The purpose of this study was to examine the comparative precision of the augmented reality (AR)-assisted navigation system and the accelerometer-based navigation system in total knee arthroplasty (TKA).
Materials and methods
We performed noninferiority analysis in a retrospective cohort. The coronal alignment of femoral prosthesis was compared between 109 TKAs performed using the AR-assisted navigation system and 118 TKAs performed using the accelerometer-based navigation system. All femoral prostheses were planned to be positioned perpendicular to the mechanical axis of the femur. The primary outcome was the success rate of coronal alignment of the femoral prosthesis defined as alignment error relative to neutral alignment <3°. We calculated the noninferiority margin as 7%-points using the 95%–95 % method and also confirmed the validity of the noninferiority margin using the fixed margin method. Noninferiority would be shown if the lower boundary of the 95 % confidence interval (CI) for the between-group difference in percentage of the success rate was not less than 0.93 (i.e., 1.00 − 0.07).
Results
Treatment success was achieved in 104 of 109 patients (95.4 %) in the AR-assisted navigation group and 110 of 118 (93.2 %) in the accelerometer-based navigation group. The risk ratio of success between the AR-assisted navigation group versus accelerometer-based navigation group was 1.02 (95 % CI, 0.96 to 1.09): the CIs did not include the noninferiority margin of 0.93.
Conclusion
The AR-assisted navigation system was noninferior to the accelerometer-based navigation system in terms of coronal alignment of the femoral prosthesis in TKA.
{"title":"Femoral prosthesis alignment of augmented reality-assisted versus accelerometer-based navigation in total knee arthroplasty: A noninferiority analysis","authors":"Sachiyuki Tsukada , Kazuha Kizaki , Masayoshi Saito , Kenji Kurosaka , Naoyuki Hirasawa , Hiroyuki Ogawa","doi":"10.1016/j.jos.2023.10.011","DOIUrl":"10.1016/j.jos.2023.10.011","url":null,"abstract":"<div><h3>Introduction</h3><div>The purpose of this study was to examine the comparative precision of the augmented reality (AR)-assisted navigation system and the accelerometer-based navigation system in total knee arthroplasty (TKA).</div></div><div><h3>Materials and methods</h3><div>We performed noninferiority analysis in a retrospective cohort. The coronal alignment of femoral prosthesis was compared between 109 TKAs performed using the AR-assisted navigation system and 118 TKAs performed using the accelerometer-based navigation system. All femoral prostheses were planned to be positioned perpendicular to the mechanical axis of the femur. The primary outcome was the success rate of coronal alignment of the femoral prosthesis defined as alignment error relative to neutral alignment <3°. We calculated the noninferiority margin as 7%-points using the 95%–95 % method and also confirmed the validity of the noninferiority margin using the fixed margin method. Noninferiority would be shown if the lower boundary of the 95 % confidence interval (CI) for the between-group difference in percentage of the success rate was not less than 0.93 (i.e., 1.00 − 0.07).</div></div><div><h3>Results</h3><div>Treatment success was achieved in 104 of 109 patients (95.4 %) in the AR-assisted navigation group and 110 of 118 (93.2 %) in the accelerometer-based navigation group. The risk ratio of success between the AR-assisted navigation group versus accelerometer-based navigation group was 1.02 (95 % CI, 0.96 to 1.09): the CIs did not include the noninferiority margin of 0.93.</div></div><div><h3>Conclusion</h3><div>The AR-assisted navigation system was noninferior to the accelerometer-based navigation system in terms of coronal alignment of the femoral prosthesis in TKA.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"29 6","pages":"Pages 1417-1422"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71482766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Total knee arthroplasty (TKA) is an effective treatment to improve mobility in patients with severe knee osteoarthritis. However, some patients continue to have poor mobility after surgery. The preoperative identification of patients with poor mobility after TKA allows for better treatment selection and appropriate goal setting. The purpose of this study was to develop a clinical prediction rule (CPR) to predict mobility after TKA.
Methods
This study included patients undergoing primary TKA. Predictors of outcome included patient characteristics, physical function, and psychological factors, which were measured preoperatively. The outcome measure was the Timed Up and Go test, which was measured at discharge. Patients with a score of ≥11 s were considered having a low-level of mobility. The classification and regression tree methodology of decision tree analysis was used for developing a CPR.
Results
Of the 101 cases (mean age, 72.2 years; 71.3 % female), 26 (25.7 %) were classified as low-mobility. Predictors were the modified Gait Efficacy Scale, age, knee pain on the operated side, knee extension range of motion on the non-operated side, and Somatic Focus, a subscale of the Tampa Scale for Kinesiophobia (short version). The model had a sensitivity of 50.0 %, a specificity of 98.7 %, a positive predictive value of 92.9 %, a positive likelihood ratio of 37.5, and an area under the receiver operating characteristic curve of 0.853.
Conclusion
We have developed a CPR that, with some accuracy, predicts the mobility outcomes of patients after TKA. This CPR may be useful for predicting postoperative mobility and clinical goal setting.
