
Author(s):  
Stephen Fahy ◽  
Joss Moore ◽  
Michael Kelly ◽  
Shane Irwin ◽  
Paddy Kenny
Keyword(s):  
Mental Health ◽  
Short Form ◽  
Hip Osteoarthritis ◽  
Surgical Care ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Physical And Mental Health ◽  
Patient Reported ◽  
Hip Function

Background: COVID-19 has placed a huge burden on healthcare systems which has led to widespread cancellation elective surgical care. Ireland is recovering from the first wave of COVID-19 and as such the expeditious return of elective surgical care is important. This is the first study to examine the attitudes of patients to undergoing total joint arthroplasty during the COVID-19 crisis. Methods: A prospective qualitative study was undertaken in our institution during the week 13/05/2020-20/05/2020. 65 patients completed a questionnaire assessing attitudes, awareness, and behavioral changes associated with COVID-19, a Charlson Comorbidity Index, modified-Harris Hip Score, and a Short Form-12 score. Results: 86% of patients felt that they were at little to no risk of COVID-19 infection. The majority of patients were happy to proceed with surgery at the current level of COVID-19 related threat (86%). Patients with higher mHHS were more likely to postpone their operation than those with lower mHHS scores. Our cohort had low patient reported outcome measures in both mHHS and SF-12, indicating the significant burden of hip osteoarthritis on both physical and mental health. Conclusion: Patients reported a significant disease-related impairment of physical function and subsequent deterioration in mental health as a result of hip osteoarthritis. Patients with worse hip function, as measured by the mHHS are more willing to proceed with surgery than those with superior hip function. This offers a potential mechanism by which to triage patients once elective surgical pathways reopen in the coming months.

Age-Adjusted Normative Values for Hip Patient-Reported Outcome Measures

2021 ◽  
pp. 036354652110566
Author(s):  
Zachary T. Sharfman ◽  
Nathan Safran ◽  
Eyal Amar ◽  
Kunal Varshneya ◽  
Marc R. Safran ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Analysis Of Variance ◽  
Clinical Decision Making ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Dependent Manner ◽  
Multicenter Survey ◽  
Patient Reported ◽  
Age Dependent

Background: Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function, assisting in clinical decision making, and quantifying outcomes of surgical and nonsurgical management. However, PROMs are often designed using patients with preexisting pathology and typically assume that a patient without the pathology would have a perfect or near perfect score. This may result in unrealistic expectations or falsely underestimate how well a patient is doing after treatment. The influence of age on PROMs about the hip of healthy individuals has not been studied. Hypothesis: We hypothesize that in asymptomatic individuals hip-specific PROM scores will decrease in an age-dependent manor. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In this multicenter survey study, volunteers who denied preexisting hip pathology and previous hip surgery completed 3 PROMs online or as traditional paper questionnaires. The International Hip Outcome Tool (iHOT), the modified Harris Hip Score (mHHS), and the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and HOS—Sport were completed. Analysis of variance with a Tukey post hoc test was used to analyze differences in PROMs among subgroups. An independent-samples Student t test and a χ2 test were used to analyze differences in continuous and categorical data, respectively. Results: In total 496, 571, 534, and 532 responses were collected for the iHOT, mHHS, HOS-ADL, and HOS–Sport, respectively. Respondents’ PROMs were scored and arranged into 3 groups by age: <40 years, 40 to 60 years, and >60 years. The iHOT, mHHS, HOS-ADL, and HOS–Sport of these asymptomatic respondents all decreased in an age-dependent manner: iHOT (<40, 94.1; 40-60, 92.4; >60, 87.0), mHHS (<40, 94.8; 40-60, 91.3; >60, 89.1), HOS-ADL (<40, 98.4; 40-60, 95.0; >60, 90.9), and HOS–Sport (<40, 95.7; 40-60, 82.9; >60, 72.9) (analysis of variance between-group differences, P < .05). Conclusion: This study demonstrated that the iHOT, mHHS, and HOS-ADL and HOS–Sport scores in asymptomatic people decrease in an age-dependent manner. It is important to compare a patient’s outcome scores with the age-normalized scores to establish an accurate reference frame with which to interpret outcomes.

scholarly journals Development of the HOOSglobal to Assess Patient-Reported Outcomes in Patients Undergoing Hip Preservation Procedures

2018 ◽  
Vol 46 (4) ◽  
pp. 940-946 ◽  
Author(s):  
Cale A. Jacobs ◽  
Michael R. Peabody ◽  
Stephen T. Duncan ◽  
Ryan D. Muchow ◽  
Ryan M. Nunley ◽  
...  
Keyword(s):  
Los Angeles ◽  
Short Form ◽  
Periacetabular Osteotomy ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Orthopaedic Community ◽  
Pro Tools ◽  
Modified Harris Hip Score

