Differences In Outcome Scores Research Articles

A Single Injection of Amniotic Suspension Allograft Is Safe and Effective for Treatment of Mild to Moderate Hip Osteoarthritis: A Prospective Study

The purpose of our study was to examine the effects of a commercially available amniotic suspension allograft (ASA) (ReNu, Organogenesis, Canton, MA) in a patient population with moderate osteoarthritis of the hip. Ten patients with symptomatic hip osteoarthritis, defined as Tonnis grade 1 or 2 on radiographic examination, were prospectively enrolled. Each patient received a single image-guided injection of ASA into the hip joint. Patient-reported outcomes measures, including the 12-item International Hip Outcome Tool, Modified Harris Hip Score, and Single Assessment Numeric Evaluation scores were recorded at baseline, 6 months, and 12 months postinjection. A linear regression model was performed to detect differences in outcome scores from baseline. Nine patients had complete 12-month data available for analysis. One patient failed treatment and underwent arthroplasty at 2 months postinjection. The cohort includes 5 males and 4 females, aged 47-67. International Hip Outcome Tool scores demonstrated a significant improvement between baseline and 12 months (P= .02). Single Assessment Numeric Evaluation scores demonstrated a significant difference between baseline and 6 months (P < .01), as well as between baseline and 12 months (P < .01). Modified Harris Hip Scores demonstrated a significant difference between baseline and 6 months (P= .02) and between baseline and 12 months (P= .01). There were no major adverse events in the course of the study period. This study demonstrates promising results for relief of pain and improvement in patient-reported outcomes with intra-articular ASA in patients with moderate osteoarthritis of the hip for up to one year, although the exact mechanism of action remains unknown. LEVELOFEVIDENCE: IV, case series.

Weightbearing Protocols After Posterolateral Corner Reconstruction: A Systematic Review.

Background:Multiligamentous knee injuries with a posterolateral corner injury represent a devastating insult to the knee.Purpose:To evaluate multiligamentous knee reconstruction rehabilitation programs and recommend a rehabilitation program based on a review of published outcomes studies.Study Design:Systematic review; Level of evidence, 4.Methods:A MEDLINE (PubMed), OVID, and Embase database search was conducted using the terms “posterolateral corner” and “rehabilitation.” All articles obtained were examined to confirm their rehabilitation programs for multiligamentous knee injuries. These injuries included a posterolateral corner injury plus an isolated anterior or posterior cruciate ligament injury or a combined cruciate injury.Results:Ten publications representing 245 patients with multiligamentous knee reconstruction were analyzed. Rehabilitation protocols were divided by weightbearing (WB) status: in 2 studies, patients were non-WB until postoperative 4 weeks (delayed WB; n = 61); 5 studies permitted progressive WB until postoperative 6 weeks (progressive WB; n = 123); and 3 studies allowed WB immediately after surgery (immediate WB; n = 61). No significant difference in outcome scores among the 3 WB groups was found. Arthrofibrosis requiring manipulation under anesthesia was the most common complication (11%) in the delayed WB group, followed by the immediate WB group (3%) and the progressive WB group (0%; P < .01). Overall complication rates were highest in the delayed WB group (44%), followed by the immediate and progressive WB groups (25% and 3%, respectively; P < .00001). The delayed WB group was permitted to return to sport at a mean of 10.5 months from the index procedure; the progressive WB group, at 6.0 months; and the immediate WB group, at 9.0 months (P < .05).Conclusion:This review revealed no significant difference in outcome scores when comparing immediate, progressive, and delayed WB protocols. Time to permitted return to sport was not significantly different among the groups, but there existed a trend toward earlier return in the progressive WB group. Patients in the delayed and immediate WB groups experienced a higher overall complication rate. Progressive WB postoperative protocols may decrease the risk of complications without compromising outcomes; however, more research is needed to identify the optimal postoperative rehabilitation protocol, given the significant data heterogeneity currently available in the literature.

Is Labral Size Predictive of Failure with Repair in Hip Arthroscopy? A Review of 571 Cases

