Final Outcome Research Articles

Patellofemoral stabilization with and without cartilage restoration

Introduction/ObjectivesCartilage restoration as an adjunct to patellofemoral (PF) soft tissue and/or bony stabilization in patients with symptomatic PF instability remains controversial. Our purpose was to evaluate patients undergoing surgical stabilization for PF instability with or without concomitant cartilage restoration. MethodsRetrospective review of prospectively collected data identified patients undergoing surgical stabilization for recurrent patella instability, with or without concomitant cartilage restoration. Presurgical and postsurgical patient-reported outcomes were collected. Complications requiring reoperation were recorded. Statistically significant difference was set at P < .05. ResultsOne hundred thirty patients (144 knees) were included. One hundred thirteen knees in the isolated stabilization (STAB) and 31 knees in the Stabilization-Cartilage Restoration (STAB-CART) group. The average age was 20.64 and 25.03 in the STAB and STAB-CART groups (P = .034), respectively. STAB-CART group had significantly lower preoperative Knee injury and Osteoarthritis Outcomes Score (57.24 ± 17.45 vs 46.11 ± 14.74, P = .019) and Single Assessment Numeric Evaluation scores (43.15 ± 19.05 vs 26.85 ± 13.74, P = .002). Both groups statistically improved in all Knee injury and Osteoarthritis Outcomes Score, International Knee Documentation Committee, and Single Assessment Numeric Evaluation domains with no statistically significant differences at final follow-up between groups. Thirteen knees (11.5%) in the STAB and 6 knees (19.4%) in the STAB-CART group had complications requiring reoperation, including 6 and 3 revision stabilizations, respectively. There were no statistically significant differences in total major complications (P = .246) or medial PF ligament revision (P = .405). ConclusionsThe addition of cartilage restoration in patients undergoing soft tissue and/or bony PF stabilization appears to be safe and effective. Despite lower baseline scores, patients undergoing PF stabilization with cartilage restoration had similar final subjective outcome scores compared to the group without.

Using Haptic Technology for Pain Reduction and Functional Improvement

Advancements to reduce pain severity and improve functionality are generally lacking. Chronic or recurrent pain is the most common reason patients consult primary care clinicians. Adverse events associated with existing pharmacological pain treatments have incentivized researchers to identify effective pain treatment strategies that have limited side effects, including non-invasive and non-pharmacologic options. Research has shown that a clearer understanding of the pain neuromatrix may assist in identifying alternative approaches and improving patient outcomes. A network consisting of neuronal pathways and circuits responding to sensory (nociceptive) stimulation makes up the neuromatrix of pain. Research provides strong support that these pathways and areas of the brain have elicited change in response to external stimuli. Advancements in the understanding of how external tactile stimuli, specifically “haptic vibrotactile trigger technology (VTT)” disrupts the neuromatrix of pain, has led to the development of technology that shows promise in targeting the nociceptive pathways. Through ongoing research, the technology has been incorporated into non-invasive, non-pharmacological topical patches and other routes of delivery to evaluate response as it relates to different health concerns and conditions. The purpose of this IRB-approved, minimal risk, randomized, and blinded study was to evaluate patients’ experiences and/or perceptions and patient response for those who received a haptic vibrotactile trigger technology (VTT) embedded non-pharmacologic, non-invasive, over-the-counter pain patch (FREEDOM Super Patch with VTT; Srysty Holding CO, Toronto, Canada) and those who received a placebo patch without the embedded technology. This final outcome data from the HARMONI Study adds to previously published interim data. Methods: Baseline, 7- and 14-day data were recorded in one hundred sixty-eight (168) adult subjects (107 females and 61 males) in a Treatment Group (n=148) or Control Group (n=20) with a mean age of 53 years who presented with mild, moderate and even severe musculoskeletal, arthritic and neurological pain. The study evaluated changes in overall severity and interference scores via a validated scale (Brief Pain Inventory (BPI)), changes in the use of prescription and OTC medications, patient satisfaction, and any side effects reported while using an active or placebo patch. Results: For the Treatment Group, results showed statistically significant decreases in mean BPI severity and interference scores after using the VTT embedded pain patch. After 14 days, the vast majority of patients reported “less” or “a lot less” usage of oral medications and were very/extremely satisfied with the patch. Results also showed statistically significant and positive outcomes in all measured Quality of Life (QoL) components with improvements in general activity, mood, relations with other people, sleep, normal work, walking ability, and enjoyment of life. In the Control Group, there were no significant changes in pain severity, interference levels, usage of medications, and patient satisfaction was poor during the 14 day study period. Conclusions: Study results indicate that this non-pharmacologic, non-invasive, haptic vibrotactile trigger technology (VTT) embedded topical patch reduces pain severity and interference scores and may reduce the use of concurrent medications, including prescribed anti-inflammatory and other oral medication for adult patients with arthritic, neuropathic, and musculoskeletal pain. Results reported suggest that the non-pharmacological topical pain patch should be added to the current arsenal of noninvasive and nonpharmacological pain therapies.