{"title":"Development of a clinical prediction rule for mobility status at discharge in patients with total knee arthroplasty: Using a decision tree model","authors":"Kenta Kuwahara , Toshihiro Kato , Yuko Akatsuka , Shigeto Nakazora , Aki Fukuda , Keiji Asada","doi":"10.1016/j.jos.2023.12.002","DOIUrl":"10.1016/j.jos.2023.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty<span><span> (TKA) is an effective treatment to improve mobility in patients with severe knee osteoarthritis. However, some patients continue to have poor mobility after surgery. The preoperative identification of patients with poor mobility after TKA allows for better treatment selection and appropriate goal setting. The purpose of this study was to develop a </span>clinical prediction rule (CPR) to predict mobility after TKA.</span></div></div><div><h3>Methods</h3><div>This study included patients undergoing primary TKA. Predictors of outcome included patient characteristics<span><span>, physical function, and psychological factors, which were measured preoperatively. The outcome measure was the Timed Up and Go test, which was measured at discharge. Patients with a score of ≥11 s were considered having a low-level of mobility. The classification and regression tree methodology of </span>decision tree analysis was used for developing a CPR.</span></div></div><div><h3>Results</h3><div>Of the 101 cases (mean age, 72.2 years; 71.3 % female), 26 (25.7 %) were classified as low-mobility. Predictors were the modified Gait Efficacy Scale, age, knee pain on the operated side, knee extension range of motion on the non-operated side, and Somatic Focus, a subscale of the Tampa Scale for Kinesiophobia (short version). The model had a sensitivity of 50.0 %, a specificity of 98.7 %, a positive predictive value of 92.9 %, a positive likelihood ratio of 37.5, and an area under the receiver operating characteristic curve of 0.853.</div></div><div><h3>Conclusion</h3><div>We have developed a CPR that, with some accuracy, predicts the mobility outcomes of patients after TKA. This CPR may be useful for predicting postoperative mobility and clinical goal setting.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"29 6","pages":"Pages 1451-1455"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138744172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the treatment of chronic lateral ankle instability (CLAI), the repair of the calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) is still being discussed, possibly due to the difficulty in assessing CFL injuries. In particular, it is challenging to evaluate the extent of CFL deficiency quantitively. We hypothesized that CFL tension change would alter morphology of the CFL on magnetic resonance imaging (MRI) and that measuring this morphological change allows assessing CFL injury quantitatively. Thus, this study aimed to analyze the feasibility of quantitatively assessing CFL injuries using MRI.
Methods
Sixty-four ankles with CLAI were included and divided into two groups: with (ATFL and CFL group, 31 ankles) or without CFL repair (ATFL group, 33 ankles) in addition to arthroscopic ATFL repair. The angle between the CFL and calcaneal axis (CFLCA) and the bending angles of the CFL was defined as the flexed CFL angle (FCA) were measured on the oblique CFL view of preoperative MRI. The diagnostic abilities of these angles for CFL injury and correlations between these angles and stress radiographs were analyzed.
Results
The sensitivity and specificity of CFLCA were 86.7 % and 88.7 %, and those of FCA were 63.3 % and 77.4 %, respectively. The combination of CFLCA and FCA improved the sensitivity to 93.3 %. The cutoff points of CFLCA and FCA were 3.8° and 121.2°, respectively. There were significant moderate and weak correlations between the talar tilting angle and CFLCA or FCA (rs = −0.533, and rs = −0.402, respectively). The CFLCA and FCA were significantly smaller in the ATFL and CFL group than those in the other groups.
