Pub Date : 2020-06-15DOI: 10.5435/jaaos-d-16-00815
Andrea M. Spiker, Ken Johnson, A. Cosgarea, J. Ficke
Long-distance running has become increasingly popular during the past decades. Many running patients pose questions to their orthopaedic surgeons regarding risks, benefits, and running techniques. This article identifies 11 running-related questions that patients may ask and provides information to help answer those questions. This review discusses data on the health benefits of running, common running injuries, the relationship between running and osteoarthritis, recommendations regarding running after orthopaedic surgery, running shoes, and other questions that may arise when treating the running athlete.
{"title":"A Primer on Running for the Orthopaedic Surgeon.","authors":"Andrea M. Spiker, Ken Johnson, A. Cosgarea, J. Ficke","doi":"10.5435/jaaos-d-16-00815","DOIUrl":"https://doi.org/10.5435/jaaos-d-16-00815","url":null,"abstract":"Long-distance running has become increasingly popular during the past decades. Many running patients pose questions to their orthopaedic surgeons regarding risks, benefits, and running techniques. This article identifies 11 running-related questions that patients may ask and provides information to help answer those questions. This review discusses data on the health benefits of running, common running injuries, the relationship between running and osteoarthritis, recommendations regarding running after orthopaedic surgery, running shoes, and other questions that may arise when treating the running athlete.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127529460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-15DOI: 10.5435/JAAOS-D-19-00251
N. Frisch, Tahsin M. Rahman, Brian Darrith, I. Patel, C. Silverton
INTRODUCTION This study compares functional outcome scores and revision rates between metal-on-metal (MoM) and non-MoM total hip arthroplasty patients. METHODS A cohort of 75 patients who underwent implantation of the same dual modular hip arthroplasty between the years of 2004 and 2010 was enrolled. Patients were subsequently evaluated in 2015 to 2017 for joint revision history and functionality, as measured by the Harris hip score (HHS). Patients requiring a revision arthroplasty were not included in the HHS analysis. RESULTS A total of 49 patients had MoM implants (65.3%), and 26 patients had non-MoM implants (34.8%). At a mean follow-up of 7.6 years, 10.2% (5/49) of MoM prostheses required revision, whereas 3.8% (1/26) of non-MoM prostheses required revision (P = 0.334). The mean HHS in the MoM cohort was 89.8, compared with 88.1 in the non-MoM cohort (P = 0.69). CONCLUSION HHSs were not notably different between cohorts. The MoM cohort had three times as many revisions as the non-MoM cohort, but given the numbers available, this difference did not reach significance. Given the clinical importance of these revision data, further study is warranted to determine survivorship of the MoM versus non-MoM total hip arthroplasty at long-term follow-up.
{"title":"Comparison of Harris Hip Scores and Revision Rates in Metal-on-Metal Versus Non-Metal-on-Metal Total Hip Arthroplasty.","authors":"N. Frisch, Tahsin M. Rahman, Brian Darrith, I. Patel, C. Silverton","doi":"10.5435/JAAOS-D-19-00251","DOIUrl":"https://doi.org/10.5435/JAAOS-D-19-00251","url":null,"abstract":"INTRODUCTION\u0000This study compares functional outcome scores and revision rates between metal-on-metal (MoM) and non-MoM total hip arthroplasty patients.\u0000\u0000\u0000METHODS\u0000A cohort of 75 patients who underwent implantation of the same dual modular hip arthroplasty between the years of 2004 and 2010 was enrolled. Patients were subsequently evaluated in 2015 to 2017 for joint revision history and functionality, as measured by the Harris hip score (HHS). Patients requiring a revision arthroplasty were not included in the HHS analysis.\u0000\u0000\u0000RESULTS\u0000A total of 49 patients had MoM implants (65.3%), and 26 patients had non-MoM implants (34.8%). At a mean follow-up of 7.6 years, 10.2% (5/49) of MoM prostheses required revision, whereas 3.8% (1/26) of non-MoM prostheses required revision (P = 0.334). The mean HHS in the MoM cohort was 89.8, compared with 88.1 in the non-MoM cohort (P = 0.69).\u0000\u0000\u0000CONCLUSION\u0000HHSs were not notably different between cohorts. The MoM cohort had three times as many revisions as the non-MoM cohort, but given the numbers available, this difference did not reach significance. Given the clinical importance of these revision data, further study is warranted to determine survivorship of the MoM versus non-MoM total hip arthroplasty at long-term follow-up.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131799383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-15DOI: 10.5435/JAAOS-D-19-00174
J. Maslak, T. Jenkins, Joseph A. Weiner, Abhishek Kannan, M. McCarthy, W. Hsu, Alpesh A. Patel
