Long-term Patient Satisfaction Research Articles

Essential elements of an outpatient total joint replacement programme.

To summarize the safety and feasibility of outpatient total joint arthroplasty (TJA) from the perspectives of short-term complications, long-term functional outcomes, patient satisfaction and financial impact, and to provide evidence-based guidance on how to establish an outpatient TJA programme. TJA has been recently transitioned from an exclusively inpatient procedure for all Medicare and Medicaid patients to an outpatient surgery in properly selected total knee arthroplasty patients. This change may decrease costs while maintaining comparable rates of readmission, adverse events, positive surgical outcomes and patient satisfaction. With a standardized clinical pathway, outpatient TJA can be safe and effective in a subset of patients. Essential components of a successful outpatient TJA programme include proper patient selection, preoperative patient/family education, perioperative multidisciplinary coordination and opioid-sparing analgesia, and early and effective postdischarge planning. More studies are needed to further assess and optimize this new care paradigm.

Evaluating Current Scar Assessment Methods.

Current scar surveys have included many questions to evaluate the physical characteristics of scars, with some expanding to include physical implications and patient opinions. This review provides an analysis of frequently used scar assessment methods to date and highlights potential areas for improvement. We build the case that a new assessment tool is necessary, specifically one that centers on psychosocial consequences of scars that influence patient decision making for treatment, allowing physicians to individualize treatment conversations with patients. We postulate that survey techniques used in consumer product marketing, such as choice-based conjoint analysis, may be effective in determining the factors strongly influencing patient decision making and spending in scar treatment; therefore, more research in this area is warranted. By incorporating these psychosocial and economic considerations driving scar treatment decisions, future scar assessment tools may accomplish much more than characterizing/documenting the clinical aspects of scars. Rather, these patient-centered, holistic tools may be implemented by plastic surgeons and other clinicians specifically to provide patients with personalized treatment options that maximize long-term patient satisfaction.

How satisfied are cervical dystonia patients after 3\xa0years of botulinum toxin type A treatment? Results from a prospective, long-term observational study

BackgroundPatients with cervical dystonia (CD) typically require regular injections of botulinum toxin to maintain symptomatic control. We aimed to document long-term patient satisfaction with CD symptom control in a large cohort of patients treated in routine practice.MethodsThis was a prospective, international, observational study (NCT01753349) following the course of adult CD treated with botulinum neurotoxin type A (BoNT-A) over 3 years. A comprehensive clinical assessment status was performed at each injection visit and subjects reported satisfaction in two ways: satisfaction with symptom control at peak effect and at the end of treatment cycle.ResultsSubject satisfaction remained relatively stable from the first to the last injection visit. At 3 years, 89.9% of subjects reported satisfaction with symptom control at peak effect and 55.6% reported satisfaction with symptom control at end of treatment cycle. By contrast, objective ratings of CD severity showed an overall reduction over 3 years. Mean ± SD Toronto Western Spasmodic Rating Scale (TWSTRS) Total scores (clinician assessed at end of treatment cycle) decreased from 31.59 ± 13.04 at baseline to 24.49 ± 12.43 at 3 years (mean ± SD reduction from baseline of − 6.97 ± 11.56 points). Tsui scale scores also showed gradual improvement; the percent of subjects with a tremor component score of 4 reduced from 12.4% at baseline to 8.1% at 3 years.ConclusionsDespite objective clinical improvements over 3 years, subject satisfaction with symptom control remained relatively constant, indicating that factors other than symptom control also play a role in patient satisfaction.

Predictors of patient satisfaction following 1- or 2-level anterior cervical discectomy and fusion: insights from the Quality Outcomes Database.