Conclusions
Measurement of CFLCA and FCA in oblique CFL view on MRI could be useful for the quantitative evaluation of CFL injury in patients with CLAI．
{"title":"Quantitative evaluation of calcaneofibular ligament injury on the oblique coronal view of magnetic resonance imaging in chronic lateral ankle instability","authors":"Akinori Nekomoto , Tomoyuki Nakasa , Yasunari Ikuta , Yasuteru Shimamura , Naoyuki Kitamura , Junichi Sumii , Shingo Kawabata , Nobuo Adachi","doi":"10.1016/j.jos.2023.10.008","DOIUrl":"10.1016/j.jos.2023.10.008","url":null,"abstract":"<div><h3>Background</h3><div>In the treatment of chronic lateral ankle instability (CLAI), the repair of the calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) is still being discussed, possibly due to the difficulty in assessing CFL injuries<span>. In particular, it is challenging to evaluate the extent of CFL deficiency quantitively. We hypothesized that CFL tension change would alter morphology of the CFL on magnetic resonance imaging (MRI) and that measuring this morphological change allows assessing CFL injury quantitatively. Thus, this study aimed to analyze the feasibility of quantitatively assessing CFL injuries using MRI.</span></div></div><div><h3>Methods</h3><div>Sixty-four ankles with CLAI were included and divided into two groups: with (ATFL and CFL group, <strong><u>31</u></strong> ankles) or without CFL repair (ATFL group, <strong><u>33</u></strong> ankles) in addition to arthroscopic ATFL repair. The angle between the CFL and calcaneal axis (CFLCA) and the bending angles of the CFL was defined as the flexed CFL angle (FCA) were measured on the oblique CFL view of preoperative MRI. The diagnostic abilities of these angles for CFL injury and correlations between these angles and stress radiographs were analyzed.</div></div><div><h3>Results</h3><div><span>The sensitivity and specificity of CFLCA were 86.7 % and </span><strong><u>88.7</u></strong> %, and those of FCA were 63.3 % and <strong>77.4</strong> %, respectively. The combination of CFLCA and FCA improved the sensitivity to <strong><u>93.3</u></strong> %. The cutoff points of CFLCA and FCA were 3.8° and 121.2°, respectively. There were significant moderate and weak correlations between the talar tilting angle and CFLCA or FCA (<em>rs</em> = −0.533, and <em>rs</em> = −0.402, respectively). The CFLCA and FCA were significantly smaller in the ATFL and CFL group than those in the other groups.</div></div><div><h3>Conclusions</h3><div>Measurement of CFLCA and FCA in oblique CFL view on MRI could be useful for the quantitative evaluation of CFL injury in patients with CLAI．</div></div><div><h3>Level of evidence</h3><div>Level IV. case-control study.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"29 6","pages":"Pages 1456-1461"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71482769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.jos.2023.10.012
Jae Wan Suh , Ho-Seong Jang , Kyu-Beom Kim , Ju Hyun Kim , Sung Joon Choi , Ka Ram Kim , In-Tak Chu , Hyun-Woo Park
Background
Various operative methods for the treatment of Morton's neuroma have been discussed, and osteotomy of the metatarsal bone has been reported recently. However, there has been no report of pedobarographic changes after metatarsal osteotomy. Pedobarographic changes of other metatarsal area after the surgery may cause transfer metatarsalgia, and thorough analysis of the pedobarographic data should be performed peri-operatively. The purpose of this study is to investigate the post-operative pedobarographic changes of sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma.
Methods
Forty patients (45 feet) who underwent metatarsal sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma from November 2013 to December 2021 were retrospectively reviewed. Proximal sliding osteotomy was performed at the proximal 3rd metatarsal bone through dorsal approach. Clinical outcomes were evaluated with American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal Interphalangeal Scale (AOFAS LMIS), Foot Function Index (FFI), and Visual Analogue Scale (VAS). Plain radiograph and pedobarogram were performed to evaluate the radiologic and pedobarographic outcomes.
Results
AOFAS score was improved from 52.8 ± 9.0 (18–62) to 88.8 ± 9.8 (78–100) and FFI was improved from 61.8 ± 4.9 (50–70) to 32.2 ± 5.1 (23–42) on average. The 3rd metatarsal bone was shortened by 3.1 ± 0.8 mm and dorsally shifted by 1.5 ± 0.4 mm after the surgery. Plantar intermetatarsal distances between 2nd and 3rd and 3rd and 4th metatarsal heads were significantly increased post-operatively. Average forefoot pressure and maximum pressure of the 2nd to 4th metatarsal head were not significantly changed between pre-operatively and post-operatively.
Conclusion
Proximal metatarsal sliding osteotomy of the 3rd metatarsal bone shows a satisfactory result in both clinical and pedobarographical evaluations. It could be an effective treatment of permanent indirect decompression of Morton's neuroma with avoiding recurred neuroma, adhesion of tissue, paresthesia, and transfer metatarsalgia.
