Visual Analog Scale Satisfaction Scores Research Articles

Association of Patient Satisfaction 2 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome With Minimum 10-Year Patient-Reported Outcomes and Survivorship

Background: Previous studies have shown that short-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) predict midterm outcomes, but a limited number of studies have evaluated whether short-term outcomes predict long-term outcomes and survivorship. Purpose: To evaluate whether achieving clinically significant outcomes at 2 years after hip arthroscopy for FAIS can predict patient-reported outcomes (PROs) and survivorship at 10 years. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between June 2012 and December 2012 with a minimum 10-year follow-up were identified. Using previously established thresholds, we classified patients who achieved the 2-year Patient Acceptable Symptom State (PASS) for the visual analog scale (VAS) for satisfaction as the high satisfaction group and patients who did not as the low satisfaction group. Minimum 10-year PROs were then compared between the groups, including scores for the Hip Outcome Score (HOS)–Activities of Daily Living and –Sports Specific, the modified Harris Hip Score, the VAS for pain, and the VAS for satisfaction. Reoperation-free survivorship was compared. Results: Of 120 eligible consecutive patients, 85 patients were included (70.8% follow-up rate), of whom 61.2% were female. The mean age was 34.0 ± 12.8 years, and the mean body mass index was 25.4 ± 4.6. Of the 85 patients, 29 (34.1%) did not achieve PASS for the VAS for satisfaction at 2 years postoperatively compared with 56 (65.9%) who did. The low satisfaction group had significantly worse acetabular chondral grades at the time of surgery (P = .008). At minimum 10-year follow-up, the high satisfaction group showed significantly better HOS-Activities of Daily Living, HOS-Sports Specific, modified Harris Hip Score, VAS pain, and VAS satisfaction scores (P≤ .031). Compared with the low satisfaction group, the high satisfaction group had a significantly lower rate of secondary surgery (1.8% vs 24.1%, respectively; P = .002). Conclusion: Patients who achieved PASS for the VAS for satisfaction at 2 years after hip arthroscopy demonstrated superior minimum 10-year outcomes compared with patients who did not, including greater PRO scores and a higher survivorship rate. The high satisfaction group had lower grade acetabular cartilage damage at the time of surgery compared with those who did not achieve PASS for the VAS for satisfaction at 2 years.

Safety and efficacy of second-generation all-suture anchors in labral tear arthroscopic repairs: prospective, multicenter, 1-year follow-up study

BackgroundThis study’s primary aim was to assess the safety and performance of second-generation all-soft suture anchors following arthroscopic labral tear repair. MethodsThis prospective, multicenter study was conducted by 6 surgeons at 6 sites in Europe and the United States between November 2018 and August 2020. Patients who required shoulder arthroscopic repair, for a range of labral injuries, were treated with a second-generation all-soft suture anchor. The primary outcome was clinical success rate (percentage of patients without signs of failure and/or re-intervention) at 6 months. Secondary outcomes included clinical success rate at 12 months, intraoperative anchor deployment success rate, and patient-reported outcomes (PROs) at 6 and 12 months, including visual analog scale (VAS) pain assessment, VAS satisfaction assessment, EQ-5D-5L Index Score, EQ-5D-5L VAS Health Score, Rowe Shoulder Score for Instability, American Shoulder and Elbow Surgeons score, and Constant-Murley Shoulder (CMS) Score. Serious adverse events (SAE) and serious adverse device effects (SADE) were collected throughout the study. ResultsForty-one patients were enrolled (mean age, 28.2 years; 87.8% male, 12.2% female). Clinical success was achieved in 27/28 and 31/32 patients at 6 months and 12 months, respectively. Anchor deployment had a 100% success rate. Significant improvements over baseline were reported for all PROs except CMS (6 months) and VAS Satisfaction Score (12 months). One patient experienced 1 SAE and 1 patient experienced 1 SADE. ConclusionSecond-generation all-soft suture anchors used in this study demonstrated a high clinical success rate, a favorable safety profile, and patients exhibited significant improvement in PROs.

