Nonresponder bias in hand surgery: analysis of 1945 cases lost to follow-up over a 6-year period

2021 ◽  
pp. 175319342110456
Author(s):  
Paul H. C. Stirling ◽  
Paul J. Jenkins ◽  
Nathan Ng ◽  
Nicholas D. Clement ◽  
Andrew D. Duckworth ◽  
...  
Keyword(s):  
Postoperative Outcome ◽  
Hand Surgery ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Level Of Evidence ◽  
Loss To Follow Up ◽  
Significant Difference ◽  
Patient Reported ◽  
The Impact

The primary aim of this study was to identify factors associated with nonresponse to routinely collected patient-reported outcome measures (PROMs) after hand surgery. The secondary aim was to investigate the impact of nonresponder bias on postoperative PROMs. We identified 4357 patient episodes for which the patients received pre- and 1-year postoperative questionnaires. The response rate was 55%. Univariate and regression analyses were undertaken to determine factors predicting nonresponse. We developed a predictive model for the postoperative Quick version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores for nonresponders using imputation. Younger age, increasing deprivation, higher comorbidity, worse preoperative QuickDASH scores and unemployment predicted nonresponse. No significant difference in mean postoperative QuickDASH score was observed between the responders, and the scores for the responders combined with the predicted scores for the nonresponders. Preoperative function was the primary predictor of postoperative outcome. These results challenge the dogma that ‘loss to follow-up’ automatically invalidates the results of a study. Level of evidence: III

scholarly journals Return to Sport After Large Single-Surface, Multisurface, or Bipolar Osteochondral Allograft Transplantation in the Knee Using Shell Grafts

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712096792
Author(s):  
James L. Cook ◽  
Kylee Rucinski ◽  
Cory R. Crecelius ◽  
Richard Ma ◽  
James P. Stannard
Keyword(s):  
Femoral Condyle ◽  
Case Series ◽  
Return To Sport ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Osteochondral Allograft ◽  
Level Of Evidence ◽  
Recreational Athletes ◽  
Patient Reported

Background: Return to sport (RTS) after osteochondral allograft (OCA) transplantation for large unipolar femoral condyle defects has been consistent, but many athletes are affected by more severe lesions. Purpose: To examine outcomes for athletes who have undergone large single-surface, multisurface, or bipolar shell OCA transplantation in the knee. Study Design: Case series; Level of evidence, 4. Methods: Data from a prospective OCA transplantation registry were assessed for athletes who underwent knee transplantation for the first time (primary transplant) between June 2015 and March 2018 for injury or overuse-related articular defects. Inclusion criteria were preinjury Tegner level ≥5 and documented type and level of sport (or elite unit active military duty); in addition, patients were required to have a minimum of 1-year follow-up outcomes, including RTS data. Patient characteristics, surgery type, Tegner level, RTS, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures were assessed and compared for statistically significant differences. Results: There were 37 included athletes (mean age, 34 years; range, 15-69 years; mean body mass index, 26.2 kg/m2; range, 18-35 kg/m2) who underwent large single-surface (n = 17), multisurface (n = 4), or bipolar (n = 16) OCA transplantation. The highest preinjury median Tegner level was 9 (mean, 7.9 ± 1.7; range, 5-10). At the final follow-up, 25 patients (68%) had returned to sport; 17 (68%) returned to the same or higher level of sport compared with the highest preinjury level. The median time to RTS was 16 months (range, 7-26 months). Elite unit military, competitive collegiate, and competitive high school athletes returned at a significantly higher proportion ( P < .046) than did recreational athletes. For all patients, the Tegner level at the final follow-up (median, 6; mean, 6.1 ± 2.7; range, 1-10) was significantly lower than that at the highest preinjury level ( P = .007). PROMs were significantly improved at the final follow-up compared with preoperative levels and reached or exceeded clinically meaningful differences. OCA revisions were performed in 2 patients (5%), and failures requiring total knee arthroplasty occurred in 2 patients (5%), all of whom were recreational athletes. Noncompliance was documented in 4 athletes (11%) and was 15.5 times more likely ( P = .049) to be associated with failure or a need for revision than for compliant patients. Conclusion: Large single-surface, multisurface, or bipolar shell OCA knee transplantations in athletes resulted in two-thirds of these patients returning to sport at 16 to 24 months after transplantation. Combined, the revision and failure rates were 10%; thus, 90% of patients were considered to have successful 2- to 4-year outcomes with significant improvements in pain and function, even when patients did not RTS.

scholarly journals Lisfranc injuries: fix or fuse?

