Longitudinal changes in patient-reported outcome measures following total hip arthroplasty and predictors of deterioration during follow-up

2019 ◽  
Vol 101-B (7) ◽  
pp. 768-778 ◽  
Author(s):  
V. P. Galea ◽  
P. Rojanasopondist ◽  
L. H. Ingelsrud ◽  
H. E. Rubash ◽  
C. Bragdon ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Significant Deterioration ◽  
Sf 36 ◽  
Patient Reported ◽  
Clinically Significant ◽  
One Year ◽  
Anxiety Depression

AimsThe primary aim of this study was to quantify the improvement in patient-reported outcome measures (PROMs) following total hip arthroplasty (THA), as well as the extent of any deterioration through the seven-year follow-up. The secondary aim was to identify predictors of PROM improvement and deterioration.Patients and MethodsA total of 976 patients were enrolled into a prospective, international, multicentre study. Patients completed a battery of PROMs prior to THA, at three months post-THA, and at one, three, five, and seven-years post-THA. The Harris Hip Score (HHS), the 36-Item Short-Form Health Survey (SF-36) Physical Component Summary (PCS), the SF-36 Mental Component Summary (MCS), and the EuroQol five-dimension three-level (EQ-5D) index were the primary outcomes. Longitudinal changes in each PROM were investigated by piece-wise linear mixed effects models. Clinically significant deterioration was defined for each patient as a decrease of one half of a standard deviation (group baseline).ResultsImprovements were noted in each PROM between the preoperative and one-year visits, with one-year values exceeding age-matched population norms. Patients with difficulty in self-care experienced less improvement in HHS (odds ratio (OR) 2.2; p = 0.003). Those with anxiety/depression experienced less improvement in PCS (OR -3.3; p = 0.002) and EQ-5D (OR -0.07; p = 0.005). Between one and seven years, obesity was associated with deterioration in HHS (1.5 points/year; p = 0.006), PCS (0.8 points/year; p < 0.001), and EQ-5D (0.02 points/year; p < 0.001). Preoperative difficulty in self-care was associated with deterioration in HHS (2.2 points/year; p < 0.001). Preoperative pain from other joints was associated with deterioration in MCS (0.8 points/year; p < 0.001). All aforementioned factors were associated with clinically significant deterioration in PROMs (p < 0.035), except anxiety/depression with regard to PCS (p = 0.060).ConclusionThe present study finds that patient factors affect the improvement and deterioration in PROMs over the medium term following THA. Special attention should be given to patients with risk factors for decreased PROMs, both preoperatively and during follow-up. Cite this article: Bone Joint J 2019;101-B:768–778.

Patient-reported outcome measures after surgery for an acetabular fracture

2018 ◽  
Vol 100-B (5) ◽  
pp. 640-645 ◽  
Author(s):  
B. Frietman ◽  
J. Biert ◽  
M. J. R. Edwards
Keyword(s):  
Outcome Measures ◽  
Hip Joint ◽  
Acetabular Fracture ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Ct Scans ◽  
Sf 36 ◽  
Patient Reported ◽  
Post Traumatic

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.

Identification of Factors Predictive for Patient Reported Outcomes in the Prospective Australian Breast Device Registry

2021 ◽  
Author(s):  
Jessy Hansen ◽  
Susannah Ahern ◽  
Pragya Gartoulla ◽  
Ying Khu ◽  
Elisabeth Elder ◽  
...  
Keyword(s):  
Risk Adjustment ◽  
Breast Implants ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Logistic Regression Models ◽  
Multivariate Risk ◽  
Patient Reported ◽  
The Aesthetic ◽  
One Year