The purpose is to assess whether labral size is predictive of labral repair failure or demonstrates association with patient outcomes post-hip arthroscopy. A retrospective chart review was performed for patients undergoing arthroscopic hip labral repair from April 2009 to July 2015. Labral size was measured in 4 quadrants (antero-inferior, antero-superior, posterior-superior, and posterior-inferior). The average size across torn labral segments was assessed for statistical significance with labral repair failure as determined by patient reported outcomes (PROs) and need for additional surgery. Outcomes were evaluated for any continuous correlation as well as significant differences between classes of labral sizes derived from quartile and decile ranges. Included hips were those from patients between the ages 18 and 55 with 2-year postoperative follow up and lateral center edge angles (LCEA) between 25-40°. Exclusion criteria included less than 2 year follow up, Tonnis osteoarthritis grade ≥ 2, coxa profunda or protrosio, previous hip surgeries, pediatric hip conditions such as Perthes and slipped capital femoral epiphysis, avascular necrosis, and certain surgical factors such as labral debridement or reconstruction, and peri-trochanteric or deep gluteal space procedures. A total of 571 hips were included in the study. The mean labral width of involved quadrants was 5.35 ± 1.40 mm. Labral width averages did not show significant difference between those requiring revision versus those not requiring revision (p= .4054). There was no significant correlation between labral width and the change in preoperative and 2-year postoperative iHOT (R2 = 0.05780), mHHS (R2 = 0.19826), or NAHS (R2 = 0.23543) outcome scores. Those with labral sizes in the upper decile of our cohort showed significantly decreased improvement in the iHOT (p= .0287) and NAHS (p= .0490) when compared to the middle 50% of labral sizes. No significant differences in outcome scores were found for the bottom decile, bottom quartile, or upper quartile groups compared to middle 50%. Labral size did not predict clinical outcomes or need for revision in the majority of patients in our cohort. Hypertrophic labrums in the largest 10th percentile, or a size of 7.3 mm or greater, demonstrated lower postoperative outcome scores. This may suggest that patients with extremely large labrums may not improve after arthroscopy to the same degree as those with more normally sized labrums. However, for the majority of patients it is reasonable to suggest differences in labral size should not alter the treatment plan if morphology is otherwise standard. The reported poor outcomes associated with hypoplastic or hypertrophic labra may be due to associated factors rather than labral size alone.

Assessment of Impact of a mHealth Self-Management Intervention for Children with Sickle Cell Disease

Introduction: Children with sickle cell disease (SCD) frequently experience pain beginning in early childhood progressing throughout the lifespan. SCD-related pain during childhood is associated with decreased physical, psychological, social, and quality of life (QOL) outcomes. As a chronic, multi-organ condition, treatment for SCD may require complicated preventive health and acute treatment regimens necessitating development of self-management strategies for children and their families. mHealth may be an ideal mechanism for implementation of self-management strategies. A mHealth self-management intervention was developed with an end-user-based approach (Voice Crisis Alert V2) and guided by the Pediatric Self-Management model. Initial feasibility testing was conducted. This abstract describes preliminary impacts of the Voice Crisis Alert V2 intervention on symptoms and QOL. Methods: The characteristics and names of application (app) components such as "Crisis Care" and "I'm in Pain" are outlined in Table 1. Targeted sample size was 60 dyads of children with SCD up to age 18 and the parent/caregiver. For assessment of impact, data sources included app use, child and parent/caregiver surveys at baseline, mid-intervention, end-of intervention and post-intervention. Survey instruments included the PROMIS SF for anxiety, fatigue, depressive symptoms, pain interference, pain intensity and sleep disturbance, and the PedsQL and Sickle Cell Disease Module (SCDM) for health-related quality of life (HRQOL). Data analysis was conducted using descriptive statistics, t-tests, Wilcoxon Signed Rank test, and Spearman's rho. Independent variables were number of times and length of time (minutes) using the app and individual app components. Dependent variables were pre-post differences in scores for total PedQL, school functioning, total SCDM, and subscales: pain and hurt, pain intensity, pain management, and treatments. Results are reported with 95% CIs. Results: The most substantial pre- to post-intervention differences in symptoms and QOL scores were noted in children ages 8 - 17. Pre-post-intervention differences in scores demonstrated improvement for all symptoms outcomes except anxiety, with clinically significant improvements in depressive symptoms, fatigue, and pain interference. Improvement in total scores and all subscale scores on the PedsQL and SCDM instruments were also noted from pre- to post-intervention. The majority of correlations had CIs that crossed zero, indicating either negative or positive associations may be observed in the population. Thus, overall, frequency and length of app use was not correlated with degree of improvement in outcomes. Negative correlations were observed between the number of times the Crisis Care component was used and treatment score (rs = -.46, 95% CI [-.75, -.00]), the number of minutes the Crisis Care component was used and the treatment score (rs = -.54, 95% CI [-.80, -.11]), and the number of minutes the Crisis Care component was used and the total SCDM score (rs = -.48, 95% CI [-.77, -.03]). These correlations suggest more frequent and longer use of the Crisis Care component was associated with less substantial improvement in SCDM total score and treatments score. Conclusions: Greater improvement in scores for children ages 8 - 17 compared to children less than 8 years suggests the intervention may be particularly useful in older children with SCD. Changes in scores from pre- to post-intervention and their CIs suggest intervention use may lead to improvement in the following domains: fatigue, pain interference, HRQOL, physical functioning, social functioning, pain and hurt, pain impact, pain management, and treatments. While improvements in scores from pre- to post-intervention were noted in nearly all areas, few meaningful correlations were observed between app use and differences in outcome scores. Improvement in symptoms and QOL outcomes may be attributable to individual characteristics, such as disease severity, or the amount and type of app use required to develop self-management skills may be individualized. Sample sizes were small and future efficacy testing is warranted with a larger sample. Disclosures Kanter: AGIOS: Membership on an entity's Board of Directors or advisory committees; BEAM: Membership on an entity's Board of Directors or advisory committees; NHLBI Sickle Cell Advisory Board: Membership on an entity's Board of Directors or advisory committees; SCDAA Medical and Research Advisory Board: Membership on an entity's Board of Directors or advisory committees; Cowen: Honoraria; Wells Fargo: Honoraria; bluebird bio, inc: Consultancy, Honoraria; Novartis: Consultancy; Sanofi: Consultancy; Medscape: Honoraria; Guidepoint Global: Honoraria; GLG: Honoraria; Jeffries: Honoraria.

