Acta Orthopaedica最新文献

Background and purpose:  Measuring patient satisfaction after total hip (THA) and total knee arthroplasty (TKA) is important. We aimed to cross-culturally adapt and examine the psychometric properties of the self-reported Goodman Satisfaction Score (GSS) in a sample of Norwegian patients following primary THA and TKA.

Methods:  The GSS was translated and adapted into Norwegian (GSS-NO) following standard guidelines. 800 patients from the Norwegian Arthroplasty Register who had undergone surgery 6-11 months prior were invited to complete GSS-NO and questions on sociodemographic factors, pain, and function in a cross-sectional study. We examined validity in relation to internal structure, response processes, and precision using Rasch analysis, relationships between the GSS-NO and pain and function using Pearson's correlation coefficients, and test-retest reliability using linear weighted kappa statistics.

Results:  The GSS-NO was adapted with few challenges. 404 patients (49% THA, 51% TKA) returned complete answers. The GSS-NO met all criteria regarding the rating scale functioning. Local independence among items and unidimensionality was supported and there was acceptable goodness-of-fit. The internal consistency was 0.94. We found no systematic differential item functioning by age, sex, work status, education, cohabitation status, or hip or knee surgery. The correlation coefficients between GSS-NO and pain and function outcomes were 0.79 (95% confidence interval [CI] 0.76-0.82) and 0.79 (CI 0.76-0.82), respectively. Test-retest reliability with weighted kappa ranged from 0.43-0.55 for THA and 0.54-0.81 for TKA.

Conclusion:  The cross-cultural adaptation of GSS-NO proved to be a valid and reliable measure for use in Norwegian-speaking patients following primary THA and TKA.

Background and purpose:  Computed tomography radiostereometric analysis (CT-RSA) assesses implant micromovements using low-dose CT scans. We aimed to investigate whether CT-RSA is comparable to marker-based radiostereometric analysis (RSA) measuring early femoral head migration in cemented stems. We hypothesized that CT-RSA is comparable to marker-based RSA in evaluating femoral head subsidence.

Methods:  We prospectively included 31 patients undergoing cemented total hip arthroplasty (THA), of which 27 were eligible for the analysis. Femoral head migration at 1 year was measured with marker-based RSA and CT-RSA. Comparison was performed using paired analysis and Bland-Altman plots, and the intra- and interobserver reliability of CT-RSA was assessed Results: The median (interquartile range [IQR]) translation on the Y-axis measured with marker-based RSA was -0.86 mm (-1.10 to -0.37) and -0.83 mm (-1.11 to -0.48) for CT-RSA (i.e. subsidence), with a median difference of -0.03 mm (95% confidence interval [CI] -0.08 to 0.18). The minimal important difference in translation was set to 0.2 mm. This value was excluded from the CI of the differences. No statistical difference was found between marker-based RSA and CT-RSA regarding assessment of subsidence of the femoral head. The Bland-Altman plots showed good agreement between the 2 methods in measuring subsidence of the femoral head. The intra- and interobserver reliability of the CT-RSA method was excellent with intraclass correlation coefficient (ICC) = 1 (0.99-1) and ICC = 0.99 (0.99-1), respectively.

Conclusion:  We showed that CT-RSA was comparable to marker-based RSA in measuring femoral head subsidence. Moreover, the intra- and interobserver reliability of the CT-RSA method was excellent, suggesting that the method is assessor independent.

Purpose:  We aimed to evaluate the association between socioeconomic factors and patient-reported Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 1 year after hemiarthroplasty, reverse, or anatomical total shoulder arthroplasty for osteoarthritis or cuff-tear arthropathy.

Methods:  Eligible patients were identified using linked national data from the Danish Shoulder Arthroplasty Registry and Statistics Denmark between April 2012 and April 2019. Univariable and multivariable linear regression was used to identify the association between socioeconomic factors and the WOOS index at 1 year following primary shoulder arthroplasty adjusted for age, sex, underlying diagnosis, implant design, and comorbidities. We examined socioeconomic factors including employment status, marital status, education, and income. Estimates were provided with 95% confidence intervals (CI).