Patient satisfaction with treatment outcome is gaining an increasingly important role in assessing the value of surgical spine care delivery. Nationwide data evaluating the predictors of patient satisfaction in elective cervical spine surgery are lacking. The authors sought to decipher the impacts of the patient, surgical practice, and surgeon on satisfaction with outcome following anterior cervical discectomy and fusion (ACDF). The authors queried the Quality Outcomes Database for patients undergoing 1- to 2-level ACDF for degenerative spine disease since 2013. Patient satisfaction with the surgical outcome as measured by the North American Spine Society (NASS) scale comprised the primary outcome. A multivariable proportional odds logistic regression model was constructed with adjustments for baseline patient characteristics and surgical practice and surgeon characteristics as fixed effects. A total of 4148 patients (median age 54 years, 48% males) with complete 12-month NASS satisfaction data were analyzed. Sixty-seven percent of patients answered that "surgery met their expectations" (n = 2803), while 20% reported that they "did not improve as much as they had hoped but they would undergo the same operation for the same results" (n = 836). After adjusting for a multitude of patient-specific as well as hospital- and surgeon-related factors, the authors found baseline Neck Disability Index (NDI) score, US geographic region of hospital, patient race, insurance status, symptom duration, and Workers' compensation status to be the most important predictors of patient satisfaction. The discriminative ability of the model was satisfactory (c-index 0.66, overfitting-corrected estimate 0.64). The authors' results found baseline NDI score, patient race, insurance status, symptom duration, and Workers' compensation status as well as the geographic region of the hospital to be the most important predictors of long-term patient satisfaction after a 1- to 2-level ACDF. The findings of the present analysis further reinforce the role of preoperative discussion with patients on setting treatment goals and realistic expectations.

Predictors of Patient Satisfaction Following One- or Two-Level Anterior Cervical Discectomy and Fusion: Insights From the Quality Outcomes Database

Abstract INTRODUCTION Patient satisfaction with the outcome is gaining an increasingly important role in assessing the value of surgical spine care delivery. There is a lack of nationwide data evaluating the predictors of patient satisfaction in elective cervical spine surgery. The aim of this study was to decipher the impact of patient, practice, and surgeon on satisfaction with outcome following anterior cervical discectomy and fusion (ACDF). METHODS We queried the Quality Outcome Database for patients undergoing 1 to 2 level ACDF for degenerative spine disease since 2013. Patient satisfaction with the surgical outcome as measured by the North American Spine Society (NASS) scale comprised the primary outcome. A multivariable proportional odds logistic regression model was constructed adjusting for baseline patient characteristics, practice ID and surgeon ID characteristics as fixed effects. RESULTS A total of 4148 patients (median age 54 yr, 48% males) with complete 12-mo NASS satisfaction data were analyzed. Sixty-seven percent of patients answered that “surgery met their expectations” (n = 2803), while 20% “did not improve as much as they had hoped but they would undergo the same operation for the same results” (n = 836). After adjusting for a multitude of patient specific as well as hospital and surgeon related factors, we found baseline NDI score, region of hospital, patient race, insurance status, symptom duration, and worker's compensation to be the most important predictors of patient satisfaction. The discriminative ability of the model was satisfactory (c-index = 0.66, overfitting-corrected = 0.64). CONCLUSION Our results found baseline NDI score, patient race, insurance status, symptom duration, worker's compensation as well as region of hospital to be the most important predictors of long-term patient satisfaction after a 1 to 2 level ACDF. The findings of the present analysis further reinforce the role of preoperative discussion with the patients on setting treatment goals and realistic expectations.

Evaluation of Long-Term Outcome and Patient Satisfaction after Inguinal Hernia Repair

Evaluation of Long-Term Outcome and Patient Satisfaction after Inguinal Hernia Repair

Comparison of laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopic (CMPL) surgery for hysterectomy: long-term outcomes of abdominal incisional scar

