Improvement In Clinical Outcome Scores Research Articles

Comparative Outcomes Between Step-Cut Lengthening Calcaneal Osteotomy vs Traditional Evans Osteotomy for Stage IIB Adult-Acquired Flatfoot Deformity.

The forefoot abduction component of the flexible adult-acquired flatfoot can be addressed with lengthening of the anterior process of the calcaneus. We hypothesized that the step-cut lengthening calcaneal osteotomy (SLCO) would decrease the incidence of nonunion, lead to improvement in clinical outcome scores, and have a faster time to healing compared with the traditional Evans osteotomy. We retrospectively reviewed 111 patients (143 total feet: 65 Evans, 78 SLCO) undergoing stage IIB reconstruction followed clinically for at least 2 years. Preoperative and postoperative radiographs were analyzed for the amount of deformity correction. Computed tomography (CT) was used to analyze osteotomy healing. The Foot and Ankle Outcome Scores (FAOS) and lateral pain surveys were used to assess clinical outcomes. Mann-Whitney U tests were used to assess nonnormally distributed data while χ2 and Fisher exact tests were used to analyze categorical variables (α = 0.05 significant). The Evans group used a larger graft size ( P < .001) and returned more often for hardware removal ( P = .038) than the SLCO group. SLCO union occurred at a mean of 8.77 weeks ( P < .001), which was significantly lower compared with the Evans group ( P = .02). The SLCO group also had fewer nonunions ( P = .016). FAOS scores improved equivalently between the 2 groups. Lateral column pain, ability to exercise, and ambulation distance were similar between groups. Following SLCO, patients had faster healing times and fewer nonunions, similar outcomes scores, and equivalent correction of deformity. SLCO is a viable technique for lateral column lengthening. Level III, retrospective cohort study.

Surgical Treatment of Rotator Cuff Tears After 65 Years of Age: A Systematic Review.

The objective of this study was to analyze current evidence regarding surgical management of rotator cuff tears in patientsof 65 years of age and above. Our hypothesis was that surgical repair of rotator cuff tears, in patients older than 65 years, conveysgood outcome scores. We have not found a similar systematic review in current literature. Medline®, PubMed, Scopus, and the Cochrane Register of Controlled Trials were searched from January 1999unto December 2015 for studies, regardless of language, including the words 'rotator cuff' and '65 years' or '70 years'. Inclusion criteriawere studies (level I to IV) that reported clinical outcomes in patients older than 65 years, having undertaken surgical repair of a symptomaticrotator cuff tears. Arthroscopic, mini open and open techniques were included. Exclusion criteria were: studies with patientsyounger than 65 years, studies that did not use validated outcome evaluation scores as primary assessment tools and those with followup under one year. This work followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA guidelines.Data abstracted included patient demographics, tear pattern, surgical procedures, clinical and repair results. Outcome scores wereconverted to percentages, allowing comparison of data between studies. After deep analysis, 14 studies met the inclusion criteria: 11 level IV studies, 1 level III study and 2 level II studies. Sevenstudies found statistically significant outcome improvements between pre and postoperative evaluations. All studies reported good orexcellent surgical outcomes. Better results would probably be achieved if all studies had rigorous and homogeneous patient selection criteria, but thefact is, that even though this was not the case, the clinical scores remained favorable, and with statistically significant outcome improvementin all studies with prospectively collected data. Based on current literature, rotator cuff repair in patients older than 65 years imparts favorable improvement in clinicaloutcome scores and overall patient satisfaction.

