Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003351
Tina A Greenlee, Steven Z George, Bryan Pickens, Daniel I Rhon
<p><strong>Background: </strong>A number of efforts have been made to tailor behavioral healthcare treatments to the variable needs of patients with low back pain (LBP). The most common approach involves the STarT Back Screening Tool (SBST) to triage the need for psychologically informed care, which explores concerns about pain and addresses unhelpful beliefs, attitudes, and behaviors. Such beliefs that pain always signifies injury or tissue damage and that exercise should be avoided have been implied as psychosocial mediators of chronic pain and can impede recovery. The ability of physical therapy interventions guided by baseline stratification for risk of persistent LBP or related functional limitations to improve unhelpful pain beliefs has not been well assessed. Because treatments are aimed at addressing these beliefs, understanding a bit more about the nature of beliefs about pain (for example, attitudes and knowledge) might help us understand how to better tailor this care or even our risk-stratification approaches for future treatment of patients with LBP.</p><p><strong>Questions/purposes: </strong>(1) Did patients assigned to receive risk-stratified care score higher on an assessment of pain science knowledge? (2) Did patients assigned to receive risk-stratified care have fewer unhelpful attitudes related to pain? (3) Did patients assigned to receive risk-stratified care have less pain-associated psychological distress? (4) Regardless of intervention received, is baseline SBST risk category (low, medium, or high) associated with changes in attitudes and knowledge about pain?</p><p><strong>Methods: </strong>This is a secondary analysis of short-term changes in pain beliefs following the 6-week treatment phase of a randomized controlled trial that examined the effectiveness of a risk-stratified physical therapy intervention on pain-related disability at 1 year. Between April 2017 and February 2020, a total of 290 patients in the Military Health System seeking primary care for LBP were enrolled in a trial comparing a behavioral-based intervention to usual care. The intervention involved psychologically informed physical therapy using cognitive behavioral principles and included tailored education, graded exercise, and graded exposure. Individuals assigned to usual care followed treatment plans set forth by their primary care provider. Thirty-one patients were removed from Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool analyses due to missing assessments at 6 weeks (n = 15 intervention; n = 16 usual care). This resulted in 89% (259 of 290) of participants included for secondary analysis, with no difference in baseline demographic characteristics between groups. The usual-care group comprised 50% of the total study group (129 of 259), with a mean age of 34 ± 9 years; 67% (87 of 129) were men. The risk-stratified care group comprised 50% (130 of 259) of the total study group, with a mean ± SD age of 35 ± 8
{"title":"Risk-stratified Care Improves Pain-related Knowledge and Reduces Psychological Distress for Low Back Pain: A Secondary Analysis of a Randomized Trial.","authors":"Tina A Greenlee, Steven Z George, Bryan Pickens, Daniel I Rhon","doi":"10.1097/CORR.0000000000003351","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003351","url":null,"abstract":"<p><strong>Background: </strong>A number of efforts have been made to tailor behavioral healthcare treatments to the variable needs of patients with low back pain (LBP). The most common approach involves the STarT Back Screening Tool (SBST) to triage the need for psychologically informed care, which explores concerns about pain and addresses unhelpful beliefs, attitudes, and behaviors. Such beliefs that pain always signifies injury or tissue damage and that exercise should be avoided have been implied as psychosocial mediators of chronic pain and can impede recovery. The ability of physical therapy interventions guided by baseline stratification for risk of persistent LBP or related functional limitations to improve unhelpful pain beliefs has not been well assessed. Because treatments are aimed at addressing these beliefs, understanding a bit more about the nature of beliefs about pain (for example, attitudes and knowledge) might help us understand how to better tailor this care or even our risk-stratification approaches for future treatment of patients with LBP.</p><p><strong>Questions/purposes: </strong>(1) Did patients assigned to receive risk-stratified care score higher on an assessment of pain science knowledge? (2) Did patients assigned to receive risk-stratified care have fewer unhelpful attitudes related to pain? (3) Did patients assigned to receive risk-stratified care have less pain-associated psychological distress? (4) Regardless of intervention received, is baseline SBST risk category (low, medium, or high) associated with changes in attitudes and knowledge about pain?