How Can Patient-Reported Outcomes of Periacetabular Osteotomy be Improved? A Short-Term Follow-up of 79 Hips.

Abstract Background Bernese periacetabular osteotomy (PAO) is an effective treatment for patients with developmental dysplasia of the hip (DDH). PAO has been widely used in China, but few follow-up outcomes have been reported in the international community. Moreover, the risk factors affecting patient-reported outcomes have not been discussed in recent studies. In this study, patient-reported outcomes after PAO were reported, and risk factors affecting patient-reported outcomes were analyzed. Methods Patients who underwent PAO for DDH from January 2014 to January 2020 were selected as the study subjects, and 79 hips were included in the analysis after screening (71 patients, with an average follow-up time of 2.98 years). The Harris Hip Score (HHS) and International Hip Outcome Instrument-12 (iHOT-12) were used to assess hip function and patient quality of life. A HHS < 80 was defined as symptomatic hips, that is, an adverse outcome; otherwise, it indicated preserved hips. Multivariate logistic regression analysis was used to predict the risk factors influencing the patient-reported outcomes, and receiver operating characteristic (ROC) curve analysis was performed on the risk factors to determine their sensitivity, specificity and cutoff value. Results Clinical outcome analysis demonstrates marked improvements in patient-reported outcomes. The multivariate logistic regression analysis showed that when the postoperative LCEA was > 38°, adverse outcomes were much more likely. However, a Tönnis angle of -10°-0 was a protective factor. In addition, hips with fair or poor joint congruency were 7.794-fold more likely to develop negative outcomes. The ROC curve analysis showed that the optimal thresholds for the LCEA and Tönnis angles used to predict outcomes after PAO were 38.1° and − 9°, respectively. The patients with a postoperative LCEA < 38.1° had a success rate of 83%. In contrast, the success rate was 32% for patients with a postoperative LCEA > 38.1°. In addition, while the patients with a postoperative Tönnis angle of -9°-0 had a success rate of 70%, and those with a Tönnis angle of 0–10° had a success rate of 65%; the success rate of a Tönnis angle <-9° was only 10%. Conclusions Our results demonstrate marked improvements in patient-reported outcomes. Among hips with preoperative excellent or good joint congruency treated by experienced surgeons who obtain the proper postoperative LCEA and Tönnis angles, good patient-reported outcomes can be expected.

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The association the patient-reported outcomes after periacetabular osteotomy with radiographic features: a short-term retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02858-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yinuo Fan ◽

Weifeng Li ◽

Yunlong Wu ◽

Ruoyu Li ◽

Guoju Hong ◽

...

Keyword(s):

Risk Factors ◽

Roc Curve ◽

Patient Reported Outcomes ◽

Periacetabular Osteotomy ◽

Multivariate Logistic Regression Analysis ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Joint Congruency ◽

Patient Reported

Abstract Background Bernese periacetabular osteotomy (PAO) is an effective treatment for patients with developmental dysplasia of the hip (DDH). PAO has been widely used in China, but few follow-up outcomes have been reported in the international community. Moreover, the risk factors affecting patient-reported outcomes have not been discussed in recent studies. In this study, patient-reported outcomes after PAO were reported, and risk factors affecting patient-reported outcomes were analyzed. Methods Patients who underwent PAO for DDH from January 2014 to January 2020 were selected as the study subjects, and 66 hips were included in the analysis after screening (59 patients, with an average follow-up time of 3.01 years). The Harris Hip Score (HHS) and International Hip Outcome Instrument-12 (iHOT-12) were used to assess hip function and patient quality of life. The changes of preoperative and latest follow-up HHSs less than 9 were defined as symptomatic hips, that is, an adverse outcome; otherwise, the score indicates preserved hips. Also, the changes of preoperative and latest follow-up iHOT-12 were defined as symptomatic hips and preserved hips. Multivariate logistic regression analysis was used to predict the risk factors influencing the patient-reported outcomes, and receiver operating characteristic (ROC) curve analysis was performed on the risk factors to determine their sensitivity, specificity and cutoff value. Results Clinical outcome analysis demonstrates marked improvements in patient-reported outcomes. The multivariate logistic regression analysis showed that when the postoperative LCEA was > 38°, adverse outcomes were much more likely. However, a Tönnis angle of − 10° to 0° was a protective factor. In addition, hips with fair or poor joint congruency were more likely to develop negative outcomes. The ROC curve analysis showed that the optimal thresholds for the LCEA and Tönnis angles used to predict outcomes after PAO were 38.2° and − 9°, respectively. Based on the results of the ROC curve analysis, among hips with poor or fair joint congruency preoperatively treated by surgeons who obtained the improper postoperative LCEAs and Tönnis angles, bad patient-reported outcomes will most likely be obtained. Conclusions Our results demonstrate marked improvements in patient-reported outcomes. Among hips with preoperative excellent or good joint congruency treated by experienced surgeons who obtain the proper postoperative LCEA and Tönnis angles, good patient-reported outcomes can be expected.