Elderly Patients Achieving Clinical and Radiological Outcomes Comparable with Those of Younger Patients Following Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Study DesignRetrospective analysis of prospective database.PurposeTo compare 2-year clinical and radiological outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) among “middle-age” (50–64.99 years), “young-old” (65–74.99 years), and “old-old” (>75 years) patients.Overview of LiteratureOwing to higher perioperative morbidity and mortality rates, elderly patients with degenerative lumbar conditions are occasionally denied surgical care, even after conservative treatment failure. MIS-TLIF advantages include reduced blood loss, reduced analgesia requirements, early mobilization, and shorter hospital stays.MethodsBetween 2007 and 2012, 22 patients (age >75 years) treated with 1-2 level MIS-TLIF were matched with “young-old” and “middle-age” patients (22 each) based on race, body mass index (BMI), diagnosis, spinal level, number of spinal levels operated upon, and bone graft type. Clinical outcomes included the Oswestry disability index (ODI), neurogenic symptom score (NSS), 36-item short form health survey (SF-36), and visual analogue scale (VAS) for back and leg pain. Radiological assessment included plain radiographs and preoperative magnetic resonance imaging (MRI) and plain radiographs at 1, 3, 6, and 24 months postoperatively. Fusion grade, loosening, cage migration, and adjacent segment degeneration were assessed.ResultsThe groups had similar fluoroscopy time, operation duration, and postoperative analgesia type used. “Old-old” patients took longer to ambulate (1.6 days) and had longer hospital stays (6 days). All patients showed significant improvement in clinical outcome scores at all time-points compared with the preoperative status. “Middle-age” patients showed better ODI and SF-36 physical function scores than “old-old” patients preoperatively and 2 years post surgery. NSS, VAS (back and leg), and SF-36 mental function scores were similar between groups preoperatively and at every time-point postoperatively. Minimal clinical important differences (63.6%–95.5% at 2 years) were achieved. Grade 1 fusion occurred in a minimum of 80% patients in each group 2 years post surgery. Complication rates were similar. Adjacent segment disease occurred in 2 patients from the “young-old” group, with no significant differences between groups.ConclusionsMIS-TLIF showed comparable results in selected “old-old” patients compared with “young-old” and “middle-age” patients without increased complication risks.

Extreme lateral interbody fusion relieves symptoms of spinal stenosis and low-grade spondylolisthesis by indirect decompression in complex patients

Spinal stenosis and low-grade spondylolisthesis produce symptoms of neural compression that can be treated with extreme lateral lumbar interbody fusion (XLIF) via indirect decompression. This study aimed to investigate whether the restoration of disc dimensions would relieve symptoms of radiculopathy, claudication and back pain. In this retrospective study, patients undergoing XLIF surgery for relief of radicular symptoms or degenerative disc disease were included. Radiologically proven changes were used to assess the modes of degeneration. Objective measures such as the Visual Analogue Scale (VAS) for back and legs and the Oswestry Disability Index (ODI) were used. Complications were collated post-operatively from clinical notes and outpatient appointments. Twenty-three consecutive patients were included, of whom 91% had spinal stenosis. The cohort presented with multiple comorbidities and 35% of the cohort had undergone previous lumbar surgery. There was a 61% improvement of coronal Cobb angle and an 11% correction of the lordosis sustained 1year after surgery. Clinical outcomes at 1year showed 39%, 50% and 60% improvements in the ODI, back and leg VAS scores respectively. 48% of patients had reduced sensation related to lumbosacral plexus manipulation and one retroperitoneal haematoma was conservatively managed. Minimally invasive spinal (MIS) XLIF resulted in effective restoration of disc dimensions via indirect decompression, providing good relief of clinical symptoms evidenced by significant improvement in clinical outcome scores. XLIF corrected scoliosis and improved lumbar lordosis significantly. Several plexopathies did not hinder long-term recovery. XLIF is highly suited to treating complex patients with multiple comorbidities and degenerative disease.