On the feasibility of minimally invasive Le Fort I with patient-specific implants: Proof of concept

A novel approach to Le Fort I osteotomy is presented, integrating patient-specific implants (PSIs), osteosynthesis and cutting guides within a minimally invasive surgical framework, and the accuracy of the procedure is assessed through 3D voxel-based superimposition. The technique was applied in 5 cases. Differences between the surgical plan and final outcome were evaluated as follows: a 2-mm color scale was established to assess the anterior surfaces of the maxilla, mandible and chin, as well as the condylar surfaces. Measurements were made at 8 specific landmarks, and all of them showed a mean difference of less than 1 mm. In conclusion, the described protocol allows for minimally invasive Le Fort I osteotomy using PSIs. Besides, although the accuracy of the results may be limited by the small sample size, the findings are consistent with those reported in the literature. A prospective comparative study is needed to obtain statistically significant results and draw meaningful conclusions.

Utility of DECAF Score as A Bed Side Tool in Predicting Outcomes in Patient with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be fatal. It is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. The DECAF (Dyspnea, Eosinopenia, Consolidation, Acidemia, Atrial Fibrillation) score is a widely used system for predicting the survival of patients with AECOPD. It uses Routinely available indices, is quick and can be easily used by clinicians to identify sick patients who need vigilant care. MethodsA cross sectional study was conducted at College of Medical Sciences Teaching Hospital, Bharatpur for 6 months. Patients with COPD meeting inclusion Criteria were selected and the DECAF score at time of admission was calculated. Their duration of hospital stay, use of ventilator and final outcome were noted and its relation to the Decaf score was analysed. ResultsA total of 163 patients (Male-87, Female-76) were included in the study. The mean age of the patients was 70 ±10 years and mean duration of hospital stay was 5.91±2.19 days. There is significant relationship between DECAF score and the mortality (p-value &lt; 0.001) with higher the score higher the chance of not improving. Analysis between the DECAF score and length of Hospital stay by regression equation found the regression coefficient 0.410 to be significant (p-value &lt; 0.001) indicating that if DECAF score increases by one, the length of hospital stay will also increases by 0.41 day.Conclusions Patients with a DECAF score of four or higher have a significant risk of mortality as well as long duration of hospital stay. Thus, DECAF is a simple tool that incorporates routinely available indices to predict adverse outcomes in AECOPD.

Bilateral Maxillary Duplication in Tessier No. 7 Cleft: An Uncommon Congenital Deformity with a Challenging Radiological Diagnosis.

