Conditional Survival Is Greater Than Overall Survival at Diagnosis in Patients With Osteosarcoma and Ewing’s Sarcoma
Conditional survival is a measure of the risk of mortality given that a patient has survived a defined period of time. These estimates are clinically helpful, but have not been reported previously for osteosarcoma or Ewing’s sarcoma.
Integrating Patient-reported Outcomes Into Orthopaedic Clinical Practice: Proof of Concept From FORCE-TJR
Good orthopaedic care requires a knowledge of the patient’s history of musculoskeletal pain and associated limitations in daily function. Standardized measures of patient-reported outcomes (PROs) can provide this information. Integrating PROs into routine orthopaedic patient visits can provide key information to monitor changes in symptom severity over time, support shared clinical care decisions, and assess treatment effectiveness for quality initiatives and value-based reimbursement.
Modern interest in patient-reported outcomes measures (PROMs) in orthopaedics dates back to the mid-1980s. While gradual growth of activity in this area has occurred over the past 25 years, the extent to which this research methodology is applied in clinical practice to improve patient care is unclear.
Challenges in Outcome Measurement: Discrepancies Between Patient and Provider Definitions of Success
Some orthopaedic procedures, including TKA, enjoy high survivorship but leave many patients dissatisfied because of residual pain and functional limitations. An important cause of patient dissatisfaction is unfulfilled preoperative expectations. This arises, in part, from differences between provider and patient in their definition of a successful outcome.
Advances in the surgical treatment of musculoskeletal conditions have resulted in an interest in better defining and understanding patients’ expectations of these procedures, but the best ways to do this remain a topic of considerable debate.
Commonalities, Differences, and Challenges With Patient-derived Outcome Measurement Tools: Function/Activity Scales
There is a critical need to evaluate the success of orthopaedic treatments through valid outcome measures. Previous attempts to express patient outcomes using a single aggregate score led to scores that were ambiguous, often insensitive to change, and poorly correlated with the patient’s assessment of the outcome of surgical procedures.
Validation of PROMIS® Physical Function Computerized Adaptive Tests for Orthopaedic Foot and Ankle Outcome Research
In 2012, the American Orthopaedic Foot & Ankle Societyestablished a national network for collecting and sharing data on treatment outcomes and improving patient care. One of the network’s initiatives is to explore the use of computerized adaptive tests (CATs) for patient-level outcome reporting.
An emphasis on “value” over volume in health care is driving new healthcare measurement, delivery, and payment models. Orthopaedic surgery is a major contributor to healthcare spending and, as such, is the focus of many of these new models.
Incorporating Patient-reported Outcomes in Total Joint Arthroplasty Registries: Challenges and Opportunities
Total joint arthroplasty (TJA) registries traditionally have focused on implant longevity and rates of revision surgery. Registries would benefit from the addition of standardized patient-reported outcomes (PROs) such as pain relief and improved physical function. However, PROs have not been routinely adopted, and their incorporation into TJA registries presents challenges.
The evaluation of the outcomes of total knee arthroplasty requires measurement tools that are valid, reliable, and responsive to change. However, the accuracy of any outcome measurement is determined by the validity and reliability of the instrument used. To ensure this accuracy, it is imperative that each instrument used in orthopaedics is free of biases leading to inaccurate estimates of treatment effects.
Comparative effectiveness research evaluates treatments as actually delivered in routine clinical practice, shifting research focus from efficacy and internal validity to effectiveness and external validity (“generalizability”). Such research requires accurate assessments of the numbers of patients treated and the completeness of their followup, their clinical outcomes, and the setting in which their care was delivered. Choosing measures and methods for clinical outcome research to produce meaningful information that may be used to improve patient care presents a number of challenges.
Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction
Failed ACL reconstruction frequently is accompanied by irreparable medial meniscal tear and/or visible osteoarthritis (OA) in the medial tibiofemoral joint. Thus, assessment for the presence of varus malalignment is important in caring for patients in whom revision ACL reconstruction is considered.
Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors
Although arthroscopic anchor suturing is commonly used for rotator cuff repair and achieves good results, certain shortcomings remain, including difficulty with reoperation in cases of retear, anchor dislodgement, knot impingement, and financial cost. In 2005, we developed an anchorless technique for arthroscopic transosseous suture rotator cuff repair.
Bariatric Orthopaedics: Total Knee Arthroplasty in Super-obese Patients (BMI > 50 kg/m2 ). Survivorship and Complications
Some studies have suggested that patients who are super obese (BMI > 50 kg/m) may have poorer outcomes and more frequent complications when undergoing TKA compared with those who have lower BMI, however, the literature on this is scant.
The Oxford knee is a unicompartmental implant featuring a mobile-bearing polyethylene component with excellent long-term survivorship results reported by the implant developers and early adopters. By contrast, other studies have reported higher revision rates in large academic practices and in national registries. Registry data have shown increased failure with this implant especially by lower-volume surgeons and institutions.
Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial
Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup.
Animal, epidemiologic, and human clinical studies suggest a putative role for vitamin D in osteoarthritis (OA). Inadequate sunlight exposure and lower serum levels of 25(OH)D appear in some reports to be associated with an increased risk for progression of knee OA.
