Visual Analog Scale Satisfaction Research Articles

Influence of Acetabular Labral Tear Length on Postoperative Clinical Outcomes and Patient Satisfaction following Hip Arthroscopy for Femoroacetabular Impingement Syndrome with Capsular Plication

Objectives: To determine the effect of labral tear length on post-operative outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified in a prospectively collected database. All patients completed the hip outcome score (HOS)-activities of daily living (ADL), HOS-sports subscale (HOS-SS), modified Harris hip score (mHHS), international hip outcome tool-12 (IHOT-12), and visual analog scales (VAS) for pain and satisfaction. Patients were stratified by labral tear length into small (<2.5 cm) or large (>2.5 cm) labral tear based on the ROC curve analysis. Patient demographics and outcomes were analyzed using parametric and multivariate linear regression analyses to identify predictors of labral tear length. Binary logistic regression analysis was performed to determine whether labral tear length predicted the likelihood of achieving the Minimal Clinically Important Difference (MCID). Results: A total of 747 eligible patients were included in the analysis. Mean age and BMI were 33.5±12.3 years and 25.4±8.6 kg/m2 22, respectively. Mean length of labral tears was 2.7±0.7 cm with 99% occurring in the anterosuperior position. Men had a higher proportion of large tears (>2.5 cm) when compared to women (75% vs 44%; p<0.001). All PROs showed improvement at a minimum of 2-years postoperatively (p<0.05 for all). Independent T-test demonstrated significant differences in two-year outcomes between patients with tears less than and greater than 2.5 cm: HOS-ADL (87.3±16.3 vs. 84.3±18.3, p=0.033), HOS-SS (76.6±23.5 vs. 70.5±27.7, p=0.005), mHHS (82.5±18.0 vs. 78.5±18.2, p=0.009), and satisfaction (83.5±23.4 vs. 77.8±34.9, p=0.026). Multivariate regression analysis demonstrated that labral tear length is an independent predictor of VAS satisfaction, HOS-ADL, -SS, and mHHS. Binary logistic regression analysis demonstrated that patients with small labral tears (<2.5 cm) had a higher likelihood of achieving MCID HOS-SS (OR: 1.61; p-value<0.02) and PASS mHHS (OR:1.56; p-value 0.038) than those with larger tears (more than 2.5 cm). Conclusion: Labral tear length is associated with numerous preoperative factors. These factors were found to be predictive of injury pathology and outcomes following hip arthroscopy for FAIS. Furthermore, patients with smaller tears (< 2.5 cm) had better outcomes and a higher likelihood of achieving a minimal clinically important difference at 2 years follow-up. [Table: see text]

Comparison of the effect of Western-made unloading knee brace with physical therapy in Asian patients with medial compartment knee osteoarthritis—A preliminary report

To compare the effect of unloading knee brace with physical therapy (PT) in Asian patients with osteoarthritis (OA) of the knee. This is a non-random, two-group comparative study. Patients with medial compartment knee OA (n=41) were assigned to either the brace group (n=20) or PT group (n=21). Patients in the brace group were fitted with an unloading knee brace for three months and the PT group received a 60-min session of physiotherapy over the affected knee, three times a week, for three months. The primary outcome measures were the pain visual analogue scale (VAS) and the Western Ontario McMaster University Osteoarthritis Index (WOMAC); the second outcome measures were the 36-item Short-Form Health Survey (SF-36) and patient's satisfaction. The patients were evaluated at baseline, and at one month and three months. Group comparison showed no significant difference regarding pain VAS, WOMAC, SF-36, and patient's satisfaction, except stiffness in WOMAC (P=.006) and social functioning in SF-36 (P=.007). Time and group interaction revealed significant differences only in general health (P=.007) and mental health (P=.006) of SF-36. Within-group comparison found that pain VAS and WOMAC decreased significantly at one months and three months in both groups. The effect of brace fitting in patients with knee OA was similar to that of physical therapy. A Western-made unloading knee brace is acceptable in some Asian people with knee OA. NCT02712710.

Radiographic Prevalence of Symphysis Pubis Abnormalities and Clinical Outcomes in Patients With Femoroacetabular Impingement Syndrome