Tessier No. 7 cleft, known as lateral facial cleft, is a rare and understudied entity with an incidence of 1/80,000-1/300,000 live births. Besides perioral tissue abnormalities manifesting as macrostomia, Tessier 7 cleft also involves anomalies of the underlying bony structures. It can appear as part of a syndrome, such as Treacher-Collins syndrome or Goldenhar/Orbito-Auriculo-Vestibular Spectrum, or as an isolated form (unilateral or bilateral) with variable expressions. Bilateral maxillary duplication in Tessier 7 cleft is considered extremely rare, accounting for only two previously presented cases. Given that the cases presented in the literature mainly focus on clinical appearance and surgical treatment, without providing sufficient imaging, we aim to present key radiological features of Tessier 7 cleft in terms of evaluating the involved structures, which is essential for the therapeutic approach and final outcome. A 17-year-old male with incompetent lips and orthodontic abnormalities was referred to our Radiology Department for orthopantomography (OPG) and CT examinations. Hetero-anamnestic data revealed a history of surgical treatment of the commissural cleft conducted 2 months after the birth to enable feeding. Intraoral examination showed a maxillary cleft and supernumerary teeth. Since the given clinical presentation was inconclusive, radiological diagnostics took precedence in elucidating this complex entity.

Ensemble Learning-Based Pain Intensity Identification Model Using Facial Expressions

The pain identification model (PIM) can assist the healthcare professionals to render effective services to individuals. Disabled individuals can benefit from the automated PIM. Ensemble learning is widely employed for developing medical applications. A model for classifying the pain intensity using facial expression images is proposed in this study. A ShuffleNet V2 model is fine-tuned to extract features using fusion feature and class activation map techniques. CatBoost and XGBoost models are used as base models to predict pain intensities. The authors used the support vector machine (SVM) model as a meta-model to produce a final outcome. They optimize the SVM model in order to identify pain using the predictions of the base models. The model is generalized using the University of Northern British Columbia–McMaster dataset. The dataset encompasses 200 videos and 48,000 annotated images. The comparative analysis outcome highlights the exceptional performance of the proposed PIM. An optimal accuracy of 98.7% and an F1-score of 98.0% indicate the effectiveness of the proposed model. The uncertainty analysis outcome revealed that the model is reliable and can be deployed in healthcare centers. However, substantial training is required to boost the efficiency of the proposed model in real-time settings.

Clinical Outcomes in Patients With Traumatic Dehiscence of Penetrating Keratoplasty Grafts.

The purpose of this study was to report clinical characteristics and outcomes of surgical repair for patients with traumatic dehiscence of penetrating keratoplasty (PKP) grafts. Retrospective, consecutive chart review of patients evaluated at Bascom Palmer Eye Institute between 2015 and 2020 with traumatic dehiscence of penetrating keratoplasty grafts. The study cohort consisted of 65 eyes of 65 patients. The mean age at presentation was 72 years (SD 18), with a male predominance (65%). The most common indications for PKP included keratoconus (42%), corneal scar (31%), and Fuchs corneal dystrophy (8%). Dehiscence occurred as a result of blunt trauma in 94% of cases, and the mean wound length was 6.4 clock hours (SD 2.4), with a predominance of inferior dehiscence. The mean presenting visual acuity (VA) was 2.45 logMAR (SD 0.41), and the mean final VA was 2.17 logMAR (SD 0.99). Graft failure occurred in 64% of patients, and 22% underwent repeat PKP. When stratified by indication for corneal transplantation (keratoconus vs. other), there was no significant difference in graft age at the time of rupture, final VA, rate of graft failure, or rate of repeat PKP. Traumatic dehiscence of corneal grafts remains a rare but serious subtype of ocular trauma with generally poor visual prognoses. Presenting VA along with severity of trauma and posterior segment involvement tend to be the worst prognostic factors in final visual outcome.

54-year-old Woman with Chest Pain.

Chest pain is a common presentation to the emergency department (ED) that can be caused by a multitude of etiologies. It can be challenging to differentiate life-threatening conditions from more benign causes. A 54-year-old woman presented to the ED complaining of chest pain with dyspnea in the setting of recent blunt trauma. This case offers a thorough yet practical approach to the diagnostic workup of chest pain with dyspnea in the ED setting. The surprising final diagnosis and case outcome are then revealed.

