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Improved Risk Adjustment for Comorbid Diagnoses in Administrative Claims Analyses of Orthopaedic Surgery.
Pub Date : 2025-01-29 DOI: 10.2106/jbjs.23.01451
Jayme C B Koltsov,Thompson Zhuang,Serena S Hu,Robin N Kamal
BACKGROUNDThe accurate inclusion of patient comorbidities ensures appropriate risk adjustment in clinical or health services research and payment models. Orthopaedic studies often use only the comorbidities included at the index inpatient admission when quantifying patient risk. The goal of this study was to assess improvements in capture rates and in model fit and discriminatory power when using additional data and best practices for comorbidity capture.METHODSHip fracture care was used as an exemplary case of an inpatient condition in a population typically having multiple comorbidities. Cohorts were built from 3 administrative resources: (1) Medicare, (2) all-payer, and (3) private-payer. Elixhauser comorbidities were calculated first using only the index admission and subsequently by adding inpatient and outpatient data from the previous year. Comorbidities identified on outpatient records required 2 instances occurring ≥30 days apart. Model fit and discriminatory power for in-hospital metrics (death, length of stay, and costs or charges) and post-discharge metrics (90-day readmission and surgical site infection, and 90-day and 1-year death) were compared among capture strategies.RESULTSThe index admission missed 9.3% to 65.6% of individual Elixhauser comorbidities for the Medicare cohort, 2.9% to 39.0% for the all-payer cohort, and 14.1% to 57.9% for the private-payer cohort compared with data from the index admission plus the previous year. Using prior inpatient and outpatient data provided substantial improvements in model fit and explanatory power for post-discharge outcomes, whereas information from the index admission was sufficient for in-hospital death and length of stay. The utility of outpatient data was greatest when complete outpatient claims were captured compared with only ambulatory surgery claims.CONCLUSIONSThe comorbidity capture strategies demonstrated in this study, namely including all available data for post-discharge outcomes, using a 1-year lookback period, and requiring outpatient codes to appear on 2 claims ≥30 days apart, are relevant for improved risk adjustment in orthopaedic clinical or health services research and quality improvement and payment models.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Improved Risk Adjustment for Comorbid Diagnoses in Administrative Claims Analyses of Orthopaedic Surgery.","authors":"Jayme C B Koltsov,Thompson Zhuang,Serena S Hu,Robin N Kamal","doi":"10.2106/jbjs.23.01451","DOIUrl":"https://doi.org/10.2106/jbjs.23.01451","url":null,"abstract":"BACKGROUNDThe accurate inclusion of patient comorbidities ensures appropriate risk adjustment in clinical or health services research and payment models. Orthopaedic studies often use only the comorbidities included at the index inpatient admission when quantifying patient risk. The goal of this study was to assess improvements in capture rates and in model fit and discriminatory power when using additional data and best practices for comorbidity capture.METHODSHip fracture care was used as an exemplary case of an inpatient condition in a population typically having multiple comorbidities. Cohorts were built from 3 administrative resources: (1) Medicare, (2) all-payer, and (3) private-payer. Elixhauser comorbidities were calculated first using only the index admission and subsequently by adding inpatient and outpatient data from the previous year. Comorbidities identified on outpatient records required 2 instances occurring ≥30 days apart. Model fit and discriminatory power for in-hospital metrics (death, length of stay, and costs or charges) and post-discharge metrics (90-day readmission and surgical site infection, and 90-day and 1-year death) were compared among capture strategies.RESULTSThe index admission missed 9.3% to 65.6% of individual Elixhauser comorbidities for the Medicare cohort, 2.9% to 39.0% for the all-payer cohort, and 14.1% to 57.9% for the private-payer cohort compared with data from the index admission plus the previous year. Using prior inpatient and outpatient data provided substantial improvements in model fit and explanatory power for post-discharge outcomes, whereas information from the index admission was sufficient for in-hospital death and length of stay. The utility of outpatient data was greatest when complete outpatient claims were captured compared with only ambulatory surgery claims.CONCLUSIONSThe comorbidity capture strategies demonstrated in this study, namely including all available data for post-discharge outcomes, using a 1-year lookback period, and requiring outpatient codes to appear on 2 claims ≥30 days apart, are relevant for improved risk adjustment in orthopaedic clinical or health services research and quality improvement and payment models.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062038","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}
引用次数: 0
Early MRI Can Predict the Indication for Surgery in Brachial Plexus Birth Injury: Results of the NAPTIME Study.
Pub Date : 2025-01-29 DOI: 10.2106/jbjs.24.00561
Andrea S Bauer,Ann E Van Heest,M Claire Manske,Peter Y Shen,Martin J Asis,Jennifer Chang,Sandra Taylor,Michelle A James
BACKGROUNDMagnetic resonance imaging (MRI) has not been routinely used for infants with brachial plexus birth injury (BPBI); instead, the decision to operate is based on the trajectory of clinical recovery by 6 months of age. The aim of this study was to develop an MRI protocol that can be performed without sedation or contrast in order to identify infants who would benefit from surgery at an earlier age than the age at which that decision could be made clinically.METHODSThis prospective multicenter NAPTIME (Non-Anesthetized Plexus Technique for Infant MRI Evaluation) study included infants aged 28 to 120 days with BPBI from 3 tertiary care centers. Subjects had nonsedated non-contrast rapid volumetric proton density MRI on 3-T scanners. Neuroradiologists at each site calculated the NAPTIME nerve root injury score for subjects at their site. Interrater reliability was performed on a subset of subjects. All of the subjects were evaluated with routine clinical examinations up to 6 months of age, by which time the treating surgeon determined whether to offer nerve surgery. Surgeons were blinded to the MRI results. The ability of the NAPTIME score to discriminate surgeon indication for surgery was evaluated using the receiver operating characteristic (ROC) curve, by estimating the area under the curve (AUC) across the range of NAPTIME scores.RESULTSSixty-five infants successfully completed the NAPTIME MRI; 18 (28%) ultimately met the clinical criteria for nerve surgery. The interrater reliability for the NAPTIME score was moderate at 0.703 (95% confidence interval [CI], 0.582 to 0.818). The median NAPTIME score for subjects who met the criteria for nerve surgery was 16.2 (interquartile range [IQR], 9.9 to 18.9), while the median score for those who did not was 7.0 (IQR, 5.0 to10.5). The NAPTIME score predicted meeting the criteria for surgery with an AUC of 0.812 (95% CI, 0.688 to 0.936). A score of >13 offered a specificity of 0.94 and a sensitivity of 0.61 for surgical indication.CONCLUSIONSNon-contrast MRI without sedation is a useful tool in determining the severity of injury in BPBI. The NAPTIME score might distinguish which infants will meet the criteria for reconstructive nerve surgery earlier than when the decision can be made clinically.LEVEL OF EVIDENCEPrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Early MRI Can Predict the Indication for Surgery in Brachial Plexus Birth Injury: Results of the NAPTIME Study.","authors":"Andrea S Bauer,Ann E Van Heest,M Claire Manske,Peter Y Shen,Martin J Asis,Jennifer Chang,Sandra Taylor,Michelle A James","doi":"10.2106/jbjs.24.00561","DOIUrl":"https://doi.org/10.2106/jbjs.24.00561","url":null,"abstract":"BACKGROUNDMagnetic resonance imaging (MRI) has not been routinely used for infants with brachial plexus birth injury (BPBI); instead, the decision to operate is based on the trajectory of clinical recovery by 6 months of age. The aim of this study was to develop an MRI protocol that can be performed without sedation or contrast in order to identify infants who would benefit from surgery at an earlier age than the age at which that decision could be made clinically.METHODSThis prospective multicenter NAPTIME (Non-Anesthetized Plexus Technique for Infant MRI Evaluation) study included infants aged 28 to 120 days with BPBI from 3 tertiary care centers. Subjects had nonsedated non-contrast rapid volumetric proton density MRI on 3-T scanners. Neuroradiologists at each site calculated the NAPTIME nerve root injury score for subjects at their site. Interrater reliability was performed on a subset of subjects. All of the subjects were evaluated with routine clinical examinations up to 6 months of age, by which time the treating surgeon determined whether to offer nerve surgery. Surgeons were blinded to the MRI results. The ability of the NAPTIME score to discriminate surgeon indication for surgery was evaluated using the receiver operating characteristic (ROC) curve, by estimating the area under the curve (AUC) across the range of NAPTIME scores.RESULTSSixty-five infants successfully completed the NAPTIME MRI; 18 (28%) ultimately met the clinical criteria for nerve surgery. The interrater reliability for the NAPTIME score was moderate at 0.703 (95% confidence interval [CI], 0.582 to 0.818). The median NAPTIME score for subjects who met the criteria for nerve surgery was 16.2 (interquartile range [IQR], 9.9 to 18.9), while the median score for those who did not was 7.0 (IQR, 5.0 to10.5). The NAPTIME score predicted meeting the criteria for surgery with an AUC of 0.812 (95% CI, 0.688 to 0.936). A score of >13 offered a specificity of 0.94 and a sensitivity of 0.61 for surgical indication.CONCLUSIONSNon-contrast MRI without sedation is a useful tool in determining the severity of injury in BPBI. The NAPTIME score might distinguish which infants will meet the criteria for reconstructive nerve surgery earlier than when the decision can be made clinically.LEVEL OF EVIDENCEPrognostic Level II. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062066","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}
引用次数: 0
The Risk of Postoperative Periprosthetic Femoral Fracture After Total Hip Arthroplasty Depends More on Stem Design Than Cement Use: An Analysis of National Health Data from England.
Pub Date : 2025-01-28 DOI: 10.2106/jbjs.24.00894
J N Lamb,R M West,S D Relton,J M Wilkinson,H G Pandit
BACKGROUNDIn this study, we estimated the risk of surgically treated postoperative periprosthetic femoral fractures (POPFFs) associated with femoral implants frequently used for total hip arthroplasty (THA).METHODSIn this cohort study of patients who underwent primary THA in England between January 1, 2004, and December 31, 2020, POPFFs were identified from prospectively collected revision records and national hospital records. POPFF incidence rates, adjusting for potential confounders, were estimated for common stems. Subgroup analyses were performed for patients >70 years of age, with non-osteoarthritic indications, and with femoral neck fracture.RESULTSPOPFFs occurred in 0.6% (5,100) of 809,832 cases during a median follow-up of 6.5 years (interquartile range [IQR], 3.9 to 9.6 years). After cemented stem implantation, the majority of POPFFs were treated with fixation. Adjusted prosthesis time incidence rates (PTIRs) for POPFFs varied by stem design, regardless of cement fixation. Cemented composite beam (CB) stems demonstrated the lowest risk of POPFF. Collared cementless stems had an equivalent or lower rate of POPFF compared with the current gold standard of a polished taper slip cemented stem.CONCLUSIONSCemented CB stems were associated with the lowest POPFF risk, and some cementless stem designs outperformed modern cemented stem designs. Stem design was strongly associated with POPFF risk, regardless of the presence of cement. Surgeons, policymakers, and patients should consider these findings when considering femoral implants in those most at risk for POPFF.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"The Risk of Postoperative Periprosthetic Femoral Fracture After Total Hip Arthroplasty Depends More on Stem Design Than Cement Use: An Analysis of National Health Data from England.","authors":"J N Lamb,R M West,S D Relton,J M Wilkinson,H G Pandit","doi":"10.2106/jbjs.24.00894","DOIUrl":"https://doi.org/10.2106/jbjs.24.00894","url":null,"abstract":"BACKGROUNDIn this study, we estimated the risk of surgically treated postoperative periprosthetic femoral fractures (POPFFs) associated with femoral implants frequently used for total hip arthroplasty (THA).METHODSIn this cohort study of patients who underwent primary THA in England between January 1, 2004, and December 31, 2020, POPFFs were identified from prospectively collected revision records and national hospital records. POPFF incidence rates, adjusting for potential confounders, were estimated for common stems. Subgroup analyses were performed for patients >70 years of age, with non-osteoarthritic indications, and with femoral neck fracture.RESULTSPOPFFs occurred in 0.6% (5,100) of 809,832 cases during a median follow-up of 6.5 years (interquartile range [IQR], 3.9 to 9.6 years). After cemented stem implantation, the majority of POPFFs were treated with fixation. Adjusted prosthesis time incidence rates (PTIRs) for POPFFs varied by stem design, regardless of cement fixation. Cemented composite beam (CB) stems demonstrated the lowest risk of POPFF. Collared cementless stems had an equivalent or lower rate of POPFF compared with the current gold standard of a polished taper slip cemented stem.CONCLUSIONSCemented CB stems were associated with the lowest POPFF risk, and some cementless stem designs outperformed modern cemented stem designs. Stem design was strongly associated with POPFF risk, regardless of the presence of cement. Surgeons, policymakers, and patients should consider these findings when considering femoral implants in those most at risk for POPFF.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"125 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057040","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}
引用次数: 0
Evolution of Sagittal Spinal Alignment During Pubertal Growth: A Large-Scale Study in a Chinese Pediatric Population.
