Patient-reported outcome measures after surgery for an acetabular fracture

Aims The aim of this study was to record the incidence of post-traumatic osteoarthritis (OA), the need for total hip arthroplasty (THA), and patient-reported outcome measures (PROMS) after surgery for a fracture of the acetabulum, in our centre. Patients and Methods All patients who underwent surgery for an acetabular fracture between 2004 and 2014 were included. Patients completed the 36-Item Short Form Health Survey (SF-36) and the modified Harris Hip Score (mHHS) questionnaires. A retrospective chart and radiographic review was performed on all patients. CT scans were used to assess the classification of the fracture and the quality of reduction. Results A total of 220 patients were included, of which 55 (25%) developed post-traumatic OA and 33 (15%) underwent THA. A total of 164 patients completed both questionnaires. At a mean follow-up of six years (2 to 10), the mean SF-36 score for patients with a preserved hip joint was higher on role limitations due to physical health problems than for those with OA or those who underwent THA. In the dimension of bodily pain, patients with OA had a significantly better score than those who underwent THA. Patients with a preserved hip joint had a significantly better score on the function scale of the mHHS and a better total score than those with OA or who underwent THA. Conclusion Of the patients who were treated surgically for an acetabular fracture (with a mean follow-up of six years), 15% underwent THA at a mean of 2.75 years postoperatively. Patients with a THA had a worse functional outcome than those who retain their native hip joint. We recommend using PROMS and CT scans when reviewing these patients. Cite this article: Bone Joint J 2018;100-B:640–5.

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Pigmented Villonodular Synovitis of the Hip Managed with Arthroscopic Synovectomy: An Analysis of 19 Cases with up to 10-year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00413 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0041

Author(s):

Mark R. Nazal ◽

John W. Stelzer ◽

Ali Parsa ◽

Alex A. Discuillo ◽

Ravi Agrawal ◽

...

Keyword(s):

Outcome Measures ◽

Hip Joint ◽

Patient Reported Outcome Measures ◽

Pigmented Villonodular Synovitis ◽

Patient Reported Outcome ◽

Arthroscopic Synovectomy ◽

Patient Reported ◽

The Mean ◽

Pigmented Villonodular

Objectives: A tenosynoival giant cell tumor known as pigmented villonodular synovitis (PVNS) is a rare, benign, yet locally aggressive neoplasm arising from the synovium. Although most frequently encountered in the knee joint, PVNS is secondly most commonly seen in the hip joint. Occurrence of PVNS in the hip may destroy intra-articular soft tissue and bone, and at times invade extra-articular tissues. There are two categorizations of PVNS: localized and diffuse. The localized manifestation, often referred to as nodular, involves a focal or limited area of the synovium, while the diffuse manifestation involves more widespread areas throughout the synovium. Surgical management by resection of the PVNS within the hip joint has been described with open procedures and arthroscopic procedures. Although surgical management has been shown to be promising, PVNS has a high recurrence rate, of 15-50%. To date, we present the largest cohort of hip joint PVNS managed by arthroscopic synovectomy with mid-term follow-up. Methods: A cohort of 19 patients were diagnosed with hip PVNS and underwent arthroscopic synovectomy between 2008 and 2016. Patients were identified preoperatively based on suspected MRI findings of PVNS or intraoperatively after unexpected PVNS was identified during arthroscopy for another pathology. We assessed patients’ functional ability at a minimum of 2-years follow-up using five patient reported outcome measures (PROMs): mHHS (modified Harris Hip Score), HOS (Hip Outcome Score), iHOT-33 (international Hip Outcome Tool), NAHS (Non-Arthritic Hip Score), and LEFS (Lower Extremity Functional Score). Results: Nineteen patients with hip PVNS were treated with an arthroscopic hip synovectomy. Sixteen of the patients completed patient reported outcome measures. This cohort consisted of 7 (44%) females and 9 (56%) males. The mean patient age was 37 years (range, 25-54). Mean follow-up was 83 months (6.9 years), ranging from 24 months (2 years) to 123 months (10.3 years). Eight (50%) patients had diffuse PVNS and 8 (50%) of patients had nodular PVNS. Laterality of the arthroscopic procedure was 8 (50%) right hip and 8 (50%) left hip. Five (31%) of the patients had a smoking history, while 11 (69%) were non-smokers. Four (25%) had a cam lesion, 4 (25%) had a pincer lesion, 8 (50%) had neither cam nor pincer lesion, and 0 (0%) had combined cam and pincer lesion. Fourteen (88%) patients had histologically confirmed PVNS. Eleven (69%) patients had MRI suspected PVNS prior to arthroscopy, while 5 (31%) patients had unexpected PVNS discovered intraoperatively. Concomitant pathology addressed at the time of arthroscopy, includes 11 (79%) labral tear repair. For the sixteen patients that completed patient reported outcome measures, the mean mHHS was 78.2 (SD, 10.6). Mean HOS-ADL was 10 (SD, 10). Mean HOS-SSS was 21 (SD, 20). Mean iHOT-33 was 69.4 (SD, 16.3). Mean NAHS was 86.5 (SD, 10.2). Mean LEFS was 70.8 (SD, 7.7). A mean percentage of maximal function was 88.6% (SD, 9.8%). To date, 0 (0%) patients have shown evidence of recurrence upon physical exam, follow-up MRI, or repeat arthroscopy. Conclusion: Based on the largest arthroscopically managed cohort of PVNS in the hip to date, we conclude that arthroscopic synovectomy is a reliable and effective treatment of hip PVNS. Patients reported good functional outcomes without evidence of recurrence in a 19 patient cohort with an average follow-up of almost 7 years.