</p><p><strong>Methods: </strong>This is a secondary analysis of short-term changes in pain beliefs following the 6-week treatment phase of a randomized controlled trial that examined the effectiveness of a risk-stratified physical therapy intervention on pain-related disability at 1 year. Between April 2017 and February 2020, a total of 290 patients in the Military Health System seeking primary care for LBP were enrolled in a trial comparing a behavioral-based intervention to usual care. The intervention involved psychologically informed physical therapy using cognitive behavioral principles and included tailored education, graded exercise, and graded exposure. Individuals assigned to usual care followed treatment plans set forth by their primary care provider. Thirty-one patients were removed from Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool analyses due to missing assessments at 6 weeks (n = 15 intervention; n = 16 usual care). This resulted in 89% (259 of 290) of participants included for secondary analysis, with no difference in baseline demographic characteristics between groups. The usual-care group comprised 50% of the total study group (129 of 259), with a mean age of 34 ± 9 years; 67% (87 of 129) were men. The risk-stratified care group comprised 50% (130 of 259) of the total study group, with a mean ± SD age of 35 ± 8 ","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003375
Trevor A Lentz, Kate N Jochimsen, David Ring, Prakash Jayakumar, Julia Blackburn
{"title":"Editorial Comment on the Fourth Annual I-MESH Symposium: Communicating Complexity in Mental and Social Health.","authors":"Trevor A Lentz, Kate N Jochimsen, David Ring, Prakash Jayakumar, Julia Blackburn","doi":"10.1097/CORR.0000000000003375","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003375","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003374
Casey Jo Humbyrd
{"title":"Virtue Ethics in a Value-driven World: \"Voluntourism\" and Effective Altruism.","authors":"Casey Jo Humbyrd","doi":"10.1097/CORR.0000000000003374","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003374","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003380
Kwadwo Owusu-Akyaw
{"title":"The Forward Movement: Amplifying Black Voices on Race and Orthopaedics-Redefining Leadership Education.","authors":"Kwadwo Owusu-Akyaw","doi":"10.1097/CORR.0000000000003380","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003380","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003357
Yurou Chen, Wei Tian, Jia Li, Bo Sheng, Furong Lv, Shixin Nie, Fajin Lv
<p><strong>Background: </strong>Nonweightbearing preoperative assessments avoid quadriceps contraction that tends to affect patellar motion and appear to be inaccurate in quantifying anatomic factors, which can lead to incorrect corrections and postoperative complications.</p><p><strong>Questions/purposes: </strong>(1) Does the relationship of patellar axial malalignment and other anatomic factors change during weightbearing? (2) What anatomic factor was most strongly correlated with recurrent patellar dislocation during weightbearing?</p><p><strong>Methods: </strong>This prospective, comparative, observational study recruited participants at our institution between January 2023 and September 2023. During this time, all patients with recurrent patellar dislocations received both weightbearing and nonweightbearing CT scans; control patients who received unilateral CT scans because of injuries or benign tumors received both weightbearing and nonweightbearing CT scans. Between January 2023 and September 2023, 52 patients were treated at our institution for patellar dislocation. We included those who had experienced at least two dislocations. The exclusion criteria were as follows: (1) traumatic dislocation, (2) prior knee surgery, (3) osteoarthritis (≥ Kellgren-Lawrence Grade 3), and (4) abnormal walking and standing postures confirmed by the orthopaedic surgeon and an inability to complete weightbearing CT with their body in a neutral position (meaning their body weight was evenly placed on both knees) because of severe pain. After applying prespecified exclusions, 63% (33 patients) of the original number were included, and data for 33 patients (65 knees) with weightbearing CT data and 28 patients (52 knees) with nonweightbearing CT data were obtained. Because of ethical requirements, the control group included patients who underwent unilateral CT scanning (for an injury or a benign tumor), and weightbearing CT and nonweightbearing CT covered both knees. Control knees were confirmed to have normal patellofemoral function by physical examination by an orthopaedic surgeon involved with the study. The control group consisted of the normal knees (52 knees underwent both weightbearing CT and nonweightbearing CT) and the