Effect of Travel Time and Distance on Outcomes in Total Ankle Arthroplasty

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Surgeons who perform a higher volume of total ankle arthroplasty (TAA) are known to have decreased complication rates; evidence shows that low volume centers performing TAA have decreased survivorship when compared with high volume centers. Understanding differences in outcomes for patients traveling different distances for their TAA is important for future patients deciding where to travel for their surgery. No study has previously examined differences in outcomes of patients traveling different distances to a high volume center for their TAA. This study compares preoperative and postoperative PROMIS scores for patients undergoing total ankle arthroplasty who traveled less than and more than 50 miles for their TAA. We hypothesized that there would be no difference in outcome scores based on distance traveled or estimated drive time.Methods:This study is a single center retrospective review of 162 patients undergoing primary total ankle arthroplasty between January 2016 and December 2018. We collected the primary address as listed in the patient’s medical record and used the directions feature on Google Maps to estimate driving mileage and estimated driving time from the patient’s address to the hospital. To analyze the distance patients traveled, patients were divided into two groups: <50 miles traveled (n=91) and >50 miles traveled (n=71). To analyze the estimated drive time, patients were divided into two groups: <90 minutes (n=77), >90 minutes (n=85). We collected preoperative and most recent postoperative PROMIS scores for all patients. Differences in most recent post-operative PROMIS scores between distance groups and travel time groups were assessed using multivariable linear regression models, adjusting for the pre-operative score and follow-up time.Results:We found no significant difference in post-operative PROMIS scores between the two groups when analyzed for distance traveled or for estimated travel time after adjustment for pre-operative PROMIS score and follow-up time (Table 1). The average follow-up for all 162 patients was 1.49 years. Power analysis showed that with a sample size of 110 (55 in each group), we had 81% power to detect an effect size of 4. Patients saw an increase in their Physical Function scores and a decrease in their Pain Interference and Pain Intensity scores with postoperative scores better than population means (Table 1). Overall complication rate for the <50 miles group was 17.6%, 7.7% required surgery. The >50 miles group had an overall complication rate of 24.0%, 9.9% required surgery.Conclusion:Patients traveling further distances to a high volume orthopedic specialty hospital for their total ankle arthroplasty do not have different clinical outcomes than patients traveling shorter distances. This is particularly important for patients deciding where to have their total ankle arthroplasty surgery. Patients who travel further have the opportunity to be treated at a local academic center; however our results show that outcomes do not change when traveling further for total ankle arthroplasty.

Superior capsular reconstruction using a porcine dermal xenograft for irreparable rotator cuff tears: outcomes at minimum two-year follow-up

To evaluate midterm outcomes of arthroscopic superior capsular reconstruction (SCR) using a decellularized porcine dermal xenograft in patients with massive, irreparable rotator cuff tears and to determine the influence of concomitant, repairable subscapularis tears. This is a retrospective study of 56 patients with a minimum 2-year follow-up. Preoperative and postoperative range of motion, American Shoulder and Elbow Surgeonsscore, Subjective Shoulder Value, and visual analog score for pain were measured. Postoperative data were collected at 3, 6, 12, 24, and 36 months. Of the 56 patients who underwent arthroscopic SCR, there were 39 men and 17 women. The mean age at operation was 65 ± 9 years, and the mean follow-up was 34 ± 8 months. The mean preoperative American Shoulder and Elbow Surgeons improved from 41 ± 19 to 78 ± 18 at 24 weeks, to 86± 16 at 12 months, and to 90±9 at 24 months, P < .0001. Similarly, the mean preoperative Subjective Shoulder Value improved from 39 ± 17 to 74 ± 18 at 24 weeks, to 80 ± 18 at 12 months, and to 80 ± 11 at 24 months, P < .0001. The mean preoperative visual analog score improved from 6.5 ± 2.1 to 1.4 ± 2.2 at 24 weeks, to 0.7± 1.1 at 12 months, and to 0.2 ± 0.4 at 24 months, P < .0001. There were no differences in outcome scores between patients with intact vs. repaired subscapularis. Similarly, no statistically significant differences were found in forward flexion or external rotation after SCR between patients with an intact vs. repaired subscapularis. Failure of the SCR graft was observed on magnetic resonance imaging in 14 patients, 4 of whom opted for revision to reverse shoulder arthroplasty. Eleven patients were truly pseudoparalytic before surgery; in 5 cases, pseudoparalysis was reversed after SCR. SCR can alleviate pain and disability from irreparable rotator cuff tears and provide significant improvements in shoulder function; however, the xenograft technique resulted in inconsistent reversal of true pseudoparalysis. No difference was found between patients who required concomitant subscapularis repair vs. those who did not.