{"title":"Metatarsal sliding osteotomy is effective without altering plantar pressure in Morton's neuroma","authors":"Jae Wan Suh , Ho-Seong Jang , Kyu-Beom Kim , Ju Hyun Kim , Sung Joon Choi , Ka Ram Kim , In-Tak Chu , Hyun-Woo Park","doi":"10.1016/j.jos.2023.10.012","DOIUrl":"10.1016/j.jos.2023.10.012","url":null,"abstract":"<div><h3>Background</h3><div><span>Various operative methods for the treatment of Morton's neuroma have been discussed, and </span>osteotomy<span> of the metatarsal bone<span><span> has been reported recently. However, there has been no report of pedobarographic changes after metatarsal osteotomy. Pedobarographic changes of other metatarsal area after the surgery may cause transfer </span>metatarsalgia<span>, and thorough analysis of the pedobarographic data should be performed peri-operatively. The purpose of this study is to investigate the post-operative pedobarographic changes of sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma.</span></span></span></div></div><div><h3>Methods</h3><div>Forty patients (45 feet) who underwent metatarsal sliding osteotomy of the 3rd metatarsal bone for treating Morton's neuroma from November 2013 to December 2021 were retrospectively reviewed. Proximal sliding osteotomy was performed at the proximal 3rd metatarsal bone through dorsal approach. Clinical outcomes were evaluated with American Orthopaedic<span> Foot and Ankle Society Lesser Metatarsophalangeal Interphalangeal Scale (AOFAS LMIS), Foot Function Index (FFI), and Visual Analogue Scale (VAS). Plain radiograph and pedobarogram were performed to evaluate the radiologic and pedobarographic outcomes.</span></div></div><div><h3>Results</h3><div>AOFAS score was improved from 52.8 ± 9.0 (18–62) to 88.8 ± 9.8 (78–100) and FFI was improved from 61.8 ± 4.9 (50–70) to 32.2 ± 5.1 (23–42) on average. The 3rd metatarsal bone was shortened by 3.1 ± 0.8 mm and dorsally shifted by 1.5 ± 0.4 mm after the surgery. Plantar intermetatarsal distances between 2nd and 3rd and 3rd and 4th metatarsal heads were significantly increased post-operatively. Average forefoot pressure and maximum pressure of the 2nd to 4th metatarsal head were not significantly changed between pre-operatively and post-operatively.</div></div><div><h3>Conclusion</h3><div>Proximal metatarsal sliding osteotomy of the 3rd metatarsal bone shows a satisfactory result in both clinical and pedobarographical evaluations. It could be an effective treatment of permanent indirect decompression of Morton's neuroma with avoiding recurred neuroma, adhesion of tissue, paresthesia, and transfer metatarsalgia.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"29 6","pages":"Pages 1423-1429"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89718747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgical site infections are common in spinal surgeries. It is uncertain whether outcomes in spine surgery patients with vs. without surgical site infection are equivalent. Therefore, we assessed the effects of surgical site infection on postoperative patient-reported outcomes.
Methods
We enrolled patients who underwent elective spine surgery at 12 hospitals between April 2017 and February 2020. We collected data regarding the patients' backgrounds, operative factors, and incidence of surgical site infection. Data for patient-reported outcomes, namely numerical rating scale, Neck Disability Index/Oswestry Disability Index, EuroQol Five-Dimensional questionnaire, and 12-Item Short-Form Health Survey scores, were obtained preoperatively and 1 year postoperatively. We divided the patients into with and without surgical site infection groups. Multivariate logistic regression analyses were performed to identify the risk factors for surgical site infection. Using propensity score matching, we obtained matched surgical site infection-negative and -positive groups. Student's t-test was used for comparisons of continuous variables, and Pearson's chi-square test was used to compare categorical variables between the two matched groups and two unmatched groups.
Results
We enrolled 8861 patients in this study; 74 (0.8 %) developed surgical site infections. Cervical spine surgery and American Society of Anesthesiologists physical status classification ≥3 were identified as risk factors; microendoscopy was identified as a protective factor. Using propensity score matching, we compared surgical site infection-positive and -negative groups (74 in each group). No significant difference was found in postoperative pain or dysesthesia of the lower back, buttock, leg, and plantar area between the groups. When comparing preoperative with postoperative pain and dysesthesia, statistically significant improvement was observed for both variables in both groups (p < 0.01 for all variables). No significant differences were observed in postoperative outcomes between the matched surgical site infection-positive and -negative groups.
Conclusions
Patients with surgical site infections had comparable postoperative outcomes to those without surgical site infections.
{"title":"Does surgical site infection affect patient-reported outcomes after spinal surgery? A multicenter cohort study","authors":"Hideki Nakamoto , Koji Nakajima , Junya Miyahara , So Kato , Toru Doi , Yuki Taniguchi , Yoshitaka Matsubayashi , Mitsuhiro Nishizawa , Naohiro Kawamura , Yudai Kumanomido , Akiro Higashikawa , Katsuyuki Sasaki , Yujiro Takeshita , Masayoshi Fukushima , Masaaki Iizuka , Takashi Ono , Jim Yu , Nobuhiro Hara , Naoki Okamoto , Seiichi Azuma , Yasushi Oshima","doi":"10.1016/j.jos.2023.10.010","DOIUrl":"10.1016/j.jos.2023.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infections are common in spinal surgeries. It is uncertain whether outcomes in spine surgery patients with vs. without surgical site infection are equivalent. Therefore, we assessed the effects of surgical site infection on postoperative patient-reported outcomes.</div></div><div><h3>Methods</h3><div><span><span>We enrolled patients who underwent elective spine surgery at 12 hospitals between April 2017 and February 2020. We collected data regarding the patients' backgrounds, operative factors, and incidence of surgical site infection. Data for patient-reported outcomes, namely numerical rating scale, Neck Disability Index/Oswestry Disability Index, EuroQol Five-Dimensional questionnaire, and 12-Item Short-Form Health Survey scores, were obtained preoperatively and 1 year postoperatively. We divided the patients into with and without surgical site infection groups. </span>Multivariate logistic regression analyses were performed to identify the risk factors for surgical site infection. Using </span>propensity score matching, we obtained matched surgical site infection-negative and -positive groups. Student's t-test was used for comparisons of continuous variables, and Pearson's chi-square test was used to compare categorical variables between the two matched groups and two unmatched groups.</div></div><div><h3>Results</h3><div><span>We enrolled 8861 patients in this study; 74 (0.8 %) developed surgical site infections. Cervical spine surgery and American Society of Anesthesiologists physical status classification ≥3 were identified as risk factors; microendoscopy was identified as a protective factor. Using propensity score matching, we compared surgical site infection-positive and -negative groups (74 in each group). No significant difference was found in postoperative pain or </span>dysesthesia<span><span> of the lower back, buttock, leg, and plantar area between the groups. When comparing preoperative with postoperative pain and </span>dysesthesia, statistically significant improvement was observed for both variables in both groups (p < 0.01 for all variables). No significant differences were observed in postoperative outcomes between the matched surgical site infection-positive and -negative groups.</span></div></div><div><h3>Conclusions</h3><div>Patients with surgical site infections had comparable postoperative outcomes to those without surgical site infections.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"29 6","pages":"Pages 1370-1375"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71412694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.jos.2024.09.010
İnci Hazal Ayas, Baran Sarıkaya, Mustafa Özer, Mehmet Ali Tokgöz, Zeynep Hazar, Almasbek Akhmetov, Dilek Yapar, Ulunay Kanatlı
Background: The objective of this study is to examine the association between special tests for subscapularis tears and both pain and tear severity.