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What are the Risk Factors for Worse Outcomes of Meniscus Surgery in 23-39-Year-Old Patients Ligamentously Stable Knees?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00468 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0046

Author(s):

◽

Megan Flynn ◽

Anthony Egger ◽

Yuxuan Jin ◽

Elizabeth Sosic ◽

...

Keyword(s):

Risk Factors ◽

Young Adult ◽

Patient Reported Outcomes ◽

Meniscal Repair ◽

Patient Specific ◽

Lower Baseline ◽

Patient Reported ◽

Grade 3 ◽

One Year

Objectives: Meniscus tears are a common and significant source of knee dysfunction in active young adult patients, and no high-quality prospective cohort or RCTs studies exist evaluating patient-reported outcomes in patients in this age group with ligamentously stable knees. Our objective was to identify patient-reported outcomes and patient-specific risk factors from a prospective cohort with a minimum of one-year follow-up following meniscal repair or excision in patients with ligamentously stable knees. We hypothesized that both groups would have significant improvement in outcomes; patients undergoing meniscal repair would have a higher reoperation rate; and articular cartilage injuries, subsequent knee surgery, and certain demographic characteristics would be significant risk factors to inferior outcomes at one year. Methods: Between February 2015 and December 2017, ligamentously stable meniscal procedures were enrolled and prospectively followed using the outcomes management evaluation system (OME) at Cleveland Clinic. Patients aged 23-39 preoperatively completed a series of validated outcome measurements including the Knee Injury and Osteoarthritis Outcome Score for both Pain (KOOS Pain) and Quality of Life (KOOS QoL). At the time of surgery, physicians documented all intra-articular findings, treatment, and surgical techniques utilized. Patients were followed at minimum of 1-year postoperatively through the OME platform and asked to complete the same outcome instruments done at baseline as well as a question designed to evaluate the Patient Acceptable Symptom State (PASS). The incidence and details of any subsequent knee surgeries were also obtained. Multivariable regression analysis was used to identify significant predictors of outcomes. Results: A total of 371 patients aged 23-39 underwent meniscus excision or repair during the study period. One hundred ninety-four met inclusion criteria, and one-year follow-up was obtained on 72% (n = 139) of the cohort (67% male; median age 32). Both KOOS Pain and KOOS QoL improved significantly at one-year for the entire cohort. Fourteen percent of the cohort (9% on the ipsilateral knee, 5% on the contralateral knee) underwent subsequent surgery at a minimum of one-year postoperatively. The patient-specific risk factors for worse one-year outcomes included preoperative baseline mental capacity score (VR-12 MCS), lower baseline KOOS QoL score, and the intraoperative finding of any grade 3 or 4 chondral changes. Conclusion: Young adult patients with ligamentously stable knees undergoing meniscal surgery have significantly improved patient-reported outcomes regardless of excision or repair; however, 14% of patients underwent additional knee surgery at a minimum of one-year postoperatively. The risk factors for worse outcomes include lower baseline mental health score, lower baseline KOOS QoL score, and any grade 3 or 4 chondromalacia scene.