Post-Prosthetic Surgery: Using Complete Denture Prosthesis for Propriotous Outcome During Vestibuloplasty By IJISRT

Prosthodontic rehabilitation of edentulous patient is quite challenging. The success of complete dentures depends on many factors among which the anatomical factors play a major role. For functioning of complete denture in harmony there should exist proper stability, support and retention. Any compromising factors among them which might probably result in failure of prosthesis. As soft tissue anatomy in which the denture borders are placed are movable. It’s imperative that the prosthesis will not hamper the tissue mobility to maintain retention. Sometimes alteration of the soft tissue anatomy may greatly increase the retention of the fabricated prosthesis. In this article we are presenting a clinical tip to improvise the final outcome and prognosis of prosthetic surgery after delivering the final prosthesis.

Effect of Prebiotic, Probiotic Bacteria and Symbiotic Diets Containing Bacillus Coagulans and Gum Arabic on Lipid Profile in Hypercholesterolemic Rats

Purpose: Hypercholesterolemia poses a significant challenge for numerous communities and healthcare professionals because of the association between cardiovascular conditions and dyslipidemia. The objective of this research was to assess the impact of prebiotics, probiotics, as well as a diet incorporating Bacillus coagulants and gum Arabic on blood lipid levels in hypercholesterolemic rats.&#x0D; Methodology: In order to create an antiseptic solution, acquire the organic substance known as gum Arabic. Thirty-five male Albino rats (170 ± 5 g) were feeding a prepared diet includes supplemented cholesterol to raise the levels of cholesterol. Mice were divided to 5 groups (n = 7). Group 1: simple diet (negative control), the other 4 groups were assigned for a hypercholesterolemia diet comprising 25% lard and 2% cholesterol for 6 weeks in order to increase fat cholesterol in rats. Group 2: (positive control), Group 3: fed with a supplement including 5% gum Arabic (prebiotic), Group 4: fed with a dietary supplement comprising coagulase spores, Group 5: assigned for a simple meal. It was supplemented with 5% daily gum Arabic and Bacillus coagulants spores (symbiotic).&#x0D; Results: Triglyceride levels and total cholesterol (mg/dL) were improved (P&lt;0.05). In (advantageous manipulate) fed a simple diet (B.D.), compared with (poor manipulate).&#x0D; Unique Contribution to theory, Practice and Policy: The Anti-Inflammatory Theory and the concept of prebiotics usage to decrease cholesterol and minimize its absorption. This shows that the concept used has been validated. The satisfactory results which confirmed the extreme spread variations with the poor manipulate organization had been done within side the hypercholesterolemia organizations include with Gum Arabic (GA5%), where the best indicated a fee recorded (28.54 ± 3. seventy one mg/dL), which transferred into the poor manipulate (36.33 ± 5.00 mg/dL). As for the organizations that took B. coagulants and GA 5% + B. coagulants, a lower in LDL-c, (VLDL-c), levels of AST and AST, and the satisfactory outcome documented and directed within side of the organization GA 5% + B.Coagulants. Histological checkups furthermore confirmed that the liver sections inside the 5th organization established a regular structure, also the liver cells mild degeneration. CONCLUSION: The satisfactory final outcome indicated within side the organization of GA 5%+ B. coagulants remedy organization compared with the opposite organizations.

Aesthetic Palpebral Reconstruction Following the Excision of Basal Cell Carcinoma (BCC): A Case Report

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin malignancy, and when considering its predilection for the face – it is most commonly found on the eyelids. CASE PRESENTATION: In our patient’s case, the BCC was located on the left lower eyelid exemplifying the classic macroscopic appearance of a nodular basalioma. We took into account all of the patient’s variables (particularly the lesion’s difficult location) to choose the best surgical approach for excision of the tumor, as well as the reconstructive strategy that would result in the most functional and aesthetic outcome. CONCLUSION: In this report, we present a case of our patient with BCC on the lower eyelid, our surgical method for excision and palpebral reconstruction using an autologous auricular cartilage graft, and the final outcome, which we consider was the best option for the patient in question.