Return-to-play rates following arthroscopic treatment of femoroacetabular impingement in competitive baseball players

ABSTRACTObjective: Femoroacetabular impingement (FAI) has been increasingly recognized in cutting sports including soccer, hockey and football. More recently, the prevalence among overhead athletes has also been recognized. The purpose of this study was to review impingement patterns, return-to-play rates and clinical outcome following arthroscopic treatment of FAI among high-level baseball players.Methods: Between 2010 and 2014, 70 competitive baseball players (86 hips; age 22.4 ± 4.5 years) were identified. Demographics and return-to-play rates were recorded. Patient-reported outcome scores, including the Modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL), the Sport-specific Subscale (HOS-SSS), and the International Hip Outcome Tool (iHOT-33), were collected pre-operatively at 6 months and 1year (n = 34, 49% of cohort).Results: The cohort included professional (27.1%), college (57.1%), high-school (8.6%) and club-team athletes (7.1%). Infielder (37.5%), pitcher (22.9%) and catcher (16.7%) were the most common positions. Average follow-up was 16.8 months (range 12.1–34.2). There was no relationship between playing position and impingement pattern (p ≥ 0.459), or between symptom laterality and handedness, batting position or playing position (p ≥ 0.179). One patient required revision surgery (infection). Return to sport rate was 88%, at a mean of 8.6 ± 4.2 months, with 97.7% returning at/above their pre-injury level of play. There was significant improvement in all outcome measures: mHHS (60.1 ± 11.9 to 93 ± 9.5), HOS-ADL (71.3 ± 16.7 to 96.3 ± 3.6), HOS-SSS (51.3 ± 24.8 to 92.3 ± 8.2) and iHOT-33 (40.7 ± 19.9 to 85.9 ± 14) (p < 0.001).Conclusion: Arthroscopic treatment of FAI in competitive baseball players resulted in high return-to-play rates at short-term follow-up, with significant improvements in clinical outcome scores.

Outcomes of a Stepcut Lengthening Calcaneal Osteotomy (SLCO) Compared to Evans Calcaneal Osteotomy for Stage IIb Adult-Acquired Flatfoot Deformity

Category: Hindfoot Introduction/Purpose: Lateral column lengthening is a powerful procedure utilized to correct the associated abduction deformity in stage II flatfoot deformity; however, prior studies have shown complications of nonunion, graft collapse, and lateral column overload with the Evans osteotomy. The Stepcut Lengthening Calcaneal Osteotomy (SLCO) is a z-lengthening calcaneal osteotomy that can correct midfoot abduction while providing inherent stability by creating a large surface area for bony healing. The goal of our study was to compare outcomes in patients undergoing a SLCO versus an Evans osteotomy. It is our hypothesis that patients following a SLCO would have a decreased incidence of nonunion and lateral overload of the foot, and similar improvement in clinical outcome scores. Methods: All consecutive patients from 2006 to 2013 undergoing stage IIB flatfoot reconstruction from our institution’s Foot &amp; Ankle Registry were identified and included. There were 65 Evans &amp; 79 Stepcut patients with a minimum of two year followup. All patients undergoing flatfoot reconstruction were included regardless of associated procedures which were not significantly different between the groups (Table 1). Deformity correction was assessed using preoperative and postoperative weightbearing radiographs. Healing of the osteotomy was assessed by computed tomography (CT). Clinical outcomes were assessed by the Foot and Ankle Outcomes Score (FAOS) survey which has been validated for flatfoot. Rate of return to the OR was also assessed. Differences in continuous variables between groups were assessed with independent samples t-tests, or Mann-Whitney U tests when non-normally distributed. Differences in categorical variables between groups were assessed with chi-squared and Fisher’s exact tests. An alpha level of 0.05 was deemed statistically significant. Results: The Evans group had a 0.9 mm larger graft size (p &lt; 0.001) than the SLCO Group (Table 2). The SLCO group had greater improvement in talonavicular coverage angle (p &lt; 0.001) and talonavicular incongruency angle (p = 0.023) than the Evans group. The Evans group returned more often for additional surgeries (p = 0.030). While there was improvement in mean FAOS scores in both groups for all subscales, only the mean FAOS score for sports activities (p = 0.012) was statistically better in the SLCO group. Rate of nonunion was not statistically significant (p = 0.086) between groups. There was no occurrence of loss of correction or lack of healing of the main (horizontal) arm of the osteotomy site in the SLCO group. Conclusion: Patients who underwent the SLCO for stage IIb adult-acquired flatfoot deformity demonstrated excellent healing, good correction of deformity, utilized a smaller graft size for correction, and less frequently needed to have a second operation on the involved foot. Additionally when compared to the Evans osteotomy, the SLCO group had comparable improvements in FAOS scores; thus making the SLCO a reasonable alternative for lateral column lengthening