affected but uninvolved knees (47 knees underwent weightbearing CT and 6 knees underwent nonweightbearing CT), and a total of 52 patients (99 knees) with weightbearing CT data and 31 patients (58 knees) with nonweightbearing CT data were included. There were no differences between the recurrent patellar dislocation and control groups in terms of gender, side, and BMI. Although the patients in the control group were older than those in the study group, most patients in both groups were at or at least near skeletal maturity. Patellofemoral measurements were evaluated with the Insall-Salvati ratioextension, Blackburne-Peel ratioextension, Caton-Deschamps ratioextension, bisect offset index, lateral patellar tilt angle, tibial tubercle-troch
{"title":"Decreased Association Between Patellar Axial Malalignment and Patellar Height and Increased Association Between Patellar Axial Malalignment and Tibial Tubercle-Trochlear Groove During Weightbearing.","authors":"Yurou Chen, Wei Tian, Jia Li, Bo Sheng, Furong Lv, Shixin Nie, Fajin Lv","doi":"10.1097/CORR.0000000000003357","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003357","url":null,"abstract":"<p><strong>Background: </strong>Nonweightbearing preoperative assessments avoid quadriceps contraction that tends to affect patellar motion and appear to be inaccurate in quantifying anatomic factors, which can lead to incorrect corrections and postoperative complications.</p><p><strong>Questions/purposes: </strong>(1) Does the relationship of patellar axial malalignment and other anatomic factors change during weightbearing? (2) What anatomic factor was most strongly correlated with recurrent patellar dislocation during weightbearing?</p><p><strong>Methods: </strong>This prospective, comparative, observational study recruited participants at our institution between January 2023 and September 2023. During this time, all patients with recurrent patellar dislocations received both weightbearing and nonweightbearing CT scans; control patients who received unilateral CT scans because of injuries or benign tumors received both weightbearing and nonweightbearing CT scans. Between January 2023 and September 2023, 52 patients were treated at our institution for patellar dislocation. We included those who had experienced at least two dislocations. The exclusion criteria were as follows: (1) traumatic dislocation, (2) prior knee surgery, (3) osteoarthritis (≥ Kellgren-Lawrence Grade 3), and (4) abnormal walking and standing postures confirmed by the orthopaedic surgeon and an inability to complete weightbearing CT with their body in a neutral position (meaning their body weight was evenly placed on both knees) because of severe pain. After applying prespecified exclusions, 63% (33 patients) of the original number were included, and data for 33 patients (65 knees) with weightbearing CT data and 28 patients (52 knees) with nonweightbearing CT data were obtained. Because of ethical requirements, the control group included patients who underwent unilateral CT scanning (for an injury or a benign tumor), and weightbearing CT and nonweightbearing CT covered both knees. Control knees were confirmed to have normal patellofemoral function by physical examination by an orthopaedic surgeon involved with the study. The control group consisted of the normal knees (52 knees underwent both weightbearing CT and nonweightbearing CT) and the affected but uninvolved knees (47 knees underwent weightbearing CT and 6 knees underwent nonweightbearing CT), and a total of 52 patients (99 knees) with weightbearing CT data and 31 patients (58 knees) with nonweightbearing CT data were included. There were no differences between the recurrent patellar dislocation and control groups in terms of gender, side, and BMI. Although the patients in the control group were older than those in the study group, most patients in both groups were at or at least near skeletal maturity. Patellofemoral measurements were evaluated with the Insall-Salvati ratioextension, Blackburne-Peel ratioextension, Caton-Deschamps ratioextension, bisect offset index, lateral patellar tilt angle, tibial tubercle-troch","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003367
Baochao Ji, Kevin I Perry, Guoqing Li, Xiaogang Zhang, Guoqiang Zhang, Boyong Xu, Yicheng Li, Li Cao