Pub Date : 2025-01-28 DOI: 10.2106/jbjs.24.00829
Zongshan Hu,Yanjie Xu,Changsheng Fan,Chunxiao Chen,Dongyue Li,Qiang Liu,Ming Wang,Zezhang Zhu,Yong Qiu,Zhen Liu
BACKGROUNDPrevious studies have reported normative data for sagittal spinal alignment in asymptomatic adults. The sagittal spinal alignment change in European children was recently reported. However, there is a lack of studies on the normative reference values of sagittal spinal and pelvic alignment and how these parameters change at different growth stages in Chinese children. The aims of this study were to establish the normative reference values of sagittal spinopelvic parameters in Chinese children, to investigate their variation during growth, and to compare these parameters between Chinese and European populations.METHODSThe radiographic data of 1,916 healthy Chinese children (female:male sex ratio, 1.02:1; mean age, 11.9 ± 4.3 years) were analyzed in a retrospective, single-center study. Full-spine radiographs were utilized to measure several sagittal parameters, including pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser sign, and triradiate cartilage status).RESULTSDuring skeletal growth, pelvic incidence (PI) increased from 31.3° to 38.4° (p < 0.001), and pelvic tilt (PT) increased from 7.8° to 12.2° (p < 0.001). There were also increases in LL (from 45.0° to 46.3°; p = 0.020) and proximal LL (from 14.5° to 15.9°; p = 0.023). The peak of change in PI occurred between Groups 1 and 2 (from 31.3° to 35.8°; p = 0.011). The peak of change in LL was observed between Groups 1 and 3 (from 45.0° to 47.7°; p = 0.008). The peak of change in proximal LL (from 14.5° to 15.9°; p = 0.039) and distal TK (from 6.1° to 6.9°; p = 0.039) occurred between Groups 1 and 5. A subgroup comparison showed that age and TK were significantly higher in male patients than in female patients across the skeletal growth groups.CONCLUSIONSThis was a comprehensive study of sagittal alignment in a large cohort of Chinese children. These findings can serve as age, sex, and ethnicity-specific reference values for spine surgeons when assessing and planning correction surgery for pediatric patients. The sagittal alignment variations during skeletal growth were different from those in European children, representing a unique cascade effect occurring during skeletal maturation in the Chinese population.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Evolution of Sagittal Spinal Alignment During Pubertal Growth: A Large-Scale Study in a Chinese Pediatric Population.","authors":"Zongshan Hu,Yanjie Xu,Changsheng Fan,Chunxiao Chen,Dongyue Li,Qiang Liu,Ming Wang,Zezhang Zhu,Yong Qiu,Zhen Liu","doi":"10.2106/jbjs.24.00829","DOIUrl":"https://doi.org/10.2106/jbjs.24.00829","url":null,"abstract":"BACKGROUNDPrevious studies have reported normative data for sagittal spinal alignment in asymptomatic adults. The sagittal spinal alignment change in European children was recently reported. However, there is a lack of studies on the normative reference values of sagittal spinal and pelvic alignment and how these parameters change at different growth stages in Chinese children. The aims of this study were to establish the normative reference values of sagittal spinopelvic parameters in Chinese children, to investigate their variation during growth, and to compare these parameters between Chinese and European populations.METHODSThe radiographic data of 1,916 healthy Chinese children (female:male sex ratio, 1.02:1; mean age, 11.9 ± 4.3 years) were analyzed in a retrospective, single-center study. Full-spine radiographs were utilized to measure several sagittal parameters, including pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser sign, and triradiate cartilage status).RESULTSDuring skeletal growth, pelvic incidence (PI) increased from 31.3° to 38.4° (p < 0.001), and pelvic tilt (PT) increased from 7.8° to 12.2° (p < 0.001). There were also increases in LL (from 45.0° to 46.3°; p = 0.020) and proximal LL (from 14.5° to 15.9°; p = 0.023). The peak of change in PI occurred between Groups 1 and 2 (from 31.3° to 35.8°; p = 0.011). The peak of change in LL was observed between Groups 1 and 3 (from 45.0° to 47.7°; p = 0.008). The peak of change in proximal LL (from 14.5° to 15.9°; p = 0.039) and distal TK (from 6.1° to 6.9°; p = 0.039) occurred between Groups 1 and 5. A subgroup comparison showed that age and TK were significantly higher in male patients than in female patients across the skeletal growth groups.CONCLUSIONSThis was a comprehensive study of sagittal alignment in a large cohort of Chinese children. These findings can serve as age, sex, and ethnicity-specific reference values for spine surgeons when assessing and planning correction surgery for pediatric patients. The sagittal alignment variations during skeletal growth were different from those in European children, representing a unique cascade effect occurring during skeletal maturation in the Chinese population.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057041","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}
引用次数: 0
Results of 331 Two-Stage Exchanges for PJI Following THA: Low Reinfection and Mechanical Failure Rates at 10 Years. 331例髋关节置换术后PJI两阶段置换的结果:10年再感染和机械故障率低。
Pub Date : 2025-01-17 DOI: 10.2106/jbjs.24.00911
E Bailey Terhune,Mason F Carstens,Kristin M Fruth,Charles P Hannon,Nicholas A Bedard,Daniel J Berry,Matthew P Abdel