Prior Pelvic Osteotomy Affects the Outcome of Subsequent Total Hip Arthroplasty

BackgroundAlthough pelvic osteotomy (PO) is an important surgical procedure that can alleviate symptoms and potentially slow progression of osteoarthritis in patients with development dysplasia of the hip, some patients eventually require conversion to total hip arthroplasty (THA). This study aimed to determine the outcome of conversion THA in patients with prior PO. MethodsForty nine patients with a history of prior PO who underwent conversion THA at a single institution were matched at a 1:3 ratio based on the date of surgery, age, gender, and body mass index with 147 developmental dysplasia of the hip patients who underwent primary THA without prior PO. A retrospective chart review was performed to compare outcomes at a minimum follow-up of 2 years. ResultsPatients with prior PO required more supplemental screw fixation for the acetabular component (59.2% vs 38.1%, P = .016), more autologous bone grafting (24.5% vs 11.6%, P = .048), had a longer mean operative time (106.0 vs 79.8 minutes, P < .001), and greater estimated blood loss (350.0 vs 206.8 mL, P = .015). Patients with prior PO had smaller cup version angle (26.0° vs 29.0°, P = .012) and greater discrepancy in the limb length (10.3 vs 7.26 mm, P = .041). Eight hips (16.3%) with prior PO and 6 (4.1%) without osteotomy required reoperation (P = .008). There was no difference in outcome scores at the latest follow-up.Conclusion: THA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation. ConclusionTHA after prior PO is technically demanding, leading to longer operative times, greater blood loss, and variation in implant placement. Although functional outcomes are similar, THA after a prior PO is more likely to require reoperation.

Outcomes of Arthroscopic Rotator Cuff Repair in Stiff Shoulders are Comparable to Non-Stiff Shoulders When Combined With Manipulation Under Anesthesia

The purpose of this study was to compare the outcomes of arthroscopic rotator cuff repair (ARCR) in patients with preoperative stiffness to those without. A total of 135 patients were prospectively evaluated for 2 years after ARCR for small to medium sized rotator cuff tears at our institution. Patients were divided into stiff (<100° of passive forward flexion) and non-stiff cohorts. The stiff group underwent manipulation under anesthesia (MUA) before ARCR was performed. Outcomes were measured using visual analog scale (VAS), Constant Shoulder Score (CSS), and Oxford Shoulder Score (OSS) recorded at the preoperative, 6- , 12-, and 24-month time points. The results of ARCR between the cohorts were then compared. A total of 123 out of 135 patients (91.1%) completed the follow-up (stiff n= 46, non-stiff n= 77). There were significant improvements in the mean CSS scores at 6 (mean, 59.87; P < .001) and 12 months (mean, 65.88; P= .021) in the stiff group. There were no significant differences detectable in the CSS and OSS scores between the stiff and non-stiff groups at 6, 12, and 24 months. However, the percentage of patients achieving minimal clinically important difference was significantly higher in the stiff group (97.8%) compared with the non-stiff group (75.3%; P= .001). The VAS scores, forward flexion, and strength in both groups were found to be comparable. The results of our study showed no significant differences in outcomes scores in patients with stiff shoulders who underwent MUA combined with ARCR compared with patients with non-stiff shoulders who underwent ARCR alone. Therefore, early surgical repair should be considered in patients with rotator cuff tears and concomitant shoulder stiffness. Level II, prospective cohort study.

Low-Grade Intraventricular Hemorrhage and Neurodevelopmental Outcomes at 24-42 Months of Age.

Infants with high-grade (III-IV) intraventricular hemorrhage have been reported to have worse neurodevelopmental outcomes than those without, but outcomes of infants with low-grade (I-II) intraventricular hemorrhage are mixed. We sought to compare neurodevelopmental outcomes of infants with low-grade intraventricular hemorrhage to those with no intraventricular hemorrhage. This is a retrospective cohort study of very preterm (≤32 weeks' gestation) infants evaluated between 24 and 42 months chronologic age using the Bayley Scales of Infant Development, 3rd edition, to determine neurodevelopmental outcomes. Linear regression was used to control for potential confounders. There was no difference in outcome scores between groups when controlling for confounding variables. Infants with low-grade intraventricular hemorrhage, however, had higher rates of enrollment in early intervention services (64% vs 49%, P = .023). Low-grade intraventricular hemorrhage itself may not significantly increase the risk of neurodevelopmental impairment through the first 3 years of life considering other conditions of prematurity.

Do glenoid retroversion and humeral subluxation affect outcomes following total shoulder arthroplasty?