There is scarcity of data about the long-term results such as port-site hernia, body image scale and cosmesis scale outcomes between laparoendoscopic single-site (LESS) surgery and conventional multiport laparoscopy (CMPL) for hysterectomy. Eighty women, who underwent total hysterectomy by the LESS (n = 40) and CMPL (n = 40) technique due to benign and malign gynecological disorders, were evaluated with a cosmesis and body image questionnaire in an age-matched cohort study.Median follow-up time was 25 (6–30) months in both groups. The mean age of the patients was 49.3 ± 6.3 years. The mean body image scale scores were 5.3 ± 0.6 and 5.5 ± 1.2 in the LESS and CMPL groups, respectively (p = 0.268). The mean cosmesis and scar scale scores were significantly higher in the LESS group compared to the CMPL group (p = .011 and p < .001, respectively). Port-site hernia was detected in two patients in the LESS group, but not in the CMPL group. There was no cuff dehiscence in the LESS nor in the CMPL group. The LESS technique provides better cosmesis when compared with the CMPL technique. The body image perceptions in the two groups were similar. Women who wish to undergo the LESS surgery should be informed about the risk of incisional hernia.Impact statementWhat is already known on this subject? Short-term results of LESS hysterectomy such as complication rates, additional port requirement, conversion to CMPL or laparotomy, pain score and analgesic use were evaluated in various studies. Several studies have been published on the safety and efficacy of single-port laparoscopic hysterectomy (LH); however, it has been unclear whether single-port LH offers benefits over multiport LH regarding long-term patient satisfaction and cosmetic satisfaction.What do the results of this study add? In this prospective cohort study, we aimed to compare long-term results (at least six months) of abdominal incisional scar between LESS and CMPL surgery for hysterectomy. The LESS technique provides better cosmesis when compared with the CMPL technique, although, the body image perceptions in the two groups were similar.What are the implications of these findings for clinical practice and/or further research? LESS technique can be offered as an option for hysterectomy since it provides better long-term cosmesis compared to CMPL.

WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition.

Management of individuals presenting with partial loss of teeth is a common task for dentists. Outcomes important to the management of missing teeth in the partially absent dentition should be systematically summarized. This review recognizes both the challenges associated with such a summarization and the critical nature of the information for patients. To assess the effects of different prostheses for the treatment of partially absent dentition in terms of the following outcomes: long-term success, function, morbidity and patient satisfaction. We searched the Cochrane Oral Health Group's Trials Register (to 21 March 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to March 2011) and EMBASE via OVID (1980 to March 2011). There were no restrictions regarding language or date of publication. We contacted several authors to identify non-published trials. Randomized controlled trials (RCTs) comparing different methods (including the design and materials used) of treating partial edentulism, with clinically relevant outcomes, were included in this review. Trials reporting only surrogate outcomes, such as plaque accumulation or gingival volume, were excluded from this review. Two review authors independently carried out the screening of eligible studies, assessment of dimensions of quality of trials, and data extraction. Results were expressed as mean differences for continuous data, risk ratios for dichotomous outcomes, and hazard ratios with 95% confidence intervals for time-to-event data. Twenty-one trials met the inclusion criteria for this review. Twenty-four per cent of these were assessed as being at high risk of bias and the remainder were at unclear risk of bias. The clinical heterogeneity among the included studies precluded any attempt at meta-analysis. There was insufficient evidence to determine whether one type of removable dental prosthesis (RDP) was better or worse than another. With fixed dental prostheses (FDPs), there was no evidence that high gold alloys are better or worse than other alloys, nor that gold alloys or frameworks are better or worse than titanium. There is insufficient evidence to determine whether zirconia is better or worse that other FDP materials, that ceramic abutments are better or worse than titanium, or that one cement was better or worse than another in retaining FDPs. There is insufficient evidence to determine the relative effectiveness of FDPs and RDPs in patients with shortened dental arch or to determine the relative advantages of implant supported FDPs versus tooth/implant supported FDPs. Based on trials meeting the inclusion criteria for this review, there is insufficient evidence to recommend a particular method of tooth replacement for partially edentulous patients.

Long-term Outcomes of Bone Conduction Hearing Implants in Patients With Bilateral Microtia-atresia.

