Periacetabular metastatic disease can cause notable morbidity, prompting potential surgical intervention. Open approaches, including the Harrington type reconstructive with a total hip replacement and cemented gap cup, have been the standard approach; however, these surgeries are invasive. Minimally invasive techniques, including screw fixation with cementation and potential ablation, aim to reduce morbidity. This study compares surgical and short-term postoperative outcomes between open reconstructive techniques and minimally invasive treatments in patients with periacetabular metastatic disease. Prospectively maintained institutional medical records were used to retrospectively identify patients who had undergone an open approach, who would be minimally invasive candidates, and patients who have undergone the minimally invasive procedure. Demographic, surgical data, and postoperative outcomes of patients with minimum 3-month follow-up were collected. Wilcoxon rank-sum test, chi-squared, and minimal clinically important difference (MCID) tests were used to determine statistical and clinical differences. Seventeen open and 48 minimally invasive patients were identified. Minimally invasive patients had statistically significant lower rate of surgical blood loss, transfusion rates, surgical time, and length of stay (P < 0.05). Fourteen open and 32 minimally invasive patients had minimum 3-month follow-up. No notable difference was found in the need for secondary procedures, complications, death within 90 days, or Pain and Ambulatory Function Scores (P > 0.05). 57.1% of the open cohort and 43.8% of the minimally invasive cohort met the MCID threshold. Minimally invasive patients had statistically significant quicker return to adjuvant therapies (P < 0.05). Our cohort study demonstrated that minimally invasive techniques reduced surgical morbidity while achieving similar short-term (3 month) postoperative outcomes and a faster return to potentially life-prolonging therapies. Larger patient sample will help determine patients at risk for failure of both approaches and the need for secondary procedures to further define patients who might benefit from the different techniques.

Postoperative pain management after lumbar spine surgery often involves modest to high doses of opioids, which can contribute to the risk of dependence. Epidural analgesia has emerged as a promising opioid-sparing alternative, but its efficacy compared with conventional opioid-based intravenous patient-controlled analgesia (IV-PCA) in a randomized trial has not been established in these patients. We asked whether an opioid-sparing protocol, compared with conventional opioid-based IV-PCA, (1) provides superior pain control, (2) reduces opioid consumption, and (3) lowers the frequency of opioid-related adverse events. In this multicenter, randomized, double-blind, parallel-group trial, we enrolled 98 patients undergoing single-level lumbar fusion or decompression. Eligible participants were adults age 20 to 80 years diagnosed with lumbar spinal stenosis or spondylolisthesis. Exclusion criteria included history of prior lumbar surgery, coagulation disorders, or opioid dependence. Patients were randomized to either the epidural opioid-free IV-PCA group (intraoperative single-shot epidural ropivacaine injection with opioid-free IV-PCA; epidural group) or the conventional opioid-based IV-PCA group (fentanyl-based IV-PCA; control group). In the epidural opioid-free group, fentanyl was administered solely as a rescue analgesic for breakthrough pain. All patients and outcome assessors were blinded to group allocation. In the fusion arm, 25 patients were randomized to the epidural group and 25 to the control group; data from all randomized patients (n = 25 in each group) were fully analyzed. In the decompression arm, 24 were randomized to the epidural group and 24 to the control group; data from all randomized patients (n = 24 in each group) were fully analyzed. Three patients (one in the fusion arm and two in the decompression arm) discontinued the intervention because of severe postoperative nausea and vomiting but were included in the final analysis based on the intention-to-treat principle, preventing differential loss to follow-up bias. There were no important differences between treatment and control groups in terms of baseline demographic or clinical data in either study arm. The minimum clinically important difference (MCID) for the numeric rating scale (NRS) pain score was defined as 2 points. The sample size was calculated to detect a 15% reduction in NRS scores (0.9 points), ensuring sensitivity to differences smaller than the MCID of 2 points. Secondary outcomes included total fentanyl consumption, rescue analgesic demand, and opioid-related adverse events. There were no clinically important differences between the epidural and control groups in either the decompression or the fusion arms of the study in terms of NRS pain scores at any time point (the largest difference was seen at 24 hours in the fusion group, but it was not clinically important: mean ± SD 2.7 ± 1.5 versus 4.4 ± 1.5 points of 10 total, mean difference -1.8 points [95% confidence interval (CI) -2.6 to -0.9]; p = 0.04). However, despite no important differences in pain control, fentanyl consumption was lower in the epidural groups than the control groups of both the fusion arm (122 ± 140 versus 1467 ± 481 µg, mean difference -1345 µg [95% CI -1550 to -1140]; p < 0.001) and the decompression arm (41 ± 51 versus 1046 ± 451 µg, mean difference -1005 µg [95% CI -1196 to -813]; p < 0.001). In the fusion arm of the study, postoperative urinary retention was less common in the epidural group (4% [1 of 25] versus 32% [8 of 25], relative risk 0.13 [95% CI 0.02 to 0.93]; p = 0.02); there were no differences in complications between the epidural and control groups in the decompression arm of the study. A single epidural ropivacaine injection with opioid-free IV-PCA provided effective pain control, reduced opioid consumption, and decreased urinary retention risk after single-level lumbar spine surgery. This protocol is a viable and effective opioid-sparing strategy. Level I, therapeutic study.

