scholarly journals Clinical Outcomes Evaluation of Combined Valgus and Chiari Osteotomy Inconsistent with Patient Satisfaction

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Akira Hozumi ◽  
Kennichi Kidera ◽  
Ko Chiba ◽  
Takayuki Shida ◽  
Makoto Osaki
Keyword(s):  
Japanese Orthopaedic Association ◽  
Patient Reported Outcome ◽  
Evaluation Tool ◽  
Patient Dissatisfaction ◽  
Outcomes Evaluation ◽  
Patient Reported ◽  
Hip Disease ◽  
The Mean ◽  
Chiari Osteotomy

The Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire, which is tailored to Japanese lifestyles, has recently been developed in Japan as a patient-reported outcome measure. In this study, combined valgus and Chiari osteotomy were evaluated using the JHEQ and JOA scores. The subjects were 42 hips of 39 patients with a mean age at surgery of 45.3 years. The mean follow-up period was 95.3 months. Radiological osteoarthritis stage, preoperative and postoperative JOA scores, JHEQ score at final follow-up, and patient dissatisfaction with hip joint status rated on a visual analog scale were evaluated. The factors that affected patient dissatisfaction were also identified using multiple regression analysis. Radiological osteoarthritis stage at final follow-up was either maintained or improved in 85.7%. The mean JOA score improved from 57.2 preoperatively to 78.7 at final follow-up. The JHEQ score at final follow-up, however, was low, at 43.3 points. Patients who were comparatively satisfied accounted for 47.6%. Of the JHEQ subscales, movement had the lowest scores, and this was the subscale that had the greatest effect on patient dissatisfaction. The present results suggest that the results of JOA score are inconsistent for postoperative patients’ satisfaction after CVCO, and patient-based evaluation tool must also be used.

scholarly journals Treatment Outcomes of Total Ankle Arthroplasty Using an Artificial Talus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0021
Author(s):  
Takaaki Hirano ◽  
Yui Akiyama ◽  
Tomoko Karube ◽  
Naoki Haraguchi ◽  
Hisateru Niki ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Japanese Society ◽  
Japanese Orthopaedic Association ◽  
Total Ankle Arthroplasty ◽  
Short Term ◽  
Short Term Treatment ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
The Mean

Category: Ankle Arthritis Introduction/Purpose: Problems associated with mid- to long-term total ankle arthroplasty (TAA) include loosening and sinking of the talus implant. These problems arise due to a lack of stability compared with artificial joints such as knees and hips. In Japan, aluminum ceramic talus implants have been developed and are reported to result in good treatment outcomes. Here we investigated and report the treatment outcomes for combined TAA (cTAA), in which TAA is combined with a talus implant during the initial procedure. Methods: We assessed 15 cases involving 16 feet that underwent cTAA for which follow-up was available for at least 6 months. These cases comprised five feet with stage IIIb osteoarthritis and nine feet with stage IV osteoarthritis according to the Takakura classification as well as two feet with talus necrosis. The mean patient age was 73.5 years, and the mean follow-up period was 9.1 months. The talus implant was completely customized for all cases, and TNK Ankle (Kyocera, Japan) tibial components were used. Assessments were performed before and after surgery using the Japanese Society for Surgery of the Foot scale (JSSF scale) for physician-led objective evaluation and the Japanese Orthopaedic Association/Japanese Society for Surgery of the Foot and Self- Administered Foot Evaluation Questionnaire (SAFE-Q) subscales for patient-reported subjective evaluation. The validity and reliability of the JSSF scale and SAFE-Q have been verified by metering psychological verification. Scores were compared using paired t-tests. Results: The mean JSSF score improved significantly from 46.7 points preoperatively to 85.3 points postoperatively. For the SAFE-Q, pain and pain-related scores improved significantly from 40.5 points preoperatively to 75.8 points postoperatively (p < 0.001), physical function and daily lifestyle status improved significantly from 41.1 points preoperatively to 72.9 points postoperatively (p < 0.001), social lifestyle function improved significantly from 37.8 points preoperatively to 76.4 points postoperatively (p < 0.001), and overall sense of health improved significantly from 51.7 preoperatively to 80.7 postoperatively (p < 0.001). Shoe-related results improved from 50.0 points preoperatively to 69.4 points postoperatively (p = 0.038). Only one postoperative complication was noted, which was a case of deep wound infection. Conclusion: Short-term outcomes for cTAA were mostly good in our study population. The findings suggest that talus implants could be used as a treatment option for cases involving severe deformities, crushed talus injuries, and bone defects in which the use of TAA had previously been difficult, which can be handled with cTAA. These findings reveal new possibilities for expanded indications going forward. However, as these were short-term treatment outcomes, further follow-up is required in future studies.