Abstract Background Patient-reported outcome measures (PROMs) are an important tool for evaluating outcomes following breast device procedures, and are used by breast device registries. PROMs can assist with device monitoring through benchmarked outcomes, but need to account for demographic and clinical factors which may affect PROMs responses. Objectives This study aimed to develop appropriate risk-adjustment models for the benchmarking of PROMs data to accurately track device outcomes and identify outliers in an equitable manner. Methods Data for this study were obtained from the Australian Breast Device Registry, which consists of a large prospective cohort of patients with primary breast implants. The five-question BREAST-Q implant surveillance module was used to assess PROMs at one-year following implant insertion. Logistic regression models were used to evaluate associations between demographic and clinical characteristics and PROMs separately by implant indication. Final multivariate risk-adjustment models were built sequentially assessing the independent significant association of these variables. Results 2,221 reconstructive and 12,045 aesthetic primary breast implants with complete one-year follow-up PROMs were included in the study. Indication for operation (post-cancer, risk-reduction, developmental deformity) was included in the final model for all reconstructive implant PROMs. Site type (private or public hospital) was included in the final breast reconstruction model for look, rippling and tightness. Age at operation was included in the reconstruction models for rippling and tightness and in the aesthetic models for look, rippling, pain and tightness. Conclusions These multivariate models will be useful for equitable benchmarking of breast devices by PROMs to help track device performance.

No Clinically Meaningful Differences in 1-Year Patient-Reported Outcome Measures between Hip Resurfacing and Total Hip Arthroplasty: An Age-Matched Prospective Cohort Study

2021 ◽  
Author(s):  
Marcelo Siqueira ◽  
Keyword(s):  
Total Hip Arthroplasty ◽  
Outcome Measures ◽  
Hip Arthroplasty ◽  
Prospective Cohort ◽  
Patient Reported Outcome Measures ◽  
Hip Resurfacing ◽  
Patient Reported Outcome ◽  
Total Hip ◽  
Patient Reported

AbstractThis study compared patient-reported outcome measures (PROMs), readmissions, and reoperations between hip resurfacing (HR) and total hip arthroplasty (THA) in a matched prospective cohort. Between 2015 and 2017, 4,268 patients underwent HR or THA at a single institution. A prospective cohort of 2,147 patients were enrolled (707 HRs, 1,440 THAs). PROMs were collected at baseline and 1-year follow-up. Exclusion criteria: females (n = 2,008), inability/refusal to complete PROMs (n = 54), and diagnosis other than osteoarthritis (n = 59). Each HR patient was age-matched to a THA patient. Multivariate regression models were constructed to control for race, body mass index, education, smoking status, Charlson Comorbidity Index, mental health, and functional scores. A significance threshold was set at p = 0.017. A total of 707 HRs and 707 THAs were analyzed and 579 HRs (81.9%) and 490 THAs (69.3%) were followed up at 1 year. There was no statistically significant difference for Hip Injury and Osteoarthritis Outcomes Score (HOOS) Pain subscale (p = 0.129) and HOOS-Physical Function Shortform (HOOS-PS) (p = 0.03). HR had significantly higher median University of California in Los Angeles (UCLA) activity scores (p = 0.004). Ninety-day readmissions for HR and THAs were 1.8 and 3.5%, respectively (p = 0.06), and reoperations at 1 year were 1.2 and 2.3%, respectively (p = 0.24). For male patients, differences in medians for UCLA activity scores were 0.383 points, which were statistically significant but may not be clinically relevant. No differences exist in 90-day readmissions, reoperations, and HOOSpain and HOOS-PS scores. Because patients undergoing HR are advised to return to full activity at 1-year postoperative, follow-up is required. Metal ion levels were not obtained postoperatively for either group.

Patient-Reported Outcome Measures and Radiological Outcomes in Mobile-Bearing Total Ankle Arthroplasty With Varus or Valgus Deformity

2020 ◽  
pp. 107110072094985
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Mohammad Alkhreisat ◽  
Malik S. Siddique
Keyword(s):  
Physical Health ◽  
Mobile Bearing ◽  
Varus Deformity ◽  
Patient Reported Outcome Measures ◽  
Valgus Deformity ◽  
Patient Reported Outcome ◽  
Ankle Arthroplasty ◽  
Sf 36 ◽  
Patient Reported

