Wed, 2 May 2018
The authors describe a method of collecting patient-reported outcomes (PROs) using computerized adaptive tests (CATs) in a high-volume orthopedic surgery practice with limited resources and no research coordinator. Using tablets to administer CATs and entering the data in the electronic medical record for later retrieval was an effective technique to collect PROs. An adequate number of tablets are needed for acceptable completion rates. Modest sample size requirements for comparative studies highlight the potential of these tools and techniques.
To view the article, click here. |
Mon, 2 April 2018
The purpose of this study was to compare the functional and radiographic outcomes of patients who received juvenile allogenic chondrocyte implantation with autologous bone marrow aspirate (JACI-BMAC) for treatment of talar osteochondral lesions with those of patients who underwent microfracture (MF). JACI-BMAC and MF resulted in improved functional outcomes. However, while the majority of patients improved, functional outcomes and quality of repair tissue were still not normal. Based on our results, lesions repaired with DeNovo NT allograft still appeared fibrocartilaginous on MRI and did not result in significant functional gains as compared to MF.
To view the article, click here. |
Thu, 1 March 2018
The historic treatment of Charcot foot arthropathy has been immobilization during the active phase of the disease process, followed by accommodative bracing of the acquired deformity. Evidence derived from modern patient-reported outcomes investigations has convinced many surgeons to attempt operative correction of the acquired deformity with a goal of improving quality of life. Operative correction of the acquired deformity of Charcot foot arthropathy was performed with a goal of improving quality of life. Stratification of patients by deformity pattern allowed alterations of the basic surgery to afford improved outcomes. In addition to achieving historic goals of resolution of infection and limb salvage, almost 80% of the patients were able to achieve the functional goal of independent ambulation with commercially available therapeutic footwear. The clinical outcomes achieved in this retrospective case series appear to support the modern paradigm of operative correction of deformity in this complex patient population. This realistic appreciation of outcome expectations should both be helpful in counseling patients on the risk-benefit ratio associated with surgery and provide a benchmark to measure newer strategies of treatment.
To view the article, click here. |
Thu, 1 February 2018
Over the past decade, total ankle arthroplasty (TAA) has become a mainstay in the treatment of end-stage ankle arthritis. Currently in its fourth generation, the Scandinavian Total Ankle Replacement (STAR) is the only 3-piece mobile bearing ankle prosthesis available in the United States. Our current study reports implant survivorship at 15 years and patient outcomes for a subset of these survivors available for study. Our small cohort demonstrated STAR ankles with retention at 9 years were highly likely to survive to 15 years,and patients continued to have significant improvement in pain relief and minimal decrease in function. At 15 years from TAA, metal survivorship was 73%. As with all ankle replacements, supplementary procedures were common.
To view the article, click here. |
Tue, 2 January 2018
Capsular interposition arthroplasty is a joint- and motion-sparing procedure that has been shown as an effective alternative to fusion. This study aimed to evaluate patient function and satisfaction after long-term follow-up. The mean VAS for pain was 7.9 preoperatively and 1.8 postoperatively (P = .003). The mean preoperative SF-12 physical score was 42.0 vs 64.2 postoperatively (P = .02). The mean preoperative SF-12 mental score was 50.7, while the postoperative SF-12 mental score was 54.6 (P = .01). The total FFI score also significantly improved, with a preoperative value of 98.3 and a postoperative mean score of 49.6 (P = .001). The mean patient satisfaction score was 7.4 of 10. Overall, 39 of 42 patients (92.9%) stated they would have the surgery again. Four of the 42 patients (9.5%) required conversion to hallux metatarsophalangeal fusion at a mean of 6.1 years after the index procedure secondary to pain, but no other complications were reported.
To view the article, click here. |
Mon, 27 November 2017
We present our results with an INBONE I (Wright Medical, Memphis, TN) prosthesis that have a minimum of 4 to 10 years of follow-up and include a preoperative deformity analysis on outcomes. Patients who underwent INBONE I fixed-bearing total ankle arthroplasty demonstrated significant improvement in outcomes at a mean of 5.9 years. Catastrophic talar component collapse did occur (2.7% of cases), but relatively rarely. The patients with preoperative coronal plane tibiotalar deformity had similar pain relief, function, and need for revision of implant components. Despite the presumed shortcomings of the INBONE I’s design, this implant showed promising results, with or without deformity, at midterm follow-up with survivorship of 90.6%.
To view the article, click here. |
Thu, 2 November 2017
Grading systems are used to assess severity of any condition and as an aid in guiding treatment. This study examined the relationship of baseline motion, pain, and observed intraoperative cartilage loss with hallux rigidus grade. Irrespective of the grade, positive outcomes were demonstrated for both fusion and synthetic cartilage implant. Clinical symptoms and signs should be used to guide treatment, rather than a grade consisting of radiographic, symptoms, and range of motion factors.
To view the article, click here. |
Mon, 2 October 2017
Foot and ankle surgeons are increasingly relying on patient-reported outcome measures (PROMs) such as the Ankle Osteoarthritis Scale (AOS) to evaluate treatment options. The objectives of this retrospective cohort study were 2-fold: (1) to examine the AOS instrument using psychometric analysis and (2) to revise the questions on the AOS to improve the effect of questions on the score and remove redundancies. The AAS is shorter and has improved psychometric properties as compared to the AOS. Further investigation is required to better characterize the clinical utility of this proposed new patient-reported outcome score.
To view the article, click here. |
Tue, 29 August 2017
The Ankle Arthritis Score (AAS) is a new patient-reported outcome derived from the Ankle Osteoarthritis Scale (AOS). This study analyzed longitudinally collected data from a cohort of patients in the Canadian Orthopaedic Foot and Ankle Society (COFAS) Ankle Arthritis Study in order to evaluate whether the postoperative AAS is associated with need for revision surgery. TAR patients who reported higher levels of postoperative functional impairment, as indicated by a higher AAS, were more likely to require metal-component revision surgery. After adjustment for other patient factors, the risk of revision surgery increased with length of follow-up after TAR. This study provides further evidence for the utility of the AAS in the clinical setting.
To view the article, click here. |
Tue, 1 August 2017
Total joint surgeons have successfully performed hip, knee, and shoulder arthroplasty procedures in the outpatient setting without compromising safety, satisfaction, or results. The purpose of this study was to evaluate outpatient total ankle arthroplasty (TAA) as compared with overnight or extended inpatient stay, with regard to 90-day medical and operative complications, reoperations, readmissions or emergency room visits, and pain control. Eighty-one patients underwent TAA who met inclusion criteria, and 8 had a complication (10%). A significant difference in complication rate was seen among groups (P = .01) but not rate of readmission or reoperation. Of 16 patients, 5 (31%) who were admitted for 2 or more nights following surgery had a complication, as opposed to 3 of 65 (5%) who were outpatient or admitted overnight (P = .01). There were no differences in frequency of postoperative phone calls, narcotic refills, or visual analog scale pain scores at the first postoperative visit. There were no adverse medical events.
To view the article, click here. |
|
|||||||||||||||||||||||||||||||||||||||||||||||||