Endoscopic posterior nasal nerve (PNN) neurectomy and temperature-controlled radiofrequency ablation are validated interventions for medication-refractory allergic rhinitis (AR), but direct comparisons of their long-term efficacy, safety, and mechanisms remain lacking. In this prospective, multicenter, randomized, patient-blinded study, 174 adults with moderate-to-severe persistent AR were allocated to PNN neurectomy (n=89) or ablation (n=85). The primary endpoint was the percentage of participants achieving the minimal clinically important difference (MCID) for the 24-h reflective total nasal symptom score (rTNSS) at 24 months. The rTNSS MCID responder rate at 24 months was 86.5% (95% confidence interval [CI], 80.0-95.0%) in the neurectomy group and 84.9% (95% CI, 78.0-94.0%) in the ablation group, with no significant between-group difference (p=0.453). Both groups demonstrated substantial and parallel improvements in quality of life. Neurectomy provided greater and more durable control of rhinorrhea (1-24 months, all p<0.05), nasal congestion (24 months, p<0.001), and nasal itching (24 months, p=0.046), alongside a greater reduction in unilateral nasal resistance (right side, p = 0.014). Both groups showed convergent systemic neuroimmune reprogramming at 1 year, with suppression of substance P, interleukin (IL)-31, IL-33, IL-4, IL-13, and IL-6, and increased transforming growth factor-β (TGF-β)and immunoglobulin G4 (IgG4). No serious adverse events occurred; mild transitory events were reported only with neurectomy (3.4%). Both techniques are effective and safe for refractory AR over 2 years. Although overall outcomes are comparable, neurectomy offers superior and sustained control of rhinorrhea, nasal congestion, and nasal itching. Treatment can be individualized based on symptom profile.

Uncertainty persists regarding the estimated effects of vitamin C supplementation on blood pressure, including the strength of the evidence supporting these estimates and the magnitude of the observed effects relative to the minimal important difference. We aimed to provide an overview of the effects of vitamin C supplementation on blood pressure among adults through an umbrella review of randomized controlled trials (RCTs). PubMed, Scopus, and Web of Science, and the Cochrane Library were searched from the earliest date available to 25 December 2024. We identified eligible meta-analyses and included all primary trials, adding any RCTs not included in the largest review. For each trial, we extracted the mean change in blood pressure and its SD for both groups to calculate the mean difference as the effect size. The certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. We identified six meta-analyses involving a total of 17 RCTs reporting systolic blood pressure (SBP) and diastolic blood pressure (DBP) as outcomes. The findings suggest that vitamin C supplementation may reduce SBP by approximately 3.7 mmHg. Although DBP did not decrease overall, a clinically important reduction was observed in patients with diabetes (-2.27 mmHg). These results indicate that vitamin C supplementation may have a meaningful beneficial effect on blood pressure. Nevertheless, the low certainty of evidence highlights the necessity for larger, long-term randomized trials to definitively confirm its efficacy.