Background: There is increasing evidence that varus deformity does not negatively affect total ankle arthroplasty (TAA) outcomes, but there is a sparsity of evidence for valgus deformity. We present our outcomes using a mobile-bearing prosthesis for neutral, varus, and valgus ankles. Methods: This is a retrospective cohort study of consecutive cases identified from a local joint registry. In total, 230 cases were classified based on preoperative radiographs as neutral (152 cases), varus greater than 10 degrees (60 cases), or valgus greater than 10 degrees (18 cases). Tibiotalar angle was again measured postoperatively and at final follow-up (mean follow-up of 55.9 months). A total of 164 cases had adequate patient-reported outcome measures data (Foot and Ankle Outcome Score, Short Form–36 [SF-36] scores, and patient satisfaction) for analysis (mean follow-up of 61.6 months). The groups were similar for body mass index and length of follow-up, but neutral ankles were younger ( P = .021). Results: Baseline scores were equal except SF-36 physical health, with valgus ankles scoring lowest ( P = .045). Valgus ankles had better postoperative pain ( P = .025) and function ( P = .012) than neutral. Pre- to postoperative change did not reach statistical significance except physical health, in which valgus performed best ( P = .039). Mean final angle for all groups was less than 5 degrees. There was no significant difference in revision rates. Conclusion: Our study is consistent with previous evidence that varus deformity does not affect outcome in TAA. In addition, in our cohort, outcomes were satisfactory with valgus alignment. Postoperative coronal radiological alignment was affected by preoperative deformity but within acceptable limits. Coronal plane deformity did not negatively affect radiological or clinical outcomes in TAA. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive™ soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity

2021 ◽  
Vol 9 ◽  
pp. 205031212110233
Author(s):  
Cameron T Cox ◽  
Joash R Suryavanshi ◽  
Bradley O Osemwengie ◽  
Sterling Rosqvist ◽  
Matthew Blue ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Umbilical Cord ◽  
Functional Outcomes ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Human Umbilical Cord ◽  
Sf 36 ◽  
Patient Reported ◽  
Multi Level

Background: Treatment of patients with traumatic axonotmesis presents challenges. Processed human umbilical cord membrane has been recently developed with improved handling and resorption time compared to other amniotic membrane wraps, and may be beneficial in nerve reconstruction. This study evaluates postoperative outcomes after traumatic peripheral nerve injury after placement of commercially available processed human umbilical cord membrane. Methods: We performed a prospective, single-center pilot study of patients undergoing multi-level surgical reconstruction for exposed, non-transected peripheral nerve. Functional outcomes including pain, range of motion, pinch and grip strength, and the QuickDASH and SF-36 patient-reported outcome measures were recorded, when possible, at the 1-week and 3, 6, and 9 months postop visit. One-tailed paired t-tests were performed to evaluate outcome improvement at final follow-up. Results: Twenty patients had processed human umbilical cord membrane placement without surgical complications. Mean follow-up was 7.5 months (range: 3–10 months) and mean age was 39 years (range: 15–65). Twelve (67%) patients were male, and the majority of placement sites were in the upper extremity (85%). Mean preoperative visual analog scale pain score was significantly reduced at most recent follow-up, as were QuickDASH scores. All patients had improved functional outcomes at the 9-month follow-up, and SF-36 outcomes at 9 months showed improvement across all dimensions. Conclusion: This study indicates that processed human umbilical cord membrane may be a useful adjunct in nerve surgery with noted improvements in postoperative function, pain, and patient-reported outcome measures. Future studies are needed to assess long-term outcomes after traumatic nerve injury treated with processed human umbilical cord membrane.

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

2017 ◽  
Vol 11 (5) ◽  
pp. 451-456 ◽  
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

Three and a half years’ experience with outpatient total hip arthroplasty

2020 ◽  
Vol 102-B (1) ◽  
pp. 82-89 ◽  
Author(s):  
Michel J. Coenders ◽  
Nina M. C. Mathijssen ◽  
Stephan B. W. Vehmeijer
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Outpatient Setting ◽  
Total Hip ◽  
Study Results ◽  
Patient Reported ◽  
One Year