Background: The decreased hip range of motion seen in femoroacetabular impingement syndrome (FAIS) may lead to compensatory increased motion at the symphysis pubis (SP) with resultant increased stress on the joint, which can subsequently lead to osteitis pubis. Purpose: To quantify the prevalence of SP abnormalities in patients with FAIS through the use of imaging modalities and to compare outcomes based on the presence of SP abnormalities. Study Design: Cohort study; Level of evidence, 3. Methods: Radiographs and magnetic resonance imaging (MRI) scans of 1009 consecutive patients who underwent primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified. Exclusion criteria were patients undergoing revision or bilateral surgery, patients with dysplasia, and patients with less than 2-year follow-up. On radiographs, SP joints were reviewed for joint surface erosions, subchondral sclerosis and cysts, and ankylosis. MRI scans were reviewed for marrow edema in the subarticular pubic bone, subchondral sclerosis and cysts, joint surface erosions, and ankylosis. Patients with SP abnormalities were matched 1:2 to patients without SP abnormalities by age and body mass index. Outcomes included the Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scales (VAS) for pain and satisfaction. Results: 830 patients were included; 23 (2.8%) demonstrated SP abnormalities. Of the 726 (72%) MRI scans reviewed, 15 (1.8%) showed bone marrow edema, subchondral sclerosis, erosions, or ankylosis. After matching, patients without SP abnormalities had significantly greater HOS-ADL (95.7 vs 83.0; P = .008), HOS-SS (91.6 vs 61.9; P = .003), iHOT-12 (89.5 vs 74.6; P = .046), and VAS satisfaction (91.3 vs 58.8; P = .004) scores, in addition to less postoperative pain (6.3 vs 23.5; P < .001). No significant differences were found in the mHHS (92.5 vs 82.2; P = .08). Patients without SP abnormalities had higher odds of achieving the minimal clinically important difference for the HOS-ADL (odds ratio [OR], 4.5; 95% CI, 1.3-14.1; P = .010), the HOS-SS (OR, 7.2; 95% CI, 1.8-18.5; P = .006), and the mHHS (OR, 14.5; 95% CI, 1.8-24.7; P = .013). Conclusion: A low prevalence (1.8%-2.6%) of SP joint abnormality is seen on imaging in patients with FAIS. These patients may demonstrate significantly inferior clinical outcomes and persistent postoperative pain after FAIS treatment.

Influence of Acetabular Labral Tear Length on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome With Capsular Plication

Background: The literature on the effects of labral tear on patient-reported outcomes, midterm pain, and overall patient satisfaction is limited. Purpose: To determine the effect of labral tear length on postoperative outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients undergoing primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified in a prospectively collected database. All patients completed the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale for pain and satisfaction. Patients were stratified by labral tear length into small (<2.5 cm) or large (≥2.5 cm) based on the receiver operating characteristic curve analysis. Patient characteristics and outcomes were analyzed with multivariate linear regression analyses to identify predictors of labral tear length. Binary logistic regression analysis was performed to determine whether labral tear length predicted the likelihood of achieving the minimal clinically important difference. Results: Of the 747 eligible patients, 600 (80.3%) had 2-year reported outcomes and were included in the final analysis. Mean age, body mass index, and tear length were 33.5 ± 12.3 years, 25.4 ± 9.2 kg/m2, and 2.7 ± 0.7 cm, respectively. Men had higher frequency of large tears when compared with women (77% vs 43.7%, P < .001). Independent t test demonstrated significant differences in 2-year outcomes between patients with tears <2.5 and ≥2.5 cm, respectively: HOS-ADL (87.3 ± 16.3 vs 84.3 ± 18.1, P = .033), HOS-SS (76.6 ± 23.5 vs 70.5 ± 27.7, P = .005), mHHS (82.5 ± 18.0 vs 78.5 ± 18.2, P = .009), and satisfaction (83.5 ± 23.4 vs 77.8 ± 34.9, P = .026). Binary logistic regression analysis demonstrated that labral tear length is an independent predictor of visual analog scale for satisfaction, HOS-ADL, HOS-SS, and mHHS. Binary logistic regression analysis demonstrated that patients with small labral tears had a higher likelihood of achieving the minimal clinically important difference for the HOS-SS (odds ratio, 1.61; 95% CI, 1.39-1.92; P < .02) and the patient acceptable symptomatic state for the mHHS (odds ratio, 1.56; 95% CI, 1.11-2.2; P = .038) than those with larger tears. Conclusion: Labral tear length is independently predictive of patient-reported outcomes after hip arthroscopy for FAIS. Furthermore, patients with smaller tears (<2.5 cm) had better outcomes and a higher likelihood of achieving a minimal clinically important difference at 2-year follow-up. However, the mean differences between changes in pre- and postoperative outcomes were relatively small and may not be clinically meaningful.

Acute Anterior Cruciate Ligament Rupture: Repair or Reconstruction? Two-Year Results of a Randomized Controlled Clinical Trial