Relocation of polyotia tissue to reconstruct the tragus and fill the preauricular depression

ObjectivesThe present article introduces a lingual composite tissue flap based on the tragus-like structure for correcting polyotia deformity, with the aim of providing a surgical technique that involves relocating polyotia tissue to reconstruct the tragus and fill the preauricular depression. MethodsThe study included a total of 21 patients with polyotia who underwent lingual composite tissue flap reconstruction between January 2020 to December 2022. Patients were retrospectively assessed through a comprehensive review of their medical records and photographic data. Tragus morphology was evaluated based on the measurements of tragus length and width. The Aesthetic Outcomes Scale (AOS), modified Vancouver Scar Scale (mVSS), and Visual Analogue Scale (VAS) were employed for the assessment of surgical outcomes. ResultsThe follow-up period for all patients ranged from 6 to 15 months. The length and width of the normal tragus were not significantly different from those of the reconstructed tragus. The mean preoperative AOS score was 2.73 ± 0.51, while the mean postoperative AOS score increased to 7.61 ± 0.65. The mVSS yielded an average score of 1.80 ± 1.43, indicating inconspicuous scarring post polyotia surgery. The preoperative VAS satisfaction score was recorded as 1.57 ± 0.67, while the postoperative VAS score significantly increased to 8.33 ± 0.91. The flaps all successfully survived post-operation without any occurrences of flap hematoma, necrosis, infection, or wound dehiscence. ConclusionThe reconstruction of the tragus should be given careful consideration when addressing polyotia. The utilization of a lingual composite tissue flap for correction can achieve excellent aesthetic results for the tragus, with high patient satisfaction and minimal complications.

Six-Month Outcomes Correlate With 10-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

To identify whether 6-month outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) correlate with outcomes at minimum 10-year follow-up. Patients who underwent primary hip arthroscopy for FAIS from 2012 to 2013 were reviewed and included if they had 6-month and minimum 10-year follow-up. Patient-reported outcome (PRO) measures included the Hip Outcome Score Activities of Daily Living (HOS-ADL) subscale, Hip Outcome Score Sports-Specific (HOS-SS) subscale, modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain, and VAS for satisfaction. We compared 6-month and 10-year outcome scores and analyzed the relations between 6-month and 1-, 2-, 5-, and 10-year outcome scores using Pearson correlation coefficients (r). Six-month scores and clinically significant outcome achievement were then compared with 10-year clinically significant outcome achievement and reoperations, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), using logistic regressions and the Fisher exact test. This study included 60 patients (60.0% female sex; mean age, 36.0 ± 12.2 years). The mHHS, VAS pain score, and VAS satisfaction score significantly improved from 6-month to 10-year follow-up (P ≤ .021), whereas the HOS-ADL and HOS-SS did not (P ≥ .072). There were significant correlations between 6-month and 10-year scores for the HOS-ADL (r= 0.505), HOS-SS (r= 0.592), and mHHS (r= 0.362) (P ≤ .022 for all), as well as significant correlations between 6-month and 1-, 2-, and 5-year scores (P ≤ .014 for all). The 6-month HOS-ADL, HOS-SS, and mHHS were all significantly associated with their respective 10-year achievement of the patient acceptable symptom state (PASS) (P ≤ .044). Furthermore, 6-month HOS-ADL and mHHS were significantly associated with THA conversion (P ≤ .041). Comparable 6-month and 10-year achievement of the minimal clinically important difference (96.5% vs 97.8%, P > .999) and PASS (85.2% vs 87.5%, P > .999) for any PRO was observed. After hip arthroscopy for FAIS, patients' 6-month HOS-ADL and mHHS were significantly associated with their 10-year PROs, PASS achievement, and THA conversion, although correlation strengths decreased with increasing time from surgery. Level IV, case series.

Retrospective study on unilateral polyotia combined with microtia utilizing the technique of preserving residual ear tissue

The presence of polyotia in individuals with microtia is a rare deformity. Due to the intricate structure of the auricle, uncertain etiology, and challenging corrective techniques, it has always been a focal point in the field of plastic surgery. The present study presents a technique for correcting the combination of polyotia and microtia by utilizing residual ear tissue as graft material. The retrospective study included 23 patients with polyotia and microtia from 2018 to 2022. The residual ear tissue was used to rectify auricular deformities in all patients. The patients were instructed to evaluate the satisfaction of the auricle shape using a visual analog scale (VAS) both before and 6 months after the surgical procedure. The esthetic outcomes of auricle subunits were simultaneously assessed by a senior physician pre- and postoperatively. The mean duration of follow-up in this study was 8.73 months. The preoperative VAS satisfaction score was recorded as 2.26±0.86, while the post-operative VAS score significantly increased to 7.86±0.86. The preoperative auricle esthetic outcomes score was recorded as 9.95±1.74, while the post-operative score significantly increased to 24.04±2.16. The follow-up period did not present any cases of flap necrosis, hematoma, infection, or wound dehiscence. The study demonstrates that comprehensive utilization of residual auricular tissue can lead to optimal outcomes in correcting polyotia with concha-type microtia. The utilization of residual ear tissue can be maximized to streamline the operation, minimize bodily harm, and enhance patient satisfaction.