This post hoc analysis of the phase 2b/3 SELECTION (NCT02914522) study and its long-term extension (SELECTIONLTE; NCT02914535) evaluated the impact of filgotinib 200 mg (FIL200) on health-related quality of life (HRQoL) and work productivity in Japanese patients with ulcerative colitis over 3 years. Patients in SELECTION were randomized to FIL200, filgotinib 100 mg, or placebo (PBO) during the induction phase. Week-10 responders were re-randomized to continue assigned treatment or PBO in the 47-week maintenance phase. Patients who completed the SELECTION induction and maintenance phases (completers) and week-10 non-responders could enter SELECTIONLTE. HRQoL and work productivity were assessed using EQ 5-dimension (EQ-5D), EQ visual analog scale, Inflammatory Bowel Disease Questionnaire (IBDQ), 36-item Short Form Health Survey (SF-36), and Work Productivity and Activity Impairment (WPAI) questionnaires at week 10 (FIL200 vs. PBO), and at week 10 and years 1-3 (completers and non-responders who received only FIL200 in SELECTION+SELECTIONLTE). Proportions of patients with minimal clinically important differences (MCIDs) at week 10 were higher with FIL200 versus PBO for IBDQ total score (77% vs. 54%), SF-36 mental component summary (58% vs. 21%), and SF-36 physical component summary (54% vs. 36%). All measures (except WPAI absenteeism) showed mean score changes from baseline at week 10 in the direction of improved HRQoL with FIL200 versus PBO. MCID rates were maintained in completers up to 3 years and increased notably in non-responders (except WPAI absenteeism and EQ-5D) from week 10 to years 1-3. FIL200 treatment was associated with sustained improvements in HRQoL and work productivity over 3 years in Japanese patients with ulcerative colitis, consistent with the overall SELECTION and SELECTIONLTE trial populations.

Japanese International Hip Outcome Tool 12 (iHOT12J) and Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ) have been used in patients with hip labral injuries. However, patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID) from iHOT12J and JHEQ have not been investigated. We analyzed PASS score and MCID between iHOT12J and JHEQ preoperatively and at 2 years postoperatively in patients underwent hip arthroscopy. PASS score and MCID were calculated using pre- and two years post hip arthroscopy iHOT12J and JHEQ data from 99 patients. Anchor-based method was used to calculate PASS, which involved dividing patients into two groups based on their JHEQ satisfaction visual analog scale as well as performing receiver operating characteristic (ROC) curve analyses. ROC curve and PASS score were computed using obtained values and Youden index, respectively. Value with the greatest sensitivity and specificity was target value. MCID was calculated with 0.5 standard deviation (SD) method by dividing the mean of iHOT12J and JHEQ values, obtained from pre- and at two years post-surgery, by 0.5. PASS scores were 74.2 for iHOT12J and 62.0 for JHEQ. SD was 24.8% for iHOT12J and 19.4 for JHEQ. MCID was 12.4 for iHOT12J and 9.7 for JHEQ. Achievement rates of PASS and MCID were 73/99 (73.7%) for iHOT12J and 89/99 (89.9%) for JHEQ. PASS score and MCID could serve as measurable benchmarks to define significance in patient-reported outcome measure values for clinical outcomes or variables of postoperative hip arthroscopy.

Longitudinal predictive value of MOLLI T1 mapping imaging for minimal clinically important difference after surgery for cervical spondylotic myelopathy.

Suture button versus syndesmotic screw fixation in acute ankle fractures with syndesmotic injury: An umbrella review of functional outcomes and clinical relevance based on the minimal clinically important difference.

Reported Minimal Clinically Important Differences for Patient-Reported Outcome Measures in Hand and Upper-Extremity Surgery: A Systematic Review.

Evaluating prognostic block selection criteria in lumbar medical branch radiofrequency neurotomy: A retrospective cohort study.

Measurement properties of the Knee Injury and Osteoarthritis Outcome Score (KOOS) for patella fractures.

A bounded functional alignment approach for total knee arthroplasty: impact on knee phenotype and patient-reported outcomes.

Health-related quality of life among adult cancer patients with and without HIV: Analysis of SEER-MHOS data (2007-2017).