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The Value of Motion: Patient-Reported Outcome Measures Are Correlated With Range of Motion in Total Ankle Replacement

Foot & Ankle Specialist ◽

10.1177/1938640017750258 ◽

2017 ◽

Vol 11 (5) ◽

pp. 451-456 ◽

Cited By ~ 4

Author(s):

Travis J. Dekker ◽

Kamran S. Hamid ◽

Andrew E. Federer ◽

John R. Steele ◽

Mark E. Easley ◽

...

Keyword(s):

Range Of Motion ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Ankle Motion ◽

Ankle Replacement ◽

Sf 36 ◽

Patient Reported ◽

And Function

Background: The proposed benefit of total ankle replacement (TAR) over ankle fusion is preserved ankle motion, thus we hypothesized that an increase in range of motion (ROM) is positively correlated with validated patient-reported outcome measures (PROMs) in individuals receiving TAR. Methods: Patients undergoing TAR at a single academic medical center between 2007 and 2013 were evaluated in this study. In addition to a minimum of 2-year follow-up, complete preoperative and postoperative outcome measures for the Foot and Ankle Disability Index (FADI), Short Musculoskeletal Function Assessment (SMFA) Bother and Function Indices, Visual Analog Scale (VAS), and 36-Item Short Form Health Survey (SF-36) were requisite for inclusion. Standardized weightbearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained and previously described ankle and foot measurements were performed to determine ankle ROM. Results: Eighty-eight patients met inclusion criteria (33 INBONE, 18 Salto-Talaris, 37 STAR). Mean time to final ROM radiographs was 43.8 months (range 24-89 months). All aforementioned PROMs improved between preoperative evaluation and most recent follow-up ( P < .01). Final ankle ROM was significantly correlated with postoperative FADI, SF-36 Mental Component Summary (MCS), SMFA Bother and Function Indices, and VAS. Additionally, dorsiflexion was positively associated with FADI, SF-36 MCS, and SMFA Function ( P < .05) but plantarflexion had no such influence on outcomes. No differences were identified with subset stratification by prosthesis type, fixed versus mobile-bearing design or etiology. Conclusion: In this TAR cohort with prospectively collected outcomes data, radiographic sagittal plane ankle motion was positively correlated with multiple PROMs. Disease-specific and generic health-related quality of life PROMs demonstrated improvement postoperatively in all domains when evaluating final total range of motion. Patients who undergo TAR for end-stage osteoarthritis with improvement in ROM demonstrate a direct correlation with improved patient-centric metrics and outcome scores. Levels of Evidence: Level III: Retrospective comparative study

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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

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03992-z ◽

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.