OBJECTIVE This study evaluates the disease burden of sciatica on the US Medicare cohort. BACKGROUND DATA Sciatica is a common disability that has important physical, mental, and economic effects. The Medicare Health Outcomes Survey (HOS) is a demographic and outcomes survey used to monitor the performance of Medicare Advantage health plans in the United States. The HOS includes data on demographics, chronic medical conditions, and patient-reported outcomes. METHODS Medicare HOS data for cohorts from 2007 to 2013 were obtained. Patients were placed into two categories based on the survey results: with or without a history of sciatica. Baseline demographics, chronic medical conditions, and physical health symptoms were aggregated. In addition, average VR-12 physical component summary and mental component summary scores were calculated for each group at baseline and at 2-year follow-up. A Fisher exact test was used to assess significance for categorical variables, and a t-test was used for continuous variables. VR-12 changes as small as 1 to 2 units have been found to be clinically and socially relevant. RESULTS The baseline cohort data of 1,000,952 patients yielded 250,869 patients (25%) who reported the diagnosis of sciatica, compared with 750,083 patients (75%) without sciatica. Patients with a history of sciatica tended to be younger, less educated, and notably with more medical comorbidities. Physical component summary outcomes were approximately 8 units lower in the sciatica group at baseline and 7 units lower at 2-year follow-up. Mental component summary outcomes were 6 units lower in the sciatica group at baseline and 5 units lower at 2-year follow-up. CONCLUSION A large percentage of the US Medicare cohort suffers from symptomatic sciatica. Our study identified a 25% prevalence in the Medicare cohort. In addition, sciatica is associated with an increased incidence of comorbid medical conditions and poor health-related quality of life. LEVEL OF EVIDENCE Level III STUDY DESIGN:: Observational-Cohort Study.
{"title":"Burden of Sciatica on US Medicare Recipients.","authors":"J. Maslak, T. Jenkins, Joseph A. Weiner, Abhishek Kannan, M. McCarthy, W. Hsu, Alpesh A. Patel","doi":"10.5435/JAAOS-D-19-00174","DOIUrl":"https://doi.org/10.5435/JAAOS-D-19-00174","url":null,"abstract":"OBJECTIVE\u0000This study evaluates the disease burden of sciatica on the US Medicare cohort.\u0000\u0000\u0000BACKGROUND DATA\u0000Sciatica is a common disability that has important physical, mental, and economic effects. The Medicare Health Outcomes Survey (HOS) is a demographic and outcomes survey used to monitor the performance of Medicare Advantage health plans in the United States. The HOS includes data on demographics, chronic medical conditions, and patient-reported outcomes.\u0000\u0000\u0000METHODS\u0000Medicare HOS data for cohorts from 2007 to 2013 were obtained. Patients were placed into two categories based on the survey results: with or without a history of sciatica. Baseline demographics, chronic medical conditions, and physical health symptoms were aggregated. In addition, average VR-12 physical component summary and mental component summary scores were calculated for each group at baseline and at 2-year follow-up. A Fisher exact test was used to assess significance for categorical variables, and a t-test was used for continuous variables. VR-12 changes as small as 1 to 2 units have been found to be clinically and socially relevant.\u0000\u0000\u0000RESULTS\u0000The baseline cohort data of 1,000,952 patients yielded 250,869 patients (25%) who reported the diagnosis of sciatica, compared with 750,083 patients (75%) without sciatica. Patients with a history of sciatica tended to be younger, less educated, and notably with more medical comorbidities. Physical component summary outcomes were approximately 8 units lower in the sciatica group at baseline and 7 units lower at 2-year follow-up. Mental component summary outcomes were 6 units lower in the sciatica group at baseline and 5 units lower at 2-year follow-up.\u0000\u0000\u0000CONCLUSION\u0000A large percentage of the US Medicare cohort suffers from symptomatic sciatica. Our study identified a 25% prevalence in the Medicare cohort. In addition, sciatica is associated with an increased incidence of comorbid medical conditions and poor health-related quality of life.\u0000\u0000\u0000LEVEL OF EVIDENCE\u0000Level III STUDY DESIGN:: Observational-Cohort Study.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125453489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-15DOI: 10.5435/JAAOS-D-19-00261
Matthew L. Brown, K. A. Ezzet
INTRODUCTION Historically, hip precautions have been prescribed after total hip arthroplasty (THA) to limit certain motions felt to place the arthroplasty construct in a position at increased risk for dislocation. This study aimed to determine whether relaxed hip precautions after primary THA done via a posterolateral approach resulted in a higher early dislocation rate compared with standard hip precautions. METHODS The hip precaution protocol was changed from standard to relaxed at our institution for all patients with THA in December 2016. One cohort had THA in the 18 months before the protocol change and had standard hip precautions, and the second cohort had THA in the 18 months after the protocol change and had relaxed precautions. We determined the early dislocation rate (within 3 months postoperatively) for both cohorts and controlled for selected demographic and surgical details. RESULTS The standard precaution group included 597 primary THAs and the relaxed precaution group included 692 hips. No notable differences were found between the groups in terms of age at surgery, body mass index, sex, laterality, or diagnosis. Early dislocation occurred in seven hips (1.2%) in the standard precaution cohort and in nine hips (1.4%) in the relaxed precaution cohort. This difference was not statistically significant (P = 0.77). DISCUSSION The results of our study suggest that well-trained, high-volume surgeons may potentially relax hip precautions prescribed to the patients after primary THA done via a posterolateral approach without subjecting patients to a markedly higher incidence of dislocation. However, unlike previous studies, this study controlled for femoral head size, which is a well-known confounder for dislocation risk.