Background: Contemporary anterior cruciate ligament (ACL) suture repair techniques have been subject to renewed interest in recent years. Although several clinical studies have yielded good short-term results, high-quality evidence is lacking in regard to the effectiveness of this treatment compared with ACL reconstruction. Hypothesis: Dynamic augmented ACL suture repair is at least as effective as anatomic single-bundle ACL reconstruction for the treatment of acute ACL rupture in terms of patient self-reported outcomes at 2 years postoperatively. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: After stratification and randomization, 48 patients underwent either dynamic augmented ACL suture repair or ACL reconstruction with a single-bundle, all-inside, semitendinosus technique. The International Knee Documentation Committee (IKDC) subjective score at 2 years postoperatively was the primary outcome measure. Patient-reported outcomes (IKDC subjective score, Knee injury and Osteoarthritis Outcome Score, Tegner score, visual analog scale for satisfaction), clinical outcomes (IKDC physical examination score, leg symmetry index for the quadriceps, hamstrings strength, and jump test battery), and radiological outcomes as well as adverse events including reruptures were recorded. Analyses were based on an intention-to-treat principle. Results: The lower limit for the median IKDC subjective score of the repair group (86.2) fell within the prespecified noninferiority margin, confirming noninferiority of dynamic augmented ACL suture repair compared with ACL reconstruction. No statistical difference was found between groups for median IKDC subjective score (repair, 95.4; reconstruction, 94.3). Overall, 2 reruptures (8.7%) occurred in the dynamic ACL suture repair group and 4 reruptures (19.0%) in the ACL reconstruction group; further, 5 repeat surgeries—other than for revision ACL surgery—took place in 4 patients from the dynamic ACL suture repair group (20.8%) and in 3 patients from the ACL reconstruction group (14.3%). Conclusion: Dynamic augmented ACL suture repair is not inferior to ACL reconstruction in terms of subjective patient-reported outcomes as measured with the IKDC subjective score 2 years postoperatively. However, for reasons other than revision ACL surgery due to rerupture, a higher number of related adverse events leading to repeat surgery were seen in the dynamic augmented ACL suture repair group within 2 years postoperatively. Clinical Relevance: Dynamic augmented ACL suture repair might be a viable treatment option for patients with an acute ACL rupture. Registration: NCT02310854 (ClinicalTrials.gov identifier).

Effect of Centering Pregnancy Model Implementation on Prenatal Health Behaviors and Pregnancy Related Empowerment

Background: Centering pregnancy model has been associated with motivating behavior change, increasing women’s empowerment and satisfaction in comparison to standard, individual prenatal care. Aim of the present study was to evaluate the effect of centering pregnancy model implementation on prenatal health behaviors and pregnancy related empowerment. Research design: A quasi-experimental (pre-posttest comparison group). Sample: A purposive sample of 151 pregnant women was recruited for the study and divided into centering pregnancy group was (75 women) and individual prenatal care group was (76 women). Setting: The study was conducted at Obstetrics and Gynecology Outpatient Clinic along with meeting room at Outpatient Clinics' floor affiliated to Benha University Hospital. Tools used for data collection were a structured self-administrating questionnaire, prenatal health behaviors scale, pregnancy-related empowerment scale, and women’s satisfaction visual analogue scale. Results: post intervention, the total mean self-reported health behaviors score in the centering pregnancy group was higher than individual prenatal care group (18.13 versus 13.11) respectively. The mean pregnancy related empowerment score centering pregnancy group was significantly higher than individual prenatal care group (54.32 ± 3.28 versus 40.13 ± 7.74, p ≤ 0.0001) respectively. Two-thirds of the centering pregnancy group reported high satisfaction level compared to one-tenth of individual prenatal care group. Conclusion: A positive effect of centering pregnancy model, including a greater engagement in favorable health behaviors, a higher pregnancy-related empowerment, and higher satisfaction compared to individual prenatal care. Recommendation: Implementing centering pregnancy model of care more widely for promoting healthy behaviors and empowering pregnant women.

Distraction during cystoscopy to reduce pain and increase satisfaction: Randomized control study between real-time visualization versus listening to music versus combined music and real-time visualization.

Purpose:This study aims to compare the various distraction methods used during office cystoscopy to decrease pain and dissatisfaction among patients.Materials and Methods:Two hundred patients undergoing rigid cystoscopy between January 2017 and July 2017 were randomized into four groups of 50 patients: (1) Group I: Patients who listened to music during the cystoscopy, (2) Group II: Patients allowed real-time visualization of the cystoscopy, (3) Group III: Patients who listened to music and had real-time visualization of the procedure, (4) Group IV: Control group undergoing cystoscopy without any distraction used. A visual analog scale (VAS) (1–10) was used for a self-assessment of pain, satisfaction, and willingness for repeat cystoscopy.Results:Demographic characteristics, mean age, procedure duration, and procedure indications were statistically similar between the four groups. The mean VAS pain score were significantly lower in the three study Groups (I, II, and III) where distraction methods were used during cystoscopies as compared to the control Group IV (P < 0.001) and the satisfaction VAS scores and VAS scores for willingness to undergo a repeat procedure were significantly higher in the study groups (P < 0.001). Statistically significant decreased postprocedural pulse rate and blood pressure in comparison with to their preprocedural values were observed when distraction methods were used (P < 0.01). Patients undergoing cystoscopies listening to music and real-time visualization (Group III) had better VAS scores than the others (P < 0.01).Conclusions:Distraction methods reduce pain and increase satisfaction among patients. Best results are with combined listening to music and direct real-time visualization.