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A randomised trial of the effect and cost-effectiveness of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with screen-detected type 2 diabetes: the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION-Europe) study

Health Technology Assessment ◽

10.3310/hta20640 ◽

2016 ◽

Vol 20 (64) ◽

pp. 1-86 ◽

Cited By ~ 5

Author(s):

Rebecca K Simmons ◽

Knut Borch-Johnsen ◽

Torsten Lauritzen ◽

Guy EHM Rutten ◽

Annelli Sandbæk ◽

...

Keyword(s):

Risk Factors ◽

Patient Reported Outcomes ◽

Cost Effective ◽

Well Being ◽

Health Technology ◽

Patient Reported ◽

All Cause Mortality

BackgroundIntensive treatment (IT) of cardiovascular risk factors can halve mortality among people with established type 2 diabetes but the effects of treatment earlier in the disease trajectory are uncertain.ObjectiveTo quantify the cost-effectiveness of intensive multifactorial treatment of screen-detected diabetes.DesignPragmatic, multicentre, cluster-randomised, parallel-group trial.SettingThree hundred and forty-three general practices in Denmark, the Netherlands, and Cambridge and Leicester, UK.ParticipantsIndividuals aged 40–69 years with screen-detected diabetes.InterventionsScreening plus routine care (RC) according to national guidelines or IT comprising screening and promotion of target-driven intensive management (medication and promotion of healthy lifestyles) of hyperglycaemia, blood pressure and cholesterol.Main outcome measuresThe primary end point was a composite of first cardiovascular event (cardiovascular mortality/morbidity, revascularisation and non-traumatic amputation) during a mean [standard deviation (SD)] follow-up of 5.3 (1.6) years. Secondary end points were (1) all-cause mortality; (2) microvascular outcomes (kidney function, retinopathy and peripheral neuropathy); and (3) patient-reported outcomes (health status, well-being, quality of life, treatment satisfaction). Economic analyses estimated mean costs (UK 2009/10 prices) and quality-adjusted life-years from an NHS perspective. We extrapolated data to 30 years using the UK Prospective Diabetes Study outcomes model [version 1.3;©Isis Innovation Ltd 2010; seewww.dtu.ox.ac.uk/outcomesmodel(accessed 27 January 2016)].ResultsWe included 3055 (RC,n = 1377; IT,n = 1678) of the 3057 recruited patients [mean (SD) age 60.3 (6.9) years] in intention-to-treat analyses. Prescription of glucose-lowering, antihypertensive and lipid-lowering medication increased in both groups, more so in the IT group than in the RC group. There were clinically important improvements in cardiovascular risk factors in both study groups. Modest but statistically significant differences between groups in reduction in glycated haemoglobin (HbA1c) levels, blood pressure and cholesterol favoured the IT group. The incidence of first cardiovascular event [IT 7.2%, 13.5 per 1000 person-years; RC 8.5%, 15.9 per 1000 person-years; hazard ratio 0.83, 95% confidence interval (CI) 0.65 to 1.05] and all-cause mortality (IT 6.2%, 11.6 per 1000 person-years; RC 6.7%, 12.5 per 1000 person-years; hazard ratio 0.91, 95% CI 0.69 to 1.21) did not differ between groups. At 5 years, albuminuria was present in 22.7% and 24.4% of participants in the IT and RC groups, respectively [odds ratio (OR) 0.87, 95% CI 0.72 to 1.07), retinopathy in 10.2% and 12.1%, respectively (OR 0.84, 95% CI 0.64 to 1.10), and neuropathy in 4.9% and 5.9% (OR 0.95, 95% CI 0.68 to 1.34), respectively. The estimated glomerular filtration rate increased between baseline and follow-up in both groups (IT 4.31 ml/minute; RC 6.44 ml/minute). Health status, well-being, diabetes-specific quality of life and treatment satisfaction did not differ between the groups. The intervention cost £981 per patient and was not cost-effective at costs ≥ £631 per patient.ConclusionsCompared with RC, IT was associated with modest increases in prescribed treatment, reduced levels of risk factors and non-significant reductions in cardiovascular events, microvascular complications and death over 5 years. IT did not adversely affect patient-reported outcomes. IT was not cost-effective but might be if delivered at a reduced cost. The lower than expected event rate, heterogeneity of intervention delivery between centres and improvements in general practice diabetes care limited the achievable differences in treatment between groups. Further follow-up to assess the legacy effects of early IT is warranted.Trial registrationClinicalTrials.gov NCT00237549.Funding detailsThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 64. See the NIHR Journals Library website for further project information.