{"title":"Relaxed Hip Precautions Do Not Increase Early Dislocation Rate Following Total Hip Arthroplasty.","authors":"Matthew L. Brown, K. A. Ezzet","doi":"10.5435/JAAOS-D-19-00261","DOIUrl":"https://doi.org/10.5435/JAAOS-D-19-00261","url":null,"abstract":"INTRODUCTION\u0000Historically, hip precautions have been prescribed after total hip arthroplasty (THA) to limit certain motions felt to place the arthroplasty construct in a position at increased risk for dislocation. This study aimed to determine whether relaxed hip precautions after primary THA done via a posterolateral approach resulted in a higher early dislocation rate compared with standard hip precautions.\u0000\u0000\u0000METHODS\u0000The hip precaution protocol was changed from standard to relaxed at our institution for all patients with THA in December 2016. One cohort had THA in the 18 months before the protocol change and had standard hip precautions, and the second cohort had THA in the 18 months after the protocol change and had relaxed precautions. We determined the early dislocation rate (within 3 months postoperatively) for both cohorts and controlled for selected demographic and surgical details.\u0000\u0000\u0000RESULTS\u0000The standard precaution group included 597 primary THAs and the relaxed precaution group included 692 hips. No notable differences were found between the groups in terms of age at surgery, body mass index, sex, laterality, or diagnosis. Early dislocation occurred in seven hips (1.2%) in the standard precaution cohort and in nine hips (1.4%) in the relaxed precaution cohort. This difference was not statistically significant (P = 0.77).\u0000\u0000\u0000DISCUSSION\u0000The results of our study suggest that well-trained, high-volume surgeons may potentially relax hip precautions prescribed to the patients after primary THA done via a posterolateral approach without subjecting patients to a markedly higher incidence of dislocation. However, unlike previous studies, this study controlled for femoral head size, which is a well-known confounder for dislocation risk.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"333 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130710250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-15DOI: 10.5435/JAAOS-D-19-00155
Rikin V Patel, Shuyang Han, C. Lenherr, Joshua D. Harris, P. Noble
INTRODUCTION Physiotherapy is a management option for the treatment of femoroacetabular impingement (FAI) syndrome. This study examines the influence of changes in pelvic tilt and hip adduction on the range of motion (ROM) of the hip. METHODS Ten FAI hips were used to simulate impingement at two positions: (1) 20° internal rotation (IR) with 100° flexion and 10° adduction and (2) 40° IR with 35° flexion and 10° adduction; the amount of IR was measured at the point of bony impingement or to the defined limit. Each simulation was performed at neutral and 5° and 10° anterior and posterior pelvic tilt. Then, the hip was placed in 10° of abduction, and all simulations were repeated. RESULTS With neutral pelvic tilt, impingement occurred at 4.3 ± 8.4° of IR at the high-flexion position. An increase in anterior pelvic tilt led to a loss of IR, that is, earlier occurrence of FAI, whereas an increase in posterior pelvic tilt led to an increase in IR, that is, later occurrence of FAI. At the high-flexion position, abduction provided more IR before impingement (neutral: 9.1 ± 5.7°, P < 0.01; 10° anterior tilt: 14.6 ± 5.2°, P < 0.01; 10° posterior tilt: 4.2 ± 3.7° IR, P = 0.01). Placing the hip in abduction and posteriorly tilting the pelvis produce a combined effect that increased IR relative to the neutrally tilted pelvis (5° posterior tilt: 11.4 ± 7.6°, P = 0.01; 10° posterior tilt: 12.8 ± 7.6°, P < 0.01). The ROM in the mid-flexion position was not affected by any combination of pelvic tilt and hip abduction or adduction (average IR: 37.4 ± 5.0°, P > 0.05). CONCLUSIONS Abduction and posterior pelvic tilt increased the impingement-free ROM in the hips with FAI. Thus, rehabilitation aimed at altering the tilt of the pelvis may reduce the frequency of impingement and limit further joint damage.