Immediate Loading of Two Unsplinted Implants in Edentulous Patients with Mandibular Overdentures: A 10-year Retrospective Review of Patients from a Previously Conducted 1-year Cohort Study

This 10-year retrospective study aimed to report implant bone changes in completely edentulous patients after a mandibular immediate loading protocol using two ball attachments. This study was initially designed as a prospective 1-year cohort study, then extended with a 10-year retrospective evaluation of implant bone change. In the first part of the study, 43 edentulous patients wearing satisfactory maxillary and mandibular dentures for at least 3 months were included. Two interforaminal implants (Brånemark system, Nobel Biocare) were placed symmetrically in the anterior mandible using a surgical template and a torque greater than 40 Ncm. Immediately following surgery, 2.25-mm-diameter ball abutments were screwed to the implants, and their matrices (Dalbo Plus, Cendres et Métaux) were incorporated in the denture base. In an initial 1-year study, clinical recalls were scheduled 3, 6, and 12 months after implant placement with a team of two investigators. The follow-up consisted of a clinical examination and a standardized radiographic assessment of the vertical bone change. Implant stability was then monitored. The patient satisfaction was evaluated with a questionnaire before and 3 months after loading. The second part of the study occurred 10 years after the inclusion, as patients were recalled for an implant bone change monitoring. The included patients were 28 to 80 years of age (mean: 61 ± 11.4 years). Three out of 86 implants failed during the healing phase (survival rate of 96.5% [90.1%, 99.2%]). Implant stability was maintained all along the 1-year follow-up (Δ = 73.33, 95% CI [72.39 to 74.26], P = .032). The mean radiographic bone loss was 0.27 ± 0.35 mm at 3 months after surgery, 0.47 ± 0.42 mm after 1 year, and 0.95 ± 0.98 mm after 10 years. General visual analog scale satisfaction was increased by 25 units with the treatment. No patients were lost to follow-up at 1 year, but five were lost at 10 years. This protocol of immediate loading of two unsplinted mandibular implants in overdenture patients using ball attachments is a clinically viable treatment with a high implant success rate and improved satisfaction.

A Randomised Clinical Trial of Buffered Tumescent Local Anaesthesia During Endothermal Ablation for Superficial Venous Incompetence

Endovenous thermal ablation (EVTA) is the recommended first line intervention for superficial venous incompetence (SVI). While the infiltration of perivenous tumescent local anaesthesia (TLA) is key to procedural success, it is paradoxically the predominant source of patient reported discomfort. This randomised controlled trial investigates the potential to reduce peri-procedural pain and improve patient reported outcome measures (PROMs), including quality of life (QoL) using TLA buffered to physiological pH. Patients undergoing great saphenous vein EVTA with concomitant phlebectomies were randomised to either standard (ST) or buffered (BT) TLA. Follow up assessments were performed at weeks 1, 6, and 12. The primary outcome was patient reported peri-procedural pain on a 100 mm visual analogue scale (VAS). Secondary outcomes were one week post-procedural pain VAS and analgesia use, QoL (disease specific: Aberdeen Varicose Vein Questionnaire [AVVQ]; generic: Short Form-36 [SF-36] and EuroQol 5 Dimensions Questionnaire [EQ-5D]), patient satisfaction VAS, technical success on duplex ultrasound (DUS) examination, and complications. Ninety-seven patients were randomised: 50 to ST and 47 to BT. The groups had comparable baseline demographics, Clinical Etiologic Anatomic Pathological, Venous Clinical Severity Score, QoL, and DUS parameters. Equally, intra-procedural parameters (volume of TLA, length of ablation, and linear energy delivered) were also comparable. Peri-procedural pain scores were significantly lower in the BT group with a mean ± SD score of 2.86 ± 3.57 versus 4.44 ± 2.94 (p = .001). Pain scores and analgesia use over the subsequent week were equivalent. SF-36 Bodily Pain domain scores were significantly better in the BT group at week 1 (77 vs. 62; p = .008). AVVQ, SF-36, and EQ-5D scores were otherwise similar between the groups throughout follow up, significantly improving over baseline. Technical success was high in both groups, with no major complications and few minor complications. Buffered TLA offers a significantly lower peri-procedural pain experience for patients undergoing EVTA and should replace current tumescent formulae.

Arthroscopic Capsular Plication in Patients With Labral Tears and Borderline Dysplasia of the Hip: Analysis of Risk Factors for Failure