<p><strong>Background: </strong>Bacteremia is sometimes observed in patients with prosthetic joint infection (PJI), and it is associated with a lower likelihood of infection control. However, the prevalence and association of bacteremia in chronic PJI remain unknown.</p><p><strong>Questions/purposes: </strong>(1) What percentage of patients are diagnosed with bacteremia at the time of hospital admission and before surgery for chronic PJI? (2) What clinical factors are associated with positive blood cultures? (3) To what degree are positive blood cultures associated with infection-free implant survival in patients with chronic PJI?</p><p><strong>Methods: </strong>This prospective study was conducted at a single academic institution from June 2021 to August 2022. Within the study period, we treated 124 patients for chronic PJI, defined according to the modified Musculoskeletal Infection Society (MSIS) criteria. Of those, we considered patients who underwent revision surgery because of chronic PJI of the hip or knee as potentially eligible. All patients received two blood cultures within 48 hours after admission but before surgery. The second blood culture was performed on the contralateral arm 1 hour after the first was completed. Based on that, 87% (108 of 124) of patients were eligible; 13% (16 of 124) were excluded because of delayed blood sample transfers in 6% (7 of 124) of patients, contaminated samples in 2% (2 of 124), late hematogenous infection in 2% (3 of 124), and antibiotic use within 2 weeks before sampling in 3% (4 of 124). No patients were lost before the minimum study follow-up of 2 years without having reached a study endpoint (reinfection or persistent PJI) or had incomplete datasets, leaving 74% (92 of 124) for analysis here. The median (range) time from the index surgery (previous primary, debridement, or revision procedure) to the current revision for PJI in these patients was 16 months (2 to 180). Of the included patients, 40% (37 of 92) were men, 39% (36 of 92) had PJI of the hip, and 61% (56 of 92) had PJI of the knee. The mean age of patients was 65 ± 13 years, and the mean BMI was 28 ± 3 kg/m2. The interval between two cultures was at least 1 hour, and one culture was taken from each of the patient's arms. Patients were divided into blood culture-positive and blood culture-negative groups based on preoperative blood culture results. The chi-square test and the independent t-test were used to compare demographic characteristics (gender, age, BMI, and affected joint) and clinical factors (American Society of Anesthesiologists [ASA] classification, hematological tests, comorbidities) between the two groups. Further multivariable logistic regression analysis was performed to assess the factors associated with positive blood cultures, which controlled for potential confounders including age, gender, BMI, and affected joint. The Firth penalized likelihood was employed when there was monotone likelihood in logistic regression an
{"title":"How Often Does Bacteremia Occur in Patients With Chronic Periprosthetic Joint Infection? A Prospective, Observational Study.","authors":"Baochao Ji, Kevin I Perry, Guoqing Li, Xiaogang Zhang, Guoqiang Zhang, Boyong Xu, Yicheng Li, Li Cao","doi":"10.1097/CORR.0000000000003367","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003367","url":null,"abstract":"<p><strong>Background: </strong>Bacteremia is sometimes observed in patients with prosthetic joint infection (PJI), and it is associated with a lower likelihood of infection control. However, the prevalence and association of bacteremia in chronic PJI remain unknown.</p><p><strong>Questions/purposes: </strong>(1) What percentage of patients are diagnosed with bacteremia at the time of hospital admission and before surgery for chronic PJI? (2) What clinical factors are associated with positive blood cultures? (3) To what degree are positive blood cultures associated with infection-free implant survival in patients with chronic PJI?</p><p><strong>Methods: </strong>This prospective study was conducted at a single academic institution from June 2021 to August 2022. Within the study period, we treated 124 patients for chronic PJI, defined according to the modified Musculoskeletal Infection Society (MSIS) criteria. Of those, we considered patients who underwent revision surgery because of chronic PJI of the hip or knee as potentially eligible. All patients received two blood cultures within 48 hours after admission but before surgery. The second blood culture was performed on the contralateral arm 1 hour after the first was completed. Based on that, 87% (108 of 124) of patients were eligible; 13% (16 of 124) were excluded because of delayed blood sample transfers in 6% (7 of 124) of patients, contaminated samples in 2% (2 of 124), late hematogenous infection in 2% (3 of 124), and antibiotic use within 2 weeks before sampling in 3% (4 of 124). No patients were lost before the minimum study follow-up of 2 years without having reached a study endpoint (reinfection or persistent PJI) or had incomplete datasets, leaving 74% (92 of 124) for analysis here. The median (range) time from the index surgery (previous primary, debridement, or revision procedure) to the current revision for PJI in these patients was 16 months (2 to 180). Of the included patients, 40% (37 of 92) were men, 39% (36 of 92) had PJI of the hip, and 61% (56 of 92) had PJI of the knee. The mean age of patients was 65 ± 13 years, and the mean BMI was 28 ± 3 kg/m2. The interval between two cultures was at