BACKGROUNDThe relative advantages and disadvantages of 2-stage versus 1-stage management of infection following total hip arthroplasty (THA) are the current subject of intense debate. To understand the merits of each approach, detailed information on the short and, importantly, longer-term outcomes of each must be known. The purpose of the present study was to assess the long-term results of 2-stage exchange arthroplasty following THA in one of the largest series to date.METHODSWe identified 331 periprosthetic joint infections (PJIs) that had been treated with a 2-stage exchange arthroplasty between 1993 and 2021 at a single institution. Patients were excluded if they had had prior treatment for infection. The mean age at the time of reimplantation was 66 years, 38% of the patients were female, and the mean body mass index (BMI) was 30 kg/m2. The diagnosis of PJI was based on the 2011 Musculoskeletal Infection Society criteria. A competing-risk model accounting for death was utilized. The mean duration of follow-up was 8 years.RESULTSThe cumulative incidence of reinfection was 7% at 1 year and 11% at 5 and 10 years. Factors predictive of reinfection included BMI ≥30 kg/m2 (hazard ratio [HR] = 2; p = 0.049) and the need for a spacer exchange (HR = 3.2; p = 0.006). The cumulative incidence of any revision was 13% at 5 and 10 years. The cumulative incidence of aseptic revision was 3% at 1 year, 7% at 5 years, and 8% at 10 years. Dislocation occurred in 33 hips (11% at 10 years); 15 (45%) required revision. Factors predictive of dislocation were female sex (HR = 2; p = 0.047) and BMI <30 kg/m2 (HR = 3; p = 0.02). The mean Harris hip score (HHS) improved from 54 to 75 at 10 years.CONCLUSIONSIn this series of 331 two-stage exchange arthroplasties that were performed for the treatment of infection, we found a low rate of aseptic revision (8%) and a low rate of reinfection (11%) at 10 years. These long-term mechanical and infection data must be kept in mind when considering a paradigm shift to 1-stage exchanges.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景全髋关节置换术(THA)后2期和1期感染处理的相对优缺点是当前激烈争论的主题。要了解每种方法的优点,必须了解每种方法的短期和更重要的长期结果的详细信息。本研究的目的是评估THA术后2期置换关节置换术的长期效果,这是迄今为止规模最大的研究之一。方法:我们确定了1993年至2021年间在一家机构接受2期置换关节置换术治疗的331例假体周围关节感染(PJIs)。如果患者之前曾接受过感染治疗,则排除在外。再植时平均年龄66岁,女性占38%,平均体重指数(BMI)为30 kg/m2。PJI的诊断基于2011年肌肉骨骼感染学会的标准。采用了考虑死亡的竞争风险模型。平均随访时间为8年。结果1年累计再感染发生率为7%,5年和10年累计再感染发生率为11%。预测再感染的因素包括:BMI≥30 kg/m2(危险比[HR] = 2;p = 0.049),需要更换间隔器(HR = 3.2;P = 0.006)。在5年和10年期间,任何翻修的累积发生率为13%。无菌改良的累积发生率为1年3%,5年7%,10年8%。33例髋脱位(10年时11%);15(45%)需要修改。预测脱位的因素为女性(HR = 2;p = 0.047), BMI <30 kg/m2 (HR = 3;P = 0.02)。10年后Harris髋关节平均评分(HHS)从54分提高到75分。结论在331例两期置换关节置换术治疗感染的病例中,我们发现10年无菌翻修率低(8%),再感染率低(11%)。在考虑将模式转变为一期交换时,必须牢记这些长期的机械和感染数据。证据水平:治疗性三级。有关证据水平的完整描述,请参见作者说明。
{"title":"Results of 331 Two-Stage Exchanges for PJI Following THA: Low Reinfection and Mechanical Failure Rates at 10 Years.","authors":"E Bailey Terhune,Mason F Carstens,Kristin M Fruth,Charles P Hannon,Nicholas A Bedard,Daniel J Berry,Matthew P Abdel","doi":"10.2106/jbjs.24.00911","DOIUrl":"https://doi.org/10.2106/jbjs.24.00911","url":null,"abstract":"BACKGROUNDThe relative advantages and disadvantages of 2-stage versus 1-stage management of infection following total hip arthroplasty (THA) are the current subject of intense debate. To understand the merits of each approach, detailed information on the short and, importantly, longer-term outcomes of each must be known. The purpose of the present study was to assess the long-term results of 2-stage exchange arthroplasty following THA in one of the largest series to date.METHODSWe identified 331 periprosthetic joint infections (PJIs) that had been treated with a 2-stage exchange arthroplasty between 1993 and 2021 at a single institution. Patients were excluded if they had had prior treatment for infection. The mean age at the time of reimplantation was 66 years, 38% of the patients were female, and the mean body mass index (BMI) was 30 kg/m2. The diagnosis of PJI was based on the 2011 Musculoskeletal Infection Society criteria. A competing-risk model accounting for death was utilized. The mean duration of follow-up was 8 years.RESULTSThe cumulative incidence of reinfection was 7% at 1 year and 11% at 5 and 10 years. Factors predictive of reinfection included BMI ≥30 kg/m2 (hazard ratio [HR] = 2; p = 0.049) and the need for a spacer exchange (HR = 3.2; p = 0.006). The cumulative incidence of any revision was 13% at 5 and 10 years. The cumulative incidence of aseptic revision was 3% at 1 year, 7% at 5 years, and 8% at 10 years. Dislocation occurred in 33 hips (11% at 10 years); 15 (45%) required revision. Factors predictive of dislocation were female sex (HR = 2; p = 0.047) and BMI <30 kg/m2 (HR = 3; p = 0.02). The mean Harris hip score (HHS) improved from 54 to 75 at 10 years.CONCLUSIONSIn this series of 331 two-stage exchange arthroplasties that were performed for the treatment of infection, we found a low rate of aseptic revision (8%) and a low rate of reinfection (11%) at 10 years. These long-term mechanical and infection data must be kept in mind when considering a paradigm shift to 1-stage exchanges.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988799","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}
引用次数: 0
Reoperations as an Outcome Indicator for Developmental Dysplasia of the Hip Treated at Walking Age. 再手术作为行走年龄治疗的髋关节发育不良的预后指标。
Pub Date : 2025-01-17 DOI: 10.2106/jbjs.24.00486
Chia Hsieh Chang,Chi Lun Hung,Wei Chun Lee,Hsuan Kai Kao,Shu Mei Wang,Ken N Kuo
BACKGROUNDReoperation is a major adverse event following surgical treatment but has yet to be used as a primary outcome measure in population studies to assess current treatments for developmental dysplasia of the hip (DDH). The purpose of the present study was to explore the risk factors associated with reoperations following procedures under anesthesia ("operations") for DDH in patients between the ages of 1 and 3.00 years, with the goal of deriving treatment recommendations.METHODSThis retrospective birth cohort study included children who had undergone closed reduction, open reduction, or osteotomy for the treatment of unilateral DDH between the ages of 1 and 3.00 years, identified using the Taiwan National Health Insurance Research Database. The children were followed until 10 years of age for reoperations, excluding implant removal and sequential closed reduction within 3 months postoperatively. A comparison between patients with and without reoperations was conducted, and binary logistic regression was used to identify factors associated with reoperation. Patients were further stratified by age and procedure for developing