Background: Hip arthroscopy for the treatment of instability in the setting of borderline dysplasia is controversial. Capsular management in such cases is an important consideration, and plication has been described as a reliable technique, with good midterm outcomes reported when indications are appropriate. Hypothesis: Patients with borderline dysplasia who have a lower lateral center-edge angle (LCEA) and greater age will be at a higher risk of failure after arthroscopic capsular plication. Study Design: Case-control study; Level of evidence, 3. Methods: Data were retrospectively reviewed for all patients between 15 and 40 years of age who underwent hip arthroscopy from November 2008 to January 2015. Inclusion criteria were an LCEA between 18° and 25°, Tönnis grade ≤1, primary case with capsular plication, and minimum 2-year follow-up. Patients were excluded if they had any history of ipsilateral hip procedure or conditions such as Legg-Calve-Perthes disease, slipped capital femoral epiphysis, rheumatologic disease, and Tönnis grade ≥2. Age, sex, and body mass index data were retrieved for each patient. Patient-reported outcomes (PROs)—including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale, and a visual analog scale (VAS) for pain (0-10)—were obtained preoperatively and at a minimum of 2 years postoperatively, in addition to the postoperative International Hip Outcome Tool–12. The “success” group consisted of all patients who achieved the patient acceptable symptomatic state of mHHS ≥74 and had no ipsilateral hip surgery subsequent to their index arthroscopy. The “failure” group was composed of patients who were below the patient acceptable symptomatic state at latest follow-up or required secondary arthroscopy or conversion to total hip arthroplasty. Patient satisfaction and minimal clinically important difference were also calculated. Mean age for the failure group was applied as a cutoff age for subanalysis, and relative risk for failure was determined. Results: Ninety patients (97 hips; 79.5%) met criteria for the success group, and 25 patients (25 hips) met criteria for the failure group. No significant differences in preoperative baseline scores or VAS were found. However, there did appear to be a trend that the failure group had lower mean preoperative scores for all PRO measures and a higher VAS score. The differences in preoperative mHHS and NAHS closely approached significance (P = .053). Postoperative PRO, VAS, and patient satisfaction scores of the success group were significantly higher than the failure group. The failure group was significantly older than the success group (28.5 ± 7.8 vs 23.5 ± 7.5 years, P = .005). Patients >35 years old were 2.25 times more likely to fail according to relative risk (95% CI, 1.10-4.60; P = .0266). LCEA did not differ between the groups, and no other risk factors for failure were identified. Conclusion: Stringent criteria for patient selection and meticulous repair or augmentation of the static stabilizers of the hip yielded favorable clinical outcomes in this study cohort with borderline dysplasia. Within this carefully selected group, the analysis revealed that increased age was the main risk factor for failure in the management of borderline hip dysplasia via isolated primary arthroscopic hip surgery with capsular plication.

Improved clinical outcomes after revision arthroplasty with a hinged implant for severely stiff total knee arthroplasty

PurposeManagement of the severely stiff total knee arthroplasty (TKA) is challenging, with the outcome of revision arthroplasty being inferior compared to the outcome for other indications. The aim of this study was to analyse the outcome after revision TKA with hinged-type implants for severely stiff TKA [range of motion (ROM) ≤ 70°] at 2 years.MethodsA cohort of 38 patients with a hinged-type revision TKA (Waldemar Link or RT-Plus) and preoperative ROM ≤ 70° were selected from a prospectively collected database. ROM, visual analogue scale (VAS) for pain and satisfaction and Knee Society Score (KSS) were obtained preoperatively and at 3 months, 1 year and 2 years. Pre- and postoperative outcome were compared at 2 years.ResultsThere was a significant increase in ROM and KSS. VAS pain scores did not differ significantly. The median ROM at 2 years was 90° (range 50°–125°) with a median gain of 45° (range 5°–105°). Median VAS pain was 28.5 (range 0–96) points and median VAS satisfaction was 72 (range 0–100) points at 2 years. Twelve patients suffered a complication. Recurrent stiff knee was the most frequently reported complication (n = 5).ConclusionsHinged-type revision TKA following a severely stiff TKA renders a significant, although moderate, clinical improvement at 2 years.Level of evidenceRetrospective case series. Level IV.

Patients Discharged to Inpatient Rehabilitation Facilities Undergo More Diagnostic Interventions With No Improvement in Outcomes.

The purpose of this study was to determine if there is a difference in the number of diagnostic tests and interventions, pain and function scores, or satisfaction of patients discharged to inpatient rehabilitation facilities vs to home. From February to May 2015, 171 consecutive patients were prospectively recruited following primary total knee arthroplasty. Six weeks postoperatively, based on the patients' recollections, the number and types of diagnostic imaging tests, number of blood transfusions, and overall satisfaction whether discharged to inpatient rehabilitation facilities (n=85) or to home (n=86) were assessed. A significantly greater proportion of patients discharged to inpatient rehabilitation facilities reported undergoing at least 1 diagnostic imaging test compared with patients discharged to home (25.9% vs 8.1%; P=.013). Multivariate logistic regressions revealed that patients discharged to an inpatient rehabilitation facility were more likely to have a greater number of diagnostic tests (odds ratio, 5.01; 95% confidence interval, 1.69-14.92; P=.004) and radiographs (odds ratio, 16.10; 95% confidence interval, 1.54-169.70; P=.020) performed. There was no significant difference in readmission rates for patients discharged to home (2.3%) vs to an inpatient rehabilitation facility (0%) (P=.246). No significant differences were observed in postoperative Knee Society pain or function scores (P=.083 and P=.057, respectively) or visual analog scale satisfaction scores (P=.206). Twenty-nine (34.1%) patients were discharged under the care of the visiting nurse service after leaving the rehabilitation facility. Patients discharged to an inpatient rehabilitation facility underwent more diagnostic testing, especially radiographs, than patients discharged to home. There were no clinically relevant differences in Knee Society pain or function scores or patient satisfaction. [Orthopedics. 2018; 41(6):e841-e847.].