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Patient-Reported Outcome Measures and Clinical Outcomes in Children with Foregut Anomalies

Children ◽

10.3390/children8070587 ◽

2021 ◽

Vol 8 (7) ◽

pp. 587

Author(s):

Isabel I. Sreeram ◽

Chantal A. ten Kate ◽

Joost van Rosmalen ◽

Johannes M. Schnater ◽

Saskia J. Gischler ◽

...

Keyword(s):

Linear Regression ◽

Clinical Outcomes ◽

Outcome Measures ◽

Clinical Decision Making ◽

Linear Regression Analysis ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Added Value ◽

Patient Reported

Increasing numbers of children and adults with chronic disease status highlight the need for a value-based healthcare system. Patient-reported outcome measures (PROMs) are essential to value-based healthcare, yet it remains unclear how they relate to clinical outcomes such as health and daily functioning. We aimed to assess the added value of self-reported PROMs for health status (HS) and quality of life (QoL) in the long-term follow-up of children with foregut anomalies. We evaluated data of PROMs for HS and/or QoL among eight-year-olds born with congenital diaphragmatic hernia (CDH), esophageal atresia (EA), or congenital lung malformations (CLM), collected within the infrastructure of a multidisciplinary, longitudinal follow-up program. Clinical outcomes were categorized into different outcome domains, and their relationships with self-reported HS and QoL were assessed through multivariable linear regression analyses. A total of 220 children completed HS and/or QoL self-reports. In children with CDH and EA, lower cognition was significantly associated with lower self-reported HS. Due to the low number of cases, multivariable linear regression analysis was not possible in children with CLM. HS, QoL, and clinical outcomes represent different aspects of a child’s wellbeing and should be measured simultaneously to facilitate a more holistic approach to clinical decision making.

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Assessment of computer adaptive testing version of the Neuro-QOL for people with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458518810159 ◽

2018 ◽

Vol 25 (13) ◽

pp. 1791-1799 ◽

Cited By ~ 1

Author(s):

Brian C Healy ◽

Jonathan Zurawski ◽

Cindy T Gonzalez ◽

Tanuja Chitnis ◽

Howard L Weiner ◽

...

Keyword(s):

Multiple Sclerosis ◽

Outcome Measures ◽

Computerized Adaptive Testing ◽

Short Form ◽

Patient Reported Outcome Measures ◽

Adaptive Testing ◽

Patient Reported Outcome ◽

Longitudinal Change ◽

Sf 36 ◽

Patient Reported

Background: To date, the computerized adaptive testing (CAT) version of the Neuro-quality of life (QOL) has not been assessed in a large sample of people with multiple sclerosis (MS). Objective: The aim of this study was to assess the associations between the CAT version of Neuro-QOL and other clinical and patient-reported outcome measures. Methods: Subjects ( n = 364) enrolled in SysteMS completed the CAT version of the Neuro-QOL and the 36-Item Short Form Survey (SF-36) within 4 weeks of a clinical exam that included the Multiple Sclerosis Functional Composite-4 (MSFC-4). The correlations between the Neuro-QOL domains and the MSFC-4 subscores and the SF-36 scores were calculated. The changes over time in the Neuro-QOL and other measures were also examined. Results: The lower extremity functioning score of the Neuro-QOL showed the highest correlations with MSFC-4 components including Timed 25-Foot Walk, 9-Hole Peg Test, and cognitive score. The expected domains of the Neuro-QOL showed high correlations with the SF-36 subscores, and some Neuro-QOL domains were associated with many SF-36 subscores. There was limited longitudinal change on the Neuro-QOL domains over 12 months, and the change was not associated with change on other measures. Conclusion: The CAT version of the Neuro-QOL shows many of the expected associations with clinical and patient-reported outcome measures.

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Implementing electronic patient reported outcome measures (ePROMs) into routine lung cancer follow-up: the patient perspective

Lung Cancer ◽

10.1016/s0169-5002(20)30231-2 ◽

2020 ◽

Vol 139 ◽

pp. S86-S87

Author(s):

A. Payne ◽

M. Christodoulou ◽

N. Khalil ◽

P. Rust ◽

D. Thompson ◽

...