Aims The aim of this study was to report our experience at 3.5 years with outpatient total hip arthroplasty (THA). Methods In this prospective cohort study, we included all patients who were planned to receive primary THA through the anterior approach between 1 April 2014 and 1 October 2017. Patient-related data and surgical information were recorded. Patient reported outcome measures (PROMs) related to the hip and an anchor question were taken preoperatively, at six weeks, three months, and one year after surgery. All complications, readmissions, and reoperations were registered. Results Of the 647 THA patients who had surgery in this period through the anterior approach, 257 patients (39.7%) met the inclusion criteria and were scheduled for THA in an outpatient setting. Of these, 40 patients (15.6%) were admitted to the hospital, mainly because of postoperative nausea and/or dizziness. All other 217 patients were able to go home on the day of surgery. All hip-related PROMs improved significantly up to 12 months after surgery, compared with the scores before surgery. There were three readmissions and two reoperations in the outpatient cohort. There were no complications related to the outpatient THA protocol. Conclusion These study results confirm that outpatient THA can be performed safe and successfully in a selected group of patients, with satisfying results up to one year postoperatively, and without outpatient-related complications, readmissions, and reoperations. Cite this article: Bone Joint J 2020;102-B(1):82–89

scholarly journals 2017 IFFAS Award for Excellence Winner

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Adam Bennett ◽  
Malik Siddique ◽  
Jayasree Ramas Ramaskandhan
Keyword(s):  
Patient Satisfaction ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Pilon Fracture ◽  
Patient Satisfaction Scores ◽  
Ankle Replacement ◽  
Sf 36 ◽  
Patient Reported ◽  
Chi Squared ◽  
One Year

Category: Ankle Arthritis Introduction/Purpose: Pilon fractures of the distal tibia are high energy injuries often occurring in a young patient cohort. Despite optimal acute fracture management, post traumatic osteoarthritis of the tibiotalar joint is a common corollary. Standard treatment is by way of tibiotalar arthrodesis, however the lack of motion at the ankle afforded by this treatment is often poorly tolerated by patients and can lead to arthrosis of adjacent joints. Total ankle replacement (TAR) offers an attractive pain relieving and motion preserving option for this patient subgroup. Here we report the two-year patient reported outcome measures for a cohort of patients undergoing TAR for osteoarthritis secondary to tibial pilon fracture and compare them to the outcomes for other indications for total ankle replacement. Methods: The results of patient-reported outcome measures (PROMs) for TAR performed between March 2006 and November 2014 by a single surgeon at a single institution in the United Kingdom were reviewed. Data collected included Foot and Ankle Outcome Scores (FAOS) (WOMAC pain/stiffness/function); SF-36 General Health Questionnaire; number of comorbidities; self- reported BMI and patient satisfaction scores. Time points for data collection were pre-operatively and then at one and two years post-operatively. Clinical notes and radiographs were reviewed to highlight the indication for TAR and were categorised into the following sub-groups: osteoarthritis (OA); rheumatoid arthritis (RA); arthritis following pilon fracture; arthritis following ankle fracture; and post-traumatic arthritis without previous fracture (PTOA). FAOS and SF-36 were analysed using a general linear model to assess variance and by way of repeated measures ANOVA. Demographic data was assessed using student t-test and chi- squared analysis. Patient satisfaction scores were evaluated using cross-tabulation and chi-squared examination. Results: The pilon fracture group had the youngest average age and highest BMI (56.5 years; mean BMI 31.6). There was no statistically significant difference in number of reported comorbidities between subgroups (p>0.05). Significant improvement in FAOS pain, function and stiffness scores was seen in all subgroups from pre-operatively to one year post-operatively (p=0.01, 0.05 and 0.03 respectively). No further statistically significant improvement in the same scores was seen at two years. SF-36 analysis demonstrated similar results for all subgroups. There was general improvement in all parameters except for general health (p=0.890 at one year) and reduction in physical function in the RA group from first to second post-operative years (p=0.046). Patient satisfaction survey showed similar results for all subgroups. Conclusion: Our study has demonstrated that statistically significant improvement is seen in FAOS pain, function and stiffness scores in all subgroups of patients undergoing TAR by one year post surgery and that this improvement is maintained by two year follow up. There was no major difference in any of the reported outcomes between subgroups by two years post-operatively, suggesting that TAR performed for arthritis secondary to pilon fracture is a realistic alternative to tibio-talar arthrodesis.

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