treatment recommendations.RESULTSAmong 2,261,455 live births from 2000 to 2009, 701 patients underwent operations for unilateral DDH between 1 and 3.00 years of age (an incidence of 31.0 per 1,000 live births). The initial operations included closed reduction (n = 86; mean age, 1.34 years), open reduction (n = 73; mean age, 1.53 years), pelvic osteotomy (n = 405; mean age, 1.59 years), femoral osteotomy (n = 93; mean age, 1.76 years), and pelvic osteotomy plus femoral osteotomy (n = 44; mean age, 1.84 years). Reoperations were performed in 91 patients (13%) at a mean age of 3.80 years. Comparison between patients with and without reoperations revealed the operative procedure as a significant factor. Logistic regression revealed that closed reduction was associated with a 1.8 to 9.0 times higher reoperation risk than open reduction, depending on age, whereas pelvic osteotomy was associated with 0.34 times the risk of reoperation than open reduction in patients 1.5 to 2.0 years of age.CONCLUSIONSReoperations may not be directly linked to radiographic and functional outcomes but are important from the patient's perspective and in terms of cost-effectiveness. To reduce the risk of reoperation, the findings of the present study support open reduction to properly reduce the hip joint at walking age and additional pelvic osteotomy for patients beyond 1.5 years of age.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景:再手术是手术治疗后的主要不良事件,但尚未被用作人群研究中评估髋关节发育不良(DDH)当前治疗方法的主要结果指标。本研究的目的是探讨1 - 3.00岁DDH患者麻醉下再手术的相关危险因素,目的是得出治疗建议。​随访儿童至10岁再手术,不包括术后3个月内取出种植体和连续闭合复位。再手术患者与未再手术患者进行比较,采用二元logistic回归分析再手术相关因素。患者进一步按年龄和程序分层,以制定治疗建议。结果在2000 - 2009年的2,261,455例活产婴儿中,701例患者在1 - 3.00岁之间接受了单侧DDH手术(每1,000例活产婴儿中有31.0例)。初始手术包括闭合复位(n = 86;平均年龄1.34岁),切开复位(n = 73;平均年龄1.53岁),盆腔截骨术(n = 405;平均年龄1.59岁),股骨截骨术(n = 93;平均年龄1.76岁),盆腔截骨加股骨截骨术(n = 44;平均年龄1.84岁)。再手术91例(13%),平均年龄3.80岁。再手术患者与未再手术患者的比较显示手术方式是重要的影响因素。Logistic回归显示闭合复位的再手术风险是切开复位的1.8 - 9.0倍,与年龄有关,而盆腔截骨术的再手术风险是1.5 - 2.0岁患者切开复位的0.34倍。结论再手术可能与影像学和功能预后没有直接联系,但从患者的角度和成本效益来看是重要的。为了降低再次手术的风险,本研究的结果支持在步行年龄时进行切开复位以适当地复位髋关节,并支持对1.5岁以上的患者进行额外的骨盆截骨。证据水平:预后III级。有关证据水平的完整描述,请参见作者说明。
{"title":"Reoperations as an Outcome Indicator for Developmental Dysplasia of the Hip Treated at Walking Age.","authors":"Chia Hsieh Chang,Chi Lun Hung,Wei Chun Lee,Hsuan Kai Kao,Shu Mei Wang,Ken N Kuo","doi":"10.2106/jbjs.24.00486","DOIUrl":"https://doi.org/10.2106/jbjs.24.00486","url":null,"abstract":"BACKGROUNDReoperation is a major adverse event following surgical treatment but has yet to be used as a primary outcome measure in population studies to assess current treatments for developmental dysplasia of the hip (DDH). The purpose of the present study was to explore the risk factors associated with reoperations following procedures under anesthesia (\"operations\") for DDH in patients between the ages of 1 and 3.00 years, with the goal of deriving treatment recommendations.METHODSThis retrospective birth cohort study included children who had undergone closed reduction, open reduction, or osteotomy for the treatment of unilateral DDH between the ages of 1 and 3.00 years, identified using the Taiwan National Health Insurance Research Database. The children were followed until 10 years of age for reoperations, excluding implant removal and sequential closed reduction within 3 months postoperatively. A comparison between patients with and without reoperations was conducted, and binary logistic regression was used to identify factors associated with reoperation. Patients were further stratified by age and procedure for developing treatment recommendations.RESULTSAmong 2,261,455 live births from 2000 to 2009, 701 patients underwent operations for unilateral DDH between 1 and 3.00 years of age (an incidence of 31.0 per 1,000 live births). The initial operations included closed reduction (n = 86; mean age, 1.34 years), open reduction (n = 73; mean age, 1.53 years), pelvic osteotomy (n = 405; mean age, 1.59 years), femoral osteotomy (n = 93; mean age, 1.76 years), and pelvic osteotomy plus femoral osteotomy (n = 44; mean age, 1.84 years). Reoperations were performed in 91 patients (13%) at a mean age of 3.80 years. Comparison between patients with and without reoperations revealed the operative procedure as a significant factor. Logistic regression revealed that closed reduction was associated with a 1.8 to 9.0 times higher reoperation risk than open reduction, depending on age, whereas pelvic osteotomy was associated with 0.34 times the risk of reoperation than open reduction in patients 1.5 to 2.0 years of age.CONCLUSIONSReoperations may not be directly linked to radiographic and functional outcomes but are important from the patient's perspective and in terms of cost-effectiveness. To reduce the risk of reoperation, the findings of the present study support open reduction to properly reduce the hip joint at walking age and additional pelvic osteotomy for patients beyond 1.5 years of age.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988735","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}
引用次数: 0
Orthopaedic Surgery in the Jehovah's Witness Patient: Clinical, Ethical, and Legal Considerations.
Pub Date : 2025-01-15 DOI: 10.2106/jbjs.24.00749
Benjamin K Stone,Tucker C Callanan,Alejandro Perez-Albela,Bryce A Basques
➢ Jehovah's Witnesses refuse allogeneic blood products based on religious beliefs that create clinical, ethical, and legal challenges in orthopaedic surgery, requiring detailed perioperative planning and specific graft selection.➢ Detailed perioperative planning is particularly important for procedures with high intraoperative blood loss.➢ Graft selection must align with Jehovah's Witnesses patients' religious beliefs, with options including autografts, allografts, and synthetic materials; this requires shared decision-making between the patient and surgeon.➢ A multidisciplinary approach, integrating medical, ethical, and religious considerations, ensures optimal care, with innovative techniques and open dialogue being key to successful outcomes.