Preserving visual acuity: a compelling 12-year case study of controlling neovascular age-related macular degeneration

IntroductionIn neovascular age-related macular degeneration (nAMD) trials, anti-VEGF injection frequency decreases after the first year, while outcomes remain primarily related to the number of injections. To the best of our knowledge, there are no reports of maintaining the best corrected visual acuity (BCVA) for more than 7 years in extension studies.ObjectiveTo report a 12-year follow-up of a real-world case of nAMD where BCVA was preserved from declining.Case descriptionA 67-year-old Caucasian female presented to our department in June 2010 due to decreased vision in her left eye (LE) within the preceding months. Examination showed a BCVA of 85 letters (L) in the right eye (RE) and 35 L in the LE. Fundus examination showed drusen in the macula of both eyes. Macular edema, loss of the macular lutein pigment, macular hypo/hyperpigmentation were observed in the LE. A diagnosis of Type 2 choroidal neovascular membrane (CNV) in the LE was established and within two months a Type 1 CNV developed in the RE. She undergone 9 injections of bevacizumab (six) and ranibizumab (three) within the first year of treatment in the LE and seven injections of ranibizumab within the first year in the RE.ResultsThe LE had a mean of 5.2 injections per year, and the RE had a mean of 7.5 injections per year, from 2010 to 2022. RE's BCVA dropped by 8L (85L to 77L) and central retinal thickness (CRT) increased by 16 μm (276 μm to 292 μm) while LE’s BCVA increased by 28L (35L to 63L) and CRT decreased by 369 μm (680 μm to 311 μm), at the twelfth year.ConclusionsAlthough the final visual outcome depends on baseline BCVA and lesion type or size, the number of injections is paramount in preserving BCVA and achieving favorable functional outcomes in nAMD, even after 12 years of treatment.

Goal Orientation for Fair Machine Learning Algorithms

A key challenge facing the use of machine learning (ML) in organizational selection settings (e.g., the processing of loan or job applications) is the potential bias against (racial and gender) minorities. To address this challenge, a rich literature of Fairness-Aware ML (FAML) algorithms has emerged, attempting to ameliorate biases while maintaining the predictive accuracy of ML algorithms. Almost all existing FAML algorithms define their optimization goals according to a selection task, meaning that ML outputs are assumed to be the final selection outcome. In practice, though, ML outputs are rarely used as-is. In personnel selection, for example, ML often serves a support role to human resource managers, allowing them to more easily exclude unqualified applicants. This effectively assigns to ML a screening rather than a selection task. It might be tempting to treat selection and screening as two variations of the same task that differ only quantitatively on the admission rate. This paper, however, reveals a qualitative difference between the two in terms of fairness. Specifically, we demonstrate through conceptual development and mathematical analysis that miscategorizing a screening task as a selection one could not only degrade final selection quality but also result in fairness problems such as selection biases within the minority group. After validating our findings with experimental studies on simulated and real-world data, we discuss several business and policy implications, highlighting the need for firms and policymakers to properly categorize the task assigned to ML in assessing and correcting algorithmic biases.

Estimation of the lot fraction defective in a finite lot of products with auxiliary quality characteristics

Many companies use sampling plans for the acceptance or rejection of lots of products. The final outcome of this decision-making process is based on the inspection of a sample of products selected from a lot under inspection, where a quality characteristic is observed. An important parameter of interest related to acceptance sampling for attributes is the proportion of defective items. This parameter is unknown for a given lot of products, but it can be estimated from the aforementioned sample information. Additional quality characteristics can be observed at the inspection stage. We propose to use this auxiliary information to obtain more accurate estimators of the lot fraction defective at the estimation stage. Various relevant applications of this process are described. For possible scenarios that may arise in practice, the empirical properties of the suggested estimation methods are investigated using Monte Carlo simulations, and desirable results are obtained when there is a strong relationship between the quality characteristic of interest and the auxiliary quality characteristic.