The addition of 3D printed models to enhance the teaching and learning of bone spatial anatomy and fractures for undergraduate students: a randomized controlled study.

Whether or not the addition of 3D (three-dimension) printed models can enhance the teaching and learning environment for undergraduate students in regard to bone spatial anatomy is still unknown. In this study, we investigated the use of 3D printed models versus radiographic images as a technique for the education of medical students about bone spatial anatomy and fractures. The computed tomography (CT) data from four patients, each with a different fracture type (one spinal fracture, one pelvic fracture, one upper limb fracture, and one lower limb fracture), were obtained, and 3D models of the fractures were printed. A total of 90 medical students were enrolled in the study and randomly divided into two groups as follows: a traditional radiographic image group (presented by PowerPoint) and a 3D printed model group (combined PowerPoint and 3D models). Each student answered 5 questions about one type of fracture and completed a visual analog scale of satisfaction (0-10 points). No significant differences were found in the upper limb or lower limb test scores between the 3D printed model group and the traditional radiographic image group; however, the scores on the pelvis and spine test for the traditional radiographic image group were significantly lower than the scores for the 3D printed model group (P=0.000). No significant differences were found in the test-taking times for the upper limb or lower limb (P=0.603 and P=0.746, respectively) between the two groups; however, the test-taking times for the pelvis and spine in the traditional radiographic image group were significantly longer than those of the 3D printed model group (P=0.000 and P=0.002, respectively). The 3D printed model may improve medical students' understanding of bone spatial anatomy and fractures in some anatomically complex sites.

Using of Birthing Ball during the first Stage of Labor: Its Effect on the Progress of Labor and Outcome among Nulliparous Women

Background: It is beyond argument that women who are about to give natural birth to their babiesneed some physical exercise such as standing, walking around, sitting, or kneeling in order to provide for the “gravity effect” that would help in speeding up the dilation of the cervix. The birth ball used to be utilized in various settings of birth and is highly considered as a powerful, secureand easy method of promoting the progress of labor and relieving pain. The current study aim sat studying the using of the birthing ball during the first stage of labor and its effect on the progress of labor and outcome among nulliparous women. The design: The quasi-experimental design was utilized. A group of 120 laboring women was included by purposive sampling technique; the study subjects randomly assigned into two equal group. Setting: The study was implemented in the maternity Unit located in El-Nabawy El Mohandes Hospital (economical part), Fayoum. Five tools have been employed ingathering the needed data; 1) structure interview schedule questionnaire, 2) Partograph, 3) Visual analog pain intensity scale, 4) State Trait Anxiety Inventory and 5) Satisfaction visual analogue scale. The Findings of the present results revealsa high significant statistical difference between the two groups concerning the improvement of the dilatation of the cervix and fetus head descent that end in decreases duration of the first and second labor stages in the study sample. Also the sample of the study expressed less pain and anxiety score. Conclusion: the using of birthing ball throughout the first stage of labor is associated with positive effect on labor progress and outcome. Recommendation: Encourage women to use birth ball during the first stage of labor as one of the significant modalities to improve labor progress, manage pain, anxiety and attain more satisfactory birthing experience.

Managing Superficial Distal Medial Collateral Ligament Insufficiency in Primary Total Knee Arthroplasty Using Bone Staples.

Superficial medial collateral ligament (MCL) injury is an occasional intraoperative complication during total knee arthroplasty (TKA) that can lead to failure. Although previous studies have recommended complex repair or conversion to a constrained implant, the authors evaluated results of superficial distal MCL reapproximation using bone staples. Records of 31 patients who underwent staple reapproximation for superficial MCL avulsion from the tibial attachment during primary TKA from 2005 to 2015 were reviewed. They were compared with 685 patients who underwent uncomplicated TKA (primary control) and 18 who underwent revision TKA for instability (secondary control). Subjective knee instability was assessed with a patient questionnaire, and other end points included revision for instability or stiffness and manipulations under anesthesia. The authors prospectively collected Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analog scale satisfaction scores. The mean follow-up was 2.6 years. No patients treated with staple repair required revision for instability, whereas two patients were revised in the primary control. Subjective instability was reported in 19.2% of staple repair patients compared with 24.2 and 46.2% of patients in the primary and secondary controls. The mean KOOS for the staple group was 71.7 points, 77.3 for the primary control, and 49.3 for the secondary. KOOSs for the staple group were 5.6 points lower than the primary control, but 22.4 points higher than the secondary. Staple reapproximation is a simple and effective method for repairing the superficial distal MCL in primary TKA. The rate of instability and functional outcomes was comparable to uncomplicated primary TKA.