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Patient-Reported Outcomes After Multiligament Knee Injury

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117694818 ◽

2017 ◽

Vol 5 (3) ◽

pp. 232596711769481 ◽

Cited By ~ 9

Author(s):

Jessica M. Hanley ◽

Christopher A. Anthony ◽

David DeMik ◽

Natalie Glass ◽

Annunziato Amendola ◽

...

Keyword(s):

Risk Factors ◽

Patient Reported Outcomes ◽

Knee Injury ◽

Lysholm Score ◽

Level Of Evidence ◽

Time To Surgery ◽

Patient Reported ◽

Ikdc Score ◽

Univariate Analyses

Background: Management of the medial collateral ligament (MCL) in the setting of a multiligamentous knee injury (MLKI) represents an area of great controversy. Purpose: Our study was designed to compare long-term patient-reported outcomes (PROs) after MCL repair versus reconstruction in the setting of a multiligamentous injury of the knee. Study Design: Cohort study; Level of evidence, 3. Methods: At a single institution, 68 patients were identified over a 10-year period as having MCL intervention in the setting of MLKI. Of these patients, 34 (50%) were successfully contacted via telephone to collect Lysholm and International Knee Documentation Committee (IKDC) scores. A retrospective chart review of these subjects was also conducted to identify patient and surgical factors affecting PROs. Results: At a mean 6-year follow-up (range, 2-11 years), the mean Lysholm score was 77.4 ± 23.1 and mean IKDC score was 72.6 ± 23.6. Univariate analyses identified time to surgery ( P = .005) and MCL reconstruction ( P = .001) as risk factors for Lysholm score ≤75. Univariate analyses identified patient age ( P = .049), time to surgery ( P = .018), and MCL reconstruction ( P = .004) as risk factors for IKDC score ≤75. On subsequent multivariate analysis, MCL reconstruction was found to be a predictor of Lysholm or IKDC score of ≤75. Conclusion: Patients undergoing MCL repair in the setting of MLKI generally had higher PROs than those undergoing reconstructions at a mean 6 years of follow-up. Further work is needed to elucidate patient and surgical factors that may influence subjective outcomes after multiligament knee injuries.

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Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence

World Journal of Urology ◽

10.1007/s00345-021-03676-8 ◽

2021 ◽

Author(s):

James R. Furr ◽

Eric S. Wisenbaugh ◽

Joel Gelman

Keyword(s):

Risk Factors ◽

Success Rate ◽

Skin Graft ◽

Long Term Results ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Patient Reported ◽

Early Success

Abstract Purpose To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence. Methods We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success. Results Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3–17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6–240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months. Conclusion Staged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up.

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Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Minimum 10-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546520962756 ◽

2020 ◽

Vol 49 (1) ◽

pp. 130-136

Author(s):

Justin W. Arner ◽

Bryant P. Elrick ◽

Philip-C. Nolte ◽

Daniel B. Haber ◽

Marilee P. Horan ◽

...