​(四)对于术中出血量大的手术,详细的围手术期计划尤为重要。​这需要患者和外科医生共同决策。(五)采用多学科方法,综合考虑医学、伦理和宗教因素,确保最佳护理,创新技术和公开对话是取得成功的关键。
{"title":"Orthopaedic Surgery in the Jehovah's Witness Patient: Clinical, Ethical, and Legal Considerations.","authors":"Benjamin K Stone,Tucker C Callanan,Alejandro Perez-Albela,Bryce A Basques","doi":"10.2106/jbjs.24.00749","DOIUrl":"https://doi.org/10.2106/jbjs.24.00749","url":null,"abstract":"➢ Jehovah's Witnesses refuse allogeneic blood products based on religious beliefs that create clinical, ethical, and legal challenges in orthopaedic surgery, requiring detailed perioperative planning and specific graft selection.➢ Detailed perioperative planning is particularly important for procedures with high intraoperative blood loss.➢ Graft selection must align with Jehovah's Witnesses patients' religious beliefs, with options including autografts, allografts, and synthetic materials; this requires shared decision-making between the patient and surgeon.➢ A multidisciplinary approach, integrating medical, ethical, and religious considerations, ensures optimal care, with innovative techniques and open dialogue being key to successful outcomes.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988680","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}
引用次数: 0
Prevalence of Complications Due to Transphyseal Hematogenous Osteomyelitis. 经骨骺血液性骨髓炎并发症的发生率。
Pub Date : 2024-12-27 DOI: 10.2106/jbjs.24.00101
Blaise Cochard,Asia Ciprani,Marco Cirillo,Céline Habre,Oscar Vazquez,Louise Frizon,Benedetta Bracci,Romain Dayer,Andrezj Krzysztofiak,Dimitri Ceroni
BACKGROUNDTransphyseal hematogenous osteomyelitis (THO) is a common infectious condition, being present in 25% of patients with hematogenous osteomyelitis. A large proportion of pediatric hematogenous osteomyelitis infections can spread through the growth cartilage and therefore may be potentially responsible for growth disorders, leading to limb-length discrepancy or angular deformities. The purpose of the present study was to identify both the prevalence of complications caused by transphyseal osteomyelitis and factors influencing their occurrence.METHODSThe records for all patients who had been treated for THO over a 17-year period at the University Hospitals of Geneva and the Gesù Bambino Hospital in Rome were retrospectively analyzed. Clinical, biological, and bacteriological data were analyzed. Magnetic resonance imaging (MRI) scans were reviewed for all patients to assess the cross-sectional area of growth plate involvement. Restart of growth of the affected physeal cartilage was subsequently monitored by means of iterative radiographic examination.RESULTSFrom a cohort of 594 patients with hematogenous osteomyelitis, 89 patients (15.0%) were found to have THO. The median age was 84 months (range, 1 to 167 months), with a bimodal distribution and peaks at 30 and 150 months; 59.6% (53) of the 89 patients were male. The lower limbs were most often affected, with the distal tibia and fibula accounting for 47.2% of all cases. Methicillin-sensitive Staphylococcus aureus and Kingella kingae were the most frequently identified pathogens, accounting for 61.8% of the cases. Virulence factors, such as Panton-Valentine leukocidin (PVL), toxic shock syndrome toxin (TSST), and accessory gene regulator (Agr), were recorded in 12.4% of MSSA strains. Transphyseal lesions affected a median of 7.6% (range, 0.79% to 58.2%) of the physeal surface. Complications affecting further growth were noted in 13% of patients with THO. Thrombocytopenia, leukocytosis, and the presence of virulence factors significantly influenced the occurrence of complications.CONCLUSIONSTHO affects all age categories of the pediatric population. In the present study, growth disturbance occurred in 13% of cases. The presence of deep thrombocytopenia, leukocytosis, and virulence factors, such as Agr, TSST, and PVL, seems to strongly influence the occurrence of such complications.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景:经骨骺血流性骨髓炎(THO)是一种常见的感染性疾病,在25%的血流性骨髓炎患者中存在。很大一部分儿童血液性骨髓炎感染可以通过生长软骨传播,因此可能潜在地导致生长障碍,导致肢体长度差异或角度畸形。本研究的目的是确定由骨髓炎引起的并发症的患病率和影响其发生的因素。方法回顾性分析日内瓦大学医院和Gesù罗马Bambino医院17年来治疗THO的所有患者的记录。对临床、生物学和细菌学资料进行分析。对所有患者进行磁共振成像(MRI)扫描以评估生长板受累的横截面积。随后通过反复x线检查监测受影响的骨骺软骨的重新生长。结果594例血液性骨髓炎患者中,89例(15.0%)发现有THO。年龄中位数为84月龄(1 ~ 167月龄),呈双峰分布,高峰在30月龄和150月龄;89例患者中男性53例,占59.6%。下肢多见,胫骨远端和腓骨占47.2%。以甲氧西林敏感金黄色葡萄球菌和金氏菌最为常见,占病例数的61.8%。12.4%的MSSA菌株存在潘通-瓦伦丁杀白细胞素(PVL)、中毒性休克综合征毒素(TSST)和辅助基因调节剂(Agr)等毒力因子。经骨骺病变影响骨骺表面的中位数为7.6%(范围0.79%至58.2%)。13%的THO患者出现影响进一步生长的并发症。血小板减少症、白细胞增多症和毒力因子的存在显著影响并发症的发生。结论tho影响所有年龄段的儿童人群。在本研究中,13%的病例发生生长障碍。深度血小板减少症、白细胞增多症和毒力因子(如Agr、TSST和PVL)的存在似乎强烈影响此类并发症的发生。证据级别:治疗性IV级。参见《作者说明》获得证据级别的完整描述。
{"title":"Prevalence of Complications Due to Transphyseal Hematogenous Osteomyelitis.","authors":"Blaise Cochard,Asia Ciprani,Marco Cirillo,Céline Habre,Oscar Vazquez,Louise Frizon,Benedetta Bracci,Romain Dayer,Andrezj Krzysztofiak,Dimitri Ceroni","doi":"10.2106/jbjs.24.00101","DOIUrl":"https://doi.org/10.2106/jbjs.24.00101","url":null,"abstract":"BACKGROUNDTransphyseal hematogenous osteomyelitis (THO) is a common infectious condition, being present in 25% of patients with hematogenous osteomyelitis. A large proportion of pediatric hematogenous osteomyelitis infections can spread through the growth cartilage and therefore may be potentially responsible for growth disorders, leading to limb-length discrepancy or angular deformities. The purpose of the present study was to identify both the prevalence of complications caused by transphyseal osteomyelitis and factors influencing their occurrence.METHODSThe records for all patients who had been treated for THO over a 17-year period at the University Hospitals of Geneva and the Gesù Bambino Hospital in Rome were retrospectively analyzed. Clinical, biological, and bacteriological data were analyzed. Magnetic resonance imaging (MRI) scans were reviewed for all patients to assess the