2021 ◽  
Vol 2 (10) ◽  
pp. 842-849
Author(s):  
Noortje Anna Clasina van den Boom ◽  
Guido A. N. L. Stollenwerck ◽  
Laureanne Lodewijks ◽  
Jeroen Bransen ◽  
Silvia M. A. A. Evers ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Risk Of Bias ◽  
Level Of Evidence ◽  
Assessment Development ◽  
Significant Difference ◽  
Patient Reported ◽  
Mean Differences ◽  
Lisfranc Injuries

Aims This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. Methods A systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis. Results A total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. Conclusion This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I Cite this article: Bone Jt Open 2021;2(10):842–849.

scholarly journals Results of Functional Treatment of Epi-Metaphyseal Fractures of the Base of the Fifth Metatarsal

2020 ◽  
Vol 41 (6) ◽  
pp. 666-673 ◽  
Author(s):  
Sebastian F. Baumbach ◽  
Marcel Urresti-Gundlach ◽  
Wolfgang Böcker ◽  
J. Turner Vosseller ◽  
Hans Polzer
Keyword(s):  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Functional Treatment ◽  
Type I ◽  
Level Of Evidence ◽  
Midterm Outcome ◽  
Patient Reported ◽  
Fracture Types ◽  
Metaphyseal Fractures

Background: Fractures of the fifth metatarsal base (5th MT) are common foot injuries, but their treatment remains a subject of debate. The aim was to assess the midterm outcome of functionally treated epi-metaphyseal fractures (Lawrence and Botte types I and II) of the 5th MT. Methods: This study was a longitudinal retrospective database study with prospective follow-up. Included were all patients with an acute, isolated fracture to the 5th MT base (types I and II). All patients were treated functionally: weightbearing as tolerated without immobilization. Fracture types and fracture characteristics (displacement <2 mm/>2 mm, articular involvement, number of fragments) were assessed retrospectively. Patient-reported outcome measures (PROMs) including the visual analog scale for foot and ankle (VAS FA) and the quality-of-life score (QoL) SF-12 were collected prospectively at 2- and 5-year follow-up. Out of 95 patients, 43 patients (45%) were included with a median follow-up of 5.7 (1.5) years. Results: For both the VAS FA and SF-12, excellent scores were observed. For 30 patients (77%), longitudinal 2- and 5-year follow-up was available. No significant longitudinal changes could be observed for the VAS FA and SF-12. For both time points, neither fracture type nor characteristics significantly influenced any outcome parameter assessed. Conclusion: Functional treatment by full weightbearing and free range of motion led to excellent 5-year results for both type I and II fractures. Neither fracture location nor characteristics had a significant influence on the 5-year PROMs. Level of Evidence: Level III, comparative study.

scholarly journals Are responders to patient health surveys representative of those invited to participate? An analysis of the Patient-Reported Outcome Measures Pilot from the Australian Orthopaedic Association National Joint Replacement Registry

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254196
Author(s):  
Ian A. Harris ◽  
Kara Cashman ◽  
Michelle Lorimer ◽  
Yi Peng ◽  
Ilana Ackerman ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Joint Replacement ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Telephone Call ◽  
Joint Replacement Registry ◽  
Asa Score ◽  
Significant Difference ◽  
Patient Reported