Methods: Nine hundred and two patients (145 with isolated lesions and 757 with combined lesions) diagnosed with arthroscopically confirmed subscapularis tears between 2010 and 2022. Subscapularis tear severity was classified according to Lafosse classification type I, II, III and IV. Preoperative Visual Analogue Scale (VAS) pain score at rest of the patients, flexion and abduction range of motion (ROM) of the shoulder and the results of the Lift-off test (LOT), Belly Press test (BPT), Bear Hug test (BHT), and Empty Can test (ECT) were documented.
Results: The sensitivity of LOT in isolated and combined tears was 70.3 % and 69.5 %, 45.6 % and 41.2 % of BPT, 72.1 % and 72.6 % of BHT, 81.2 % and 84.1 % of ECT, respectively. There was no association between the severity of the subscapularis tear and the sensitivity in all special tests (p > 0.05). Only the ECT was observed to be associated with pain in the multivariate logistic regression analysis (OR = 33.1, p < 0.001).
Conclusions: The special tests used to evaluate subscapularis tears are neither sensitive to the severity of the tear nor to pain except for ECT. BHT is the most successful test to detect any subscapularis tear in both isolated and combined tears. Pain severity was related to the presence of a rotator cuff lesion accompanying subscapularis lesion, but not with the severity of subscapularis or remaining rotator cuff tear.
Study design: Levels of Evidence III, cross-sectional archive study.
Clinical trial registration number: Since the study was a retrospective archive study, there was no clinical trial registration.
{"title":"Assessing subscapularis tears: Relationship between special tests and pain & tear severity.","authors":"İnci Hazal Ayas, Baran Sarıkaya, Mustafa Özer, Mehmet Ali Tokgöz, Zeynep Hazar, Almasbek Akhmetov, Dilek Yapar, Ulunay Kanatlı","doi":"10.1016/j.jos.2024.09.010","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.010","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study is to examine the association between special tests for subscapularis tears and both pain and tear severity.</p><p><strong>Methods: </strong>Nine hundred and two patients (145 with isolated lesions and 757 with combined lesions) diagnosed with arthroscopically confirmed subscapularis tears between 2010 and 2022. Subscapularis tear severity was classified according to Lafosse classification type I, II, III and IV. Preoperative Visual Analogue Scale (VAS) pain score at rest of the patients, flexion and abduction range of motion (ROM) of the shoulder and the results of the Lift-off test (LOT), Belly Press test (BPT), Bear Hug test (BHT), and Empty Can test (ECT) were documented.</p><p><strong>Results: </strong>The sensitivity of LOT in isolated and combined tears was 70.3 % and 69.5 %, 45.6 % and 41.2 % of BPT, 72.1 % and 72.6 % of BHT, 81.2 % and 84.1 % of ECT, respectively. There was no association between the severity of the subscapularis tear and the sensitivity in all special tests (p > 0.05). Only the ECT was observed to be associated with pain in the multivariate logistic regression analysis (OR = 33.1, p < 0.001).</p><p><strong>Conclusions: </strong>The special tests used to evaluate subscapularis tears are neither sensitive to the severity of the tear nor to pain except for ECT. BHT is the most successful test to detect any subscapularis tear in both isolated and combined tears. Pain severity was related to the presence of a rotator cuff lesion accompanying subscapularis lesion, but not with the severity of subscapularis or remaining rotator cuff tear.</p><p><strong>Study design: </strong>Levels of Evidence III, cross-sectional archive study.</p><p><strong>Clinical trial registration number: </strong>Since the study was a retrospective archive study, there was no clinical trial registration.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Patient safety is crucial in high-risk specialties such as orthopedic surgery due to the significant incidence of preventable adverse events. Analyzing extensive databases of orthopedic surgery-related incidents in operating rooms is vital for enhancing medical safety and identifying targeted interventions. This study analyzed orthopedic surgery-related incidents in operating rooms using a nationwide incident reporting database in Japan to identify risk factors associated with severe harm.