A new version of The Knee Society Knee Scoring System(KSS) has recently been developed. Before this scale can be used in non-English-speaking populations, it has to be translated and validated for a particular population.
Do Monoblock Cups Improve Survivorship, Decrease Wear, or Reduce Osteolysis in Uncemented Total Hip Arthroplasty?
Monoblock acetabular components used in uncemented total hip arthroplasty (THA) have certain mechanical characteristics that potentially reduce acetabular osteolysis and polyethylene wear. However, the degree to which they achieve this goal is not well documented.
Cam morphology in femoroacetabular impingement has been implicated in the development of osteoarthritis. The alpha angle and femoral head/neck offset are widely used to determine femoral head asphericity. To our knowledge, no study has evaluated the alpha angle circumferentially using three-dimensional imaging in a population of healthy individuals of adolescent age.
Improved Survival of Uncemented versus Cemented Femoral Stems in Patients Aged < 70 Years in a Community Total Joint Registry
Aseptic loosening of the femoral stem remains a significant reason for revision in total hip arthroplasty (THA). Although stem fixation methods have changed over time, there is relatively little evidence supporting cemented or uncemented stems as more durable constructs.
Low Wear of a Second-generation Highly Crosslinked Polyethylene Liner: A 5-year Radiostereometric Analysis Study
A sequentially irradiated and annealed, second-generation highly crosslinked polyethylene (XLPE) liner was introduced clinically in 2005 to reduce in vivo oxidation. This liner design has also been shown to reduce wear in vitro when compared with conventional and first-generation crosslinked liners. To date, there is only one study reporting an in vivo wear rate of this liner at 5 years’ followup. However, that study used measurements made from plain radiographs, which have limited sensitivity, particularly when monitoring very low amounts of wear.
Image Guided Core Needle Biopsy of Musculoskeletal Lesions: Are Nondiagnostic Results Clinically Useful?
The clinical utility of nondiagnostic core needle biopsies is not fully understood. Understanding the clinical and radiologic factors associated with nondiagnostic core needle biopsies may help determine the utility of these nondiagnostic biopsies and guide clinical decision making.
Risk Factors for Significant Wound Complications Following Wide Resection of Extremity Soft Tissue Sarcomas
Wound complications following resection of a localized soft tissue sarcoma have been associated with lower extremity location, large tumor volume, and use of preoperative radiation. Some of these wounds, however, show the potential for healing with local wound care and nonsurgical techniques. We are unaware of any published data establishing factors associated with nonhealing wounds that ultimately are treated with local or free vascularized tissue transfer.
Tumor-induced osteomalacia is a paraneoplastic syndrome resulting in renal phosphate wasting and decreased bone mineralization. Phosphaturic mesenchymal tumors represent a rare etiology of tumor-induced osteomalacia. Nonspecific symptoms of fatigue, bone pain, and musculoskeletal weakness make the diagnosis elusive and lead to a delay in surgical treatment.
Amount of Torque and Duration of Stretching Affects Correction of Knee Contracture in a Rat Model of Spinal Cord Injury
Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions.
Does Rewording MRI Reports Improve Patient Understanding and Emotional Response to a Clinical Report?
Diagnostic MRI reports can be distressing for patients with limited health literacy. Humans tend to prepare for the worst particularly when we are in pain, and words like “tear” can make us feel damaged and in need of repair. Research on words used in provider-patient interactions have shown an affect on response to treatment and coping strategies, but the literature on this remains relatively sparse.
Extracorporeal Shock Wave Therapy Is Effective In Treating Chronic Plantar Fasciitis: A Meta-analysis of RCTs
Plantar fasciitis is the most common cause of heel pain. It may remain symptomatic despite conservative treatment with orthoses and analgesia. There is conflicting evidence concerning the role of extracorporeal shock wave therapy (ESWT) in the management of this condition.
Débridement and bone marrow stimulation is an effective treatment option for patients with talar osteochondral defects. However, whether surgical factors affect the success of microfracture treatment of talar osteochondral defects is not well characterized.
Fractures of the talus in the elderly are rare and usually result from high-impact injuries, suggesting only minor age-related bone structure changes. However, total ankle replacement failures with age often result from talar subsidence, suggesting age-related bone loss in the talus. Despite a number of histological analyses of talar microarchitecture, the effects of age and sex on talar microarchitecture changes remain poorly defined.
The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI).
Since 2003 many orthopaedic journals have adopted grading systems for levels of evidence (LOE). It is unclear if the quality of orthopaedic literature has changed since LOE was introduced.
What Is the Current Status of Global Health Activities and Opportunities in US Orthopaedic Residency Programs?
Interest in developing national health care has been increasing in many fields of medicine, including orthopaedics. One manifestation of this interest has been the development of global health opportunities during residency training.
Case Reports: Treatment of Traumatic Triradiate Cartilage Epiphysiodesis: What is the Role of Bridge Resection?
Acetabular fractures are rare in children and can be complicated by premature fusion of the triradiate cartilage resulting in secondary acetabular dysplasia. Early recognition and treatment of a physeal bar in this location can be difficult. The purpose of this case report was to investigate whether early intervention could restore acetabular growth and prevent secondary acetabular dysplasia as measured on plain radiographs.