Background Patient-reported outcome measures (PROMs) are commonly used to evaluate surgical outcome in patients undergoing joint replacement surgery, however routine collection from the target population is often incomplete. Representative samples are required to allow inference from the sample to the population. Although higher capture rates are desired, the extent to which this improves the representativeness of the sample is not known. We aimed to measure the representativeness of data collected using an electronic PROMs capture system with or without telephone call follow up, and any differences in PROMS reporting between electronic and telephone call follow up. Methods Data from a pilot PROMs program within a large national joint replacement registry were examined. Telephone call follow up was used for people that failed to respond electronically. Data were collected pre-operatively and at 6 months post-operatively. Responding groups (either electronic only or electronic plus telephone call follow up) were compared to non-responders based on patient characteristics (joint replaced, bilaterality, age, sex, American Society of Anesthesiologist (ASA) score and Body Mass Index (BMI)) using chi squared test or ANOVA, and PROMs for the two responder groups were compared using generalised linear models adjusted for age and sex. The analysis was restricted to those undergoing primary elective hip, knee or shoulder replacement for osteoarthritis. Results Pre-operatively, 73.2% of patients responded electronically and telephone follow-up of non-responders increased this to 91.4%. Pre-operatively, patients responding electronically, compared to all others, were on average younger, more likely to be female, and healthier (lower ASA score). Similar differences were found when telephone follow up was included in the responding group. There were little (if any) differences in the post-operative comparisons, where electronic responders were on average one year younger and were more likely to have a lower ASA score compared to those not responding electronically, but there was no significant difference in sex or BMI. PROMs were similar between those reporting electronically and those reporting by telephone. Conclusion Patients undergoing total joint replacement who provide direct electronic PROMs data are younger, healthier and more likely to be female than non-responders, but these differences are small, particularly for post-operative data collection. The addition of telephone call follow up to electronic contact does not provide a more representative sample. Electronic-only follow up of patients undergoing joint replacement provides a satisfactory representation of the population invited to participate.

scholarly journals Minimum ten-year follow-up of a randomized trial comparing acetabular component fixation of two porous in-growth surfaces using radiosteriometric analysis

2020 ◽  
Vol 1 (10) ◽  
pp. 653-662
Author(s):  
Luthfur Rahman ◽  
Mazin S. Ibrahim ◽  
Lyndsay Somerville ◽  
Matthew G. Teeter ◽  
Douglas D. Naudie ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
P Value ◽  
Significant Difference ◽  
Patient Reported ◽  
Acetabular Components

Aims To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA). Methods This was a minimum ten-year follow-up of a prospective randomized trial of 62 hips with two different porous ingrowth acetabular components. RSA exams had previously been acquired through two years of follow-up. Patients returned for RSA examination at a minimum of ten years. In addition, radiological appearance of these acetabular components was analyzed, and patient-reported outcome measures (PROMs) obtained. Results In all, 15 hips were available at ten years. There was no statistically significant difference in PROMS between the two groups; PROMs were improved at ten years compared to preoperative scores. Conventional radiological assessment revealed well-fixed components. There was minimal movement for both porous surfaces in translation (X, Y, Z, 3D translation in mm (median and interquartile range (IQR)), StikTite (Smith and Nephew, Memphis, Tennessee, USA): 0.03 (1.08), 0.12 (0.7), 0.003 (2.3), 0.37 (0.30), and Roughcoat (Smith and Nephew): -0.6 (0.59),–0.1 (0.49), 0.1 (1.12), 0.48 (0.38)), and rotation (X, Y, Z rotation in degrees (median and IQR), (Stiktite: -0.4 (3), 0.28 (2), -0.2 (1), and Roughcoat: - 0.4 (1),–0.1 (1), 0.2 (2)). There was no statistically significant difference between the two cohorts (p-value for X, Y, Z, 3D translation - 0.54, 0.46, 0.87, 0.55 and for X, Y, Z rotation - 0.41, 0.23, 0.23 respectively) at ten years. There was significant correlation between two years and ten years 3D translation for all components ( r = 0.81(p =< 0.001)). Conclusion Both porous ingrowth surfaces demonstrated excellent fixation on plain radiographs and with RSA at ten years. Short-term RSA data are good predictors for long-term migration data.

scholarly journals Long-term Patient-Reported Outcome Measures Following Particulated Juvenile Allograft Cartilage Implantation for Treatment of Difficult Osteochondral Lesions of the Talus