Prograde transposition for anteriorly low-set earlobe in lobule-type microtia reconstruction

BackgroundLobule transposition, a common procedure in auricle reconstruction, has been successfully performed over the past few decades. However, the transposition methods for unilateral microtia with evident asymmetry of bilateral earlobe positions still remain a challenge. The objective of this study was to investigate the application of prograde transposition for anteriorly low-set earlobes. MethodA total of 25 patients with lobule-type microtia with anteriorly low-set residual earlobe underwent prograde transposition during auricle reconstruction between 2020 and 2022. The post-operative earlobe aesthetic assessment and patient satisfaction were evaluated, and the data on any complications that occurred when followed-up were collected. This study provides a comprehensive analysis and summary of the techniques used in earlobe transposition for auricular reconstruction. ResultsThe patients with evident asymmetry between the residual and healthy earlobes were usually concomitant with hemifacial microsomia and the residual ear was located in the anterior and lower region. No instances of flap necrosis, hematoma, or wound dehiscence were observed following auricular reconstruction. The mean aesthetic score of the auricle was 3.52, with 23 patients attaining good or excellent aesthetic outcomes. The mean Visual Analog Scale satisfaction score was 3.68, with 24 patients reporting relative satisfaction or satisfaction. ConclusionThe prograde transposition of anteriorly low-set earlobe in lobule-type microtia reconstruction can effectively ensure adequate blood supply, enhance aesthetic appearance, and significantly improve patient satisfaction.

Comparison of the Postoperative Analgesia Effects of Patient-Controlled Analgesia and Epidural Catheter After Posterior Instrumentation Surgery

Objective: To prospectively assess the effects of intravenous patient-controlled analgesia (IV PCA) and epidural patient-controlled analgesia (epidural PCA) on postoperative pain management following posterior instrumentation surgery.
 Materials and Methods: The study involved the ASA 1-2 group, 60 patients who underwent elective thoracic or lumbar posterior instrumentation surgery at our tertiary centre for spinal stenosis. Two groups of patients were created: Group 1 (n = 30), IV PCA group, and Group 2 (n=30), epidural PCA group. IV PCA was applied by fentanyl. Epidural PCA was maintained by lading to epidural space by the neurosurgeon. Bupivacaine was administered to Group 2 patients in the recovery room. Following surgery, patients in both groups were assessed for pain using the visual analogue scale (VAS) and for motor block using the Bromage scale. Additionally, hemodynamic parameters, side effects, and patient satisfaction were noted. Following 48 hours, patients' overall rescue analgesia, opioid, and local anaesthetic requirements were recorded. 
 Results: Postoperative VAS scores of Group 2 at the 1st, 2nd, 4th, 8th and 16th hours were lower than Group 1 and these differences was statistically significant. Postoperative patient satisfaction scores at 1st, 2nd, 4th, 8th, 12th, 16th, 20th, 24th, 30th, 36th, 42nd and 48th hours were significantly different between the groups and the patient satisfaction scores of Group 2 were higher than the Group 1. Side effects were similar in both groups. Group 1 required statistically significantly higher number of rescue analgesia. 
 Conclusion: This study shows that epidural PCA is more comfortable than IV PCA with low VAS and high patient satisfaction scores. As a conclusion, epidural PCA is a safe, highly efficient method for patients with posterior instrumentation surgery.

Cross-Cultural Adaptation and Validation of the Persian Version of the Harris Hip Score.

The Persian language, also known as Farsi, is a pluricentric language spoken in Iran, Afghanistan, and Tajikistan by about 140 million people. This study aims to translate the Harris hip score (HHS) into Persian with cross-cultural adaptation and to evaluate its validity and reliability. One hundred fifty-six total hip arthroplasty patients completed the Persian version of the HHS, Western Ontario and McMaster Universities Osteoarthritis Index, Forgotten Joint Score, and visual analog scale (VAS) for pain and satisfaction postoperatively. Using Cronbach's alpha (α) coefficient, internal consistency was evaluated. Correlations (Spearman's Rho) were used to assess validity. A test-retest reliability assessment of the Persian HHS was conducted (n= 47) using the intraclass correlation coefficient. Content validity was evaluated using the floor and ceiling effects of the HHS. The final translation of the Persian HHS was approved to be used. The preoperative and postoperative Cronbach's alpha were 0.71 and 0.70, respectively, and showed acceptable internal consistency. The intraclass correlation coefficient was excellent (0.869, P < .001). Insignificant ceiling effects (13.5%) and no floor effects (0) were observed. The HHS score was significantly and strongly correlated with Western Ontario and McMaster Universities Osteoarthritis Index (r= 0.696, P < .001), VAS pain (r= 0.654, P < .001), VAS satisfaction (r= 0.634, P < .001), and Forgotten Joint Score (r= 0.648, P < .001). The Persian HHS demonstrated excellent reliability and validity properties. Accordingly, Persian HHS may be a helpful tool for assessing patients undergoing total hip arthroplasty.