Impact of glenosphere size on clinical outcomes after reverse total shoulder arthroplasty: an analysis of 297 shoulders

Although increasing glenosphere diameter has been found to increase passive range of motion (ROM) in simulated models of reverse total shoulder arthroplasty (rTSA), the clinical implications of glenosphere size are unclear. The purpose of our study was to determine the impact that glenosphere size had on short-term and midterm clinical outcomes, specifically American Shoulder and Elbow Surgeons (ASES) scores and ROM. Prospectively collected data comparing patients receiving an rTSA with either a 38- or 42-mm glenosphere after a minimum 2-year follow-up were obtained. Clinical outcome measures included active ROM and ASES scores. We included 297 primary rTSAs in 290 patients: a 38-mm-diameter glenosphere was used in 160 shoulders and a 42-mm-diameter glenosphere in 137 shoulders. Of the patients, 191 were women and 99 were men. The mean age at the time of surgery was 72 years (range, 50-88 years). At last follow-up, improvements in active forward elevation (aFE) and active external rotation (aER) were significantly greater in shoulders with a 42-mm glenosphere (+59° vs +44° for aFE and +24° vs +18° for aER). Female shoulders treated with a 42-mm glenosphere had significantly greater improvements in aFE, aER, and functional scores. Male shoulders treated with a 38-mm glenosphere had significantly greater improvements in pain levels and ASES scores but less improvement in aFE. Complications and rates of scapular notching were similar between glenosphere sizes. Patients treated with 42-mm glenospheres had greater improvements in aFE and aER when compared with 38-mm glenospheres. Our results suggest a potential association among gender, glenosphere size, and improvement in clinical outcome scores. Level III; Retrospective Cohort Design; Treatment Study.

Microfracture produces inferior outcomes to other cartilage repair techniques in chondral injuries in the paediatric knee

Chondral injuries are becoming increasingly common in the paediatric knee. First line surgical therapy is usually microfracture (MF), but the emergence of alternative techniques raises the question of what is the optimal treatment in paediatric patients. A comprehensive search of PubMed, OVID, Web of Science, SportDiscus and Cochrane databases was performed using the key words 'autologous chondrocyte implantation, MF, mosaicplasty, juvenile, paediatric'. Each technique demonstrated a significant post-surgical improvement in clinical outcome scores. However, MF demonstrated poorer outcomes in larger lesions (>3 cm(2)) and shorter durability. The quality of the available literature is poor, and there is a lack of comparative trials. The impact of defect characteristics, mechanism of injury and concomitant surgeries should be investigated. Appropriately powered randomized controlled trials with suitably long follow up and condition-specific outcome measures should compare different techniques against each other and placebo.

Outcomes of a Stepcut Lengthening Calcaneal Osteotomy for Adult-Acquired Flatfoot Deformity.