{"title":"Pelvic Tilt and Range of Motion in Hips With Femoroacetabular Impingement Syndrome.","authors":"Rikin V Patel, Shuyang Han, C. Lenherr, Joshua D. Harris, P. Noble","doi":"10.5435/JAAOS-D-19-00155","DOIUrl":"https://doi.org/10.5435/JAAOS-D-19-00155","url":null,"abstract":"INTRODUCTION\u0000Physiotherapy is a management option for the treatment of femoroacetabular impingement (FAI) syndrome. This study examines the influence of changes in pelvic tilt and hip adduction on the range of motion (ROM) of the hip.\u0000\u0000\u0000METHODS\u0000Ten FAI hips were used to simulate impingement at two positions: (1) 20° internal rotation (IR) with 100° flexion and 10° adduction and (2) 40° IR with 35° flexion and 10° adduction; the amount of IR was measured at the point of bony impingement or to the defined limit. Each simulation was performed at neutral and 5° and 10° anterior and posterior pelvic tilt. Then, the hip was placed in 10° of abduction, and all simulations were repeated.\u0000\u0000\u0000RESULTS\u0000With neutral pelvic tilt, impingement occurred at 4.3 ± 8.4° of IR at the high-flexion position. An increase in anterior pelvic tilt led to a loss of IR, that is, earlier occurrence of FAI, whereas an increase in posterior pelvic tilt led to an increase in IR, that is, later occurrence of FAI. At the high-flexion position, abduction provided more IR before impingement (neutral: 9.1 ± 5.7°, P < 0.01; 10° anterior tilt: 14.6 ± 5.2°, P < 0.01; 10° posterior tilt: 4.2 ± 3.7° IR, P = 0.01). Placing the hip in abduction and posteriorly tilting the pelvis produce a combined effect that increased IR relative to the neutrally tilted pelvis (5° posterior tilt: 11.4 ± 7.6°, P = 0.01; 10° posterior tilt: 12.8 ± 7.6°, P < 0.01). The ROM in the mid-flexion position was not affected by any combination of pelvic tilt and hip abduction or adduction (average IR: 37.4 ± 5.0°, P > 0.05).\u0000\u0000\u0000CONCLUSIONS\u0000Abduction and posterior pelvic tilt increased the impingement-free ROM in the hips with FAI. Thus, rehabilitation aimed at altering the tilt of the pelvis may reduce the frequency of impingement and limit further joint damage.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133721440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-15DOI: 10.5435/jaaos-d-19-00214
A. Rondon, T. Tan, K. Goswami, N. Shohat, C. Foltz, P. Courtney, J. Parvizi
INTRODUCTION A common question by patients considering total joint arthroplasty (TJA) is when can I return to driving. The ability to return to driving has enormous effect on the independence of the patient, ability to return to work, and other activities of daily living. With advances in accelerated rehabilitation protocols, newer studies have questioned the classic teaching of waiting 6 weeks after TJA. The goal of this prospective study was to determine specific patient predictors for return to driving and create individualized models able to estimate return to driving based on patient risk factors for both total knee arthroplasty (TKA) and total hip arthroplasty (THA). METHODS From July 2017 to January 2018, 554 primary TKA and 490 primary THA patients were prospectively enrolled to obtain information regarding return to driving. Patients were sent a survey every 2 weeks regarding their return to driving. Additional information regarding vehicle type, transmission, and involvement in motor vehicle accidents was collected. Bivariate analysis was done followed by the creation of a multiple linear regression models to analyze return to driving after TKA and THA. RESULTS The majority (98.2%, 1,025/1,044) of patients returned to driving within 12 weeks of surgery. On average, patients returned to driving at 4.4 and 3.7 weeks for TKA and THA (P < 0.001), respectively. The rate of motor vehicle accidents was 0.7% (7/1,044) within 12 weeks after surgery with no injuries reported. After multivariate analysis, baseline return to driving began at 10.9 days for TKA and 17.1 days for THA. The following predictors added additional time to return to driving for TJA: not feeling safe to drive, limited range of motion, female sex, limitations due to pain, other limitations, discharge to a rehabilitation facility, right-sided procedures, limited ability to break, preoperative anemia, and preoperative use of a cane. DISCUSSION Important predictors identified for return to driving were sex, joint laterality, limited ability to walk or ability to break, and feeling safe. Surgeons should consider these factors when counseling patients on their postoperative expectations regarding driving after TJA.