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim &amp;lt;/strong&amp;gt;To compare outcomes and minimal clinically important differences (MCID) between single-level laminectomy (SLL) and two-level laminectomy (TLL) for lumbar spinal stenosis (LSS).&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Methods &amp;lt;/strong&amp;gt;This prospective study included 119 patients with confirmed LSS who underwent SLL or TLL at Cantonal Hospital Zenica from January 2018 to January 2025. Assessments were performed preoperatively and at 1 and 6 months postoperatively using the Oswestry Disability Index (ODI), Swiss Spinal Stenosis Questionnaire (SSSQ), and Visual Analogue Scale (VAS) for back and leg pain, along with evaluation of motor, sensory, and urinary function. MCID values were used to assess meaningful improvement.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Results &amp;lt;/strong&amp;gt;At six months, SLL patients had lower ODI (15.0 vs. 18.0, p = 0.006), VAS-LB (3.0 vs. 5.0, p &amp;amp;lt; 0.001), and SSSQ scores (17.2 vs. 21.6, p &amp;amp;lt; 0.001) than TLL patients. Motor deficits (14.8% vs. 35.5%, p = 0.019) and urinary dysfunction at 1 month (5.7% vs. 22.6%, p = 0.013) were less frequent in SLL. More SLL patients achieved MCID for ODI (80.7% vs. 58.1%, p = 0.024) and SSSQ (73.9% vs. 48.4%, p = 0.017) at 6 months, with TLL patients 28% and 34% less likely to reach MCID for ODI and SSSQ, respectively. No significant differences were found preoperatively or at 1 month.&amp;lt;/p&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion &amp;lt;/strong&amp;gt;The study suggests that SLL and TLL have comparable outcomes, with a slight tendency toward better functional improvement and fewer deficits after SLL.&amp;lt;/p&amp;gt;

Sarcopenia, the progressive loss of skeletal muscle mass and function, needs upstream, low-burden tools for early detection and high-frequency monitoring, especially in older adults. Conventional assessments such as handgrip strength and gait speed mainly capture downstream impairment and may miss early physiological change. The tongue-coating microbiome is an emerging, measurable niche on the oral-gut-muscle axis that may provide proximal signals of metabolic, inflammatory, and circadian status. We performed a narrative summary of recent evidence on tongue-gut coupling, mapped plausible mechanisms to muscle regulation, and evaluated the feasibility of tongue-based measurement. We propose a minimal methods set (fixed pre-breakfast sampling, strict low-biomass quality control, AI-assisted standardized tongue imaging, saliva assays integrated with multi-omics) and a three-tier metric structure aligned to the minimal clinically important difference (MCID) for functional endpoints. Evidence supports links across three axes: metabolic (microbial metabolites such as short-chain fatty acids and niacin that modulate mitochondrial energetics and anabolism), inflammatory (oral dysbiosis and barrier disruption amplifying systemic inflammation via lipopolysaccharide, Toll-like receptor 4, and NF-κB signaling), and circadian (microbiome rhythms coupled to eating and sleep timing). The tongue coating forms a stable niche suitable for frequent follow-up. An upstream-midstream-downstream metric stack enables MCID-anchored interpretation. Current data are limited and heterogeneous, so tongue-derived metrics should complement stool testing and functional standards. Tongue-based monitoring is a practical adjunct for earlier risk signaling and community-level follow-up. Priorities are multicenter validation, interpretable and device agnostic models, and axis-stratified trials to define when and for whom tongue-derived signals add MCID-level clinical value. Because direct longitudinal human evidence linking tongue-coating signals to clinically meaningful sarcopenia outcomes remains limited, we frame the tongue-coating microbiome primarily as a hypothesis-driven, upstream monitoring niche and outline testable priorities for validation and translation.

Myocardial infarction (MI) poses a formidable health challenge, frequently necessitating management through percutaneous coronary intervention (PCI). However, PCI comes with potential complications that can impact patient outcomes. Traditional Chinese medicine (TCM), particularly the utilization of Chinese patent medicines with blood-activating and stasis-resolving properties, offers another approach to enhance PCI efficacy and improve patient quality of life. The aim of this study is to assess the comparative efficacy and safety of blood activating and stasis removing Chinese patent medicines for the perioperative period of PCI for MI. This systematic review and network meta-analysis will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search strategy will be implemented across seven electronic databases to identify relevant studies. Eligible studies will be limited to randomized controlled trials that compare any Chinese patent medicine (added to standard care) with standard care or another treatment in patients in the perioperative period of PCI after MI. Two independent reviewers will screen all retrieved citations, extract pertinent data, and assess the risk of bias. We will conduct Bayesian random-effects network meta-analysis and network meta-regression. To elucidate whether the intervention has an important impact on certain outcomes within the perioperative period of PCI for MI, we will conduct a patient values and preferences survey to determine the minimum important difference for outcomes. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. This study will provide new insights into the efficacy and safety of blood activating and stasis removing Chinese patent medicines for the perioperative period of PCI for MI patients, providing help for future clinical practice and research. Ethical approval is not required for this review. The findings will be disseminated through publication in a peer-reviewed academic journal, presentations at scientific conferences, and outreach via various media platforms.