Comparison of 3 Approaches to Percutaneous Epidural Adhesiolysis and Neuroplasty in Post Lumbar Surgery Syndrome

Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to be safe and effective in treating different spine pathologies, in particular post lumbar surgery syndrome (PLSS). The purpose of this study was to compare the efficacy and complication rates of the 3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to treat PLSS. This study used a case control, blind study. The research took place at the pain clinic and interventional pain practice room at Asyut University Hospital, Assiut, Egypt. Sixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal, S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was performed prior to the procedure to determine the patients' baseline levels of pain severity. Follow-up assessments were performed 1-, 3-, and 6-months after the procedure. Results of the group pairwise analysis indicated that, relative to baseline, there were significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by patients' satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications between the 3 different groups. Our study was limited by the low number of patients and the short duration (6 months) of follow-up. The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) result in the same outcome with regard to pain relief and complication rate. Post lumber surgery syndrome, post laminectomy back pain, percutaneous adhesiolysis, Racz catheter, percutaneous neuroplasty.

The Clinical Outcomes and Their Associated Factors in Staged Bilateral Arthroscopic Rotator Cuff Repair

To compare perioperative characteristics and postoperative outcomes of both shoulders in patients who underwent arthroscopic bilateral rotator cuff repair sequentially and to assess the associated factors that would affect the anatomic healing in staged bilateral rotator cuff repair. The study enrolled 64 patients who underwent bilateral rotator cuff repair with follow-up imaging at least 12months postoperatively. We allocated the shoulders operated on first to the surgery I group and those operated on second to the surgery II group. Visual analog scale (VAS) pain and satisfaction scores, range of motion, the American Shoulder and Elbow Surgeons score, the Simple Shoulder Test score, and healing failure were evaluated. Range of motion improved with no significant between-group differences (all P > .05). In the surgery II group, VAS pain and VAS satisfaction scores were significantly worse at 6months postoperatively (P=.048 and P= .041, respectively) but were comparable at final follow-up (P= .598 and P= .065, respectively). American Shoulder and Elbow Surgeons and Simple Shoulder Test scores at 6months were worse in the surgery II group (P= .038 and P= .048, respectively) but similar at final follow-up (P= .786 and P= .087, respectively). Tear size was similar between the 2 surgical procedures (κ= 0.537, P < .001). Of the 11 patients with nonhealing in the surgery I group, 7 (63.6%) had subsequent failure in the other shoulder, and if one shoulder had healing failure, the other shoulder had ahigh possibility of healing failure as well (κ= 0.373, P= .004). Bilateral arthroscopic rotator cuff repair showed good outcomes at final follow-up on both sides. Tear size was closely related in both shoulders, and healingfailureafter the first rotator cuff repair was an associated factor with healing failure after the second operation. Level IV, case series.

A Prospective, Randomized Trial of Mobilization Protocols Following Ligament Reconstruction and Tendon Interposition.

The purpose of this study was to evaluate the hypothesis that an increased duration of immobilization following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) leads to improved patient-reported outcomes compared with an early mobilization protocol. At 2 institutions, we prospectively randomized 223 patients (238 thumbs) undergoing LRTI to receive 1 of 2 postoperative rehabilitation protocols. The immobilization protocol consisted of use of a postoperative forearm-based thumb-spica splint for 7 days followed by a forearm-based thumb-spica cast for 5 weeks and then by a custom forearm-based thermoplastic thumb-spica splint for an additional 6 weeks. An active range of motion (ROM) was started 6 weeks postoperatively. The early mobilization protocol consisted of the same postoperative splint for 7 days followed by use of a forearm-based thermoplastic thumb-spica splint for 3 weeks and then by a hand-based thumb-spica splint for 4 weeks. An active ROM was started 4 weeks postoperatively. The outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; pinch and grip strength; 9-hole peg test (NHP); visual analog scale (VAS) for pain; VAS for patient satisfaction; and wrist and thumb ROM. These were measured preoperatively and at 6, 12, 26, 52, and 104 weeks postoperatively. Differences in continuous and categorical variables were assessed with use of Tukey multiple comparisons following 1-way analysis of variance and Fisher exact tests, respectively. A minimum follow-up of 1 year (mean, 1.7 years) was achieved for 71% (169) of the 238 randomized thumbs (157 of the 223 patients): 74 patients (80 thumbs) treated with the immobilization protocol and 83 patients (89 thumbs) treated with the early mobilization protocol. DASH scores, VAS pain scores, VAS patient satisfaction scores, and strength all improved similarly with no significant differences between groups at any time point. Wrist and thumb ROM and NHP outcomes were significantly worse for the immobilization group at 6 weeks postoperatively, with no differences observed between groups at 12 weeks and beyond. A conservative immobilization protocol does not improve functional outcomes, satisfaction, strength, or ROM following LRTI compared with an early mobilization protocol. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

A Randomised Clinical Trial of Buffered Tumescent Local Anaesthesia During Endothermal Ablation for Superficial Venous Incompetence