{"title":"When Can I Drive? Predictors of Returning to Driving After Total Joint Arthroplasty.","authors":"A. Rondon, T. Tan, K. Goswami, N. Shohat, C. Foltz, P. Courtney, J. Parvizi","doi":"10.5435/jaaos-d-19-00214","DOIUrl":"https://doi.org/10.5435/jaaos-d-19-00214","url":null,"abstract":"INTRODUCTION\u0000A common question by patients considering total joint arthroplasty (TJA) is when can I return to driving. The ability to return to driving has enormous effect on the independence of the patient, ability to return to work, and other activities of daily living. With advances in accelerated rehabilitation protocols, newer studies have questioned the classic teaching of waiting 6 weeks after TJA. The goal of this prospective study was to determine specific patient predictors for return to driving and create individualized models able to estimate return to driving based on patient risk factors for both total knee arthroplasty (TKA) and total hip arthroplasty (THA).\u0000\u0000\u0000METHODS\u0000From July 2017 to January 2018, 554 primary TKA and 490 primary THA patients were prospectively enrolled to obtain information regarding return to driving. Patients were sent a survey every 2 weeks regarding their return to driving. Additional information regarding vehicle type, transmission, and involvement in motor vehicle accidents was collected. Bivariate analysis was done followed by the creation of a multiple linear regression models to analyze return to driving after TKA and THA.\u0000\u0000\u0000RESULTS\u0000The majority (98.2%, 1,025/1,044) of patients returned to driving within 12 weeks of surgery. On average, patients returned to driving at 4.4 and 3.7 weeks for TKA and THA (P < 0.001), respectively. The rate of motor vehicle accidents was 0.7% (7/1,044) within 12 weeks after surgery with no injuries reported. After multivariate analysis, baseline return to driving began at 10.9 days for TKA and 17.1 days for THA. The following predictors added additional time to return to driving for TJA: not feeling safe to drive, limited range of motion, female sex, limitations due to pain, other limitations, discharge to a rehabilitation facility, right-sided procedures, limited ability to break, preoperative anemia, and preoperative use of a cane.\u0000\u0000\u0000DISCUSSION\u0000Important predictors identified for return to driving were sex, joint laterality, limited ability to walk or ability to break, and feeling safe. Surgeons should consider these factors when counseling patients on their postoperative expectations regarding driving after TJA.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129763413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-15DOI: 10.5435/JAAOS-D-19-00330
J. Wells, Miles Batty, H. Box, P. Nakonezny
INTRODUCTION Patient satisfaction serves an increasingly important role in health care. Multiple nonmodifiable patient factors have been found to influence patient satisfaction. To the best of our knowledge, however, no study has investigated the influence of body mass index (BMI) on satisfaction scores. The objective of this study was to evaluate whether BMI and provider recommendation for patient weight modification were associated with patient satisfaction. METHODS We reviewed Press Ganey patient satisfaction survey scores from 3,044 clinical encounters in an academic orthopaedic center between November 2010 and May 2017. Multiple patient factors, BMI, and recommendation for weight loss, or requirement of weight loss, before surgery were recorded. Patient satisfaction was operationalized as a binary outcome of completely satisfied or not completely satisfied, and multiple logistic regression was used to estimate the odds of being completely satisfied from the subset of potential predictors. RESULTS White patients (odds ratio [OR] = 1.340, 95% confidence interval [CI]: 1.113 to 1.584, P = 0.0007) and Medicare-insured patients (OR = 1.260, 95% CI: 1.044 to 1.521, P = 0.0164) were more likely to be completely satisfied, whereas patients being seen by a provider for the first time were less likely to be completely satisfied (OR = 0.728, 95% CI: 0.626 to 0.847, P < 0.0001). BMI, recommendation for weight loss, and requirement of weight modification before surgery were not found to be associated with patient satisfaction. DISCUSSION Neither patient BMI nor provider recommendation for weight loss, or as a requirement for surgery, was associated with patient satisfaction. Race, insurance status, and previous visits with the care provider were identified as nonmodifiable patient factors that influence patient satisfaction. LEVEL OF EVIDENCE Level III.