To evaluate the long-term outcomes of three different types of bone conduction hearing implants (BCHI)-BAHA, Ponto, and Bonebridge-in Mandarin-speaking patients with bilateral microtia-atresia. This cohort study enrolled 59 patients affected by bilateral microtia-atresia, with an upper bone conduction threshold limit of 30 dB HL at frequencies of 0.5 to 4 kHz. All subjects underwent unilateral BCHI surgery, including 26 (18 males, 8 females, of mean age 8.7 ± 1.9 yr) implanted with BAHA devices; 10 (7 males, 3 females, of mean age 11.7 ± 2.8 yr) implanted with Ponto devices; and 23 (14 males, 9 females, of mean age 9.0 ± 1.8 yr) implanted with Bonebridge devices. The main outcome measures included long-term audiological benefits, patient satisfaction, and complications. Each subject acted as his or her own control. Two years after BCHI surgery, the mean hearing thresholds in the BAHA, Ponto, and Bonebridge groups had improved to 22.6 ± 1.6 dB HL, 21.6 ± 1.2 dB HL, and 22.5 ± 1.5 dB HL, respectively. The mean percentages of subjects in these three groups recognizing speech at 65 dB SPL under quiet conditions were 97.7 ± 4.2%, 96.3 ± 1.1%, and 94.4 ± 9.4%, respectively, whereas the mean percentages recognizing speech under noise conditions (signal:noise ratio +5) were 87.0 ± 1.8%, 89.3 ± 9.3%, and 85.3 ± 4.7%, respectively. Questionnaires revealed patients' benefits and satisfaction with this surgery. Three (11.5%) of 26 patients in the BAHA group and 1 (10%) of 10 in the Ponto group experienced skin irritation, but all recovered after local treatment. Five (19.2%) patients in the BAHA group and two (20%) in the Ponto experienced abutment extrusion about 6 months postoperatively, with all achieving good results after revision surgery to replace the abutment. One (3.8%) patient in the BAHA group experienced local chronic inflammation and underwent surgery to replace the BAHA with a Bonebridge implant. One (4.3%) patient in the Bonebridge group developed a local infection 3 months postoperatively and underwent implant removal. All three BCHIs were well tolerated after long-term follow-up, and all improved audiometric thresholds and the intelligibility of speech in the presence of both quiet and noise. These implants should be considered valid and safe options for the functional rehabilitation of patients with bilateral microtia-atresia.

Effects of uterine preservation on long-term subjective outcomes of sacrospinous ligament fixation for the treatment of pelvic organ prolapse

ObjectiveTo evaluate the long-term subjective outcomes in women who underwent sacrospinous ligament fixation with and without uterine preservation for treatment of uterovaginal prolapse. Study designTwo hundred and ten women with POP-Q≧stage III uterovaginal prolapse, who underwent sacrospinous ligament fixation from January 1994 to December 2007 were included. Patient Global Impression of Improvement was used to assess the surgical outcome in July 2016. Primary outcome measures were subjective success rate and current satisfaction. Kaplan-Meier method and Cox proportional hazard model were used for analysis. ResultsThe mean follow-up was 13.3 years (range 8.5–22.6 years). One hundred and thirty-nine patients were successfully interviewed and analyzed. The cumulative subjective success rate was 88.5% and current satisfaction was 77.7%. The repeat surgery rate was 2.9%. There were no significant differences in subjective success (89% vs. 88%) or current satisfaction (78.1% vs. 77.3%) between uterine preservation (n = 64) and concomitant hysterectomy (n = 75). Kaplan-Meier analysis showed that sacrospinous ligament fixation with uterine preservation had a better subjective outcome at mid-term follow-up but was not significantly different compared with concomitant hysterectomy after long-term follow-up (P = 0.63). The adjusted HR of uterine preservation was 0.75 (95%CI: 0.22–2.12, P = 0.59). ConclusionSacrospinous ligament fixation with or without uterine preservation in the treatment of women with uterovaginal prolapse has no significant difference in long-term subjective outcomes and patient satisfaction.

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database.

OBJECTIVESince the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the "value"-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1-4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom.RESULTSA total of 502 patients, out of a cohort of 608 patients (82.5%) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5%, n = 113) or 1-level decompression and fusion (77.5%, n = 389), met the inclusion criteria; of these, 82.1% (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7%, n = 172, vs 24.4%, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1%, n = 95, vs 11.1%, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5-9] vs 8 [6-9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95% CI 1.09-2.76; p = 0.009), preoperative active employment (OR 2.06, 95% CI 1.27-3.67; p = 0.015), and fusion surgery (OR 2.3, 95% CI 1.30-4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome.CONCLUSIONSCurrent findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.