cross-sectional area of growth plate involvement. Restart of growth of the affected physeal cartilage was subsequently monitored by means of iterative radiographic examination.RESULTSFrom a cohort of 594 patients with hematogenous osteomyelitis, 89 patients (15.0%) were found to have THO. The median age was 84 months (range, 1 to 167 months), with a bimodal distribution and peaks at 30 and 150 months; 59.6% (53) of the 89 patients were male. The lower limbs were most often affected, with the distal tibia and fibula accounting for 47.2% of all cases. Methicillin-sensitive Staphylococcus aureus and Kingella kingae were the most frequently identified pathogens, accounting for 61.8% of the cases. Virulence factors, such as Panton-Valentine leukocidin (PVL), toxic shock syndrome toxin (TSST), and accessory gene regulator (Agr), were recorded in 12.4% of MSSA strains. Transphyseal lesions affected a median of 7.6% (range, 0.79% to 58.2%) of the physeal surface. Complications affecting further growth were noted in 13% of patients with THO. Thrombocytopenia, leukocytosis, and the presence of virulence factors significantly influenced the occurrence of complications.CONCLUSIONSTHO affects all age categories of the pediatric population. In the present study, growth disturbance occurred in 13% of cases. The presence of deep thrombocytopenia, leukocytosis, and virulence factors, such as Agr, TSST, and PVL, seems to strongly influence the occurrence of such complications.LEVEL OF EVIDENCETherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887506","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}
引用次数: 0
Developing Linkages Between PROMIS Physical Function CAT and QuickDASH Scores in Hand Surgery: A Crosswalk Study. 手外科中PROMIS身体功能CAT和QuickDASH评分之间的联系:一项人行横道研究。
Pub Date : 2024-12-27 DOI: 10.2106/jbjs.23.01400
Joshua R Daryoush,Miranda J Rogers,Chong Zhang,Mario J Quesada,Amy M Cizik,Angela P Presson,Nikolas H Kazmers
BACKGROUNDThere is no standardization within hand and upper-extremity surgery regarding which patient-reported outcome measures (PROMs) are collected and reported. This limits the ability to compare or combine cohorts that utilize different PROMs. The aim of this study was to develop a linkage model for the QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand) and PROMIS PF CAT (Patient-Reported Outcomes Measurement Information System Physical Function computerized adaptive testing) instruments to allow interconversion between these PROMs in a hand surgery population.METHODSA retrospective review was conducted to identify adults (≥18 years old) who had completed the QuickDASH and PROMIS PF CAT instruments at the same clinical encounter. Patients with shoulder pathology were excluded. The linear relationship between scores was evaluated with use of the Pearson correlation coefficient. Linking was performed with use of several common methods, and an optimal linkage model was recommended on the basis of a higher R2, strong intraclass correlation coefficient (ICC), and lower standard error (SE). The recommended model was further evaluated in subgroups based on age (<60 or ≥60 years), sex, etiology for presentation (traumatic versus atraumatic), and treatment type (operative versus nonoperative).RESULTSA total of 15,019 patients (mean age, 49 years; 54% female; 86% White) were included. The mean QuickDASH score (and standard deviation) was 37 ± 22, and the mean PROMIS PF CAT score was 45 ± 10. There was a strong negative linear relationship between the QuickDASH and PROMIS PF CAT (r = -0.73). The circle-arc linkage model demonstrated good accuracy and reliability (R2 = 0.55; ICC = 0.71), and crosswalk tables were developed from this model. The subgroup analysis demonstrated age-related bias in the linkage model (root expected mean squared difference, 0.12). To address this, a separate crosswalk table was developed, which was dichotomized by age category.CONCLUSIONSThe QuickDASH and PROMIS PF CAT scores were successfully linked. Utilization of the developed crosswalks-one specific to patients <60 years old and another specific to patients ≥60 years old-will allow for score interconversion in future meta-analyses and multicenter hand surgery studies.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景:在手部和上肢手术中,关于收集和报告患者报告的结果测量(PROMs)没有标准化。这限制了比较或组合使用不同prom的队列的能力。本研究的目的是为QuickDASH(手臂、肩膀和手的残疾的缩写版本)和PROMIS PF CAT(患者报告的结果测量信息系统物理功能计算机化自适应测试)仪器开发一个联动模型,以便在手外科人群中实现这些PROMs之间的相互转换。方法回顾性分析在同一次临床会面中完成QuickDASH和PROMIS PF CAT仪器的成人(≥18岁)。排除有肩部病变的患者。使用Pearson相关系数评估得分之间的线性关系。使用几种常用的方法进行链接,并以较高的R2、较强的类内相关系数(ICC)和较低的标准误差(SE)为基础推荐了最优链接模型。根据年龄(<60岁或≥60岁)、性别、病因(创伤性与非创伤性)和治疗类型(手术与非手术)进一步评估推荐的模型。结果共15019例患者(平均年龄49岁;54%的女性;86%为白人)。平均QuickDASH评分(及标准差)为37±22分,平均PROMIS PF CAT评分为45±10分。QuickDASH与PROMIS PF CAT呈显著负线性关系(r = -0.73)。圆弧联动模型具有良好的精度和可靠性(R2 = 0.55;ICC = 0.71),并根据该模型编制人行横道表。亚组分析显示连锁模型存在年龄相关偏倚(根期望均方差为0.12)。为了解决这个问题,开发了一个单独的人行横道表,按年龄分类。结论QuickDASH评分与PROMIS PF CAT评分成功衔接。使用已开发的人行横道-一个针对<60岁的患者,另一个针对≥60岁的患者-将允许在未来的meta分析和多中心手外科研究中进行评分转换。证据水平:预后III级。有关证据水平的完整描述,请参见作者说明。