BackgroundGlenoid retroversion and humeral head subluxation have been suggested to lead to inferior outcomes after total shoulder arthroplasty (TSA). There are limited data to support this suggestion. We investigated whether preoperative glenoid retroversion and humeral head subluxation are associated with inferior outcomes after TSA and whether change of retroversion influences outcomes after TSA.MethodsPatients undergoing TSA with minimum 2-year follow-up were included from a prospectively collected institutional shoulder arthroplasty database. Retroversion and humeral head subluxation before and after surgery were measured on axillary radiographs. Postoperative radiographs were -evaluated for glenoid component loosening and compared between groups. Spearman correlations were determined between retroversion measurements and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) scores. Patients were analyzed in groups based on retroversion and humeral head subluxation.ResultsThere were 113 patients (50% follow-up rate) evaluated at 4.2 years postoperatively. The mean preoperative retroversion (15.3° ± 7.7°) was significantly higher than postoperative retroversion (10.0° ± 6.8°; P < .0001). There was no correlation between postoperative glenoid version or humeral head subluxation and ASES scores. For patients with preoperative retroversion of >15°, there was no difference in outcome scores based on postoperative retroversion. There were no differences in preoperative or postoperative version for patients with or without glenoid lucencies.DiscussionWe observed no significant relationship between postoperative glenoid retroversion or humeral head subluxation and clinical outcomes in patients following TSA. For patients with preoperative retroversion >15°, change of retroversion during TSA had no impact on their clinical outcomes at short-term follow-up.

Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction Using Transosseous Sutures Versus Suture Anchors: A Prospective Nonrandomized Controlled Trial

Background:Patellar instability remains a challenging problem for orthopaedic surgeons. Recurrent patellar instability is traditionally treated with medial patellofemoral ligament (MPFL) reconstruction using a suture anchor or bone tunnel technique. Although the use of transosseous sutures was recently described for MPFL reconstruction, relevant clinical data have not been reported.Purpose/Hypothesis:The purpose of this study was to compare a new transosseous suture fixation technique with the suture anchor technique for MPFL reconstruction. The hypothesis was that reconstruction with transosseous sutures would show similar clinical results to reconstruction with suture anchors.Study Design:Cohort study; Level of evidence, 2.Methods:There were 65 patients with recurrent lateral patellar dislocations from January 2014 to December 2016 who were included in this prospective nonrandomized controlled trial. In total, 31 patients underwent MPFL reconstruction with suture anchors at the patella site (suture anchor group), while the other 34 patients underwent MPFL reconstruction with transosseous sutures (transosseous suture group). The main outcome variable (patellar redislocation) was recorded at follow-up (range, 25-60 months). The International Knee Documentation Committee (IKDC) score, Kujala score, range of motion, congruence angle, patellar tilt, redislocation rate, and complications were collected preoperatively and/or postoperatively.Results:No recurrent dislocations or other complications were observed in any of the patients. No significant differences were found at follow-up between the suture anchor and transosseous suture groups for subjective IKDC score, Kujala score, congruence angle, patellar tilt, redislocation rate, or range of motion.Conclusion:This short-term study showed that after MPFL reconstruction (suture anchors or transosseous sutures), patellar stability could be restored. With the numbers available, no significant differences in outcome scores were observed between patients in the transosseous suture and suture anchor groups.

Outcomes of periacetabular osteotomy for borderline hip dysplasia in adolescent patients.

Treatment of borderline acetabular dysplasia (lateral center edge angle ≥18°) remains controversial, and there is a paucity of literature focusing on outcomes in adolescent patients. The purpose of this study was to evaluate the outcomes of a periacetabular osteotomy (PAO) as surgical management of borderline acetabular dysplasia in adolescent patients. We performed a retrospective review of prospectively collected data and included patients ≤ 21 years of age that underwent PAO for borderline acetabular dysplasia. All patients had a minimum of 1-year follow-up. Outcomes were assessed using modified Harris Hip Scores (mHHS), Hip Outcome Scores (HOS) and international Hip Outcome Tool (iHOT-33). Descriptive and univariate statistical analyses were performed. This study included 33 adolescent patients (35 hips) with symptomatic, borderline acetabular dysplasia. The majority of patients was female (32 patients, 97%); half of all patients reported a history of hip pain for over 1 year; and seven patients had previous hip arthroscopy. In addition to PAO, seven hips (20%) underwent a concurrent hip arthroscopy at the time of surgery. There were significant improvements in mean mHHS, HOS-activities of daily living (ADL), HOS-Sport and iHOT-33 scores after surgery (P < 0.01). Minimal clinically important difference in outcome scores was achieved for over 90% of patients at a minimum of 1-year follow-up. Borderline acetabular dysplasia is a major cause of hip pain in adolescent patients. Patients with symptomatic borderline acetabular dysplasia report a significant benefit after a PAO to correct structural hip instability.