Repair of complex abdominal wall hernias with a cross-linked porcine acellular matrix: cross-sectional results of a Dutch cohort study

BackgroundThe use of synthetic mesh in potentially contaminated and contaminated incisional hernias may lead to a higher morbidity and mortality. Biological meshes may provide a solution, but since these meshes are rarely used, little is known about long-term results. The aim of this cohort study was to evaluate the long-term clinical efficacy and patient satisfaction following Permacol™ in complex abdominal wall hernia repair (CAWHR) patients in a cross-sectional fashion. Materials and methodsAll patients were operated for CAWHR with Permacol™ in the Netherlands between 2009 and 2012. The design was a multicenter cross-sectional cohort study. The STROCSS statement was followed. Patients were interviewed, underwent abdominal examination, and completed quality-of-life questionnaires. ClinicalTrials.gov Identifier NCT02166112. Research Registry Identifier researchregistry4713. ResultsSeventy-seven patients were seen in the outpatient clinic. Their hernias were classified as potentially contaminated in 25 patients (32.5%) and infected in 52 patients (67.5%). The mean follow-up was 22.2 ± 12.6 months. The most frequent postoperative complication was wound infection (n = 21; 27.3%), meshes had to be removed in five patients (6.5%). By the time of their visit to the outpatient clinic, 22 patients (28.6%) had a recurrence of whom ten (13%) had undergone reoperation. Thirty-nine patients (50.6%) had bulging of the abdominal wall. Quality-of-life questionnaires revealed that patients graded their health status with a mean 6.8 (± 1.8) out of 10 points. ConclusionBulging and recurrence are frequently observed in patients treated with Permacol™ for CAWHR. Considering both recurrence and bulging as undesirable outcomes of treatment, a total of 46 patients (59.7%) had an unfavorable outcome. Infection rates were high, but comparable with similar patient cohorts. Quality-of-life questionnaires revealed that patients were satisfied with their general health, but scored significantly lower on most quality-of-life modalities of the Short Form-36 questionnaire.

Topology optimization of fixed complete denture framework.

The functionality of a denture is directly related to the quality of life of the edentulous patients because treatment failure results in demoralizing consequences including difficulties in oral activities. Framework for fixed complete dentures plays a crucial role by transferring loads from the denture to the implants, which are integrated into the remaining bones and gingiva, thereby providing stability to the denture. Current techniques utilize 3D scan data of the implant site to capture the locations and soft tissue contours to design customized framework using computer-aided design (CAD) and computer-aided manufacturing (CAM) technology to properly support the denture teeth in their position. The performance and efficiency of these frameworks may be enhanced by incorporating a design optimization in the design process. We tested the feasibility of using the topology optimization to design patient-specific dental frameworks. The shapes of the optimized frameworks may be significantly different from the traditional designs, but better structural integrity is likely to be achieved with potentially less material. The numerical study reveals that commercially available dental framework would experience 16% less maximum stress when topology optimized even with a compliance minimization formulation with 50% volume fraction constraint. Topology optimization for designing dental frameworks might improve current clinical methods and provide better long-term patient satisfaction.

Pelvic Organ Prolapse Recurrence and Patient-Centered Outcomes Following Minimally Invasive Abdominal Uterosacral Ligament and Mesh-Augmented Sacrohysteropexy.

The objective of this study was to compare outcomes after minimally invasive uterosacral ligament hysteropexy (USLH) and mesh-augmented sacrohysteropexy (MSH) for women with uterovaginal prolapse including prolapse recurrence and long-term patient satisfaction. This was a retrospective cohort study with a cross-sectional survey component. The medical record was queried for perioperative data for patients undergoing USLH and MSH between 2004 and 2016. Pelvic organ prolapse (POP) recurrence was defined as bulge symptoms and/or retreatment with a pessary or surgery. A cross-sectional survey assessed for adverse events and used validated questionnaires to assess symptoms and improvement. Ninety-seven patients met the inclusion criteria: 42 MSH and 55 USLH. Mean age was 48 ± 14 years. Patients undergoing MSH were older, had more advanced POP, and were less likely to undergo concurrent procedures. There were no differences in perioperative complications between groups; 22.7% (n = 22) of patients experienced POP recurrence with 8.3% (n = 8) undergoing repeat surgery. After controlling for preoperative differences, there was no difference in POP recurrence between groups. The incidence of sacrohysteropexy mesh exposure was 7% (n = 3). Sixty-one percent (n = 59) of patients completed the survey; median follow-up time was 104 (46-164) months. Forty-one percent of respondents reported bothersome pelvic floor symptoms. Bulge symptoms were more common after MSH (41% vs 10%, P = 0.006). Ninety-three percent of all patients reported improvement after surgery, which was not different between groups. One in 5 patients experienced POP recurrence with fewer than 10% undergoing repeat surgery for recurrence. There does not seem to be a significant difference in the incidence of recurrence between MSH and USLH.