The PROMIS-29 questionnaire assesses general aspects of physical and mental health that may be relevant to surgical recovery. Although this tool has been endorsed by expert consensus for use in perioperative care, evidence regarding its psychometric performance in this context is limited. This study aimed to assess the content validity, internal consistency, construct validity, and responsiveness of PROMIS-29 as a measure of recovery after colorectal surgery. This study was conducted according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. A cohort of adult patients undergoing elective colorectal resection at two academic hospitals in Canada completed the PROMIS-29 questionnaire preoperatively and weekly until postoperative week (POW) 4. Physical Health Summary (PHS) and Mental Health Summary (MHS) scores were derived from PROMIS-29 t-scores (higher = better health status). Content validity was assessed by comparing PROMIS-29 items against a previously reported conceptual framework of recovery after abdominal surgery. Internal consistency was assessed using Cronbach α. Construct validity was assessed by testing a priori hypotheses that PROMIS-29 scores would be better in patients: (1) with shorter length of stay (≤4 days); (2) without 30-day complications; (3) undergoing minimally invasive surgery; and (4) without a new stoma. Responsiveness was examined by hypothesizing that PROMIS-29 scores would follow the expected recovery trajectory-showing an initial postoperative decline followed by gradual improvement toward preoperative levels. Consistent with PROMIS guidelines, a minimal important difference of 3 points was used as the criterion for confirming hypotheses. A total of 282 patients were included (mean±SD age 59±16 years; 48% female; 78% minimally invasive; 19% with stoma; median [IQR] hospital stay 3 [1-6] days). PROMIS-29 items covered 36% of health domains considered important by patients in the conceptual framework, indicating limited content validity. Internal consistency across PROMIS domains was acceptable, with Cronbach α ranging from 0.81 to 0.98. Construct validity of PHS and MHS was limited, with 0 of 4 predefined hypotheses supported on POW1 and only 1 to 2 hypotheses supported in subsequent weeks (mean difference between groups ≥3). Responsiveness was supported until POW2 (mean difference between timepoints ≥3), but not after. Despite demonstrating adequate internal consistency, PROMIS-29 has limited content validity, construct validity, and responsiveness within the first 4 weeks after colorectal surgery. These findings suggest that PROMIS-29 may not fully capture patients' recovery experiences, underscoring the need for psychometrically sound PROMs tailored to the context of perioperative care.