Surgical Tips for Aesthetic Lower Lid Blepharoplasty: Prevention of Round Eye

Purpose: In the present study, we highlight surgical tips based on our experience in lower eyelid blepharoplasty. These have been shown to be crucial in the prevention of several complications, specifically lateral lower-lid displacement. Methods: A series of bilateral lower-lid blepharoplasties were performed on 280 patients at Humanitas-Research-Hospital (Milan, Italy) between January 2016 and January 2020. Patients with a history of lower-lid blepharoplasty and patients requiring canthopexy/canthoplasty were excluded. Needing to singularly evaluate and correct several lower-eyelid structures to obtain a harmonic result, we preoperatively assessed the amount of skin excess, the eyelid margin malposition relative to the globe, and the presence/absence of herniated fat-pads. Pre- and postoperative standard photographs were collected. Patients were evaluated by measuring scleral show, snap-back test, and distraction test. Blinded-fashioned photograph analysis was performed by independent plastic and oculoplastic surgeons who did not execute the procedures. A visual analogue scale was administered to all patients to assess satisfaction. Results: In total, 280 patients underwent successful lower blepharoplasty, with satisfactory results of scleral show, snap-back test, and distraction test. Of the 280 patients, four presented postoperative complications. At 10-month follow-up visit, we achieved a mean patient visual analogue scale satisfaction score of 8.4. Postoperative surgeon’s photographs mean score was 4.5. Conclusions: Without the use of muscle flaps, our technique averts tarsal ligament misposition, preserves orbicularis-muscle innervation, and limits thermal spread, assuring excellent stability of results and high patient and surgeon satisfaction. Cosmetic outcome in terms of symmetry, appearance, and lower lid line definition revealed high satisfaction with the result over time, with a remarkably low complication rate.

Poster 186: Cannabidiol for Post-Operative Pain Control after Arthroscopic Rotator Cuff Repair Demonstrates No Functional Deficits at 1-Year

Objectives: Cannabidiol (CDB) has been recently shown to positively impact patient pain and satisfaction immediately after arthroscopic rotator cuff repair. However, it is unclear if addition of CBD to a post- operative regimen will cause any changes in clinical outcomes. The purpose of this study is to evaluate 1-year functional outcomes among patients who previously underwent arthroscopic rotator cuff repair (ARCR) and received buccally-absorbed cannabidiol for post-operative pain management. We hypothesize that there will be no clinical differences in pain or shoulder function at one year follow up comparing those who receive CBD versus a placebo. Methods: Included patients had previously completed participation in a FDA-sanctioned, multi-center, placebo-controlled, randomized, double-blinded trial to evaluate the potential analgesic effects of CBD post-ARCR. The experimental group post-operatively received 25-mg of CBD (Oravexx, Orcosa Pharmaceuticals, USA) TID if &lt; 80-kg and 50-mg of CBD TID if &gt; 80-kg for 14 days, with control groups receiving an identical placebo. Patients were contacted one year following their date of surgery to obtain the following patient-reported outcome scores: the Visual Analogue Scale (VAS) for pain and satisfaction, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES), and the Single Assessment Numeric Evaluation (SANE) rating. These scores, as well as ASES sub-components, were compared between the CBD group and placebo group. Continuous variables were compared within groups with Wilcoxon signed rank test and between groups with Kruskal-Wallis test. Fisher’s exact test was used to compare categorical variables between groups. P-values &lt; 0.05 were considered significant. Results: Overall, 62 patients of the 72 patients currently eligible for 1-year follow-up were recruited, achieving a response rate of 86.1%. There were no significant differences in age, sex, or BMI between the two cohorts. There were no significant differences found between placebo and CBD cohorts in the overall ASES score (95.1% vs 91.2%, p = 0.288); furthermore, no differences (p &gt; 0.05) were found in each component of the 10-question daily activities of living scale. There were no significant differences with respect to the amount of anti-inflammatory pain medication taken on an average day, as reported on the ASES between placebo and CBD cohorts (0.23 pills ± 0.82 vs 0.50 ± 1.39; p = 0.365). No patients (0%) reported using any stronger pain medications, including opioids. There were no significant differences found in VAS pain score (0.77 ± 1.25 vs 0.91 ± 1.75, p = 0.721), VAS satisfaction (97.1% vs 97.2%, p = 0.927), and SANE score (92.4 vs 87.0, p = 0.065). All patients (100%) stated that surgery had met their expectations. Conclusions: Peri-operative use of CBD for pain control among patients undergoing ARCR does not result in any significant deficits in patient-reported pain, satisfaction, or functional outcomes at 1-year post-operatively compared to a placebo control. These findings suggest that CBD can be considered in a post-operative multimodal pain management regimen without long-term detrimental effects.