Rational design and in vitro characterization of novel dental implant and abutment surfaces for balancing clinical and biological needs.

Long-term success and patient satisfaction of dental implant systems can only be achieved by fulfilling clinical as well as biological needs related to maintenance, aesthetics, soft tissue sealing, and osseointegration, among others. Surface properties largely contribute to the biological and clinical performance of implants and abutments. To decipher the clinical and biological needs in implant dentistry. To address identified needs, next-generation dental implant and abutment surfaces are designed and characterized in vitro. Novel implant and abutment surface designs were produced and characterized using surface chemical analysis, surface topography analysis, scanning electron microscopy, contact-angle measurements, and cell-culture experiments. The novel anodized implant surface was gradually anodized, increasing the surface roughness, surface enlargement, and oxide-layer thickness from platform to apex. The surface was phosphorus enriched, nonporous, and nanostructured at the collar, and showed micropores elsewhere. The novel anodized abutment surface was smooth, nanostructured, nonporous, and yellow. Pristine surfaces with high density of hydroxyl-groups were protected during storage using a removable cell-friendly layer that allowed dry packaging. A novel anodized implant system was developed with surface chemistry, topography, nanostructure, color, and surface energy designed to balance the clinical and biological needs at every tissue level.

Sagittal Alignment of the Femoral Component and Patient Height Are Associated With Persisting Flexion Contracture After Primary Total Knee Arthroplasty

BackgroundThe aim of our retrospective case-control study is to identify risk factors associated with a persisting flexion contracture after total knee arthroplasty (TKA). This is an important clinical issue as a flexion contraction can lead to poor long-term clinical outcomes and patient satisfaction after TKA. MethodsThe study group included 120 knees treated for a varus osteoarthritic deformity of the knee using a posterior cruciate-retaining TKA. We evaluated the association between a flexion contracture >10°, 2 years after surgery, and the following potential risk factors, using logistic regression analysis: age, body height, body mass index, preoperative knee extension and hip-knee-ankle angle, and radiological parameters of component alignment, namely the femoral component medial angle, the femoral component flexion angle (FFA), the tibial component medial angle, and the posterior tibial slope. ResultsOf the 120 knees, a persisting flexion contracture >10° was identified in 33 (28%). The mean FFA in these cases was 7.3° (standard deviation, 1.4) compared to 4.2° (standard deviation, 1.2) for cases with a contracture of ≤10° (P = .034). On multivariate analysis, the FFA (odds ratio, 3.73; 95% confidence interval, 1.16-17.81; P = .034) and body height (odds ratio, 0.43; 95% confidence interval, 0.29-0.57; P = .041) were independent predictive risk factors for a residual flexion contracture >10°. ConclusionClinicians should be aware that flexed position of the femoral component, particularly in patients of short stature, is associated with increased occurrence of persistent flexion contracture.

Patient-reported outcome measures (PROMs) and maintenance events in 2-implant-supported mandibular overdenture patients: A 5-year prospective study.

To prospectively evaluate patient-reported outcome measures (PROMs) and treatment outcomes of mandibular two-implant retained overdentures (IOD) in an edentulous geriatric cohort with history of deficient complete dentures (CD). A total of 103 patients with deficient CD received new optimal CD. After a period of 3months, 80 of the patients voluntarily received IOD. Outcomes collected at pre-, post-CD/post-IOD treatment annually up to 5years, included (a) Clinical outcomes: denture-quality (Woelfel's index), complications, and maintenance events, (b) PROMs: patient complaints (maxillary, mandibular functional complaint scores, generic aesthetic complaint scores, frequency, and intensity of complaints) and patient satisfaction, and (c) Maintenance events: technical complications and adverse events. Five-year data were collected from 67 patients (mean age at initiation=71.3years, mean observation=5.9years) with cumulative implant survival rate=98.72%. Multiple comparisons for 8 time points showed significant improvements in denture quality and PROMs after new CD and IOD delivery. Further significant improvements were only after IOD delivery in: mandibular denture-quality, mandibular and generic functional complaints, frequency, intensity of complaints, and overall patient satisfaction score. Thereafter, denture-quality and PROMs remained stable. Maintenance events clustered on 1st year and within a minority of patients. Technical complications and overall maintenance events significantly correlated with overall patient satisfaction score at 1st year. Mandibular IOD was a beneficial treatment option for seniors with history of deficient CD, improving denture-quality, patient satisfaction, and reducing patient complaints up to 5years. Maintenance events clustered on 1st year, showing no significant impact on long-term patient satisfaction and other PROMs.