CYCLODEXTRIN IN NOVEL FORMULATIONS AND SOLUBILITY ENHANCEMENT TECHNIQUES: A REVIEW

Using cyclodextrin helps make different dosage forms more soluble. The oligosaccharide class known as cyclodextrins (CDs) is made up of glucose units bound together in a ring. CDs have the promising ability to assemble into complexes with drug molecules and improve their physicochemical properties without the need for molecular modifications. Generally, drug-CD complexes have a stoichiometry of 1:1. However, natural CDs have a tendency to self-assemble and form aggregates in aqueous media, which can reduce the solubility of the CDs by aggregating. One can increase their complexation capacity and solubility through derivative formation, but the final outcome depends on the kind and extent of substitution. Drug penetration through biological membranes can be improved by the formation of water-soluble drug-CD complexes. Solubility is the property of a solid dissolving into a liquid phase to form a homogenous system. Solubility is a crucial component in obtaining the right drug concentration in the systemic circulation for the optimal pharmacological response. Orally administered poorly soluble drugs often require high dosages to reach therapeutic plasma concentrations. Their low solubility in water is one of the primary problems with creating new chemical entities through formulation. The BCS classification system places these medications in class II, which is characterized by high permeability and poor solubility. To greatly improve these medications, it is possible to make them more bioavailable and soluble.

Earthen Builder Simulation: Representing Natural Materials and Embodied Carbon With Computational Play.

Natural building materials are critical to the future of a decarbonized built environment. Involving low-carbon and readily available materials such as clay-richsoils and plant fibers in building processes employ a range of techniques, and hence, a range of environmental and visual features, from rammed earth to cob and light straw clay. However, despite their advantages, natural materials are not represented in mainstream construction, perceived mistakenly as poor in theirperformance, low-tech, and are missing representation in training for building professionals. This research develops a digital representations-study of naturalmaterial futures and their associated embodied carbon. It links, for the first time, computational play, and critical data with traditional recipes of designing with natural materials. A digital tool for sustainable engagement was developed by utilizing a geological database of locally available soil-based repositories. As an exploratory design tool, it was tested through 24 playtests for its mechanics, graphical user interface, and perception shifts among designers and researchers. The final outcome seeks to establish a digital foundation for a more comprehensive earthen materials knowledge tool and life-cycle assessment. As a final deliverable, this work aims to unveil the strength of simulative material representations in heightening the knowledge base of an overlooked, historic, and sustainable practice.

Senam Hipertensi Bagi Lanjut Usia (LANSIA) Di Posyandu Cekke Kabupaten Enrekang

Hypertension exercise is an exercise that aims to increase blood flow and oxygen supply to active muscles and skeleton, especially the heart muscle, so that it can reduce blood pressure. The aim of this community service (PkM) is to increase the understanding of elderly people about hypertension elderly exercise and to determine the effect of elderly hypertension exercise on the blood pressure of elderly people with hypertension in the Posyandu Cekke work area, Enrekang Regency. The method used to achieve the target of this activity is by approaching, lecturing and jointly doing exercises for the elderly with hypertension. The final outcome of this PkM activity is that it can increase the client's knowledge about exercise for the elderly with hypertension and can control complications of hypertension, namely stroke due to hypertension in old age. The method for implementing community service (PkM) is by using counseling which aims to gain knowledge about the importance of exercise for the elderly. It is hoped that after getting the theory about the importance of exercise for the elderly, they will be able to increase their knowledge and be willing to do exercise either at the Posyandu for the Elderly or at home. The result of this community service (PkM) is an increase in the elderly's knowledge about the importance of posyandu, which can be seen from the results of the pre-test and post-test, namely an increase of 32%. Increasing the activeness of elderly people in posyandu and motivation for elderly exercisers to always take part in elderly exercise seriously.