Background: The creation of a single patient-reported outcome (PRO) platform validated across hip preservation, osteoarthritis (OA), and total hip arthroplasty (THA) populations may reduce barriers and streamline the routine collection of PROs in clinical practice. As such, the purpose of this study was to determine if augmenting the Hip disability and Osteoarthritis Outcome Score–Joint Replacement (HOOS, JR) with additional HOOS questions would result in a PRO platform that could be used across a wider spectrum of hip patient populations. Hypothesis: The HOOS, JR would demonstrate a notable ceiling effect, but by augmenting the HOOS, JR with additional HOOS questions, a responsive PRO platform could be created. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Using preoperative and postoperative HOOS responses from a sample of 304 patients undergoing periacetabular osteotomy (PAO), additional items were identified to augment the HOOS, JR. The psychometric properties of a newly created PRO tool (HOOSglobal) were then compared with the HOOS, JR and other PRO instruments developed for patients with hip OA and/or undergoing THA. Results: By augmenting the HOOS, JR with 2 additional questions, the HOOSglobal was more responsive than all other included PRO tools and had significantly fewer maximum postoperative scores than the HOOS, JR ( P < .0001), HOOS–Physical Function Short form ( P < .0001), Western Ontario and McMaster Universities Osteoarthritis Index ( P = .02), University of California, Los Angeles activity scale ( P = .0002), and modified Harris Hip Score ( P = .04). The postoperative HOOSglobal score threshold associated with patients achieving the patient acceptable symptom state (PASS) was 62.5. Conclusion: The HOOSglobal is a valid and responsive PRO tool after PAO and may potentially provide the orthopaedic community with a PRO platform to be used across hip-related subspecialties. For patients undergoing PAO, a postoperative HOOSglobal score ≥62.5 was associated with patients achieving the PASS.

scholarly journals Self-reported allergies correlate with a worse patient-reported outcome after hip arthroscopy: a matched control study

2021 ◽  
Author(s):  
Erica L Swartwout ◽  
Jacob D Feingold ◽  
Joshua I Wright-Chisem ◽  
John M Apostolakos ◽  
Sacha A Roberts ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Control Group ◽  
Outcome Score ◽  
Patient Reported ◽  
Outcome Tool ◽  
Modified Harris Hip Score ◽  
Control Study

Abstract Patient-reported outcome measures (PROMs) in patients with and without at least one self-reported allergy undergoing hip arthroscopy were compared. Data on 1434 cases were retrospectively reviewed, and 267 patients were identified with at least one self-reported allergy and randomly matched to a control group on a 1:2 ratio. Four PROMs [Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sport) and 33-item International Hip Outcome Tool (iHOT-33)] were collected preoperatively, and at 5–11, 12–23 and 24–35 months postoperatively. Significant PROM differences were found 5–11 months postoperative on mHHS (P &lt; 0.001), HOS-ADL (P = 0.002), HOS-Sport (P &lt; 0.001) and iHOT-33 (P &lt; 0.001). At 12–23 months postoperative, the allergy cohort had significantly worse scores on mHHS (P = 0.002), HOS-ADL (P = 0.001), HOS-Sport (P &lt; 0.001) and iHOT-33 (P &lt; 0.001). They also had significantly worse measures 24–35 months postoperative on mHHS (P = 0.019), HOS-Sport (P = 0.006) and iHOT-33 (P &lt; 0.001). Multivariable logistic regression showed that each additional allergy reported significantly increased the risk of failing to meet the minimal clinically important difference 5–11 months after surgery on mHHS by 1.15 [OR (95% CI): 1.15 (1.03, 1.30), P = 0.014], on HOS-ADL by 1.16 [OR (95% CI): 1.16 (1.02, 1.31), P = 0.021] and on iHOT-33 by 1.20 [OR (95% CI): 1.20 (1.07, 1.36), P = 0.002]. Results suggest self-reported allergies increase the likelihood of a patient-perceived worse outcome after hip arthroscopy. An understanding of this association by the physician is essential during presurgical planning and in the management of postoperative care.

scholarly journals Outcomes of hip arthroscopy for femoroacetabular impingement: The effect of morphological type and chondrolabral damage

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 16
Author(s):  
Hatem Galal Said ◽  
Mohammad A. Masoud ◽  
Mohamed Mohamed Abdel-Hamid Morsi ◽  
Maher A. El-Assal
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Cartilage Damage ◽  
Morphological Type ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Functional Improvement ◽  
Harris Hip Score ◽  
Patient Reported

Introduction: Hip arthroscopy for treatment of femoroacetabular impingement (FAI) has shown significant pain and functional improvement. However, the differential outcome of each of the FAI morphological types in contrast to one another remains largely unknown. This study was conducted to detect a possible difference in outcome among different FAI types treated using hip arthroscopy. Methods: In this prospective non randomized comparative study, after exclusion of non-FAI cases and cases with advanced arthritic changes, 90 hips in 85 patients that had hip arthroscopy for the treatment of FAI between 2011 and 2015 in our center were analyzed. The collected patient reported outcome measures (PROMs) included visual analog scale (VAS) of pain, the modified Harris hip score (mHHS), and the non arthritic hip score (NAHS) both preoperatively and at final follow-up. Patient satisfaction was collected at final follow-up. Postoperative PROMs were subjected to three main comparisons based on each of FAI type, labral procedure, and extent of cartilage damage. Repeat comparison based on FAI type after matching of exact chondrolabral condition was also attempted. Results: Mean follow-up was 32.8 months (five patients lost from follow-up). There was a significant improvement in the overall PROMs. This improvement was significantly higher in the cam group in contrast to the mixed group. After matching for chondrolabral condition, this difference was consistent and more evident. Discussion: The outcome of arthroscopic treatment of pure cam FAI is significantly better than that of mixed FAI. Matching of the same chondrolabral condition and repeating the comparison yields similar results.

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