Prospective controlled clinical study investigating long-term clinical parameters, patient satisfaction, and microbial contamination of zirconia implants.

Dental implants made of zirconia ceramics experienced a renaissance in the past years. However, there is still a lack in reliable long-term clinical data. Aim of the present prospective clinical study was to analyze the dental implants made from zirconia, regarding their clinical performance compared to natural teeth (control). Eighty-three zirconia implants in 28 adults were analyzed after 7.8 years of integration. Approximal plaque index (API), sulcus bleeding index (SBI), probing pocket depth (PPD), probing attachment level (PAL), and creeping or recession (CR/REC) of the mucosa/gingiva were analyzed. Changes in the marginal bone level (MBL) have been determined by comparing radiographs recorded immediately after implant placement and at the follow-up investigation. Furthermore, the pink esthetic score (PES), Periotest values (PTV), microbial colonization of the implant/dental sulcus fluid, and patient satisfaction were assessed. The survival rate of zirconia implants was 100%, however one implant presented a profound peri-implantitis, resistant to therapies. No statistical significance was observed between implants and teeth regarding SBI and PAL. Statistical significance was detected regarding API and CR/REC with significantly less plaque accumulation and recession in the study group. Significantly higher values for PPD were obvious in the zirconia implant group. PES of 9 ± 2.7 indicate a rather average esthetic result. Analysis of MBL revealed a mean peri-implant bone resorption of 1.2 mm. Microbial analysis revealed a nonstatistically significant higher colonization of bacteria in the study group, whereas single bacteria species were detected in statistically significant higher amounts. The investigated one-piece zirconia dental implants presented favorable long-term clinical results, comparable to natural teeth (SBI and PAL), and, regarding adhesion of plaque and creeping attachment (CR/REC), even superior. The microbial investigation revealed a shift in peri-implant colonization around zirconia implants over years, mainly without clinical effect on peri-implantitis.

The role of prehabilitation with a telerehabilitation system prior to total knee arthroplasty.

The purpose of the current study was to evaluate the usage of prehabilitation on a telehealth platform prior to total knee arthroplasty (TKA) and its impact on short-term outcomes. Specifically, the study examined whether patients participating in a prehabilitation program impacted length of stay (LOS) and discharge disposition. A total of 476 consecutive patients who underwent TKA at three institutions were included. The average age of the 476 patients was 65.1 years (range, 35 and 93 years). There was a total of 114 patients who utilized the novel prehabilitation program that provided exercises, nutritional advice, education regarding home safety and reducing medical risks, and pain management skills prior to surgery. A group of 362 patients who did not utilize the program formed the control cohort. The outcomes evaluated were LOS and discharge disposition to home, home with health aide (HHA), or skilled nursing facility (SNF). The average LOS in the prehabilitation group was significantly shorter than in the control group (2.0 vs. 2.7 days, P<0.001). Additionally, prehabilitation patients had more favorable discharge disposition status in comparison to the control group. In the prehabilitation patients, 77.2% went home without assistance, compared to 42.8% in the control group (P<0.001). Also, significantly fewer patients in the prehabilitation group were discharged to a SNF when compared to the control group (1.8% vs. 21.8%, P<0.0001). Prehabilitation preceding TKA in the current study showed early benefits in LOS and discharge disposition. This study will help expand the current literature and educate orthopaedic surgeons on a novel technology. To truly appreciate the role of telerehabilitation in the setting of TKA, further investigation is needed to investigate long-term outcomes, cost analysis, and patient and clinician satisfaction.

Factors predicting long-term patient satisfaction with botulinum toxin treatment in cervical dystonia

Factors predicting long-term patient satisfaction with botulinum toxin treatment in cervical dystonia