least 1 hour, and one culture was taken from each of the patient's arms. Patients were divided into blood culture-positive and blood culture-negative groups based on preoperative blood culture results. The chi-square test and the independent t-test were used to compare demographic characteristics (gender, age, BMI, and affected joint) and clinical factors (American Society of Anesthesiologists [ASA] classification, hematological tests, comorbidities) between the two groups. Further multivariable logistic regression analysis was performed to assess the factors associated with positive blood cultures, which controlled for potential confounders including age, gender, BMI, and affected joint. The Firth penalized likelihood was employed when there was monotone likelihood in logistic regression an","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003379
Andrew E Anderson
{"title":"CORR Insights®: Associations Between Skeletal Alignment and Biomechanical Symmetry Before and After Transfemoral Bone-anchored Limb Implantation.","authors":"Andrew E Anderson","doi":"10.1097/CORR.0000000000003379","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003379","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003368
Daniel J Song, Emily R McDermott, Daniel Homeier, David J Tennent, Jay K Aden, Justin J Ernat, John M Tokish
<p><strong>Background: </strong>Resilience refers to the ability to adapt or recover from stress. There is increasing appreciation that it plays an important role in wholistic patient-centered care and may affect patient outcomes, including those of orthopaedic surgery. Despite being a focus of the current orthopaedic evidence, there is no strong understanding yet of whether resilience is a stable patient quality or a dynamic one that may be modified perioperatively to improve patient-reported outcome scores.</p><p><strong>Questions/purposes: </strong>(1) Does resilience change postoperatively? (2) How do outcome measures change postoperatively in relation to resilience grouping? (3) For patients who do have resilience instability (change in resilience of ≥ 1 SD between any two follow-up points), how were patient-level factors, surgical characteristics, and outcome measures associated with instability?</p><p><strong>Methods: </strong>In this single-surgeon, retrospective, comparative study, we identified all patients who underwent shoulder surgery between March 2021 and March 2023 from the medical records of one US military teaching hospital, resulting in 144 initial patients. Data on resilience (measured by the Brief Resilience Scale) and outcomes (assessed using the Numeric Rating Scale [NRS] and the Single Assessment Numeric Evaluation [SANE]) were collected for all patients and maintained in a longitudinal outcomes score database. Patients younger than 18 years of age (1% [1 of 144]) who underwent surgery for fracture, acute tendon rupture (8% [11 of 144]), or revision surgery (3% [4 of 144]); had concomitant shoulder conditions (such as, instability or rotator cuff tear) (1% [2 of 144]); or had incomplete follow-up data (4% [5 of 144]) were excluded, leaving 84% (121 of 144) of the original sample size for analysis. Among the patients, 12% (15 of 121) were women, the mean age was 41 ± 15 years, and the most common indication for surgery was instability (40% [48 of 121]) followed by rotator cuff repair (29% [35 of 121]). Based on their preoperative Brief Resilience Scale and its deviation from the mean, patients were stratified into low (> 1 SD below mean), intermediate (within 1 SD above and below mean), and high (> 1 SD above mean) resilience groups. Preoperatively, 19% (23 of 121) of patients were classified as low resilience, 62% (75 of 121) as intermediate resilience, and 19% (23 of 121) as high resilience. The mean ± SD preoperative Brief Resilience Scale score was 25 ± 4. The Brief Resilience Scale is a six-item scale with a calculated summary score ranging from 6 to 30. A higher score is suggestive of greater perceived resilience. There were no differences in the preoperative Brief Resilience Scale score with regard to age, gender, type of surgery performed, or outcome measures. Patient resilience was followed during the postoperative period for a minimum of 6 months, and instability in the scale was evaluated. Instability in resilien