2021 ◽  
pp. 107110072110141
Author(s):  
Joseph Manzi ◽  
Artine Arzani ◽  
Mathew J. Hamula ◽  
Kshitij Manchanda ◽  
Dinesh Dhanaraj ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Short Form ◽  
Preoperative Assessment ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Patient Reported

Background: Conventional methods are not suitable for difficult to treat osteochondral lesions of the talus (OCLTs). The role of particulated juvenile allograft articular cartilage implantation is not well elucidated for long-term patient outcomes. Methods: Thirteen patients with difficult-to-treat OCLTs underwent arthroscopy-assisted implantation of particulated juvenile articular cartilage graft into defects from 2010 to 2012 by the same surgeon. “Difficult to treat” was defined as having at least 3 of the following features or 2 if both variables described lesion characteristics: (1) lesions size of 107 mm2 or greater, (2) shoulder lesions, (3) patients who failed microfracture, (4) patient aged ≥40 years, or (5) patient body mass index (BMI) >25. Patients were evaluated using physical examination, patient interviews, and outcome score measures. Patients had follow-up at 2 years, 4 years, and between 6 and 10 years at their most recent follow-up. Differences in functional outcome scores were compared before and after surgery. Results: Patients (age: 46.5 ± 11.8 years, BMI: 28.5 ± 6.1) had, on average, most recent follow-up of 8.0 years (range 72-113 months). Average visual analog scale for pain score decreased for patients by 3.9 points (95% confidence interval [CI] 2.18-5.60), when compared to preoperative assessment. Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscale scores also improved from 46.5 to 80.9 (95% CI 21.35-47.43), and from 18.8 to 57.9 (95% CI 21.05-57.10), respectively. Short Form–36 Health Survey physical component scores showed significant improvement by an average of 45.5 points (95% CI 32.42-58.50). American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale scores improved from 55.2 to 80.3 (95% CI 12.459-37.741). Conclusion: These results demonstrate positive patient-reported long-term outcomes for a cohort of patients with difficult OCLTs, followed over the course of 6-10 years after treatment with arthroscopy-assisted particulated juvenile articular cartilage implantation. Level of Evidence: Level II, prospective cohort study.

Kinematically Aligned Total Knee Arthroplasty Did Not Show Superior Patient-Reported Outcome Measures: An Updated Meta-analysis of Randomized Controlled Trials with at Least 2-Year Follow-up

2020 ◽  
Author(s):  
Shuhei Hiyama ◽  
Tsuneari Takahashi ◽  
Katsushi Takeshita
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Clinical Results ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Significant Difference ◽  
Patient Reported ◽  
Total Knee

AbstractKinematically aligned total knee arthroplasty (KATKA) was developed to improve the anatomical alignment of knee prostheses, assisting in restoring the native alignment of the knee and promoting physiological kinematics. Early clinical results were encouraging, showing better functional outcomes than with mechanically aligned total knee arthroplasty (MATKA). However, there have been concerns about implant survival, and follow-up at 10 years or more has not been reported. In addition, randomized controlled trials (RCTs) comparing KATKA with MATKA have reported inconsistent results. The current meta-analysis of RCTs with a minimum of 2 years of follow-up investigated the clinical and radiological differences between KATKA and MATKA. A systematic review of the English language literature resulted in the inclusion of four RCTs. The meta-analysis found no significant difference in any of the following parameters: postoperative range of motion for flexion (mean difference for KATKA − MATKA [MD], 1.7 degrees; 95% confidence interval [CI], −1.4 to 4.8 degrees; p = 0.29) and extension (MD, 0.10 degrees; 95% CI, −0.99 to 1.2 degrees; p = 0.86); Oxford Knee Score (MD, 0.10 points; 95% CI, −1.5 to 1.7 points; p = 0.90); Knee Society Score (MD, 1.6 points; 95% CI, −2.8 to 6.0 points; p = 0.49); and Knee Function Score (MD, 1.4 points; 95% CI, −4.9 to 7.8 points; p = 0.66). In addition, there was no significant difference between KATKA and MATKA in the rate of complications requiring reoperation or revision surgery (odds ratio, 1.01; 95% CI, 0.25–4.09; p = 0.99) or in the length of hospital stay (MD, 1.0 days; 95% CI, −0.2 to 2.2 days; p = 0.092). KATKA did not increase the number of patients with poor clinical results due to implant position, particularly for varus placement of the tibial component. In this meta-analysis based on four RCTs with a minimum of 2 years of follow-up, KATKA were only relevant to cruciate retaining TKA and could not be extrapolated to posterior stabilized TKA. Patient-reported outcome measures with KATKA were not superior to those with MATKA.