Methods: We extracted orthopedic surgery-related incidents in the operating room from the Japan Council for Quality Health Care's database, which contained 127,207 near-miss and adverse event reports recorded between January 1, 2010 and September 30, 2022. We analyzed 882 incident cases, focusing on patient demographics, incident timing, surgical site, incident causes, and severity levels.
Results: The most incidents involved surgeons (93.3 %) with an average of 16.0 ± 8.5 years of experience. The frequent causes were "failure to check" (48.0 %) and "misjudgment" (24.0 %), which were non-technical errors. "Errors in methods/procedures" accounted for 37.1 % of incidents, possibly due to a wide variety of surgical approaches and implants used in orthopedic surgeries. Regarding severity, 86 % were critical incidents that threatened patients' livelihoods or lives. Surgeries involving surgeons had a significantly higher risk of severe harm than those involving healthcare professionals other than surgeons (odds ratio: 3.311, 95 % confidence interval: 1.858-5.901).
Conclusions: This study revealed that most of orthopedic surgery-related incidents in operating rooms involved experienced surgeons and resulted in severe patient harm. The frequent causes were failure to check, misjudgment, and errors in methods/procedures. These highlight the crucial role of orthopedic surgeons in actively contributing to medical safety databases and fostering a culture of reporting within their field.
{"title":"Analysis of orthopedic surgery-related incidents in operating rooms using a nationwide incident reporting database.","authors":"Shiho Nakano, Toshiaki Kotani, Arata Nakajima, Masato Sonobe, Kayo Inakuma, Seiji Ohtori, Koichi Nakagawa","doi":"10.1016/j.jos.2024.09.008","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.008","url":null,"abstract":"<p><strong>Background: </strong>Patient safety is crucial in high-risk specialties such as orthopedic surgery due to the significant incidence of preventable adverse events. Analyzing extensive databases of orthopedic surgery-related incidents in operating rooms is vital for enhancing medical safety and identifying targeted interventions. This study analyzed orthopedic surgery-related incidents in operating rooms using a nationwide incident reporting database in Japan to identify risk factors associated with severe harm.</p><p><strong>Methods: </strong>We extracted orthopedic surgery-related incidents in the operating room from the Japan Council for Quality Health Care's database, which contained 127,207 near-miss and adverse event reports recorded between January 1, 2010 and September 30, 2022. We analyzed 882 incident cases, focusing on patient demographics, incident timing, surgical site, incident causes, and severity levels.</p><p><strong>Results: </strong>The most incidents involved surgeons (93.3 %) with an average of 16.0 ± 8.5 years of experience. The frequent causes were \"failure to check\" (48.0 %) and \"misjudgment\" (24.0 %), which were non-technical errors. \"Errors in methods/procedures\" accounted for 37.1 % of incidents, possibly due to a wide variety of surgical approaches and implants used in orthopedic surgeries. Regarding severity, 86 % were critical incidents that threatened patients' livelihoods or lives. Surgeries involving surgeons had a significantly higher risk of severe harm than those involving healthcare professionals other than surgeons (odds ratio: 3.311, 95 % confidence interval: 1.858-5.901).</p><p><strong>Conclusions: </strong>This study revealed that most of orthopedic surgery-related incidents in operating rooms involved experienced surgeons and resulted in severe patient harm. The frequent causes were failure to check, misjudgment, and errors in methods/procedures. These highlight the crucial role of orthopedic surgeons in actively contributing to medical safety databases and fostering a culture of reporting within their field.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The objectives of this study were to revise the Kinesiophobia Causes Scale (KCS) to make it suitable for Chinese cultural context and to verify its applicability in Chinese Total knee arthroplasty (TKA) patients.
Methods: TKA patients in Henan Province, China (N = 418, average age ≥64 years). Exploratory and confirmatory factor analysis was performed on two samples randomly selected from the population (each N = 208). Psychometric properties, including the content, construct, predictive and concurrent validity was evaluated for KCS.
Results: The KCS scale showed desirable internal consistency (Cronbach's alpha: 0.927), test-retest reliability (0.936), and content validity (0.958). A seven-factor structure was revealed and confirmed using exploratory and confirmatory factor analysis. The area under the curve was 0.852. The optimal cut-off score for KCS was 3.68.
Conclusions: The developed Chinese version of KCS is both reliable and valid when applied in Chinese setting of TKA patients.