{"title":"Does Resilience Change in Patients Undergoing Shoulder Surgery? A Retrospective Comparative Study Utilizing the Brief Resilience Scale.","authors":"Daniel J Song, Emily R McDermott, Daniel Homeier, David J Tennent, Jay K Aden, Justin J Ernat, John M Tokish","doi":"10.1097/CORR.0000000000003368","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003368","url":null,"abstract":"<p><strong>Background: </strong>Resilience refers to the ability to adapt or recover from stress. There is increasing appreciation that it plays an important role in wholistic patient-centered care and may affect patient outcomes, including those of orthopaedic surgery. Despite being a focus of the current orthopaedic evidence, there is no strong understanding yet of whether resilience is a stable patient quality or a dynamic one that may be modified perioperatively to improve patient-reported outcome scores.</p><p><strong>Questions/purposes: </strong>(1) Does resilience change postoperatively? (2) How do outcome measures change postoperatively in relation to resilience grouping? (3) For patients who do have resilience instability (change in resilience of ≥ 1 SD between any two follow-up points), how were patient-level factors, surgical characteristics, and outcome measures associated with instability?</p><p><strong>Methods: </strong>In this single-surgeon, retrospective, comparative study, we identified all patients who underwent shoulder surgery between March 2021 and March 2023 from the medical records of one US military teaching hospital, resulting in 144 initial patients. Data on resilience (measured by the Brief Resilience Scale) and outcomes (assessed using the Numeric Rating Scale [NRS] and the Single Assessment Numeric Evaluation [SANE]) were collected for all patients and maintained in a longitudinal outcomes score database. Patients younger than 18 years of age (1% [1 of 144]) who underwent surgery for fracture, acute tendon rupture (8% [11 of 144]), or revision surgery (3% [4 of 144]); had concomitant shoulder conditions (such as, instability or rotator cuff tear) (1% [2 of 144]); or had incomplete follow-up data (4% [5 of 144]) were excluded, leaving 84% (121 of 144) of the original sample size for analysis. Among the patients, 12% (15 of 121) were women, the mean age was 41 ± 15 years, and the most common indication for surgery was instability (40% [48 of 121]) followed by rotator cuff repair (29% [35 of 121]). Based on their preoperative Brief Resilience Scale and its deviation from the mean, patients were stratified into low (> 1 SD below mean), intermediate (within 1 SD above and below mean), and high (> 1 SD above mean) resilience groups. Preoperatively, 19% (23 of 121) of patients were classified as low resilience, 62% (75 of 121) as intermediate resilience, and 19% (23 of 121) as high resilience. The mean ± SD preoperative Brief Resilience Scale score was 25 ± 4. The Brief Resilience Scale is a six-item scale with a calculated summary score ranging from 6 to 30. A higher score is suggestive of greater perceived resilience. There were no differences in the preoperative Brief Resilience Scale score with regard to age, gender, type of surgery performed, or outcome measures. Patient resilience was followed during the postoperative period for a minimum of 6 months, and instability in the scale was evaluated. Instability in resilien","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003356
Nicholas Nucci, Moyukh Chakrabarti, Zachary DeVries, Seper Ekhtiari, Sebastian Tomescu, Raman Mundi
<p><strong>Background: </strong>There is debate as to whether kinematic TKA or mechanical alignment TKA is superior. Recent systematic reviews have suggested that kinematically aligned TKAs may be the preferred option. However, the observed differences in alignment favoring kinematic alignment may not improve outcomes (performance or durability) in ways that patients can perceive, and likewise, statistical differences in outcome scores sometimes observed in clinical trials may be too small for patients to notice. Minimum clinically important differences (MCIDs) are changes that are deemed meaningful to the patient. A meta-analysis of randomized trials that frames results on this topic in terms of MCIDs may therefore be informative to surgeons and their patients.</p><p><strong>Questions/purposes: </strong>(1) Does kinematic alignment for TKA insertion improve patient-reported outcome measures (PROMs) by clinically important margins (for example, 5 points of 48 on the adjusted Oxford Knee Score [OKS] or 13.7 points of 100 on the Forgotten Joint Score [FJS]) compared with mechanical alignment? (2) Does kinematic alignment for TKA insertion improve ROM by a clinically important margin (defined as 3.8° to 6.4° in flexion) compared with mechanical alignment?