Use and Effectiveness of Physical Therapy After Hip Arthroscopy for Femoroacetabular Impingement

Background: Limited literature exists regarding how postoperative physical therapy (PT) may affect outcomes in patients with femoroacetabular impingement syndrome (FAIS) undergoing hip arthroscopy. Additionally, it is unknown how PT measures relate to traditional orthopaedic patient-reported outcomes (PROs). Purpose: To evaluate how the duration of PT may correlate with outcomes in patients with FAIS using both the Lower Extremity Functional Scale (LEFS) and standard orthopaedic PRO measures. Study Design: Cohort study; Level of evidence, 3. Methods: Patients from a single institution who underwent primary hip arthroscopy for FAIS between 2013 and 2016 were identified. Patients with a minimum 2-year follow-up and fully documented PT notes were included and stratified into 3 cohorts based on timing of PT discharge: 0 to 3 months, 3 to 6 months, and 6 to 12 months. Predictive regression models were developed to analyze the rate of improvement (ROI) in LEFS score as it relates to (1) postoperative day (POD) and (2) postoperative PT session number. Two-year PROs were collected, correlated with LEFS scores, and compared among cohorts. Results: A total of 95 patients were included (mean ± SD age, 34.6 ± 11.7 years; range, 14-55 years). Mean LEFS scores increased significantly from the initial score at 6 weeks, 3 months, and the time of PT discharge (P < .01 for all). The predicted ROI in LEFS score was 3.39% per PT session for sessions 0 to 13, 1.43% for sessions 14 to 27, and 0.37% for sessions 28 to 40. Patients who underwent 3 to 6 months of PT had significantly better Hip Outcome Score (HOS) relative to the 0- to 3-month cohort and significantly better visual analog scale (VAS) scores for satisfaction relative to the 6- to 12-month cohort. The predicted ROI in LEFS score was 0.96% per day from POD 0 to 45, 0.22% from POD 46 to 139, and 0.03% after POD 139. Moderate correlations were seen between LEFS score at the time of discharge and all 2-year PROs as follows: HOS Activities of Daily Living subscale (r = 0.488), HOS Sports-Specific subscale (r = 0.500), modified Harris Hip Score (r = 0.465), 12-item International Hip Outcome Tool (r = 0.494), VAS pain score (r = −0.346), and VAS satisfaction score (r = 0.459). Conclusion: Patients undergoing hip arthroscopy for FAIS derived substantial benefit from each PT visit during their first 13 PT sessions and then a smaller, yet still meaningful benefit from sessions 13 through 27. After session 40, or approximately 4.5 to 5 months, patients no longer benefited from additional PT sessions. Based on PRO scores, patients discharged from PT between 3 and 6 months had the best 2-year outcomes. LEFS score had moderate correlation with orthopaedic PRO scores.

Patients’ and health care providers’ perspectives on quality of hemophilia care in the Netherlands: a questionnaire and interview study

BackgroundHemophilia care has improved greatly because of advances in treatment options and comprehensive care. In-depth insight into the perspectives of persons with hemophilia and health care providers on their care may provide targets for further improvements. ObjectivesTo assess satisfaction of the hemophilia population with their care, to explore factors determining care satisfaction, and to identify areas for potential health care improvements, including digital health tools. MethodsFirst, to assess care satisfaction and factors determining satisfaction and health care improvements, data from a nationwide, cross-sectional questionnaire among 867 adult and pediatric Dutch persons with hemophilia A or B were analyzed. This included the Hemophilia Patient Satisfaction Scale questionnaire, Canadian Hemophilia Outcomes Kids’ Life Assessment Tool satisfaction questions, a visual analog scale satisfaction score, and open questions. Second, to further explore factors determining satisfaction and health care improvements, semistructured interviews were conducted with 19 persons with hemophilia or their parents and 18 health care providers. ResultsHigh care satisfaction was found, with an overall median Hemophilia Patient Satisfaction Scale score of 12 (IQR, 6-21). Participants in the interviews reported that patient-professional interactions, availability of care, and coordination of care were major factors determining satisfaction. Suggested health care improvements included improved information provision and coordination of care, especially shared care with professionals not working within comprehensive care centers. Participants suggested that digital health tools could aid in this. ConclusionSatisfaction with hemophilia care is high among persons with hemophilia in the Netherlands, although several potential improvements have been identified. Accentuating these is especially relevant in the current era of treatment innovations, in which we might focus less on other aspects of care.

