A Prediction Modeling Based on the Hospital for Special Surgery (HSS) Knee Score for Poor Postoperative Functional Prognosis of Elderly Patients with Patellar Fractures

Background. The main aim of this study was to develop a nomogram prediction model for poor functional prognosis after patellar fracture surgery in the elderly based on the hospital for special surgery (HSS) knee score. Methods. A retrospective analysis of 168 elderly patients with patellar fractures was performed to collect demographic data, knee imaging, and functional prognosis preoperatively and during the 6-month postoperative follow-up period. Good functional prognosis of knee joint was defined as the percentage of HSS knee scores on the injured side relative to the uninjured side ≥ 80 % at six-month postoperative review. Multifactorial linear regression analysis and logistic regression analysis were then used to identify risk factors of functional prognosis and develop the nomogram prediction model. Furthermore, the validity and accuracy of the prediction model were evaluated using C-index, area under the curve (AUC), and decision curve analyses. Results. The final screening from the 12 potential risk factors yielded three high-risk factors which were included in the nomogram prediction model: advanced age (OR 0.28 (95% CI 0.11-0.67), P = 0.005 ), sarcopenia (OR 0.11 (95% CI 0.05-0.26), P < 0.001 ), and low albumin level (OR 1.14 (95% CI 1.02-1.29), P = 0.025 ). The model had a good predictive ability with an AUC of 0.857 (95% CI (0.783-0.929)) for the training group and a C-index of 0.836 for the overall sample. In addition, the decision analysis curve indicated that the model had good clinical applicability. Conclusion. Our predictive model is effective in predicting the risk of poor functional prognosis after patellar fracture surgery in the elderly by assessing high-risk factors such as advanced age, sarcopenia, and serum albumin levels. This prediction model can help clinicians to make individualized risk prediction, early identification of patients at high risk for poor functional outcome, and appropriate interventions.

Functional outcome of judet’s quadriceptoplasty in posttraumatic stiff knees.

Objective: To evaluate functional outcomes of Judet’s Quadriceptoplasty in posttraumatic stiff knees according to Judet’s criteria and Hospital for special surgery score of knee. Study Design: Retrospective Cohort Study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan. Period: January 2015 to June 2017. Material & Methods: 74 patients 61 males and 13 femal with stiff knees underwent Judet’s Quadriceptoplasty and followed by 12 weeks of aggressive rehabilitation and followed by aggressive rehabilitation for 12 weeks. Range of motion was measured with goniometer at last follow up. Outcomes were measured in terms of Judet’s criteria and Hospital for special surgery score of the knee. Results: Mean age at time of operation was 33.70±10.66 years. According to Judet’s criteria 68.9% (51) patients have excellent range of motion, 21.6% (16) have Good, 6.8% (5) patients have fair, 2.7% (2) have poor outcome. According to Hospital for special surgery score of the knee (HSS) mean score was 86.68±5.92 (60-96). There were 83.8% (62), 13.5% (10) and 2.7% (2) cases in excellent, good and fair group respectively. Blood loss was minimum 250ml max 650ml mean 443ml. Conclusion: Judet’s quadriceptoplasty for knee extension contracture is a useful procedure to increase the range of motion of stiff knees.

Reliability and Validity of Adapted Russian Version of Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey

Background: Patients’ expectations are an important determinant in their decision to undergo lumbar spinal surgery—particularly their expectations of recovery after surgery. The Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey (HSS-LSSES) is one tool used to assess this; however, the original version was only available in English. Objective: We sought to evaluate the reliability and validity of a translated and adapted Russian-language version of the HSS-LSSES. Methods: This was a prospective study of 91 patients with degenerative disc disease who underwent lumbar spine surgery with instrumented fixation at a single institution in Saint Petersburg, Russia. Patients were recruited between December 2019 and February 2021 and asked about their expectations of surgery with a translated and adapted Russian version of the HSS-LSSES. To analyze construct validity, participants also completed disease-specific and general quality-of-life scales (Oswestry Disability Index, European Quality of Life–5 Dimensions, and 36-item Short-Form Health Survey). Intraclass correlation coefficients (ICCs; 2-way random effects model, absolute agreement) were used to determine test-retest reliability of the total score of the Russian HSS-LSSES. Internal consistency was evaluated through the estimation of Cronbach’s alpha between the test and retest response of the questionnaire. Results: The test-retest stability of the Russian HSS-LSSES evaluated through the estimation of ICC was found to have good stability. The instrument was shown to have high internal consistency. Conclusion: This study demonstrates that a translated and adapted Russian version of HSS-LSSES had good internal consistency, reliability, construct validity, and no floor and ceiling effects. Therefore, we recommend its use as a tool for evaluating Russian-speaking patients’ expectations before lumbar spine surgery.