{"title":"Effect of Patient Body Mass Index, Recommendation for Weight Modification, and Nonmodifiable Factors on Patient Satisfaction.","authors":"J. Wells, Miles Batty, H. Box, P. Nakonezny","doi":"10.5435/JAAOS-D-19-00330","DOIUrl":"https://doi.org/10.5435/JAAOS-D-19-00330","url":null,"abstract":"INTRODUCTION\u0000Patient satisfaction serves an increasingly important role in health care. Multiple nonmodifiable patient factors have been found to influence patient satisfaction. To the best of our knowledge, however, no study has investigated the influence of body mass index (BMI) on satisfaction scores. The objective of this study was to evaluate whether BMI and provider recommendation for patient weight modification were associated with patient satisfaction.\u0000\u0000\u0000METHODS\u0000We reviewed Press Ganey patient satisfaction survey scores from 3,044 clinical encounters in an academic orthopaedic center between November 2010 and May 2017. Multiple patient factors, BMI, and recommendation for weight loss, or requirement of weight loss, before surgery were recorded. Patient satisfaction was operationalized as a binary outcome of completely satisfied or not completely satisfied, and multiple logistic regression was used to estimate the odds of being completely satisfied from the subset of potential predictors.\u0000\u0000\u0000RESULTS\u0000White patients (odds ratio [OR] = 1.340, 95% confidence interval [CI]: 1.113 to 1.584, P = 0.0007) and Medicare-insured patients (OR = 1.260, 95% CI: 1.044 to 1.521, P = 0.0164) were more likely to be completely satisfied, whereas patients being seen by a provider for the first time were less likely to be completely satisfied (OR = 0.728, 95% CI: 0.626 to 0.847, P < 0.0001). BMI, recommendation for weight loss, and requirement of weight modification before surgery were not found to be associated with patient satisfaction.\u0000\u0000\u0000DISCUSSION\u0000Neither patient BMI nor provider recommendation for weight loss, or as a requirement for surgery, was associated with patient satisfaction. Race, insurance status, and previous visits with the care provider were identified as nonmodifiable patient factors that influence patient satisfaction.\u0000\u0000\u0000LEVEL OF EVIDENCE\u0000Level III.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116773794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.5435/JAAOS-D-19-00082
David K. Galos, Travis A Doering
Fractures of the pelvis and acetabulum, although uncommon in the pediatric cohort, represent a range of injuries with similarities to those seen in the adult cohort but with key differences that are important for the treating physician to be aware of to allow for systematic evaluation and management of these potentially life-threatening injuries. As the pediatric skeleton matures, changes in anatomy and physiology influence injury pattern, diagnosis, treatment, and complications. High-energy fractures of the pediatric pelvis are particularly concerning given the reported mortality rates ranging from 3.2% to 18%, with severe fracture patterns being associated with visceral injury in up to 60% of patients. The unique complexity of pediatric patients requires a multidisciplinary team to fully address their care. A systematic approach to the initial evaluation and diagnosis of pediatric patients with fractures of the acetabulum or pelvic ring aids in choosing between surgical and nonsurgical management of these fractures and avoiding complications unique to the maturing skeleton. We present such an approach to assist the practitioner who infrequently treats these uncommon injuries.
{"title":"High-Energy Fractures of the Pelvis and Acetabulum in Pediatric Patients.","authors":"David K. Galos, Travis A Doering","doi":"10.5435/JAAOS-D-19-00082","DOIUrl":"https://doi.org/10.5435/JAAOS-D-19-00082","url":null,"abstract":"Fractures of the pelvis and acetabulum, although uncommon in the pediatric cohort, represent a range of injuries with similarities to those seen in the adult cohort but with key differences that are important for the treating physician to be aware of to allow for systematic evaluation and management of these potentially life-threatening injuries. As the pediatric skeleton matures, changes in anatomy and physiology influence injury pattern, diagnosis, treatment, and complications. High-energy fractures of the pediatric pelvis are particularly concerning given the reported mortality rates ranging from 3.2% to 18%, with severe fracture patterns being associated with visceral injury in up to 60% of patients. The unique complexity of pediatric patients requires a multidisciplinary team to fully address their care. A systematic approach to the initial evaluation and diagnosis of pediatric patients with fractures of the acetabulum or pelvic ring aids in choosing between surgical and nonsurgical management of these fractures and avoiding complications unique to the maturing skeleton. We present such an approach to assist the practitioner who infrequently treats these uncommon injuries.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126051839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.5435/JAAOS-D-18-00481
C. Tipton, V. Bompadre, Tressa Mattioli-Lewis, Maryse Bouchard
INTRODUCTION The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) is validated for assessing the impact of foot and ankle conditions in pediatric patients. The purpose of this cross-sectional study is to assess child-parent concordance and identify patient factors that predict improved agreement. METHODS Patients aged 8 to 16 years with foot and ankle conditions and their parents completed the OxAFQ-C during routine clinic visits over a 9-month period. Demographic and medical information was collected by chart reviews. Responses in each domain were compared using a Wilcoxon signed-rank test, and the comparisons of responses by sex were analyzed with Wilcoxon rank-sum tests. Concordance was assessed with intraclass correlation coefficients. RESULTS There were 87 child-parent dyads with 50 female patients (57.5%) and 37 male patients (42.5%). Most parent responders were mothers (84%). The mean patient age was 12.4 (±2.2) years. The most common diagnosis was pes planus (17%). Child scores were significantly higher than their parents' in the school and play (P = 0.008) and emotional (P = 0.001) domains. When stratified by age, children younger than 13 years had significantly higher scores than their parents across all domains (P = 0.015 physical, 0.002 school and play, 0.001 emotional), although the concordance for the school and play and emotional domains was only moderate (0.73 and 0.58, respectively). Female patients and their parents reported significantly lower scores compared with their male counterparts only in the emotional domain (84.37 vs 93.75, P = 0.025). CONCLUSION Concordance is good between child and parent scores of the OxAFQ-C for assessing the impact of foot and ankle conditions. When stratified by age, patients younger than 13 years of age had higher scores than their parents' in all domains with the lowest concordance for the school and play and emotional domains. Female patients and their parents reported significantly lower scores than their male counterparts in the emotional domain. LEVEL OF EVIDENCE Level IV.