scholarly journals Radiological and mid- to long-term patient-reported outcome after stabilization of traumatic thoraco-lumbar spinal fractures using an expandable vertebral body replacement implant

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Siegmund Lang ◽  
Carsten Neumann ◽  
Christina Schwaiger ◽  
Andreas Voss ◽  
Volker Alt ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Spinal Fractures ◽  
Patient Reported Outcome ◽  
Bony Fusion ◽  
Sf 36 ◽  
Patient Reported ◽  
The Mean ◽  
Lumbar Spinal

Abstract Background For the treatment of unstable thoraco-lumbar burst fractures, a combined posterior and anterior stabilization instead of a posterior-only instrumentation is recommend in the current literature due to the instability of the anterior column. Data on restoring the bi-segmental kyphotic endplate angle (BKA) with expandable vertebral body replacements (VBR) and on the mid- to long-term patient-reported outcome measures (PROM) is sparse. Methods A retrospective cohort study of patients with traumatic thoraco-lumbar spinal fractures treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany) between 2001 and 2015 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively, 6 months and at least 2 years after the VBR surgery. The BKA was measured and fusion-rates were assessed. The SF-36, EQ-5D and ODI questionnaires were evaluated prospectively. Results Ninety-six patients (25 female, 71 male; age: 46.1 ± 12.8 years) were included in the study. An AO Type A4 fracture was seen in 80/96 cases (83.3%). Seventy-three fractures (76.0%) were located at the lumbar spine. Intraoperative reduction of the BKA in n = 96 patients was 10.5 ± 9.4° (p < 0.01). A loss of correction of 1.0 ± 2.8° at the first follow-up (t1) and of 2.4 ± 4.0° at the second follow-up (t2) was measured (each p < 0.05). The bony fusion rate was 97.9%. The total revision rate was 4.2%. Fifty-one patients (53.1% of included patients; age: 48.9 ± 12.4 years) completed the PROM questionnaires after 106.4 ± 44.3 months and therefore were assigned to the respondent group. The mean ODI score was 28.2 ± 18.3%, the mean EQ-5D VAS reached 60.7 ± 4.1 points. Stratified SF-36 results (ISS < and ≥ 16) were lower compared to a reference population. Conclusion The treatment of traumatic thoraco-lumbar fractures with an expandable VBR implant lead to a high rate of bony fusion. A significant correction of the BKA could be achieved and no clinically relevant loss of reduction occurred during the follow-up. Even though health related quality of life did not reach the normative population values, overall satisfactory results were reported.

Does femoral morphology and stem alignment influence outcomes of cementless total hip arthroplasty with proximally coated double-tapered titanium stems?

2020 ◽  
pp. 112070001989170 ◽  
Author(s):  
Rajkishen Narayanan ◽  
Ameer M Elbuluk ◽  
Kevin K Chen ◽  
Nima Eftekhary ◽  
Joseph D Zuckerman ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Thigh Pain ◽  
Leg Length ◽  
Neck Shaft Angle ◽  
Patient Dissatisfaction ◽  
Patient Reported ◽  
Femoral Morphology

Introduction: Stem subsidence and thigh pain can cause significant patient dissatisfaction after cementless THA. The purpose of this study was to examine the effect of proximal-femoral morphology and stem alignment on clinical outcomes using a double-tapered, cementless titanium femoral component. Methods: We retrospectively reviewed 281 consecutive, primary THAs from 2012 to 2014 with a mean follow-up of 4 years. Preoperative radiographs were used to assess femoral neck shaft angle (FNS), canal flare index (CFI), Dorr classification, and greater trochanter (GT) overhang. Postoperative radiographs were used to determine stem alignment and 6-week follow-up radiographs were used to determine subsidence. Clinical outcomes included thigh pain, leg-length discrepancy (LLD), patient-reported outcome measures (PROMs) and revision surgeries. Results: 271 stems (96%) did not subside (<4 mm) and 10 (4%) showed evidence of subsidence (>4 mm). Subsidence was significantly associated with subsequent revision surgery ( p < 0.01). 278 stems (99%) were in neutral alignment and 3 in varus (1%). Alignment did not significantly influence subsidence, thigh pain, LLD, revisions, or PROMs. Femoral morphology measures (FNS, CFI, Dorr classification, and GT overhang) were not significantly associated with stem alignment, subsidence, LLD, or revisions. CFI was significantly associated with intraoperative calcar fractures ( p = 0.02). GT overhang was associated with thigh pain ( p = 0.03) and FNS was inversely associated with postoperative HOOS scores. Conclusions: Subsidence and proximal-femoral morphology are potential sources of postoperative morbidity in certain cementless THA patients. In accordance with prior studies, CFI was identified as a potential risk factor for intraoperative calcar fractures. More research into preoperative femoral morphologies, such as GT overhang and FNS, is warranted as these may contribute to unsatisfactory results related to cementless THA.

Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement

2019 ◽  
Vol 47 (9) ◽  
pp. 2029-2037 ◽  
Author(s):  
Hirotaka Nakashima ◽  
Manabu Tsukamoto ◽  
Yasuo Ohnishi ◽  
Hajime Utsunomiya ◽  
Shiho Kanezaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Reported Outcome ◽  
Labral Tear ◽  
Harris Hip Score ◽  
Patient Reported ◽  
Outcome Scores ◽  
The Mean ◽  
Modified Harris Hip Score ◽  
Reconstruction Group

Background:The acetabular labrum plays important roles in proprioception, nociception, synovial fluid seal effect, and static and dynamic joint stability and as a shock absorber. Clinical and radiographic risk factors for unsalvageable labral tear in femoroacetabular impingement (FAI) are not well established.Purpose:To identify predictors of unsalvageable labral tear during initial hip arthroscopic management of FAI.Study Design:Case-control study; Level of evidence, 3.Methods:Patients were included who underwent primary hip arthroscopic treatment for FAI between March 2009 and March 2014. Patients were excluded who had <2-year follow-up, underwent bilateral surgery, or had a history of surgery, osteoarthritis (Tönnis grade 2 or 3), and other diagnoses, including lateral center-edge angle <25° diagnosed as developmental hip dysplasia. Patients were divided into 2 groups according to their labral condition: reconstruction and refixation. Unsalvageable labral tear was defined as any irreparable labral tear, including severe degenerative tear, frayed labrum, labral ossification, flattened labrum, and failed prior repair during surgery. Univariate and multivariate analyses identified risk factors for segmental labral reconstruction. Patient-reported outcome scores and postoperative revision rates were also assessed.Results:Twenty-five hips (18 male, 7 female) and 126 hips (65 male, 61 female) were included in the reconstruction and refixation groups, respectively. The mean ± SD ages were 52.6 ± 15.0 and 36.5 ± 16.1 years in the reconstruction and refixation groups, respectively. In the reconstruction group, the mean modified Harris Hip Score significantly improved from 67.3 ± 14.9 preoperatively to 95.0 ± 8.1 at final follow-up ( P < .001), and the mean Nonarthritic Hip Score improved from 63.0 ± 18.3 preoperatively to 89.5 ± 10.1 at final follow-up ( P < .001). In the refixation group, the mean modified Harris Hip Score significantly improved from 69.2 ± 18.6 preoperatively to 93.0 ± 11.2 at final follow-up ( P < .001), and the mean Nonarthritic Hip Score improved from 60.7 ± 18.8 preoperatively to 88.6 ± 15.0 at final follow-up ( P < .001). No significant difference was noted in patient-reported outcome scores and revision hip arthroscopy rates. The rate of conversion of total hip arthroplasty was higher in the reconstruction group than in the refixation group. Risk factors for unsalvageable labral tear were age ≥45 years (odds ratio [OR], 8.83; P < .007), body mass index ≥23.1 kg/m2(OR, 13.05; P < .001), and vertical center anterior angle ≥36° (OR, 19.03; P < .001). Furthermore, in this study, unsalvageable labral tears were present in cases with at least 2 of the 3 risk factors.Conclusion:Age ≥45 years, body mass index ≥23.1 kg/m2, and vertical center anterior angle ≥36° are risk factors for unsalvageable labral tear at initial hip arthroscopic surgery for patients with FAI.

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

2020 ◽  
Vol 48 (2) ◽  
pp. 385-394 ◽  
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.