Kegiatan Pendampingan Belajar Al Qur’an pada Anak-Anak Usia SD di TPQ Nurul Ummah Dusun Tunggulsari

Studying the Quran is a noble act in the eyes of Allah SWT. However, nowadays, many children, teenagers, and even adults prefer playing over learning the Quran, resulting in a gradual abandonment of Quranic education. Conversely, studying the Quran brings significant advantages and merits compared to other pursuits. Therefore, Quranic education activities have become a focal point of society, particularly for children who represent the future generation. This educational initiative will take place at the Nurul Ummah Quran Education Park in Tunggulsari hamlet, Pojok village, Mojogedang district, Karanganyar regency. The objectives of this activity are: To enhance children's proficiency in reading, writing, and memorizing the Quran correctly; To introduce the Quran to children from an early age; and To foster a comprehensive understanding of Islam. The mentoring will be conducted face-to-face using methods such as lectures, question-and-answer sessions, practice, and storytelling. The mentoring activities will be carried out in three stages: preparation, implementation, and evaluation. The final outcome of this service demonstrates that Quranic learning support has a positive impact on children's motivation and understanding of the Quran, as well as its benefits in their lives. This is evident through positive changes in children's behavior.

Induced Membrane Technique Combined with Surgical Lengthening of an Humerus Defect Secondary to Chronic Osteomyelitis: Case Report

Surgical management of long bone defects remains a considerable challenge for orthopedic surgeons, particularly in septic conditions. We present the case of an 8-year-old girl with a history of chronic osteomyelitis in the left humerus, referred to us following a pathologic fracture, initially managed with humeral osteosynthesis and grafting. Subsequently, the induced membrane technique was employed for pseudarthrosis after a recurrent fracture. Following consolidation, significant humeral shortening was observed, necessitating surgical lengthening using an external fixator, resulting in a satisfactory final outcome.

Using Two Predictive Models to Capture Two Types of Poor Outcomes in Knee Arthroplasty: A Multisite Longitudinal Cohort Study.

Poor outcome after knee arthroplasty (KA), a common major surgery worldwide, reportedly occurs in approximately 20% of patients. These patients demonstrate minimal improvement, at least moderate knee pain, and difficulty performing many routine daily activities. The purposes of our study were to comprehensively determine poor outcome risk after KA and to identify predictors of poor outcome. Data from 565 participants with KA in the Osteoarthritis Initiative and the Multicenter Osteoarthritis studies were used. Previously validated latent class analyses (LCAs) of good versus poor outcome trajectories of Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Disability were generated to describe minimal improvement and poor final outcome. The modified Escobar RAND appropriateness system was used to generate classifications of appropriate, inconclusive, and rarely appropriate. Multivariable prediction models included LCA-based good versus poor outcome, modified Escobar classifications, and evidence-driven preoperative prognostic variables. Modified Escobar appropriateness classifications were nonsignificant predictors of WOMAC Pain good versus poor outcomes, indicating the methods provide independent outcome estimates. For WOMAC Pain and WOMAC Disability, approximately 34% and 45% of participants, respectively, had a high probability of either minimal improvement via "rarely appropriate" classifications or poor outcome via LCA. In multivariable prediction models, greater contralateral knee pain consistently predicted poor outcome (eg, odds ratio 1.21, 95% confidence interval 1.10-1.33). Appropriateness criteria and LCA estimates provided combined poor outcome estimates that were approximately double the commonly reported poor outcome of 20%. Rates of poor outcome could be reduced if clinicians screened patients using appropriateness criteria and LCA predictors before surgery to optimize outcome.