The effect of Centella Asiatica cream on scar development in patients who underwent open carpal tunnel release surgery

AimTo evaluate the efficacy of the Centella asiatica extract in a cream preparation for the prevention of scar tenderness formation in patients who underwent conventional open carpal tunnel release (CTR) surgery. Material and MethodsA total of 280 patients with carpal tunnel syndrome who underwent CTR surgery were individually randomized into the intervention (n = 140) and control (n = 140) groups. In the intervention group, a petroleum cream mixture consisting of 1% Centella asiatica extract was applied to the patients’ wrist for 6 months after the sutures were removed. In the control group, no intervention was applied. The Vancouver Scar Scale (VSS), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) functional score, and Visual Analog Scale (VAS) satisfaction scores were assessed preoperatively and postoperatively. Follow-up evaluations were scheduled at 1, 3 and 6 months after CTR surgery. ResultsThe overall VSS score of the intervention group significantly improved at 3-6 months (-1.260, p = .040). At 6 months after surgery, the mean QuickDASH functional score was 18.54 (range 0.00-63.64, SD 17.4) in the intervention group and 28.70 ± 12 (range: 2.27-40.91) in the control group (p < .04). At 6 months after surgery, the mean VAS satisfaction score was 1.46 ± 1.95 (range: 0-4) in the intervention group and 2.48 ± 1.02 (range: 0-4) in the control group (p < .03). ConclusionThe Centella asiatica cream applied to the wrist after CTR surgery was found to be beneficial in preventing scar tenderness in the thenar and hypothenar regions of the hand.

High Rates of Satisfaction and Return to Dance in Current or Former Professional Ballet Dancers After Total Hip Arthroplasty With a Muscle-Sparing Direct Anterior Approach Using Custom Femoral Stems.

Professional ballet dancers have high expectations after total hip arthroplasty (THA), particularly if they intend to resume dancing as performers or teachers. To report clinical outcomes and return to dance after THA with a muscle-sparing direct anterior approach using a custom femoral stem in a cohort of current or former professional ballet dancers. Case series; Level of evidence, 4. Twenty-three patients (26 hips) were included, that identified as current or former professional ballet dancers, from a consecutive series of 1699 hips that underwent primary THA by 1 of 2 surgeons. Both surgeons routinely implanted custom femoral stems using a muscle-sparing direct anterior approach in active and/or high-demand patients. All patients completed a questionnaire postoperatively that assessed dance capabilities, the visual analog scale (VAS) for hip pain (0-10), the VAS for satisfaction with surgery (0-10), the Oxford Hip Score (OHS), and the Forgotten Joint Score (FJS). The initial cohort comprised 19 women and 4 men, with a mean age of 50.5 ± 14.9 years and a mean 38.0 ± 14.4 years of dance experience. One patient underwent revision THA for a leg-length discrepancy, leaving 22 patients (25 hips) with a mean follow-up of 3.4 ± 1.4 years. The mean VAS satisfaction score was 9.8 ± 0.6, and the mean VAS pain score was 0.5 ± 1.0. The postoperative OHS and FJS were 46 ± 2 and 92 ± 15, respectively. Overall, 16 patients resumed ballet at 5.1 ± 3.9 months, 3 resumed other types of dance, and 3 did not resume any type of dance. None of the 6 patients who did not resume ballet indicated pain in the operated hip as the reason for stopping. In current or former professional ballet dancers, THA by a muscle-sparing direct anterior approach using a custom femoral stem yielded excellent clinical outcomes at a minimum of 2 years, with the highest satisfaction score of 10 points reported for 88% of hips and 72% of hips being totally pain free. Furthermore, 73% of patients resumed ballet, and 86% resumed dance in general.

Associating Outcomes After Hip Arthroscopy With Patient Resilience.