Concurrent femoral head reduction and periacetabular osteotomies for the treatment of severe femoral head deformities

2018 ◽  
Vol 100-B (12) ◽  
pp. 1551-1558 ◽  
Author(s):  
J. C. Clohisy ◽  
C. Pascual-Garrido ◽  
S. Duncan ◽  
G. Pashos ◽  
P. L. Schoenecker
Keyword(s):  
Femoral Head ◽  
Periacetabular Osteotomy ◽  
Alpha Angle ◽  
Young Patients ◽  
Patient Reported Outcome ◽  
Harris Hip Score ◽  
Short Term ◽  
Patient Reported ◽  
The Mean

AimsThe aims of this study were to review the surgical technique for a combined femoral head reduction osteotomy (FHRO) and periacetabular osteotomy (PAO), and to report the short-term clinical and radiological results of a combined FHRO/PAO for the treatment of selected severe femoral head deformities.Patients and MethodsBetween 2011 and 2016, six female patients were treated with a combined FHRO and PAO. The mean patient age was 13.6 years (12.6 to 15.7). Clinical data, including patient demographics and patient-reported outcome scores, were collected prospectively. Radiologicalally, hip morphology was assessed evaluating the Tönnis angle, the lateral centre to edge angle, the medial offset distance, the extrusion index, and the alpha angle.ResultsThe mean follow-up was 3.3 years (2 to 4.6). The modified Harris Hip Score improved by 33.0 points from 53.5 preoperatively to 83.4 postoperatively (p = 0.03). The Western Ontario McMasters University Osteoarthritic Index score improved by 30 points from 62 preoperatively to 90 postoperatively (p = 0.029). All radiological parameters showed significant improvement. There were no long-term disabilities and none of the hips required early conversion to total hip arthroplasty.ConclusionFHRO combined with a PAO resulted in clinical and radiological improvement at short-term follow-up, suggesting it may serve as an appropriate salvage treatment option for selected young patients with severe symptomatic hip deformities.

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

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.

Does size of tendon gap affect patient-reported outcome following Achilles tendon rupture treated with functional rehabilitation?

2020 ◽  
Vol 102-B (11) ◽  
pp. 1535-1541 ◽  
Author(s):  
Mohamed Yassin ◽  
Richard Myatt ◽  
William Thomas ◽  
Vatsal Gupta ◽  
Tagrit Hoque ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Patient Reported Outcome ◽  
Gap Size ◽  
Functional Rehabilitation ◽  
Patient Reported ◽  
Dynamic Ultrasound ◽  
The Mean

Aims Functional rehabilitation has become an increasingly popular treatment for Achilles tendon rupture (ATR), providing comparably low re-rupture rates to surgery, while avoiding risks of surgical complications. Limited evidence exists on whether gap size should affect patient selection for this treatment option. The aim of this study was to assess if size of gap between ruptured tendon ends affects patient-reported outcome following ATR treated with functional rehabilitation. Methods Analysis of prospectively collected data on all 131 patients diagnosed with ATR at Royal Berkshire Hospital, UK, from August 2016 to January 2019 and managed non-operatively was performed. Diagnosis was confirmed on all patients by dynamic ultrasound scanning and gap size measured with ankle in full plantarflexion. Functional rehabilitation using an established protocol was the preferred treatment. All non-operatively treated patients with completed Achilles Tendon Rupture Scores (ATRS) at a minimum of 12 months following injury were included. Results In all, 82 patients with completed ATRS were included in the analysis. Their mean age was 51 years (standard deviation (SD) 14). The mean ATRS was 76 (SD 19) at a mean follow-up of 20 months (SD 11) following injury. Gap inversely affected ATRS with a Pearson’s correlation of -0.30 (p = 0.008). Mean ATRS was lower with gaps > 5 mm compared with ≤ 5 mm (73 (SD 21) vs 82 (SD 16); p = 0.031). Mean ATRS was lowest (70 (SD 23)) with gaps > 10 mm, with significant differences in perceived strength and pain. The overall re-rupture rate was two out of 131 (1.5%). Conclusion Increasing gap size predicts lower patient-reported outcome, as measured by ATRS. Tendon gap > 5 mm may be a useful predictor in physically demanding individuals, and tendon gap > 10 mm for those with low physical demand. Further studies that control for gap size when comparing non-operative and operative treatment are required to assess if these patients may benefit from surgery, particularly when balanced against the surgical risks. Cite this article: Bone Joint J 2020;102-B(11):1535–1541.

scholarly journals Patient-Reported Outcome Following Operative and Conservative Treatment of Calcaneal Fractures: A Retrospective Analysis of 79 Patients at Short- to Midterm Follow-Up