Keyword(s):

Lung Cancer ◽

Outcome Measures ◽

Patient Perspective ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Patient Reported

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Surgical Treatments of Talar Osteochondral Lesion: A Long-term Follow-up of Return to Sport and Patient-Reported Outcome Measures

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00375 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0037

Author(s):

Andrew Schwartz ◽

Shuo Niu ◽

Faris Mirza ◽

Ashley Thomas ◽

Sameh Labib

Keyword(s):

Outcome Measures ◽

Osteochondral Lesion ◽

Return To Sport ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Surgical Interventions ◽

Patient Reported ◽

Long Term Follow Up ◽

And Function

Category: Ankle, Arthroscopy, Sports, Trauma Introduction/Purpose: Talar osteochondral lesion (TOCL) is a common problem in the young athletic population, mostly related to trauma. TOCL surgical treatment algorithm remains controversial, though results are improving as we gain experience. The results of TOCL surgical treatment on function and return to sport are promising, but quantified return to sport metrics remain largely unknown. Methods: A total of 156 consecutive patients following TOCL chondroplasty (10/1/2000-5/31/2018) by a single practice were retrospectively reviewed and included in this study. There were 54.5% female with a mean age 38.2 years, and mean follow-up 40.2 months following the index surgery. Patients were divided into four groups according to the type of chondroplasty performed: Antegrade arthroscopic drilling and/or microfracture (antegrade, 83 patients), retrograde arthroscopic drilling (retrograde, 35 patients), osteochondral autograft transfer (OATS, 26 patients), and allograft cartilage implantation (allograft, 12 patients). VAS scores for pain and function at the final clinic visit were collected. Patient-reported outcome measures including the short form-12 (SF-12), The Foot and Ankle Disability Index Sports Module (FADI-sports), Tegner score, Marx scale, Naal’s Sports inventory are also actively being collected. Results: Nearly 75% of patients are satisfied with surgical intervention of TOCLs. Allograft transplant was the least satisfying (71.4%), while OATS was the most satisfying (90%). Each surgical intervention yielded significantly decreased pain and increased function postoperatively (all p<0.001). Currently, 57 patients (36%) provided patient-reported outcome measures, with an average follow up of 79.8 months (Table 1). All surgical interventions trended toward decreased Tegner score, though only antegrade drilling showed a significant decrease (p<0.001). Based on Naal’s sports inventory, 85.7% of surgically treated patients reported participating in sport activities, on average 3 times/week and 50.6 minutes/session. Conclusion: Traditionally, TOCLs presented a difficult problem that is marred by unsatisfactory surgical outcomes in typically active patients. As our surgical understanding has evolved, we’ve continued to improve on outcomes. Our patients demonstrated a 74.5% satisfaction rate, a statistically significant improvement in pain and function, and a high rate of return to sport with little difference between surgical interventions at a long-term follow-up.

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Feasibility of Collecting Multiple Patient-Reported Outcome Measures Alongside the Dutch Arthroplasty Register

Journal of Patient Experience ◽

10.1177/2374373519853166 ◽

2019 ◽

Vol 7 (4) ◽

pp. 484-492

Author(s):

Claire Tilbury ◽

Claudia S Leichtenberg ◽

Bart L Kaptein ◽

Lennard A Koster ◽

Suzan H M Verdegaal ◽

...

Keyword(s):

Outcome Measures ◽

Short Form ◽

Response Rates ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Participation Rates ◽