{"title":"Cross-cultural adaptation and validation of the kinesiophobia causes scale: A descriptive survey have undergone total knee arthroplasty in China.","authors":"Yuru Guo, Yanjin Liu, Yuan Zheng, Libai Cai, Min Ren, Yaya Zhai","doi":"10.1016/j.jos.2024.09.006","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.006","url":null,"abstract":"<p><strong>Objective: </strong>The objectives of this study were to revise the Kinesiophobia Causes Scale (KCS) to make it suitable for Chinese cultural context and to verify its applicability in Chinese Total knee arthroplasty (TKA) patients.</p><p><strong>Methods: </strong>TKA patients in Henan Province, China (N = 418, average age ≥64 years). Exploratory and confirmatory factor analysis was performed on two samples randomly selected from the population (each N = 208). Psychometric properties, including the content, construct, predictive and concurrent validity was evaluated for KCS.</p><p><strong>Results: </strong>The KCS scale showed desirable internal consistency (Cronbach's alpha: 0.927), test-retest reliability (0.936), and content validity (0.958). A seven-factor structure was revealed and confirmed using exploratory and confirmatory factor analysis. The area under the curve was 0.852. The optimal cut-off score for KCS was 3.68.</p><p><strong>Conclusions: </strong>The developed Chinese version of KCS is both reliable and valid when applied in Chinese setting of TKA patients.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.jos.2024.09.001
Emre Kaya, Mehmet Kapıcıoglu, Koray Sahin, Tolga Kececi, Kerem Bilsel
Background: Symptomatic massive rotator cuff tear (MRCT) treatment is challenging, and there is no clear treatment strategy. In our study, we aimed to compare latissimus dorsi tendon transfer (LDTT) and open complete repair (OCR) surgical techniques for the treatment of MRCT.
Methods: Cases of symptomatic MRCT treated surgically with LDTT and OCR techniques between 2014 and 2021 were included in the study. The study was conducted in two centers: 1) one surgeon performed LDTT in first center and 2) the other surgeon performed OCR in second center. This study included 18 cases of LDTT and 15 cases of OCR. The patients were evaluated preoperatively and postoperatively in terms of demographic, radiological and functional scores. The American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley (CM) score, and visual analog scale (VAS) were used for functional evaluation. Symptom duration was defined as less than 6 months after onset, longer than 6 months and less than one year (<1Y)after onset, and longer than one year (>1Y) after onset.
Results: The functional scores and range of motion improved significantly in both groups. No statistically significant differences were found between the symptom duration subgroups in the LDTT group. However, there was a significant difference in functional scores between <1Y and >1Y (P < 0.001) in the OCR group. Re-tear was seen in 5 (33.3 %) cases in the OCR group, and failure was seen in 3 (16.6 %) cases in the LDDT group. The failure rate was significantly higher in the OCR group than in the LDTT group (P < 0.05).
Conclusions: LDTT technique is good option in the treatment of MRCT. However, in acute-subacute MRCT cases, open complete repair is a simpler, successful and safe technique. In chronic cases of >1Y, re-tear rates with OCR were high, and functional outcomes were low. We recommend that LDTT treatment for chronic cases (>1Y).
{"title":"Latissimus dorsi tendon transfer versus open complete repair for symptomatic massive rotator cuff tear.","authors":"Emre Kaya, Mehmet Kapıcıoglu, Koray Sahin, Tolga Kececi, Kerem Bilsel","doi":"10.1016/j.jos.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.001","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic massive rotator cuff tear (MRCT) treatment is challenging, and there is no clear treatment strategy. In our study, we aimed to compare latissimus dorsi tendon transfer (LDTT) and open complete repair (OCR) surgical techniques for the treatment of MRCT.</p><p><strong>Methods: </strong>Cases of symptomatic MRCT treated surgically with LDTT and OCR techniques between 2014 and 2021 were included in the study. The study was conducted in two centers: 1) one surgeon performed LDTT in first center and 2) the other surgeon performed OCR in second center. This study included 18 cases of LDTT and 15 cases of OCR. The patients were evaluated preoperatively and postoperatively in terms of demographic, radiological and functional scores. The American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley (CM) score, and visual analog scale (VAS) were used for functional evaluation. Symptom duration was defined as less than 6 months after onset, longer than 6 months and less than one year (<1Y)after onset, and longer than one year (>1Y) after onset.</p><p><strong>Results: </strong>The functional scores and range of motion improved significantly in both groups. No statistically significant differences were found between the symptom duration subgroups in the LDTT group. However, there was a significant difference in functional scores between <1Y and >1Y (P < 0.001) in the OCR group. Re-tear was seen in 5 (33.3 %) cases in the OCR group, and failure was seen in 3 (16.6 %) cases in the LDDT group. The failure rate was significantly higher in the OCR group than in the LDTT group (P < 0.05).</p><p><strong>Conclusions: </strong>LDTT technique is good option in the treatment of MRCT. However, in acute-subacute MRCT cases, open complete repair is a simpler, successful and safe technique. In chronic cases of >1Y, re-tear rates with OCR were high, and functional outcomes were low. We recommend that LDTT treatment for chronic cases (>1Y).</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Central sensitization has a significant effect on pain after osteotomy around the knee (OAK). The central sensitization inventory (CSI) score is considered disease specific, and the appropriate cut-off values for OAK are unclear. The purpose of this study was to establish the optimal CSI cut-off value affecting the postoperative outcomes of OAK based on the postoperative knee injury and osteoarthritis outcome score (KOOS).