Higher patient resilience has been shown to be associated with improved patient-reported outcome measures (PROMs) at 6 months after hip arthroscopy. To examine the relationship between patient resilience and PROMs at minimum 2 years after hip arthroscopy. Cross-sectional study; Level of evidence, 3. Included were 89 patients (mean age, 36.9 years; mean follow-up, 4.6 years). Patient demographics, surgical details, and preoperative International Hip Outcome Tool-12 (iHOT-12) and visual analog scale (VAS) pain scores were collected retrospectively. Postoperative variables were collected via a survey and included the Brief Resilience Scale (BRS), Patient Activation Measure-13 (PAM-13), Pain Self-efficacy Questionnaire-2 (PSEQ-2), VAS satisfaction, and postoperative iHOT-12, and VAS pain scores. Based on the number of standard deviations from the mean BRS score, patients were stratified as having low resilience (LR; n = 18), normal resilience (NR; n = 48), and high resilience (HR; n = 23). Differences in PROMs were compared between the groups, and a multivariate regression analysis was performed to assess the relationship between pre- to postoperative change (Δ) in PROMs and patient resilience. There were significantly more smokers in the LR group compared with the NR and HR groups (P = .033). Compared with the NR and HR groups, patients in the LR group had significantly more labral repairs (P = .006), significantly worse postoperative iHOT-12, VAS pain, VAS satisfaction, PAM-13, and PSEQ-2 scores (P < .001 for all), and significantly lower ΔVAS pain and ΔiHOT-12 scores (P = .01 and .032, respectively). Regression analysis showed significant associations between ΔVAS pain and NR (β = -22.50 [95% CI, -38.81 to -6.19]; P = .008) as well as HR (β = -28.31 [95% CI, -46.96 to -9.67; P = .004) and between ΔiHOT-12 and NR (β = 18.94 [95% CI, 6.33 to 31.55]; P = .004) as well as HR (β = 20.63 [95% CI, 6.21 to 35.05]; P = .006). Male sex was a significant predictor of ΔiHOT-12 (β = -15.05 [95% CI, -25.42 to -4.69]; P = .006). The study results indicate that lower postoperative resilience scores were associated with significantly worse PROM scores, including pain and satisfaction, at 2 years after hip arthroscopy.

Non-Operative Treatment of 3-Part and 4-Part Proximal Humerus Fractures and its Related Functional Aftermath

Objective: To assess the functional outcomes of noninvasive treatment for proximal humerus three parts and four parts fracture. Study Design: Prospective-cohort study Place and Duration of Study: Department of Orthopaedics, Sialkot Medical College, Sialkot from 1st January 2021 to 31st March 2022. Methodology: Fifty patients between 56-65 years and radiograpically both anterior and lateral views were taken. There was a follow up plan in each patient at half month, three months, six months and a year with repeated imaging. Oxford-Shoulder Score and EuroQol-5 Dimensions-3 Levels was used for finding primary functional results while secondary functional outcomes were score through Visual Analog Scoring and University of California at Los Angeles Shoulder Score. Results: The mean of the patients was 62.3±5.6 years with more females (70%) than males. Majority of the cases had a high incidence of fall due to feeling low in energy. The comparison of Oxford-Shoulder Score (OSS) and EQ 5D 3L method showed a high significance within each variable. Comparative imaging at follow ups have showed timely fixation of the humerus with non-invasive procedure with improved OSS values. One-year scores for Oxford-Shoulder Score were 33.1 with 95% confidence of interval while it was 0.59 for EQ-5D-3L. Considering the secondary outcomes it was noticed that mean outcomes score of treatment was 32.1 while visual analogue scale (VAS) pain score was 32.1 with 59.2 as VAS satisfaction score. Conclusion: Good functional outcome of displaced 3-part and 4-part fracture of proximal humerus. Keywords: Noninvasive treatment, Proximal humerus fractures, Osteoporosis Neers classification, Related functional aftermath, Functional outcome

Clinical application of integrated angulated screw channel abutment crown in implant-supported rehabilitation of aesthetic area.

To evaluate the clinical effect of integrated angulated screw channel (ASC) abutment crown in implant-supported rehabilitation of the aesthetic area. Sixteen patients who received single implant-supported rehabilitation using integrated ASC abutment crown in the aesthetic area were included in the study. After one-year follow-up, the cumulative survival rate, aesthetic effectiveness, bone resorption around implants, and patient satisfaction were analyzed through periapical film, clinical examination, and the visual analog scale (VAS). The implant cumulative survival rate of the integrated ASC abutment crown in the implant-supported rehabilitation of the aesthetic area was 100%. The average pink esthetic index scores reached 9.5, and the white esthetic index scores reached 9.4. The mean marginal bone loss of implants was (0.439±0.123) mm at the mesial side and (0.341±0.118) mm at the distal side. The average VAS satisfaction score was 8.9, which showed that all patients were satisfied with the final restorative effect. Using integrated ASC abutment crown for implant restoration is an ideal implant restoration design in the aesthetic zone and can be applied clinically.

Clinical analyses of ultrasound-guided nerve block in lower-extremity surgery: A retrospective study.