Arthroplasty Register ◽

Patient Reported ◽

Lost To Follow Up

Background: Compliance rates with patient-reported outcome measures (PROMs) collected alongside arthroplasty registries vary in the literature. We described the feasibility of a routinely collected set PROMs alongside the Dutch Arthroplasty Register. Methods: The longitudinal Leiden Orthopaedics Outcomes of OsteoArthritis Study is a multicenter (7 hospitals), observational study including patients undergoing total hip or total knee arthroplasty (THA or TKA). A set of PROMs: Short Form-12, EuroQol 5 Dimensions, Hip/Knee injury and Osteoarthritis Outcome Score, Oxford Hip/Knee Score was collected preoperatively and at 6, 12, 24 months, and every 2 years thereafter. Participation rates and response rates were recorded. Results: Between June 2012 and December 2014, 1796 THA and 1636 TKA patients were invited, of whom 1043 THA (58%; mean age 68 years [standard deviation, SD: 10]) and 970 TKA patients (59%; mean age 71 years [SD 9.5]) participated in the study. At 6 months, 35 THA/38 TKA patients were lost to follow-up. Response rates were 90% for THA (898/1000) and 89% for TKA (827/932) participants. At 1 and 2 years, 8 and 18 THA and 17 and 11 TKA patients were lost to follow-up, respectively. The response rates among those eligible were 87% (866/992) and 84% (812/972) for THA and 84% (771/917) and 83% (756/906) for TKA patients, respectively. The 2-year questionnaire was completed by 78.5% of the included THA patients and by 77.9% of the included TKA patients. Conclusions: About 60% of patients undergoing THA or TKA complete PROMs preoperatively, with more than 80% returning follow-up PROMs. To increase the participation rates, more efforts concerning the initial recruitment of patients are needed.

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PROMIS Versus Legacy Patient-Reported Outcome Measures in Patients Undergoing Surgical Treatment for Symptomatic Acetabular Dysplasia

The American Journal of Sports Medicine ◽

10.1177/0363546519894323 ◽

2020 ◽

Vol 48 (2) ◽

pp. 385-394 ◽

Cited By ~ 4

Author(s):

Deborah J. Li ◽

John C. Clohisy ◽

Maria T. Schwabe ◽

Elizabeth L. Yanik ◽

Cecilia Pascual-Garrido

Keyword(s):

Outcome Measures ◽

Acetabular Dysplasia ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Patient Reported ◽

Ceiling Effects ◽

The Mean ◽

Symptomatic Acetabular Dysplasia ◽

Good Agreement

Background: No previous study has investigated how the Patient-Reported Outcomes Measurement Information System (PROMIS) performs compared with legacy patient-reported outcome measures in patients with symptomatic acetabular dysplasia treated with periacetabular osteotomy (PAO). Purpose: To (1) measure the strength of correlation between the PROMIS and legacy outcome measures and (2) assess floor and ceiling effects of the PROMIS and legacy outcome measures in patients treated with PAO for symptomatic acetabular dysplasia. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: This study included 220 patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Outcome measures included the Hip disability and Osteoarthritis Outcome Score (HOOS) pain, HOOS activities of daily living (ADL), modified Harris Hip Score (mHHS), PROMIS pain, and PROMIS physical function subsets, with scores collected preoperatively and/or postoperatively at a minimum 12-month follow-up. The change in mean scores from preoperatively to postoperatively was calculated only in a subgroup of 57 patients with scores at both time points. Distributions of the PROMIS and legacy scores were compared to evaluate floor and ceiling effects, and Pearson correlation coefficients were calculated to evaluate agreement. Results: The mean age at the time of surgery was 27.7 years, and 83.6% were female. The mean follow-up time was 1.5 years. Preoperatively, neither the PROMIS nor the legacy measures showed significant floor or ceiling effects. Postoperatively, all legacy measures showed significant ceiling effects, with 15% of patients with a maximum HOOS pain score of 100, 29% with a HOOS ADL score of 100, and 21% with an mHHS score of 100. The PROMIS and legacy instruments showed good agreement preoperatively and postoperatively. The PROMIS pain had a moderate to strong negative correlation with the HOOS pain ( r = −0.66; P < .0001) and mHHS ( r = −0.60; P < .0001) preoperatively and the HOOS pain ( r = −0.64; P < .0001) and mHHS ( r = −0.64; P < .0001) postoperatively. The PROMIS physical function had a moderate positive correlation with the HOOS ADL ( r = 0.51; P < .0001) and mHHS ( r = 0.49; P < .0001) preoperatively and a stronger correlation postoperatively with the HOOS ADL ( r = 0.56; P < .0001) and mHHS ( r = 0.56; P < .0001). Conclusion: We found good agreement between PROMIS and legacy scores preoperatively and postoperatively. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment.

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