Differences in Patients’ and Surgeons’ Expectations before Shoulder Stabilization Surgery

Purpose: The primary goal of shoulder stabilization procedures is to re-establish stability and many surgeons measure the success after shoulder stabilization surgery only by the absence of re-dislocation. However, patients might also suffer from pain, loss of range of motion and strength as well as anxiety and stigmatization and therefore have other expectations from a stabilization surgery than just a stable shoulder. Purpose of this study was to analyze if surgeons know what their patients typically expect from a shoulder stabilization surgery. Furthermore, the aim was to analyze the influence of various factors on patients’ expectations. Materials and Methods: 204 patients with a diagnosis of shoulder instability scheduled for surgical treatment were included in this prospective multicentric study. Preoperatively, objective and subjective scores were obtained and patients were asked about their postoperative expectations. Additionally, 25 surgeons were interviewed with regard to what they think their patients expect from the surgery using standardized questions. Results: With regard to postoperative expectations surveyed by the Hospital for Special Surgery questionnaire (HSS), the most important goal to achieve for the patients was ‘stopping the shoulder from dislocation’, followed by ‘to improve the ability to exercise or participate in sports’ and ‘being the shoulder to be back the way it was before the issue started’. The ranking of factors for patients was ‘stability’ as the most important to achieve, followed by ‘movement’, ‘strength’, ‘pain’ and ‘cosmetics’. For surgeons, the order was ‘stability’ (p = 0.004 **), ‘movement’ (p = 0.225), ‘pain’ (p = 0.509), ‘strength’ (p = 0.007 **) and ‘cosmetics’ (p = 0.181). There was a significant difference between patients and surgeons with regard to gaining stability at the cost of movement (p = 0.001 **). Conclusion: Patients and surgeons expectations regarding outcome after surgical shoulder stabilization procedures are quite similar with limited topics of disagreement. Generally, surgeons tend to overrate the importance of stability at the costs of other factors.

Translation and transcultural validation of the Dutch hospital for special surgery paediatric functional activity brief scale (HSS Pedi-FABS)

Background There is a need for a validated simple Dutch paediatric activity scale. The purpose was to translate and transculturally validate the Dutch Hospital for Special Surgery Paediatric Functional Activity Brief Scale (HSS Pedi-FABS) questionnaire in healthy children and adolescents. Methods The original HSS Pedi-FABS was translated forward and backward and was transculturally adapted after performing a pilot study among children and professionals. The final version of the Dutch HSS Pedi-FABS was validated in healthy children and adolescents aged 10 to 18 years old. Children who had any condition or injury limiting their normal physical activity were excluded. The interval between the first questionnaire T0 (HSS Pedi-FABS, Physical Activity Questionnaire for children or adolescents (PAQ-C/A) and Tegner activity scale) and the second questionnaire T1 (HSS Pedi-FABS) was 2 weeks. Construct validity, interpretability and reliability were evaluated. Content validity was evaluated through cognitive interviews among a smaller group of children and through a questionnaire among professionals. Results To evaluate content validity, 9 children and adolescents were interviewed, and 30 professionals were consulted. Content validity among professionals showed a relevance of less than 85% for most items on construct. However, content validity among children was good with a 92% score for item relevance. Readability was scored at a reading level of 11- to 12-year-olds. The validation group consisted of 110 healthy children and adolescents (mean age of 13.9 years ±2.6). Construct validity was considered good as 8 out of 10 hypotheses were confirmed. The Dutch HSS Pedi-FABS showed no floor or ceiling effect. Analysis of the internal consistency in the validation group resulted in a Cronbach’s alpha of 0.82. Test-retest reliability was evaluated among 69 children and adolescents and revealed an Intraclass Correlation Coefficient (ICC) of 0.76. Conclusion The Dutch HSS Pedi-FABS showed good psychometric properties in a healthy Dutch paediatric and adolescent population. Limitations of the current Dutch HSS Pedi-FABS are content validity on construct of items reported by professionals.

Functional Outcome of “Reconstruction Patellar Plate” in the treatment of patella fractures