Keyword(s):

Risk Factors ◽

Humeral Head ◽

Patient Reported Outcomes ◽

Short Form ◽

Consecutive Series ◽

Long Term Outcome ◽

Arthroscopic Management ◽

Patient Reported ◽

Glenohumeral Osteoarthritis

Background: Few long-term outcome studies exist evaluating glenohumeral osteoarthritis (GHOA) treatment with arthroscopic management. Purpose: To determine outcomes, risk factors for failure, and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA at minimum 10-year follow-up. Study Design: Case series; Level of evidence, 3. Methods: The CAM procedure was performed on a consecutive series of patients with advanced GHOA who opted for joint preservation surgery and otherwise met criteria for total shoulder arthroplasty. At minimum 10-year follow-up, postoperative outcome measures included change in the American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, 12-Item Short Form Health Survey (SF-12) Physical Component Summary, and visual analog scale for pain, along with the QuickDASH (shortened version of Disabilities of the Arm, Shoulder and Hand) and satisfaction score. Kaplan-Meier survivorship analysis was performed, with failure defined as progression to arthroplasty. Results: In total, 38 CAM procedures were performed with 10-year minimum follow-up (range, 10-14 years) with a mean patient age of 53 years (range, 27-68 years) at the time of surgery. Survivorship was 75.3% at 5 years and 63.2% at minimum 10 years. Those who progressed to arthroplasty did so at a mean 4.7 years (range, 0.8-9.6 years). For those who did not undergo arthroplasty, American Shoulder and Elbow Surgeons scores significantly improved postoperatively at 5 years (63.3 to 89.6; P < .001) and 10 years (63.3 to 80.6; P = .007). CAM failure was associated with severe preoperative humeral head incongruity in 93.8% of failures as compared with 50.0% of patients who did not go on to arthroplasty ( P = .008). Median satisfaction was 7.5 out of 10. Conclusion: Significant improvements in patient-reported outcomes were sustained at minimum 10-year follow-up in young patients with GHOA who underwent a CAM procedure. The survivorship rate at minimum 10-year follow-up was 63.2%. Humeral head flattening and severe joint incongruity were risk factors for CAM failure. The CAM procedure is an effective joint-preserving treatment for GHOA in appropriately selected patients, with sustained positive outcomes at 10 years.

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Risk factor analysis for progressive spinal deformity after resection of intracanal tumors─ a retrospective study of 272 cases

10.21203/rs.2.14477/v4 ◽

2019 ◽

Author(s):

Pangbo Wang ◽

Kang Ma ◽

Tunan Chen ◽

Xingsen Xue ◽

Dada Ma ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Spinal Deformity ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Factors Affecting ◽

Tumor Involvement

Abstract Background: Progressive spinal deformity has become a well-recognized complication of intracanal tumors resection. However, the factors affecting post-operative spinal stability remain to be further research. Here, we described the current largest series of risk factors analysis for progressive spinal deformity following resection of intracanal tumors. Methods: We retrospectively analyzed the medical records of the patients with resection of intracanal tumors between January 2009 and December 2018. All patients who underwent resection of intracanal tumors performed regular postoperative follow-up were identified and included in the study. Clinical, radiological, surgical, histopathological, and follow-up data were collected. The incidence of postoperative progressive kyphosis or scoliosis was calculated. The statistical relationship between postoperative progressive spinal deformity and radiographic, clinical, and surgical variables was assessed by using univariate tests and multivariate logistic regression analysis. Results: Two hundred seventy-two patients (mean age 42.56 ± 16.18 years) with median preoperative modified McCormick score of 3 met the inclusion criteria. Among them, 7（2.6%）patients were found to have spinal deformity preoperatively, and the extent of spinal deformity in these 7 patients deteriorated after surgery. 36 (13.2%) were new cases of postoperative progressive deformity. The mean duration of follow-up was 21.8 months (median 14 months, range 6–114 months). In subsequent multivariate logistic regression analysis, age≤18 years (p=0.027), vertebral levels of tumor involvement (p = 0.019) and preoperative spinal deformity(p=0.008) was the independent risk factors (p < 0.05), increasing the odds of postoperative progressive spinal deformity by 3.94- , 0.69- and 27.11-fold, respectively. Conclusions: The incidence of postoperative progressive spinal deformity was 15.8%, mostly in these patients who had younger age (≤18 years), tumors involved in multiple segments and preoperative spinal deformity. The risk factors of postoperative progressive spinal deformity warrants serious reconsideration that when performing resection of spinal cord tumors in these patients with such risk factors, the surgeons should consider conducting follow-ups more closely, and when patients suffering from severe symptoms or gradually increased spinal deformity, surgical spinal fusion may be a more suitable choice to reduce the risk of reoperation and improve the prognosis of patients.