Outcomes of a Heart Failure Telemonitoring Program Implemented as the Standard of Care in an Outpatient Heart Function Clinic: Pretest-Posttest Pragmatic Study.

BackgroundTelemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decisions. The Medly program enables patients to use a mobile phone to record daily HF readings and receive personalized self-care messages generated by a clinically validated algorithm. The TM system also generates alerts, which are immediately acted upon by the patients’ existing care team. This program has been operating for 3 years as part of the standard of care in an outpatient heart function clinic in Toronto, Canada.ObjectiveThis study aimed to evaluate the 6-month impact of this TM program on health service utilization, clinical outcomes, quality of life (QoL), and patient self-care.MethodsThis pragmatic quality improvement study employed a pretest-posttest design to compare 6-month outcome measures with those at program enrollment. The primary outcome was the number of HF-related hospitalizations. Secondary outcomes included all-cause hospitalizations, emergency department visits (HF related and all cause), length of stay (HF related and all cause), and visits to the outpatient clinic. Clinical outcomes included bloodwork (B-type natriuretic peptide [BNP], creatinine, and sodium), left ventricular ejection fraction, and predicted survival score using the Seattle Heart Failure Model. QoL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 5-level EuroQol 5-dimensional questionnaire. Self-care was measured using the Self-Care of Heart Failure Index (SCHFI). The difference in outcome scores was analyzed using negative binomial distribution and Poisson regressions for the health service utilization outcomes and linear regressions for all other outcomes to control for key demographic and clinical variables.ResultsAvailable data for 315 patients enrolled in the TM program between August 2016 and January 2019 were analyzed. A 50% decrease in HF-related hospitalizations (incidence rate ratio [IRR]=0.50; P<.001) and a 24% decrease in the number of all-cause hospitalizations (IRR=0.76; P=.02) were found when comparing the number of events 6 months after program enrollment with the number of events 6 months before enrollment. With regard to clinical outcomes at 6 months, a 59% decrease in BNP values was found after adjusting for control variables. Moreover, 6-month MLHFQ total scores were 9.8 points lower than baseline scores (P<.001), representing a clinically meaningful improvement in HF-related QoL. Similarly, the MLHFQ physical and emotional subscales showed a decrease of 5.4 points (P<.001) and 1.5 points (P=.04), respectively. Finally, patient self-care after 6 months improved as demonstrated by a 7.8-point (P<.001) and 8.5-point (P=.01) increase in the SCHFI maintenance and management scores, respectively. No significant changes were observed in the remaining secondary outcomes.ConclusionsThis study suggests that an HF TM program, which provides patients with self-care support and active monitoring by their existing care team, can reduce health service utilization and improve clinical, QoL, and patient self-care outcomes.

Early outcomes and safety of outpatient (surgery center) vs inpatient based L5-S1 Anterior Lumbar Interbody Fusion

We seek to determine the outcomes of patients undergoing outpatient-based ALIF compared to a consecutive series of inpatient based ALIF performed during the same time period. 58 consecutive patients at a single outpatient surgery center underwent ALIF from June 2015 - August 2017 and 79 ALIF's were performed at 2 Inpatient hospitals. Electronic medical records were reviewed for perioperative and postoperative complications as well as secondary interventions. 62 patients met inclusion criteria (29 Outpatient, 33 Inpatient). The inpatient group was significantly older (44 vs 51; p = 0.01). There were 8 postoperative complications. There was no difference in secondary interventions; 28 patients underwent a total of 36 interventions postoperatively for pain. Secondary interventions were performed at an average of 128(outpatient) and 158(inpatient) days (p = 0.55). There was no difference in outcome scores between the inpatient/outpatient groups at any time. Patients receiving a secondary intervention showed no significant improvement in Back VAS scores but, demonstrated a strong trend (p = 0.06) towards leg pain improvement. Patients who did not undergo secondary intervention had significant improvement in both Back and Leg VAS scores at all time points (p < 0.05). Outpatient ALIF is a safe and reproducible procedure with complication rates consistent with or lower than published rates. Patients outcome scores were no different in the inpatient versus outpatient group. Interestingly, there was a high number of secondary interventions performed in both groups. Patients undergoing a secondary procedure did not get statistically significant improvement in Back VAS but, demonstrated a strong trend in Leg VAS patient reported outcome scores.