scholarly journals Differences in men and women suffering from CRSwNP and AERD in quality of life

2020 ◽  
Author(s):  
Tina J. Bartosik ◽  
David T. Liu ◽  
Nicholas J. Campion ◽  
Sergio Villazala-Merino ◽  
Stefan Janik ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Included Patient ◽  
Single Center Study ◽  
Significant Difference ◽  
Patient Reported ◽  
The Impact ◽  
Impaired Quality

Abstract Purpose While the overall impact of chronic rhinosinusitis (CRS) on patients’ health is diverse, many affected individuals have a substantially impaired quality of life (QoL). The aim of this study was to evaluate the impact of sex-associated differences specifically in the subgroups of CRS with nasal polyps (CRSwNP) and aspirin-exacerbated respiratory disease (AERD) by assessing QoL parameters in women and men separately. Methods In a retrospective single-center study, 59 patients with CRSwNP (39 males and 20 females) and 46 patients with AERD (18 males and 28 females) were included. Patient-reported outcome measures (PROM) evaluating QoL via the Sino-Nasal Outcome Test-20 German Adapted Version (SNOT-20 GAV) as well as the total polyp score (TPS) were analysed. Results There was no significant difference in TPS (p = 0.5550) and total SNOT-20 GAV scores (p = 0.0726) between male or female patients with CRSwNP or AERD. Furthermore, no significant sex differences were found within disease groups regarding the subcategories of the SNOT-20 GAV items. Conclusion Thus, quality of life is severely impaired in patients suffering from various forms of CRS regardless of their sex.

scholarly journals The COVID-19 pandemic and follow-up for shoulder surgery: The impact of a shift toward telemedicine on validated patient-reported outcomes

2021 ◽  
pp. 1357633X2199099 ◽  
Author(s):  
Ramsey Sabbagh ◽  
Nihar Shah ◽  
Sarah Jenkins ◽  
Jacob Macdonald ◽  
Austin Foote ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Short Form ◽  
Total Shoulder Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Shoulder Surgery ◽  
Phone Call ◽  
Significant Difference ◽  
Patient Reported ◽  
The Impact

Introduction The emergence of COVID-19 and its ensuing restrictions on in-person healthcare has resulted in a sudden shift towards the utilization of telemedicine. The purpose of this study is to assess patient satisfaction and patient-reported outcome measures (PROMs) for individuals who underwent follow-up for shoulder surgery using telemedicine compared to those who received traditional in-person clinic follow-up. Methods Patients who underwent either rotator cuff repair or total shoulder arthroplasty during a designated pre-COVID-19 (traditional clinic follow-up) or peri-COVID-19 (telemedicine follow-up) span of time were identified. PROMs including the American Shoulder and Elbow Surgeons standardized assessment form, the three-level version of the EQ-5D form, the 12-Item Short Form survey, and a modified version of a published telemedicine survey were administered to participants six months post-operatively via phone call. Results Sixty patients agreed to participate. There was no significant difference between the pre-COVID-19 and peri-COVID-19 groups in patient satisfaction with their follow-up visit ( p = 0.289), nor was there a significant difference in PROMs between the two groups. In total, 83.33% of the telemedicine group and 70.37% of the in-person clinic group preferred traditional in-person follow-up over telemedicine. Discussion In a cohort of patients who underwent telemedicine follow-up for shoulder surgery during the COVID-19 pandemic, there was no difference in patient satisfaction and PROMs compared to traditional in-person clinic follow-up. This study indicates that while the majority of participants preferred face-to-face visits, patients were relatively satisfied with their care and had similar functional outcome scores in both groups, despite the large disruption in healthcare logistics caused by COVID-19.

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