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Risk factor analysis for progressive spinal deformity after resection of intracanal tumors─a retrospective study of 272 cases

10.21203/rs.2.14477/v2 ◽

2019 ◽

Author(s):

Pangbo Wang ◽

Kang Ma(Former Corresponding Author) ◽

Tunan Chen ◽

Xingsen Xue ◽

Dada Ma ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Spinal Deformity ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Factors Affecting ◽

Tumor Involvement

Abstract Abstract OBJECTIVE: Progressive spinal deformity has become a well-recognized complication of intracanal tumors resection. However, the factors affecting post-operative spinal stability remain to be further research. Here, we described the current largest series of risk factors analysis for progressive spinal deformity following resection of intracanal tumors. METHODS: We retrospectively analyzed the medical records of the patients with resection of intracanal tumors between January 2009 and December 2018. All patients who underwent resection of intracanal tumors performed regular postoperative follow-up were identified and included in the study. Clinical, radiological, surgical, histopathological, and follow-up data were collected. The incidence of postoperative progressive kyphosis or scoliosis was calculated. The statistical relationship between postoperative progressive spinal deformity and radiographic, clinical, and surgical variables was assessed by using univariate tests and multivariate logistic regression analysis. RESULTS: Two hundred seventy-two patients (mean age 42.56 ± 16.18 years) with median preoperative modified McCormick score of 3 met the inclusion criteria. Among them, 7（2.6%）patients were found to have spinal deformity preoperatively, and the extent of spinal deformity in these 7 patients deteriorated after surgery. 36 (13.2%) were new cases of postoperative progressive deformity. The mean duration of follow-up was 21.8 months (median 14 months, range 6–114 months). In subsequent multivariate logistic regression analysis, age≤18 years (p=0.027), vertebral levels of tumor involvement (p = 0.019) and preoperative spinal deformity(p=0.008) was the independent risk factors (p < 0.05), increasing the odds of postoperative progressive spinal deformity by 3.94- , 0.69- and 27.11-fold, respectively. CONCLUSIONS: The incidence of postoperative progressive spinal deformity was 15.8%, mostly in these patients who had younger age (≤18 years), tumors involved in multiple segments and preoperative spinal deformity. The risk factors of postoperative progressive spinal deformity warrants serious reconsideration that when performing resection of spinal cord tumors in these patients with such risk factors, the surgeons should consider conducting follow-ups more closely, and when patients suffering from severe symptoms or gradually increased spinal deformity, surgical spinal fusion may be a more suitable choice to reduce the risk of reoperation and improve the prognosis of patients.

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Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis: Minimum 10-Year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00213 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0021

Author(s):

Justin Arner ◽

Bryant Elrick ◽

Philip Nolte ◽

Marilee Horan ◽

Peter Millett ◽

...

Keyword(s):