Are Irish Gaelic Athletic Association clubs prepared to use an AED following a sudden cardiac arrest? A cross-sectional survey

ABSTRACT Objectives: To identify the availability and accessibility of AEDs in Irish GAA clubs and the knowledge, willingness, and confidence of club members to use AEDs in a medical emergency. Methods: A self-report survey was completed anonymously by GAA club members (n = 267). The survey captured demographic information, previous formal AED training, awareness of AED access in their local GAA club and knowledge, confidence, and willingness to use an AED in a medical emergency and awareness of a written club emergency action plan (EAP). Descriptive statistics were used to examine survey responses and independent samples t-tests to compare differences in outcome scores between those who have or have not completed formal AED training and those that have or have not studied toward or worked in a health-care provision role. Results: Three in every five GAA club members reported that their club owned an AED and almost half of all respondents had access to a club AED in the event of a medical emergency in their club. Formal training was noted by 53.2% of respondents; this group demonstrated significantly better knowledge, confidence, and willingness (p < 0.0001) than those without. Few (7%) respondents knew where the club EAP was or how to access it. Conclusion: To ensure the chain of survival works effectively it is essential that an AED is available, is accessible, and that club members know its location, know when to use it, and are willing and confident to use it. GAA clubs should design an individual emergency action plan and disseminate it widely among club members. Formal AED training should be encouraged among club members and at least one trained member should be present during all club activities.

CORR Insights®: No Differences in Outcomes Scores or Survivorship of Unicompartmental Knee Arthroplasty Between Patients Younger or Older than 55 Years of Age at Minimum 10-year Followup.

CORR Insights®: No Differences in Outcomes Scores or Survivorship of Unicompartmental Knee Arthroplasty Between Patients Younger or Older than 55 Years of Age at Minimum 10-year Followup.

No Differences in Outcomes Scores or Survivorship of Unicompartmental Knee Arthroplasty Between Patients Younger or Older than 55 Years of Age at Minimum 10-Year Followup.

Although patients who have undergone unicompartmental knee arthroplasty (UKA) report improvements in functional outcomes, orthopaedic surgeons tend to avoid UKA in younger patients due to implant survivorship concerns. As a result, few studies specifically have examined the outcomes of patients 55 years and younger. Is there a difference between two cohorts of patients: those 55 years and younger and those 56 years and older who underwent UKA in terms of: (1) functional outcomes scores, (2) quality-of-life scores, and (3) implant survivorship free from all-cause revision. Between 2004 and 2007, 100 patients 55 years and younger underwent UKA at one institution. Of those, three (3%) died, and 13 (13%) were lost to followup before the 10-year minimum required for this study, leaving 84 patients available for propensity score matching. During that same period, 343 patients older than 56 years underwent UKA; 48 (14%) died, and 59 (17%) were lost to followup before 10 years, leaving 236 patients available in that group for potential inclusion. After propensity score matching to account for confounding preoperative variables (surgeon, patient's body mass index, and sex), the patients were divided into two groups based on age: (1) 55 years and younger, (2) 56 years and older. There were 71 patients in each group, with minimum followup of 10 years. The mean age in the group of patients 55 years and younger was 52 years (range, 45-55 years) and that of the older patients was 64 years (range, 56-80 years). The mean (range) followup in both groups was 13 years (range, 11-15 years). Patient functional outcomes, quality of life scores, and implant survivorship were assessed for both groups of patients. To detect a minimum clinically important difference of 5 points in the Oxford Knee Score (OKS), a sample size of at least 68 patients in each group would be required to achieve a power of 0.95. With the numbers available, there were no differences between patients 55 years and younger and those 56 years and older in terms of OKS (18 ± 6 versus 20 ± 8, mean difference -1.8; 95% CI, -4.1 to 0.5; p = 0.133) and Knee Society Knee Score (84 ± 16 versus 79 ± 21, mean difference 4.7; 95% CI, -1.8 to 11.2; p = 0.157) at 10 years postoperatively. With the numbers available, there were no differences between patients 55 years and younger and those 56 years and older in terms of the physical component summary (PCS) (47 ± 10 versus 48 ± 11, mean difference -0.4; 95% CI, -4.0 to 3.2; p = 0.827) and the mental component summary (MCS) (52 ± 12 versus 51 ± 12, mean difference 1.4; 95% CI, -2.6 to 5.4; p = 0.491) of the SF-36 at 10 years postoperatively. Finally, we found no differences with the numbers available between patients 55 years and younger and those 56 years and older in terms of survivorship free from all-cause revision at a minimum of 10 years followup (both groups had the same 10-year revision-free rate of 0.96; 95% CI, 0.91-1.00). Because we found few differences between patients 55 years and younger and those older than that in terms of functional outcomes, quality of life, and implant survivorship after UKA, we believe that appropriately selected younger patients should not be excluded from the potential benefits of undergoing UKA, especially in the hands of high-volume surgeons. Level III, therapeutic study.

Evaluation of Midterm Clinical and Radiographic Outcomes of Arthroscopically Repaired Vertical Longitudinal and Bucket-Handle Lateral Meniscal Tears.