{"title":"Developing Linkages Between PROMIS Physical Function CAT and QuickDASH Scores in Hand Surgery: A Crosswalk Study.","authors":"Joshua R Daryoush,Miranda J Rogers,Chong Zhang,Mario J Quesada,Amy M Cizik,Angela P Presson,Nikolas H Kazmers","doi":"10.2106/jbjs.23.01400","DOIUrl":"https://doi.org/10.2106/jbjs.23.01400","url":null,"abstract":"BACKGROUNDThere is no standardization within hand and upper-extremity surgery regarding which patient-reported outcome measures (PROMs) are collected and reported. This limits the ability to compare or combine cohorts that utilize different PROMs. The aim of this study was to develop a linkage model for the QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand) and PROMIS PF CAT (Patient-Reported Outcomes Measurement Information System Physical Function computerized adaptive testing) instruments to allow interconversion between these PROMs in a hand surgery population.METHODSA retrospective review was conducted to identify adults (≥18 years old) who had completed the QuickDASH and PROMIS PF CAT instruments at the same clinical encounter. Patients with shoulder pathology were excluded. The linear relationship between scores was evaluated with use of the Pearson correlation coefficient. Linking was performed with use of several common methods, and an optimal linkage model was recommended on the basis of a higher R2, strong intraclass correlation coefficient (ICC), and lower standard error (SE). The recommended model was further evaluated in subgroups based on age (<60 or ≥60 years), sex, etiology for presentation (traumatic versus atraumatic), and treatment type (operative versus nonoperative).RESULTSA total of 15,019 patients (mean age, 49 years; 54% female; 86% White) were included. The mean QuickDASH score (and standard deviation) was 37 ± 22, and the mean PROMIS PF CAT score was 45 ± 10. There was a strong negative linear relationship between the QuickDASH and PROMIS PF CAT (r = -0.73). The circle-arc linkage model demonstrated good accuracy and reliability (R2 = 0.55; ICC = 0.71), and crosswalk tables were developed from this model. The subgroup analysis demonstrated age-related bias in the linkage model (root expected mean squared difference, 0.12). To address this, a separate crosswalk table was developed, which was dichotomized by age category.CONCLUSIONSThe QuickDASH and PROMIS PF CAT scores were successfully linked. Utilization of the developed crosswalks-one specific to patients <60 years old and another specific to patients ≥60 years old-will allow for score interconversion in future meta-analyses and multicenter hand surgery studies.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887812","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}
引用次数: 0
Shared Decision-Making in Total Hip and Knee Arthroplasty: Understanding Surgeon and Patient Perspectives Regarding When It Is Time for Surgery. 全髋关节和膝关节置换术的共同决策:了解外科医生和患者对何时进行手术的看法。
Pub Date : 2024-12-27 DOI: 10.2106/jbjs.24.00685
Elizabeth A Kroll,Celestine E Warren,Robert Schlegel,C McCollister Evarts,Patricia D Franklin,Conrad Persels,Nancy A Mullen,Mary Beth Crummer,Sally P Seeley,Sue Lockett,Wayne E Moschetti,James Nace,Eric M Cohen,Brent Lanting,Richard Iorio,Antonia F Chen,James A Browne,Brock A Lindsey,Michael S Kain,Yale A Fillingham,Richard M Terek,Kevin L Garvin,James I Huddleston,Stephanie F Chomos,Kimberly M Lewis,Carol A Lambourne,Vincent D Pellegrini
BACKGROUNDAlthough total hip and total knee arthroplasty are highly successful operations, the decision of whether and when to undergo surgery is highly subjective and discretionary, and specific guidelines regarding readiness for surgery remain elusive. The nature of these decisions underscores the importance of shared decision-making, which is founded on the concept that patients substantially contribute to determining their own readiness for surgery. The OPTION survey was developed as a conversation aid to facilitate shared decision-making in the context of total joint arthroplasty.METHODSThe OPTION survey was created in partnership with a panel of 10 active joint replacement patients and 15 arthroplasty surgeons, using a modified Delphi methodology that employed 3 sequential meetings by each group. The survey interrogates patient and surgeon ratings of pain, activity limitation, duration of treatment, prior treatments, and quality of life; patient-rated treatment priorities, readiness for surgery, and surgeon engagement; and surgeon-graded radiographic disease. The survey was administered as an institutional review board-approved pilot during 641 patient-clinician encounters for hip or knee arthritis at 9 U.S. sites, and was independently completed by the patient and surgeon.RESULTSPatient self-assessment of readiness for surgery includes consideration of existing functional impairment, outcome priorities, realistic expectations, and personal socioeconomic circumstances. Patients most commonly ranked removal of activity limitations as their top treatment priority, while alleviation of pain and avoidance of a long recovery were also ranked highly. Mild and severe pain were associated with similar radiographic disease severity, and worsening radiographic disease was associated with increasing patient-reported readiness for surgery. Patients and surgeons agreed on symptom severity in >90% of cases. When disagreement occurred, surgeons typically underestimated patient-reported symptoms; these cases were associated with lower patient-rated surgeon engagement in shared decision-making conversations.CONCLUSIONSShared decision-making conversations substantially contributed to the assessment of patient readiness for joint replacement surgery. When patient and surgeon assessments were not aligned, surgeons most commonly underestimated patient-perceived impairment. These observations should inform optimal surgeon-patient communications.LEVEL OF EVIDENCEPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
虽然全髋关节和全膝关节置换术是非常成功的手术,但是否以及何时进行手术的决定是高度主观和随意的,并且关于手术准备的具体指南仍然难以捉摸。这些决定的性质强调了共同决策的重要性,这是建立在患者对决定自己的手术准备程度有很大贡献的概念基础上的。OPTION调查是作为对话辅助工具开发的,以促进全关节置换术背景下的共同决策。方法OPTION调查由10名关节置换患者和15名关节置换外科医生组成,采用改进的德尔菲方法,每组进行3次连续会议。调查询问患者和外科医生对疼痛、活动限制、治疗持续时间、既往治疗和生活质量的评分;患者评价的治疗优先级、手术准备情况和外科医生参与情况;以及外科分级放射学疾病。该调查作为机构审查委员会批准的试点项目,在美国9个地点的641例髋关节或膝关节关节炎患者与临床医生的接触中进行,并由患者和外科医生独立完成。结果患者对手术准备情况的自我评估包括考虑现有功能障碍、结果优先级、现实期望和个人社会经济情况。患者通常将解除活动限制列为他们的首要治疗重点,同时减轻疼痛和避免长期恢复也被列为高度优先。轻度和重度疼痛与相似的放射学疾病严重程度相关,放射学疾病恶化与患者报告的手术准备程度增加相关。在90%的病例中,患者和外科医生对症状严重程度的看法一致。当出现分歧时,外科医生通常会低估患者报告的症状;这些病例与患者对外科医生参与共同决策对话的评价较低有关。结论共同的决策对话对评估关节置换术患者的准备程度有很大的帮助。当患者和外科医生的评估不一致时,外科医生通常会低估患者感知的损伤。这些观察结果应该为最佳的医患沟通提供信息。证据水平:预后III级。有关证据水平的完整描述,请参见作者说明。
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The Journal of Bone & Joint Surgery
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