Risk Factors ◽

Shoulder Arthroplasty ◽

Patient Reported Outcomes ◽

Total Shoulder Arthroplasty ◽

Arthroscopic Management ◽

Kaplan Meier ◽

Patient Reported ◽

Glenohumeral Osteoarthritis

Objectives: Glenohumeral osteoarthritis (GHOA) remains a common cause of shoulder pain, loss of shoulder range of motion, and upper extremity dysfunction. Few long-term outcome studies exist evaluating glenohumeral osteoarthritis (GHOA) treatment with arthroscopic management. The purpose of this study was to determine outcomes, risk factors for failure, and survivorship for the comprehensive arthroscopic management (CAM) procedure for the treatment of GHOA at minimum 10-year follow-up. It was hypothesized that while some patients would progress to total shoulder arthroplasty (TSA), the majority of patients would demonstrate sustained improvement in patient-reported outcomes and satisfaction without conversion to TSA at long term follow-up. Methods: The CAM procedure was performed on a consecutive series of patients with advanced GHOA who opted for joint preservation surgery that otherwise met criteria for total shoulder arthroplasty (TSA). At minimum 10-year follow-up, pre- and post-operative outcome measures collected included the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Short Form–12 (SF-12) Physical Component Summary (PCS), visual analog scale for pain, and satisfaction scores. Kaplan-Meier survivorship analysis was performed with failure defined as progression to arthroplasty. Results: Thirty-eight CAM procedures were performed with 10-year minimum follow-up (range, 10-14 years) with a mean age of 53 years (range, 27-68) at time of surgery. Kaplan Meier survivorship curve showing 75.3% CAM survivorship (Comprehensive Arthroscopic Management) for glenohumeral arthritis at 5 years and 63.2% at 10 years in Figure 1. Those who progressed to arthroplasty did so at a mean of 4.7 years (range, 0.8-9.6 years). For those who did not undergo arthroplasty, ASES scores significantly improved post-operatively at both 5 and 10 years (63.3-89.6, p<0.001; 63.3-80.6, p=.007) (Table 1). CAM failure was associated with severe pre-operative humeral head incongruity in 93.8% of failures compared to 50.0.% of patients who did not go onto arthroplasty (p= 0.008). Median satisfaction was 7.5 out of 10. Conclusions: Significant improvement in patient reported outcomes were sustained at minimum 10-year follow-up in young patients with GHOA who underwent a CAM procedure. Survivorship rate at minimum 10-year follow-up was 63.2%. Humeral head flattening and severe joint incongruity were risk factors for CAM failure. The CAM procedure is an effective joint preserving treatment for GHOA in appropriately selected patients with sustained positive outcomes at 10 years. [Table: see text]

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Treatment of Massive Irreparable Rotator Cuff Tears without Arthritis: A Comparison of Superior Capsular Reconstruction, Partial Rotator Cuff Repair, and Reverse Total Shoulder Arthroplasty (228)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00336 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0033

Author(s):

Travis Frantz ◽

Marisa Ulrich ◽

Joshua Everhart ◽

Andrew Mundy ◽

Jonathan Barlow ◽

...

Keyword(s):