Methods: Patients who underwent OAK for medial compartment knee osteoarthritis were included. The postoperative KOOS symptoms, pain, and activities of daily living (ADL) were categorized into two groups (score ≥80 each for symptoms, pain, and ADL, and score <80 for any of the three) and were used as factors to calculate receiver operating characteristic curves and the area under the curve with the CSI score. Cut-off values were calculated using the Youden index and the threshold value closest to the upper left corner. Subsequently, logistic multivariate analysis was performed using the KOOS and the obtained CSI cut-off values and other variables.
Results: A total of 173 patients were included in this study. The area under the curve of the model was 0.801 (95 % confidence interval, 0.74-0.87), and a CSI score of 12 was determined as the cut-off value. Logistic multivariate analysis based on the cut-off value showed that only the CSI score (odds ratio, 9.79; 95 % CI, 4.47-21.4; P < 0.01) was significant.
Conclusions: The optimal CSI cut-off value affecting the postoperative outcomes of OAK calculated using the postoperative KOOS was 12, which was supported by multivariate analysis results. Central sensitization assessment with an appropriate cut-off value would allow a more personalized treatment approach and may contribute to a better postoperative outcome.
背景：中枢敏感性对膝关节周围截骨术（OAK）后的疼痛有显著影响。中枢敏化量表（CSI）评分被认为具有疾病特异性，而 OAK 的适当临界值尚不明确。本研究的目的是根据术后膝关节损伤和骨关节炎结果评分（KOOS），确定影响OAK术后结果的最佳CSI临界值：方法：纳入因内侧室膝骨关节炎接受OAK手术的患者。将术后 KOOS 的症状、疼痛和日常生活活动能力（ADL）分为两组（症状、疼痛和 ADL 各得分≥80 分，以及得分结果：本研究共纳入 173 名患者。模型的曲线下面积为 0.801（95 % 置信区间，0.74-0.87），CSI 评分 12 分被确定为临界值。根据临界值进行的逻辑多变量分析表明，只有 CSI 评分（几率比 9.79；95 % CI，4.47-21.4；P 结论：CSI 临界值为 12 分：使用术后 KOOS 计算出的影响 OAK 术后结果的最佳 CSI 临界值为 12，多变量分析结果也支持这一观点。使用合适的临界值进行中枢敏感性评估，可使治疗方法更加个性化，并有助于获得更好的术后效果。
{"title":"Establishing an optimal central sensitization inventory cut-off value affecting postoperative outcomes of osteotomy around the knee.","authors":"Shoichi Hasegawa, Hideyuki Koga, Yusuke Nakagawa, Hao Ding, Aritoshi Yoshihara, Masaki Amemiya, Takashi Hoshino, Mai Katakura, Nobutake Ozeki, Tomomasa Nakamura, Hiroki Katagiri","doi":"10.1016/j.jos.2024.09.009","DOIUrl":"https://doi.org/10.1016/j.jos.2024.09.009","url":null,"abstract":"<p><strong>Background: </strong>Central sensitization has a significant effect on pain after osteotomy around the knee (OAK). The central sensitization inventory (CSI) score is considered disease specific, and the appropriate cut-off values for OAK are unclear. The purpose of this study was to establish the optimal CSI cut-off value affecting the postoperative outcomes of OAK based on the postoperative knee injury and osteoarthritis outcome score (KOOS).</p><p><strong>Methods: </strong>Patients who underwent OAK for medial compartment knee osteoarthritis were included. The postoperative KOOS symptoms, pain, and activities of daily living (ADL) were categorized into two groups (score ≥80 each for symptoms, pain, and ADL, and score <80 for any of the three) and were used as factors to calculate receiver operating characteristic curves and the area under the curve with the CSI score. Cut-off values were calculated using the Youden index and the threshold value closest to the upper left corner. Subsequently, logistic multivariate analysis was performed using the KOOS and the obtained CSI cut-off values and other variables.</p><p><strong>Results: </strong>A total of 173 patients were included in this study. The area under the curve of the model was 0.801 (95 % confidence interval, 0.74-0.87), and a CSI score of 12 was determined as the cut-off value. Logistic multivariate analysis based on the cut-off value showed that only the CSI score (odds ratio, 9.79; 95 % CI, 4.47-21.4; P < 0.01) was significant.</p><p><strong>Conclusions: </strong>The optimal CSI cut-off value affecting the postoperative outcomes of OAK calculated using the postoperative KOOS was 12, which was supported by multivariate analysis results. Central sensitization assessment with an appropriate cut-off value would allow a more personalized treatment approach and may contribute to a better postoperative outcome.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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