Endovenous thermal ablation (EVTA) is the recommended first line intervention for superficial venous incompetence (SVI). While the infiltration of perivenous tumescent local anaesthesia (TLA) is key to procedural success, it is paradoxically the predominant source of patient reported discomfort. This randomised controlled trial investigates the potential to reduce peri-procedural pain and improve patient reported outcome measures (PROMs), including quality of life (QoL) using TLA buffered to physiological pH. Patients undergoing great saphenous vein EVTA with concomitant phlebectomies were randomised to either standard (ST) or buffered (BT) TLA. Follow up assessments were performed at weeks 1, 6, and 12. The primary outcome was patient reported peri-procedural pain on a 100mm visual analogue scale (VAS). Secondary outcomes were one week post-procedural pain VAS and analgesia use, QoL (disease specific: Aberdeen Varicose Vein Questionnaire [AVVQ]; generic: Short Form-36 [SF-36] and EuroQol 5 Dimensions Questionnaire [EQ-5D]), patient satisfaction VAS, technical success on duplex ultrasound (DUS) examination, and complications. Ninety-seven patients were randomised: 50 to ST and 47 to BT. The groups had comparable baseline demographics, Clinical Etiologic Anatomic Pathological, Venous Clinical Severity Score, QoL, and DUS parameters. Equally, intra-procedural parameters (volume of TLA, length of ablation, and linear energy delivered) were also comparable. Peri-procedural pain scores were significantly lower in the BT group with a mean±SD score of 2.86±3.57 versus 4.44±2.94 (p=.001). Pain scores and analgesia use over the subsequent week were equivalent. SF-36 Bodily Pain domain scores were significantly better in the BT group at week 1 (77 vs. 62; p=.008). AVVQ, SF-36, and EQ-5D scores were otherwise similar between the groups throughout follow up, significantly improving over baseline. Technical success was high in both groups, with no major complications and few minor complications. Buffered TLA offers a significantly lower peri-procedural pain experience for patients undergoing EVTA and should replace current tumescent formulae.

The Importance of Comprehensive Cam Correction: Radiographic Parameters Are Predictive of Patient-Reported Outcome Measures at 2 Years After Hip Arthroscopy

Background: The specific influence of preoperative and postoperative radiographic measurements on patient-reported outcome measures after hip arthroscopy for femoroacetabular impingement (FAI) remains unclear. Purpose: To investigate the relationship between radiographic measurements and 2-year outcomes after hip arthroscopy for the treatment of FAI. Study Design: Case series; Level of evidence, 4. Methods: A clinical registry of patients undergoing primary hip arthroscopy for FAI between January 1, 2012, and December 31, 2014, was queried. Outcome measures included the Hip Outcome Score (HOS) Activities of Daily Living (ADL), HOS Sport-Specific Subscale (SSS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction. Preoperative and postoperative radiographic measurements were recorded. Univariate analysis was conducted to identify relationships between all radiographic and demographic variables and outcome scores. A multivariate regression analysis, controlling for demographic factors, was used to identify independent associations between radiographic measurements on plain radiographs and patient-reported outcomes. Results: The authors identified 707 patients who underwent primary hip arthroscopic management for FAI who were included for analysis. Two-year outcome surveys were completed for 78% to 84% of patients. The mean age of the patients was 33.2 ± 12.3 years, and 64.4% of the patients (n = 456) were female. The mean anteroposterior (AP) alpha angle decreased by 34.3° (P < .0001), false profile alpha angle by 25.2° (P < .0001), Dunn lateral alpha angle by 28.9° (P < .0001), lateral center edge angle by 2.6° (P < .0001), and anterior center edge angle by 3.4° (P < .0001). The HOS-ADL score increased from 65.7 ± 18.7 preoperatively to 85.9 ± 16.7 postoperatively (P < .0001), HOS-SSS increased from 43.4 ± 23.1 to 72.6 ± 27.2 (P < .0001), and mHHS increased from 57.7 ± 14.0 to 79.1 ± 17.2 (P < .0001). With multivariate analysis, independent predictors of the postoperative HOS-ADL score included the preoperative false profile alpha angle (beta = −0.16, P = .028). Independent predictors of HOS-SSS score were preoperative AP alpha angle (beta = −0.33, P = .032) and preoperative false profile alpha angle (beta = –0.28, P = .041). For the postoperative mHHS score, independent predictors included preoperative AP alpha angle (beta = −0.18, P = .046), preoperative false profile alpha angle (beta = −0.20, P = .014), and postoperative false profile alpha angle (beta = –0.48, P = .035). The preoperative AP alpha angle (beta = 0.28, P = .024) was a significant predictor for the postoperative VAS pain score. The preoperative false profile alpha angle (beta = −0.34, P = .040) was a significant predictor for the postoperative VAS satisfaction score. Conclusion: The authors observed that radiographic measurements, specifically the preoperative false profile alpha angle, AP alpha angle, and postoperative false profile alpha angle, are independent predictors of 2-year clinical outcomes. The femoral-side measurements were the strongest independent predictors of outcomes, especially measurements of the anterior and lateral-based CAM lesion.