The purpose of this study is to examine the clinical effects and results of lower-extremity surgery under ultrasound-guided nerve block; time required for nerve block, anesthesia onset time, duration of anesthesia, duration of analgesia, tolerable tourniquet time, visual analog scale (VAS) satisfaction score, and anesthetic-related complications. A total of 3312 cases (2597 patients) from January 2010 to April 2015 were analyzed retrospectively. A senior author performed ultrasound-guided nerve block of the lateral femoral cutaneous nerve (LFCN, 630 cases), femoral nerve (FN, 2503 cases), obturator nerve (ON, 366 cases), sciatic nerve (SN, 3271 cases), or posterior femoral cutaneous nerve (PFCN, 222 cases) depending on the type of surgery. Time required for nerve block, anesthesia onset time, duration of anesthesia, duration of analgesia, tolerable tourniquet time, VAS satisfaction score, and anesthetic-related complications were analyzed. The mean times required were 1.1 min for SN block, 2.5 min for FN/SN block (1762 cases), and 4.8 min for FN/SN/LFCN/ON block. The mean anesthesia onset time was 48 min. The mean durations of anesthesia were 4.5 h for FN dermatome and 5.6 h for SN dermatome. The mean duration of analgesia was 11.5 h. The mean tolerable tourniquet times after were 35, 51, and 84 min after SN block, FN/SN block, and FN/SN/LFCN/ON block, respectively. The mean VAS satisfaction score was 9.3. There were no anesthetic-related complications, such as infection, hematoma, paralysis, or nerve irritation. Selective block of the LFCN, FN, ON, SN, and PFCN based on the locations of lesions and type of surgery showed favorable clinical results with high efficacy. Ultrasound-guided nerve block may be a good option for anesthesia and analgesia in lower-extremity surgery.

Machine Learning Algorithms Predict Clinically Significant Improvements in Satisfaction After Hip Arthroscopy

To develop machine learning algorithms to predict failure to achieve clinically significant satisfaction after hip arthroscopy. We queried a clinical repository for consecutive primary hip arthroscopy patients treated between January 2012 and January 2017. Five supervised machine learning algorithms were developed in a training set of patients and internally validated in an independent testing set of patients by discrimination, Brier score, calibration, and decision-curve analysis. The minimal clinically important difference (MCID) for the visual analog scale (VAS) score for satisfaction was derived by an anchor-based method and used as the primary outcome. A total of 935 patients were included, of whom 148 (15.8%) did not achieve the MCID for the VAS satisfaction score at a minimum of 2 years postoperatively. The best-performing algorithm was the neural network model (C statistic, 0.94; calibration intercept, -0.43; calibration slope, 0.94; and Brier score, 0.050). The 5 most important features to predict failure to achieve the MCID for the VAS satisfaction score were history of anxiety or depression, lateral center-edge angle, preoperative symptom duration exceeding 2 years, presence of 1 or more drug allergies, and Workers' Compensation. Supervised machine learning algorithms conferred excellent discrimination and performance for predicting clinically significant satisfaction after hip arthroscopy, although this analysis was performed in a single population of patients. External validation is required to confirm the performance of these algorithms. Level III, therapeutic case-control study.

Arthroscopic realignment and osteosynthesis of unstable scaphoid nonunion with cancellous bone graft from the ipsilateral radius.

The treatment of delayed union and established nonunion of the scaphoid using a volar approach with impaction of bone graft, either a cancellous or cortico-cancellous wedge graft, for osteosynthesis and maintenance of reduction. With the advancement of instruments and techniques of wrist arthroscopy, wider indications for wrist problems can be solved by this minimally invasive technique. We report our results of arthroscopic reduction, cancellous bone grafting to the regional distal radius, and headless screw fixation for the treatment of scaphoid nonunion, even with humpback deformity. Between August 2014 and February 2018, 41 patients (42 wrists) with unstable scaphoid nonunion received arthroscopic surgery. The mean follow-up was 38.1months (range 24-70months). We evaluated the results with a function questionnaire and clinical outcomes based on the visual analog scale (VAS) pain score, range of motion and grip strength, and radiologic measurements. The union rate was 92.6% (38/41 patients) and union time was 4.6months. Patients regained almost a full range of motion compared with the contralateral wrist. The post-op Quick DASH, Mayo wrist score, and VAS pain score all had significant improvement, with p < 0.05. The scapholunate angle showed significant correction from pre-op 68.0° to post-op 58.3°. The average VAS satisfaction score at final follow-up was 8.7. Arthroscopic realignment and osteosynthesis for the treatment of unstable scaphoid nonunion with ipsilateral radius bone graft, even with humpback deformity, can achieve a high union rate, good radiological correction, and good functional recovery.