Background: The patellar fractures treatment has changed by enhancements in both an improved understanding of patellar function and fracture fixation techniques. The goals of operative fixation include repair of extensor mechanism, restoration of articular congruity, secure fixation and early movements. In this Study Reconstruction patellar plate was introduced in the management of patellar fracture. Aim: To determine the Functional outcome of fixation method of patella fractures by Open Reduction and Internal Fixation with Reconstruction Patellar Plate. Methods: This Prospective study was performed at Department of Orthopaedic Surgery at Lahore General Hospital for a period of 12 months after the approval Research Board of University of health Sciences, Lahore. Non probability purposive sampling method was used to induct 30 patients (who met the inclusive Criteria) underwent reconstruction patellar plate for the treatment of patella fracture. The patients were followed in outpatient department at 4 weeks and 16 weeks. Variables mentioned in Modified Hospital for Special Surgery Knee Score were recorded and Knee score was calculated and graded at 16 weeks. Results: In this study, overall mean age was 25.26 ± 5.02 years. There were 19 (63%) male and 11 (37%) female subjects. The mean of Modified Hospital for Special Surgery Knee Score (MHSSKS) was 84.90±8.87. In this study, there were 12(40%) patients with excellent functional outcome, 14 (46.67%) patients with good functional outcome and 4(13.34%) patients with fair functional outcome. There was no patient with poor functional outcome. Conclusion: Reconstruction Patellar Plate fixation method of patella fractures by Open Reduction and Internal Fixation produced good Functional outcome, which can be familiarized as an alternate to tension band method for the treatment of transverse patellar fracture. Keywords: fracture, patellar, reconstruction patellar plate, tension Band wiring

Preoperative characteristics and intraoperative factors do not correlate with accomplishments of active straight-leg raising, standing up, and walking after primary total knee arthroplasty

Background The correlations between patient characteristics and early postoperative functional performances after total knee arthroplasty have not been adequately studied. The purpose of this study was to clarify the effects of preoperative characteristics (sex, age, body mass index, American Society of Anesthesiologists grade, hospital for special surgery score) and intraoperative factors (duration of surgery and tourniquet use) on the time required to accomplish active straight-leg-raising, standing up, and walking as the objective performances for the initiation of early postoperative rehabilitation. Methods This cross-sectional retrospective study included 307 patients (384 primary total knee arthroplasties). Postoperative times required until each activity was accomplished were measured. Various preoperative characteristics and intraoperative factors that might affect three objective performances were evaluated. Results The postoperative times required before each activity was accomplished were 1.5 ± 0.5 days for active straight-leg-raising, 1.2 ± 0.5 days for standing up, and 1.4 ± 0.7 days for walking. There were no significant correlations between any factor (age, body mass index, hospital for special surgery score, duration of surgery, and tourniquet use) and the three objective performances using Spearman’s correlation coefficient. There were no differences in sex or American Society of Anesthesiologists grade for three objective functional assessments by Wilcoxon rank sum test. Conclusions Differences in patient preoperative characteristics and intraoperative factors are unlikely to affect three objective functional performances in the early postoperative period. Therefore, there is no need to consider differences between patients when initiating early postoperative rehabilitation.

Autologous Osteochondral Transplantation for Young Patients with Postcollapse Osteonecrosis of the Knee: A Retrospective Cohort Study with an Average 7-Year Follow-Up

Background Only a few studies exist that have assessed the efficacy of autologous osteochondral transplantation (AOT) treatment of osteonecrosis (ON) of the knee. The purpose of this study was to clarify the clinical and radiographic results of AOT performed on young patients with postcollapse ON of the knee. Methods This retrospective study included 14 young patients (6 men, 8 women, mean age 34.71 ± 5.41 years) with stage III knee ON undergoing AOT surgery. Mean follow-up time was 87 ± 10.23 months. The postoperative clinical and radiological evaluations were based on Hospital for Special Surgery (HSS) scores and plain x-rays. Paired t tests were used for the statistical analysis by SPSS software. Results Preoperative HSS (mean 66.86 ± 7.49 points) was significantly improved at mean 7 years to a postoperative HSS (mean 87.36 ± 8.63 points) ( P < 0.001). The postoperative rangeof motion (ROM; 125.71° ± 4.74°) was not significantly different from the preoperative ROM (126.86° ± 7.13°) ( P = 0.626). There was no progression of collapse observed in any knees at the last follow-up. No knees required any reoperations during the follow-up period. Conclusion Fourteen young patients with local ON of the knee were treated by AOT. No progression of bone collapse was seen and clinical improvement sustained at mean 7 years postsurgery. AOT seems to be a safe technique that can give long-term improvement and durability in young ON patients. However, large-sample and high-quality clinical trials are still needed in the future.

A Bibliometric Analysis and Visualisation of Research Trends in Surface Modification of knee Implants

Several metals are used for Knee implants. The bibliometric analysis had been conducted to understand the active authors, organizations, journals, and countries involved in the research domain of “Surface modification of knee implants”. All published articles related to “Surface modification of knee implants” from “Scopus”, were analyzed using the VOS viewer to develop analysis tables and visualization maps. This article had set the objective to consolidate the scientific literature regarding “Surface modification of knee implants”.” and also to find out the trends related to the same. The most active journals in this research domain were Journal of Arthroplasty and Journal of Bone and Joint Surgery. The most active country was the United States of America. The leading organization engaged in research regarding surface modification of knee implants was the Hospital for Special Surgery of the United States of America. The most active authors were Wright T.M. and Jacobs J.J.