2021 ◽  
Vol 8 ◽  
Author(s):  
Patrick Pflüger ◽  
Michael Zyskowski ◽  
Frederik Greve ◽  
Chlodwig Kirchhoff ◽  
Peter Biberthaler ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Functional Outcome ◽  
Retrospective Analysis ◽  
Patient Reported Outcome ◽  
Calcaneal Fractures ◽  
Severe Injuries ◽  
Patient Reported ◽  
The Mean ◽  
Operative And Conservative Treatment

Background: Fractures of the calcaneus are severe injuries of the hindfoot, mostly resulting from high-energy axial loads, which still present enormous challenges to modern trauma surgery. Possible variables influencing the outcome are the type of fracture, age, and quality of fracture reduction. These might also be factors affecting the self-reported patient outcome, but large studies are still lacking. Therefore, the aim of this study was to analyze the patient-reported outcome of calcaneal fractures following operative and conservative treatment.Methods: All patients suffering from calcaneal fractures between 2002 and 2015 were enrolled in this retrospective analysis. The calcaneal fractures were classified according to Sanders and the AO classification system. For further analysis, two groups were formed: group I involved complex intra-articular fractures defined by the involvement of the posterior calcaneal facet, while group II consisted of extra-articular and process calcaneal fractures. Data were collected via the patient registry, radiographs, and a standardized questionnaire (Foot and Ankle Outcome Score, FAOS). For outcome analysis, non-parametric Mann–Whitney U-test was performed, and Spearman's rank correlation coefficient was calculated.Results: In total, the functional outcome of 79 patients with calcaneal fractures was analyzed. In group 1 (n = 43), the mean FAOS score was 65.5 ± 18.9. The surgically treated patients with a Sanders type II calcaneal fracture had a mean FAOS score of 72.9 ± 17.2, type III fractures had 65.6 ± 20.8, and type IV had 61.1 ± 19 (p = 0.15). The reoperation rate was 22%, most frequently caused by wound complications (10%). The mean follow-up time was 64.5 ± 44 months. The mean FAOS score of group 2 (n = 36) was 75.2 ± 18.4, and 83% of the patients (=30) were managed conservatively. Only one out of six operatively managed patients had a reoperation due to regular implant removal. The mean follow-up time was 31 ± 25.9 months.Conclusion: Intra-articular calcaneal fractures are severe injuries of the hindfoot leading to a fair to poor functional outcome in the majority of the patients. Complications regarding wound healing are the most common causes for revisional surgery. Extra-articular calcaneal fractures are a heterogenous entity commonly managed non-operatively. Overall, they show a better functional outcome in comparison to intra-articular calcaneal fractures.

Patient-Reported Outcome Following Ulnotriquetral Ligament Split Tear Repair

2017 ◽  
Vol 22 (04) ◽  
pp. 445-451 ◽  
Author(s):  
Camelia Qian Ying Tang ◽  
Sean Wei Hong Lai ◽  
Geraldine Leow ◽  
Shian Chao Tay
Keyword(s):  
Grip Strength ◽  
Patient Reported Outcomes ◽  
Clinical Presentation ◽  
Surgical Repair ◽  
Patient Reported Outcome ◽  
Range Of Movement ◽  
Post Surgery ◽  
Patient Reported ◽  
The Mean

Background: While the clinical presentation and mechanism of injury of ulnotriquetral (UT) ligament split tear had been well described, there has been no other studies that has reported on the outcome of a UT ligament repair. This study aims to look at the patient-reported outcomes following UT ligament split tear repair. Methods: 18 wrists (13 right and 5 left) in 17 patients (12 males and 5 females, mean age 25.0 ± 8.4 years, range 16–50 years) who had UT ligament split tear and undergone surgical repair between November 2007 and December 2013 were retrospectively analysed. Patient-reported outcome of resolution of pain, and objective measurements such as improvement in grip strength and range of movement of the wrist were recorded. Patients were followed up until the pain was completely resolved or the last documented consultation. The mean follow-up duration was 16.2 months. Results: 94% reported improvements post-surgery, of which 63% reported complete resolution of pain. 6% reported no improvement in pain post-operatively. No patient reported worsening of pain after the surgery. There was significant improvement in grip strength from a mean of 23.5 kg to 27.1 kg. There was no significant change in range of motion of the wrist. Conclusions: The majority of patients reported resolution or improvement of pain after surgical repair. In addition, there was statistically significant improvement in grip strength recorded.

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