Background:Lateral meniscal tears in the stable knee are rare. There are few comparative studies evaluating functional and radiological outcomes of vertical longitudinal and bucket-handle lateral meniscal tears.Purpose:To evaluate the midterm clinical and radiological outcomes of arthroscopically repaired traumatic vertical longitudinal and bucket-handle lateral meniscal tears.Study Design:Case series; Level of evidence, 4.Methods:A total of 43 full-thickness lateral meniscal repairs, including 22 (51.2%) for vertical longitudinal tears and 21 (48.8%) for bucket-handle tears, were evaluated. A clinical assessment was performed according to the Barrett criteria, and patient outcomes were measured with the Lysholm knee score, Tegner activity scale, and overall satisfaction scale. Magnetic resonance imaging was used as the radiological re-examination method preoperatively and at final follow-up. A subgroup analysis examining isolated repair versus repair with concurrent anterior cruciate ligament (ACL) reconstruction was performed.Results:The mean follow-up period was 63.2 months (range, 24-86 months). Based on clinical and radiological outcomes, 38 of the 43 repairs (88.3%) were successful, and the remaining 5 (11.6%) cases were considered to be failures. Overall, the combined results for both groups demonstrated an improvement in the Lysholm score, Tegner score, and patient satisfaction. There was no significant difference in the postoperative Lysholm score (91.4 vs 87.0, respectively; P = .223), Tegner score (5.4 vs 5.5, respectively; P = .872), or patient satisfaction (7.2 vs 7.4, respectively; P = .624) between bucket-handle repair and vertical longitudinal repair. The subgroup analysis demonstrated no difference in outcome scores for isolated repair versus repair with concurrent ACL reconstruction. Smoking was identified as a risk factor for repair failure.Conclusion:Comparable clinical and radiological outcomes were obtained after vertical longitudinal and bucket-handle lateral meniscal repairs using the all-inside or hybrid suture technique with different suture configurations, regardless of whether ACL reconstruction was performed. Smoking was identified as a risk factor for failure.

Therapeutic effects of acupuncture plus fire needle versus acupuncture alone in lateral epicondylitis

Background:The aim of this study was to compare the short-term and intermediate-term efficacy of acupuncture plus fire needle therapy with that of acupuncture alone in the treatment of lateral epicondylitis (LE).Methods:Thirty-eight patients with LE who had persisted for at least 2 months were enrolled in this prospective, assessor-blinded, randomized controlled pilot trial. Twenty-one patients were randomized to the acupuncture plus fire needle group and 17 to the acupuncture-only group. The primary outcome was the visual analog scale pain score for the previous 24 hours and the secondary outcomes were the maximum grip strength, Patient-rated Forearm Evaluation Questionnaire score, and Medical Outcomes Study 36-Item Short-form Health Survey score. The values at baseline (pretreatment), at the end of treatment, and at 3 months after treatment were used to assess the short-term and intermediate-term effects of treatment. The data were analyzed using the Chi-square test and t test.Results:Within-group analyses showed better results for acupuncture plus fire needle therapy in the short term and intermediate term. Differences in the severity of pain and secondary outcomes were significant in the intermediate term in the acupuncture group. At the end of treatment, none of the differences in outcome scores were significant, except for maximum grip strength in the affected hand in the acupuncture group. No significant between-group differences in short-term or intermediate-term outcomes were observed.Conclusion:Acupuncture plus fire needle therapy was effective in the short term in patients seeking improvement of LE. Twelve treatments were effective for relieving pain and improving disability in the intermediate term in patients with chronic LE in both study groups. The findings of the pilot study confirm the feasibility of proceeding to a larger randomized controlled study of the longer-term effects of acupuncture plus fire needle therapy in patients with LE.

Anatomical and reverse shoulder arthroplasty utilizing a single implant system with a platform stem: A prospective observational study with midterm follow-up.

No studies compare outcomes of anatomic total shoulder arthroplasty to reverse total shoulder arthroplasty with more than five-year follow-up. A multicenter prospectively collected shoulder registry was utilized to review all patients undergoing primary anatomic total shoulder arthroplasty or primary reverse total shoulder arthroplasty with a minimum five-year follow-up utilizing a single platform stem implant system. One-hundred-ninety-one patients received an anatomic total shoulder arthroplasty and 139 patients received a reverse total shoulder arthroplasty. Patients were scored preoperatively and at latest follow-up using the simple shoulder test (SST), University of California Los Angeles (UCLA), American shoulder and elbow surgeons (ASES), Constant, and shoulder pain and disability index (SADI) scores as well as range of motion. Radiographs were evaluated for implant loosening or notching. Complications were reviewed. A Student's two-tailed, unpaired t-test identified differences in preoperative, postoperative, and pre-to-postoperative improvements. Reverse total shoulder arthroplasty patients were significantly older than anatomic total shoulder arthroplasty patients. All patients demonstrated significant improvement in functional metric scores and range of motion following anatomic total shoulder arthroplasty or reverse total shoulder arthroplasty. There was no difference in final outcome scores between anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty patients at midterm follow-up; however, reverse total shoulder arthroplasty patients demonstrated significantly less motion. We demonstrate equivalent outcomes with five scoring metrics at mean follow-up of 71.3 ± 14.1 months. Although postoperative scores were significantly greater than preoperative scores for both anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty patients, significant differences in outcome scores between cohorts were not observed.