Limited available evidence seems to suggest that the increased use of the dominant (versus nondominant) limb may allow for earlier return to function and better ROM in the dominant limb at 12-month follow-up after anatomic or reverse total shoulder arthroplasty (TSA). Nevertheless, whether the earlier achievement of physical therapy milestones is associated with a clinically meaningful difference in patient-reported outcome measures (PROMs) is yet to be determined. (1) What are the 12-month minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for the Shoulder Pain and Disability Index (SPADI), QuickDASH, numeric rating scale (NRS) for pain, and Constant-Murley score? (2) Is there a difference between the dominant- and nondominant-side TSAs in terms of the proportions of patients achieving an MCID or PASS at 12-month follow-up? This retrospective, comparative study analyzed data from a longitudinally maintained shoulder arthroplasty registry at a specialized orthopaedic institution. Patients were eligible for inclusion if they underwent primary anatomic or reverse TSA from 2006 to 2024 for cuff tear arthropathy or primary osteoarthritis and had 12-month follow-up for at least one PROM. We collected relevant baseline patient-related and procedure-related characteristics. The main association of interest was operated limb relative to limb dominance, and shoulders were stratified into the dominant-side or nondominant-side group. A total of 2152 shoulders, 65% (1404) of which were in the dominant-side group, were analyzed. The mean age was 73 years, and the majority of patients were women in both groups. In the dominant group, more patients were treated for cuff tear arthropathy, and a larger proportion received a reverse TSA. Loss to follow-up at 12 months did not differ between groups, reaching 13% for the dominant group and 16% for the nondominant group. The PROMs collected were the SPADI, QuickDASH, NRS for pain, and Constant-Murley score. These were administered at baseline and at 12 months postoperatively. The MCID and PASS thresholds for the PROMs of interest were estimated using a distribution-based approach. A sensitivity analysis was performed using the best available evidence for anchor-based MCIDs (20 for the SPADI, 12 for the QuickDASH, 2.2 for the NRS for pain, and 9 for the Constant-Murley score). Adjusted comparisons of distribution-based MCID estimates and PASS proportions between dominant- and nondominant-side procedures were conducted using generalized linear mixed-effects logistic regression models. Models were adjusted for admission type, surgical indication, procedure type, cuff tear severity, BMI, baseline ROM (forward flexion, abduction, external rotation), and baseline QuickDASH, with a random intercept for patient ID to account for within-patient clustering. Results are reported as ORs with 95% confidence intervals (CIs). Distribution-based absolute MCID estimates were 16 for SPADI, 13 for QuickDASH, 1.5 (reduction) for NRS for pain, and 12 for Constant-Murley score. Distribution-based absolute PASS estimates were 19 for SPADI, 5 for QuickDASH, 1.8 (reduction) for NRS for pain, and 20 for Constant-Murley score. At 12 months, MCID and PASS responder proportions did not differ in clinically important ways between dominant and nondominant shoulders, but approximately 25% (509 of 2120) of shoulders did not achieve the MCID for the QuickDASH, more than 10% (247 of 2123) did not achieve it for pain, and approximately 15% did not achieve a PASS for one or more outcomes tool. All absolute risk differences and 95% CIs fell within the prespecified ± 10% smallest important difference margin, indicating no clinically important dominance effect. In adjusted mixed-effects logistic regression models, dominance was not associated with meaningful differences in the odds of achieving MCID or PASS for SPADI, QuickDASH, NRS for pain, or Constant-Murley score (ORs near 1.0, with all CIs crossing unity). Across all sensitivity analyses, arm dominance demonstrated no association with 12-month MCID or PASS after TSA. Arm dominance was not meaningfully associated with an increased or decreased likelihood of achieving MCID or PASS across multiple PROMs. However, as many as 1 in 4 patients did not reach MCID or PASS thresholds after TSA, irrespective of arm dominance. These findings indicate that, in typical clinical practice, dominance should not be considered a major determinant of postoperative recovery expectations. Level III, therapeutic study.

Psychiatric comorbidities are increasingly prevalent among patients undergoing total hip arthroplasty (THA), yet their impact on clinically meaningful outcomes remains underexplored. This study evaluates the association between preoperative psychiatric diagnoses and patient-reported outcomes (PROMs), satisfaction, and healthcare utilization following THA. A retrospective cohort of 11,766 patients undergoing primary elective unilateral THA between 2016 and 2022 across a multisite academic center was analyzed. Psychiatric diagnoses were identified via ICD-9/10 codes within 2 years preoperatively. PROMs were collected at baseline and 1 year postoperatively, including HOOS Pain, HOOS Physical Function Shortform (PS), HOOS Joint Replacement (JR), and VR-12 Mental Component Score (MCS). Outcomes included failure to achieve minimal clinically important difference (MCID), failure to reach patient acceptable symptom state (PASS), dissatisfaction, non-home discharge, prolonged length of stay (LOS ≥ 2 days), and 90-day readmission. Multivariable logistic regression adjusted for demographic and clinical covariates. Psychiatric diagnoses were present in 26.1% of patients. Psychiatric illness was associated with failure to achieve MCID in HOOS Pain (OR 1.43), HOOS PS (OR 1.31), and HOOS JR (OR 1.54), as well as failure to reach PASS thresholds (all p < 0.001). Patients with psychiatric diagnoses had increased odds of dissatisfaction (OR 1.34), non-home discharge (OR 1.36), prolonged LOS (OR 1.24), and readmission (OR 1.54). Subgroup analysis demonstrated a dose-dependent relationship, with multiple psychiatric diagnoses conferring the highest risk of poor outcomes. Preoperative psychiatric illness is an independent predictor of suboptimal functional outcomes, lower satisfaction, and increased healthcare utilization after THA. These findings highlight the need for psychiatric screening and optimization during the preoperative period to improve outcomes in this high-risk population.

Revision Reverse Total Shoulder Arthroplasty: Clinical and Radiographic Outcomes Compared to Primary Reverse Total Shoulder Arthroplasty.