牛津儿童踝关节足问卷(OxAFQ-C)用于评估儿科患者足部和踝关节状况的影响。本横断面研究的目的是评估亲子一致性，并确定预测改善一致性的患者因素。方法8 ~ 16岁的足部和踝关节疾病患者及其父母在9个月的常规门诊期间完成OxAFQ-C。通过图表审查收集人口和医疗信息。每个领域的反应采用Wilcoxon符号秩检验进行比较，性别反应的比较采用Wilcoxon秩和检验进行分析。用类内相关系数评价一致性。结果患儿共87对，其中女性50例(57.5%)，男性37例(42.5%)。大多数回应者是母亲(84%)。患者平均年龄12.4(±2.2)岁。最常见的诊断是扁平足(17%)。儿童在学校和游戏(P = 0.008)和情感(P = 0.001)领域的得分显著高于父母。当按年龄分层时，13岁以下儿童在所有领域的得分均显著高于其父母(P = 0.015身体，0.002学校和游戏，0.001情感)，尽管学校和游戏和情感领域的一致性仅为中等(分别为0.73和0.58)。女性患者及其父母仅在情绪领域的得分明显低于男性患者(84.37 vs 93.75, P = 0.025)。结论儿童与家长的OxAFQ-C评分在评价足踝关节状况影响时具有较好的一致性。当按年龄分层时，13岁以下的患者在所有领域的得分都高于其父母，在学校、游戏和情感领域的一致性最低。女性患者及其父母在情感领域的得分明显低于男性患者。证据等级:四级。
{"title":"Outcome Tools in Pediatric Foot and Ankle Patients: Comparing Child and Parent Scores.","authors":"C. Tipton, V. Bompadre, Tressa Mattioli-Lewis, Maryse Bouchard","doi":"10.5435/JAAOS-D-18-00481","DOIUrl":"https://doi.org/10.5435/JAAOS-D-18-00481","url":null,"abstract":"INTRODUCTION\u0000The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) is validated for assessing the impact of foot and ankle conditions in pediatric patients. The purpose of this cross-sectional study is to assess child-parent concordance and identify patient factors that predict improved agreement.\u0000\u0000\u0000METHODS\u0000Patients aged 8 to 16 years with foot and ankle conditions and their parents completed the OxAFQ-C during routine clinic visits over a 9-month period. Demographic and medical information was collected by chart reviews. Responses in each domain were compared using a Wilcoxon signed-rank test, and the comparisons of responses by sex were analyzed with Wilcoxon rank-sum tests. Concordance was assessed with intraclass correlation coefficients.\u0000\u0000\u0000RESULTS\u0000There were 87 child-parent dyads with 50 female patients (57.5%) and 37 male patients (42.5%). Most parent responders were mothers (84%). The mean patient age was 12.4 (±2.2) years. The most common diagnosis was pes planus (17%). Child scores were significantly higher than their parents' in the school and play (P = 0.008) and emotional (P = 0.001) domains. When stratified by age, children younger than 13 years had significantly higher scores than their parents across all domains (P = 0.015 physical, 0.002 school and play, 0.001 emotional), although the concordance for the school and play and emotional domains was only moderate (0.73 and 0.58, respectively). Female patients and their parents reported significantly lower scores compared with their male counterparts only in the emotional domain (84.37 vs 93.75, P = 0.025).\u0000\u0000\u0000CONCLUSION\u0000Concordance is good between child and parent scores of the OxAFQ-C for assessing the impact of foot and ankle conditions. When stratified by age, patients younger than 13 years of age had higher scores than their parents' in all domains with the lowest concordance for the school and play and emotional domains. Female patients and their parents reported significantly lower scores than their male counterparts in the emotional domain.\u0000\u0000\u0000LEVEL OF EVIDENCE\u0000Level IV.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121097181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.5435/JAAOS-D-19-00163
B. S. Richards, Shawne Faulks, Kevin Felton, C. Karacz