Lateral column lengthening is used to correct abduction deformity at the midfoot and improve talar head coverage in patients with flatfoot deformity. It was our hypothesis that following a stepcut lengthening calcaneal osteotomy (SLCO), patients would have adequate correction of the deformity, a high union rate of the osteotomy, and improvement in clinical outcome scores. We retrospectively reviewed 37 consecutive patients who underwent SLCO for the treatment of stage IIB flatfoot deformity with a minimum 2-year follow-up. Deformity correction was assessed using preoperative and postoperative weight-bearing radiographs. Healing of the osteotomy was assessed by computed tomography. Clinical outcomes included the FAOS and SF-36 questionnaires. The Wilcoxon signed-rank test was used to compare clinical outcome scores. An alpha level of .05 was deemed statistically significant. Healing of the osteotomy occurred at a mean of 7.7 weeks postoperatively. The talonavicular (TN) coverage angle improved from 34.0 to 8.8 (P < .001), the percentage of TN uncoverage improved from 40.9% to 17.7% (P < .001), and the TN incongruency angle improved from 68.1 to 8.7 (P < .001). In addition, there was an improvement in FAOS pain (P < .001), daily activities (P < .001), sport activities (P = .006), and quality of life scores (P < .001). Overall SF-36 scores also showed improvement postoperatively (P < .001). There was no incidence of delayed union, nonunion, or graft collapse. Following SLCO, patients demonstrated excellent healing, good correction of the deformity, and improvement in clinical outcomes scores. The SLCO is an alternative to the Evans osteotomy for lateral column lengthening. Level IV, retrospective case review.

Prospective Evaluation Of Meniscal Allograft Transplantation Revision: A Minimum Of 2-year Follow-up

Prospective Evaluation Of Meniscal Allograft Transplantation Revision: A Minimum Of 2-year Follow-up

Surgical Technique for Total Ankle Arthroplasty in Ankles with Preoperative Coronal Plane Varus Deformity of 10° or Greater.

Total ankle replacement for end-stage ankle arthritis with talar varus malalignment of ≥10° can achieve satisfactory outcomes in the ankle joint, and ≥10° of talar varus malalignment should not be considered a contraindication for surgery. Conduct a thorough clinical and radiographic evaluation of the entire lower extremity. In the operating room, conduct a physical examination prior to and following ankle exposure to determine the ancillary procedures required. Proceed with tendon and soft-tissue release as needed to correct pes cavus deformity and improve range of motion. Correct varus talar deformity via a standard resection of the ankle joint osteophytes, starting laterally and finishing medially. Consider transfer of the posterior tibial tendon to the peroneus brevis to help maintain correction of the varus deformity. Once you determine that the talar varus is correctable and you have prepared the posterior tibial tendon for transfer, perform the total ankle replacement. Evaluate the rest of the foot and perform any required ancillary procedures; most often a dorsiflexion osteotomy of the first metatarsal is necessary to correct forefoot valgus, which is commonly seen in forefoot-driven cavovarus deformities. Patients with preoperative coronal plane varus tibiotalar deformities of ≥10° who underwent total ankle replacement have shown significant improvement in clinical outcome scores at the time of mid-term follow-up.IndicationsContraindicationsPitfalls & Challenges.

Does Patellectomy Jeopardize Function After TKA?

The patella provides important mechanical leverage to the knee extensor mechanism. Patellectomy does not exclude the development of tibiofemoral arthrosis. We asked whether (1) TKA provides improvements in clinical outcome scores in patellectomized knees and (2) the scores of TKA in patellectomized knees are comparable to those in knees with intact patellae. We evaluated 50 patients (52 primary TKAs) with patellectomized knees and a control group of 52 patients (52 primary TKAs) with intact patellae matched for age, sex, implant, and surgical year between 1984 and 2009. We compared the preoperative and latest postoperative SF-12, WOMAC, and Knee Society score (KSS). Minimum followup was 24months (mean, 69months; range, 24-204months). The mean WOMAC score in the control group improved from 41.8 (range, 7.5-72.4) preoperatively to 69.1 (range, 17.0-100.0) postoperatively, while that in the patellectomized group improved from 35.8 (range, 5.2-62.2) to 61.3 (range, 17.5-96.2). The mean KSS improved from 80.4 (range, 4.0-143.0) preoperatively to 161.4 (range, 69.0-200.0) postoperatively in the control group and from 76.9 (range, 5-134) to 136.8 (range, 7-199) in the patellectomized group. Mean postoperative WOMAC scores were comparable between the two groups, while the mean KSS was lower in the patellectomized group. The mean SF-12 scores were not different after TKA or between groups. Despite the mechanical disadvantage to the knee extensor mechanism rendered by a previous patellectomy, TKA for tibiofemoral arthrosis in these patients relieved pain and restored function, but function was on average lower than that in patients with intact patellae. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Treatment of isolated chondral and osteochondral defects in the knee by autologous matrix-induced chondrogenesis (AMIC)