</p><p><strong>Methods: </strong>A systematic review of Medline and Embase databases was performed from inception to January 29, 2023, the date of search. We identified RCTs comparing mechanical alignment TKA with kinematic alignment TKA. All English-language RCTs comparing PROMs data in kinematic versus mechanical alignment TKAs performed in patients 18 years or older were included. Studies that were not in English, involved overlapping reports of the same trial, and/or utilized nonrandomized controlled trial methodology were excluded. Conference abstracts or study protocols, pilot studies, and review articles were also excluded. Two reviewers screened abstracts, full-text, and extracted data and assessed included studies for risk of bias using the Cochrane Risk of Bias tool, version 2. Twelve randomized controlled trials (RCTs) were identified, which included 1033 patients with a mean age of 68 years (range 40 to 94) from eight countries who were undergoing primary TKA. Six studies were determined to be low risk of bias, with the remaining six studies were determined to be of moderate-to-high risk of bias. As a result, we would expect that the included studies might overestimate the benefit of the newer approach. Outcomes included ROM and PROMs. Where feasible, pooled analysis was completed. PROMs data were extracted from nine pooled studies, with a randomized n = 443 in the kinematic alignment group and n = 435 in the mechanical alignment group. ROM data were extracted from six pooled studies, with randomized n = 248 in the kinematic alignment group and n = 243 in the mechanical alignment group. PROMS were converted to common scales where possible. Multiple versions of the OKS exist; therefore, O
{"title":"Kinematic Alignment Does Not Result in Clinically Important Improvements After TKA Compared With Mechanical Alignment: A Meta-analysis of Randomized Trials.","authors":"Nicholas Nucci, Moyukh Chakrabarti, Zachary DeVries, Seper Ekhtiari, Sebastian Tomescu, Raman Mundi","doi":"10.1097/CORR.0000000000003356","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003356","url":null,"abstract":"<p><strong>Background: </strong>There is debate as to whether kinematic TKA or mechanical alignment TKA is superior. Recent systematic reviews have suggested that kinematically aligned TKAs may be the preferred option. However, the observed differences in alignment favoring kinematic alignment may not improve outcomes (performance or durability) in ways that patients can perceive, and likewise, statistical differences in outcome scores sometimes observed in clinical trials may be too small for patients to notice. Minimum clinically important differences (MCIDs) are changes that are deemed meaningful to the patient. A meta-analysis of randomized trials that frames results on this topic in terms of MCIDs may therefore be informative to surgeons and their patients.</p><p><strong>Questions/purposes: </strong>(1) Does kinematic alignment for TKA insertion improve patient-reported outcome measures (PROMs) by clinically important margins (for example, 5 points of 48 on the adjusted Oxford Knee Score [OKS] or 13.7 points of 100 on the Forgotten Joint Score [FJS]) compared with mechanical alignment? (2) Does kinematic alignment for TKA insertion improve ROM by a clinically important margin (defined as 3.8° to 6.4° in flexion) compared with mechanical alignment?</p><p><strong>Methods: </strong>A systematic review of Medline and Embase databases was performed from inception to January 29, 2023, the date of search. We identified RCTs comparing mechanical alignment TKA with kinematic alignment TKA. All English-language RCTs comparing PROMs data in kinematic versus mechanical alignment TKAs performed in patients 18 years or older were included. Studies that were not in English, involved overlapping reports of the same trial, and/or utilized nonrandomized controlled trial methodology were excluded. Conference abstracts or study protocols, pilot studies, and review articles were also excluded. Two reviewers screened abstracts, full-text, and extracted data and assessed included studies for risk of bias using the Cochrane Risk of Bias tool, version 2. Twelve randomized controlled trials (RCTs) were identified, which included 1033 patients with a mean age of 68 years (range 40 to 94) from eight countries who were undergoing primary TKA. Six studies were determined to be low risk of bias, with the remaining six studies were determined to be of moderate-to-high risk of bias. As a result, we would expect that the included studies might overestimate the benefit of the newer approach. Outcomes included ROM and PROMs. Where feasible, pooled analysis was completed. PROMs data were extracted from nine pooled studies, with a randomized n = 443 in the kinematic alignment group and n = 435 in the mechanical alignment group. ROM data were extracted from six pooled studies, with randomized n = 248 in the kinematic alignment group and n = 243 in the mechanical alignment group. PROMS were converted to common scales where possible. Multiple versions of the OKS exist; therefore, O","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1097/CORR.0000000000003378
Judith F Baumhauer
{"title":"CORR Insights®: Development of a Brief, Positively Framed Care Team Experience Measure.","authors":"Judith F Baumhauer","doi":"10.1097/CORR.0000000000003378","DOIUrl":"https://doi.org/10.1097/CORR.0000000000003378","url":null,"abstract":"","PeriodicalId":10404,"journal":{"name":"Clinical Orthopaedics and Related Research®","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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