Risk Factors ◽

Patient Satisfaction ◽

Rotator Cuff ◽

Surgical Complications ◽

Patient Reported Outcomes ◽

Independent Predictor ◽

Total Shoulder Arthroplasty ◽

Superior Capsular Reconstruction ◽

Patient Reported

Objectives: Optimal surgical indications for massive, irreparable rotator cuff tears (RCT) without arthritis remain unclear. The purpose of this study was to compare the clinical outcomes of superior capsular reconstruction (SCR), partial rotator cuff repair (PR), and reverse total shoulder arthroplasty (rTSA) at greater than 2 years follow-up and identify any characteristics or risk factors which may correlate with outcomes. Methods: A retrospective analysis of prospectively collected data from a single tertiary academic medical center of consecutive patients undergoing surgical treatment for massive irreparable RCT without arthritis using SCR, PR (using interval slide and/or margin convergence), or rTSA from 01/01/2006 to 01/01/2018 was performed. Patients were required to be at least 18 years of age, have intraoperative confirmation of a massive, irreparable, RCT without arthritis, failed attempts at prior non-operative management, and a minimum of two years of clinical post-operative data. Patient demographics and pre-operative clinical findings (strength and range of motion (ROM), external rotation (ER) lag, pseudoparalysis, subscapularis function) were collected. Post-operative data included complications, patient satisfaction, strength and ROM, and patient reported outcomes (ASES, VAS, SANE). Multivariate analysis was also performed to identify risk factors. Results: 32 patients met inclusion criteria for SCR, 24 for PR, and 42 for rTSA (mean follow-up years: SCR 3.2; PR 4.0; rTSA 3.5; p=0.02). The rTSA patients were older (66.2 years; SCR - 57.3; PR - 59.0; p=0.0001) and more likely to be female (61.9%; SCR - 12.5%; PR - 25.0%; p<0.001) than SCR or PR. SCR patients had a larger tear measured on pre-operative MRI (4.23 cm; PR - 3.64; rTSA - 3.63; p=0.01). Intra-operative evaluation demonstrated the subscapularis to be non-functional in 37.5% for SCR, 4.2% for PR, and 21.4% for rTSA (p=0.01). There were no differences in other patient demographics and characteristics (Table 1). Pre-operative assessment demonstrated the lowest ASES scores in the rTSA group (29.48; SCR - 44.17; PR - 41.51; p=0.02), the lowest SANE scores in the SCR group (25.83; PR - 51.56; rTSA - 40.00; p=0.03), and no difference in VAS. Pre-operative active forward elevation range of motion (ROM) was significantly better in the PR group (152.29 degrees) but comparable between SCR (116.25) and rTSA (105.49; p<0.001) (Table 2). Pseudoparalysis was present in 18.8% of SCR, 0% of PR, and 14.3% of rTSA patients (p=0.08). There were no differences in the rates of positive clinical exam findings or weakness (p>0.18 for all). Comparing pre-operative to post-operative outcomes within respective groups (Table 3), all groups saw significant post-operative improvement in strength in all planes and all patient reported outcomes (p<0.036 for all). SCR and rTSA both demonstrated improved forward elevation ROM post-operatively while PR did not (p=0.96). No group experienced a significant improvement in internal or external rotation ROM post-operatively (p>0.12 for all). When comparing between the three groups (Table 4), rTSA had significantly worse post-operative ROM in all planes when compared to SCR and PR (p<0.003 for all). There were no differences between groups in post-operative strength in any plane (p>0.16 for all) or patient reported outcomes (ASES p=0.14; VAS p=0.86; SANE p=0.61). Patients were satisfied or somewhat satisfied in 81.2% of SCR cases, 87.5% of PR, and 95.3% of rTSA (p=0.33). Regarding surgical complications, 3 of 32 (9.4%) SCR patients required conversion to rTSA, while 3 of 24 (12.5%) PR patients required reoperation (2 revision repairs, one conversion to rTSA). There were 4 surgical complications among 42 rTSA patients (9.5%) (2 acromial stress fractures - 1 operative, 1 non-operative; 1 dislocation requiring open reduction). There were 4 non-surgical complications in the SCR group (2 falls resulting in 1 distal radius fracture and 1 HAGL lesion; 1 persistent pain; 1 persistent stiffness) and 1 stroke in the rTSA group. One SCR patient and 3 rTSA patients were deceased within the follow-up time period. Multivariate analysis demonstrated no independent predictors of revision surgery, and the only independent predictors of patient satisfaction to be improved pre-op active ER ROM (0.03) and strength (p=0.048). However, older age (0.03), improved pre-op internal rotation (IR) strength (0.03), and having SCR (p=0.048) or PR (p=0.045) rather than rTSA were independent predictors of an improved post-op ASES score. Male gender was found to be an independent predictor of improved post-operative forward elevation ROM (p=0.03) (Table 7), while undergoing rTSA was an independent predictor of worse post-operative IR and ER ROM (p<0.009 for all). An increased AH interval distance was an independent predictor of improved post-operative strength across groups for all planes of motion (p<0.02). The presence of pseudoparalysis pre-operatively was predictive of worse post-op ER strength (p=0.003), but no difference in any other plane (p>0.05 for all). Conclusions: SCR, PR, and rTSA for massive, irreparable RCT without arthritis all significantly improved post-op strength and outcome scores with >80% patient satisfaction, but with rTSA having worse post-op ROM. For all patients, increased pre-op ER ROM and strength correlated with improved patient satisfaction, while increased AH distance correlated with improved post-op strength. No further risk factors were identified, and further study is needed to continue to delineate indications for each operation.

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