The purpose of this study is to evaluate clinical and radiological outcomes of patients treated with autologous matrix-induced chondrogenesis (AMIC) for full-thickness chondral and osteochondral defects of the femoral condyles and patella. A retrospective evaluation of clinical and radiographic outcomes of patients treated with AMIC for chondral and osteochondral full-thickness cartilage defects of the knee was performed with a mean follow-up of 28.8 ± 1.5 months (range, 13-51 months). Significant improvements in clinical outcome scores (IKDC, Lysholm, Tegner, and VAS pain score) were noted. The largest improvements were seen in the osteochondral subgroup (mean age 25.9 years), whereas patients treated for chondral defects in the patellofemoral joint and on the femoral condyles improved less. Patients in all groups were generally satisfied with their results. MRI evaluation showed that tissue filling was present but generally not complete or homogenous. AMIC is a safe procedure and leads to clinical improvement of symptomatic full-thickness chondral and osteochondral defects and to regenerative defect filling. The value of AMIC relative to other cartilage repair procedures and to the natural course remains undefined. Case series, Level IV.

The Thrust Plate Prosthesis in the Treatment of Osteoarthritis of the Hip. Clinical and Radiological Outcome with Minimum 5-year follow-up

The thrust plate prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA). We present our mid-term results from using the thrust plate prosthesis in young patients with hip arthritis. We conducted a retrospective review of a consecutive series of patients with a minimum of 5 years follow-up after total hip arthroplasty using the thrust plate prosthesis. Harris Hip Score (HHS) and Oxford Hip Score (OHS) were recorded preoperatively and at the last clinical review. Radiographic analysis was performed and patient satisfaction levels and complications were recorded. Between 1996 and 2000 we implanted 41 prostheses in 38 consecutive patients (3 bilateral). The mean age at time of surgery was 56 years (41-67) and the mean length of follow-up was 71 months. The HHS improved from a mean of 42 points preoperatively to 88 points at the last clinical review and the mean OHS also improved from 40 points to 18 points. Eighty-three percent of patients expressed that they were 'very satisfied' with the procedure. Implant survivorship was 95% at 5 years follow-up with revision surgery being the end point. Eight patients suffer discomfort when lying on the operated side. Many patients treated with the TPP show excellent improvement in clinical outcome scores and a high level of patient satisfaction but the complication rate gives some concern. We support the selective use of the TPP to treat young patients with hip osteoarthritis.

The thrust plate prosthesis in the treatment of osteoarthritis of the hip. Clinical and radiological outcome with minimum 5-year follow-up

The thrust plate prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA). We present our mid-term results from using the thrust plate prosthesis in young patients with hip arthritis. We conducted a retrospective review of a consecutive series of patients with a minimum of 5 years follow-up after total hip arthroplasty using the thrust plate prosthesis. Harris Hip Score (HHS) and Oxford Hip Score (OHS) were recorded preoperatively and at the last clinical review. Radiographic analysis was performed and patient satisfaction levels and complications were recorded. Between 1996 and 2000 we implanted 41 prostheses in 38 consecutive patients (3 bilateral). The mean age at time of surgery was 56 years (41-67) and the mean length of follow-up was 71 months. The HHS improved from a mean of 42 points preoperatively to 88 points at the last clinical review and the mean OHS also improved from 40 points to 18 points. Eighty-three percent of patients expressed that they were 'very satisfied' with the procedure. Implant survivorship was 95% at 5 years follow-up with revision surgery being the end point. Eight patients suffer discomfort when lying on the operated side. Many patients treated with the TPP show excellent improvement in clinical outcome scores and a high level of patient satisfaction but the complication rate gives some concern. We support the selective use of the TPP to treat young patients with hip osteoarthritis.