PURPOSE Once Ponseti correction of a clubfoot is achieved and 3-month full-time bracing treatment is completed, part-time bracing treatment for 12 hours at night for 2 to 4 years is considered necessary to maintain a successful outcome. This study objectively documents the amount of daily orthosis wear time in those who maintained correction at age 2 years and, in so doing, determines how well patients' caretakers comply with the prescribed brace program. METHODS Patients <3 months old with idiopathic clubfeet when Ponseti treatment was initiated, who successfully maintained correction at age 2 years without surgery and who had complete objective brace wear data, were included. The foot abduction orthoses had a temperature data logger embedded in a shoe. Six 3-month time intervals were monitored in every patient as follows: full time: 0 to 3; night time: 4 to 6, 7 to 9, 10 to 12, 13 to 15, and 16 to 18 months. The families were not informed that hours of brace wear were being measured. RESULTS One hundred twenty-four patients with 187 clubfeet were included. During the 0- to 3-month interval, wear time averaged 19.8 hr/d. After this period of full-time use, the night-time brace wear decreased over each of the subsequent five intervals: 11.9, 9.6, 8.6, 7.9, and 7.7 hours. By the 18-month period of brace wear, 1 of 3 patients wore the orthoses less than 6 hours per day, and nearly 1 of 2 patients wore the orthoses less than 8 hours per day. DISCUSSION In patients evaluated at age 2 years whose clubfeet had successful nonsurgical treatment, night-time brace wear varied greatly and decreased over each 3-month period measured. By the second year of bracing treatment, nearly half of the patients wore them 8 hours or less. LEVEL OF EVIDENCE Level IV case series.
{"title":"Objective Measurement of Brace Wear in Successfully Ponseti-Treated Clubfeet: Pattern of Decreasing Use in the First 2 Years.","authors":"B. S. Richards, Shawne Faulks, Kevin Felton, C. Karacz","doi":"10.5435/JAAOS-D-19-00163","DOIUrl":"https://doi.org/10.5435/JAAOS-D-19-00163","url":null,"abstract":"PURPOSE\u0000Once Ponseti correction of a clubfoot is achieved and 3-month full-time bracing treatment is completed, part-time bracing treatment for 12 hours at night for 2 to 4 years is considered necessary to maintain a successful outcome. This study objectively documents the amount of daily orthosis wear time in those who maintained correction at age 2 years and, in so doing, determines how well patients' caretakers comply with the prescribed brace program.\u0000\u0000\u0000METHODS\u0000Patients <3 months old with idiopathic clubfeet when Ponseti treatment was initiated, who successfully maintained correction at age 2 years without surgery and who had complete objective brace wear data, were included. The foot abduction orthoses had a temperature data logger embedded in a shoe. Six 3-month time intervals were monitored in every patient as follows: full time: 0 to 3; night time: 4 to 6, 7 to 9, 10 to 12, 13 to 15, and 16 to 18 months. The families were not informed that hours of brace wear were being measured.\u0000\u0000\u0000RESULTS\u0000One hundred twenty-four patients with 187 clubfeet were included. During the 0- to 3-month interval, wear time averaged 19.8 hr/d. After this period of full-time use, the night-time brace wear decreased over each of the subsequent five intervals: 11.9, 9.6, 8.6, 7.9, and 7.7 hours. By the 18-month period of brace wear, 1 of 3 patients wore the orthoses less than 6 hours per day, and nearly 1 of 2 patients wore the orthoses less than 8 hours per day.\u0000\u0000\u0000DISCUSSION\u0000In patients evaluated at age 2 years whose clubfeet had successful nonsurgical treatment, night-time brace wear varied greatly and decreased over each 3-month period measured. By the second year of bracing treatment, nearly half of the patients wore them 8 hours or less.\u0000\u0000\u0000LEVEL OF EVIDENCE\u0000Level IV case series.","PeriodicalId":110802,"journal":{"name":"The Journal of the American Academy of Orthopaedic Surgeons","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126453277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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