Results:  2,292 patients were identified with a mean WOOS index of 76 (standard deviation 24). In the adjusted analysis, unemployed patients had a significantly lower WOOS index compared with patients with low-level jobs (14, CI 7.0-21), patients with high-level jobs (19, CI 12-25), and retired patients (14, CI 8.3-21). Low education level was associated with a lower WOOS index compared with medium education (4.8, CI 2.6-7.0) and high education level (7.7, CI 5.0-10). There was no association between WOOS index and income or marital status.

Conclusion:  Unemployment and low education level were associated with worse WOOS index 1 year after shoulder arthroplasty for osteoarthritis or cuff-tear arthropathy. This highlights a potential inequity in patient-reported outcomes after shoulder arthroplasty.

Background and purpose:  Hand fractures are commonly presented in emergency departments, yet diagnostic errors persist, leading to potential complications. The use of artificial intelligence (AI) in fracture detection has shown promise, but research focusing on hand metacarpal and phalangeal fractures remains limited. We aimed to train and evaluate a convolutional neural network (CNN) model to diagnose metacarpal and phalangeal fractures using plain radiographs according to the AO/OTA classification system and custom classifiers.

Methods:  A retrospective analysis of 7,515 examinations comprising 27,965 images was conducted, with datasets divided into training, validation, and test datasets. A CNN architecture was based on ResNet and implemented using PyTorch, with the integration of data augmentation techniques.

Results:  The CNN model achieved a mean weighted AUC of 0.84 for hand fractures, with 86% sensitivity and 76% specificity. The model performed best in diagnosing transverse metacarpal fractures, AUC = 0.91, 100% sensitivity, 87% specificity, and tuft phalangeal fractures, AUC = 0.97, 100% sensitivity, 96% specificity. Performance was lower for complex patterns like oblique phalangeal fractures, AUC = 0.76.

Conclusion:  Our study demonstrated that a CNN model can effectively diagnose and classify metacarpal and phalangeal fractures using plain radiographs, achieving a mean weighted AUC of 0.84. 7 categories were deemed as acceptable, 9 categories as excellent, and 3 categories as outstanding. Our findings indicate that a CNN model may be used in the classification of hand fractures.

Background and purpose:  Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Repeated follow-ups after surgery are resource consuming. The aim was to examine whether patient-reported outcome measures (PROMs) change after the first year. The purpose of this study was to investigate whether it is necessary to obtain follow-up data from patients more than 1 year after surgery for DCM.

Methods:  We included individuals treated surgically for DCM in the Swedish Spine registry (Swespine), with available preoperative, 1-, and 2-year PROMs, primarily the European Myelopathy Scale (EMS) and secondarily the Neck Disability Index (NDI), and the European Quality of life Visual Analogue Scale (EQ-VAS). A tertiary analysis included available 5-year data. Median, interquartile range (IQR), and Bland-Altman plots were used to compare PROM data at different follow-up time points.

Results:  642 individuals had baseline, 1-, and 2-year follow-up data, of whom 347 also had 5-year data. EMS was 14 (12-16) preoperative, 15 (12-17) at the 1-year follow-up, and 15 (12-17) at the 2-year follow-up. Corresponding data for NDI was 38 (24-50), 25 (12-42), and 26 (12-42) and for EQ-VAS 50 (30-60), 60 (42-77), and 60 (40-75). Similar findings were seen in individuals who also had 5-year data. Bland-Altman plots indicated good agreement between 1- and 2-year data, and between 1- and 5-year data and were without proportional bias.

Conclusion:  In individuals treated for DCM no clinically meaningful change in PROMs occurred after the 1-year follow-up.

Background and purpose:  Recurrent hemarthrosis (RH) is a rare late complication of knee arthroplasty, with an unknown etiology. We aimed to evaluate the effectiveness of arterial embolization (AE) on resolution of hemarthrosis following knee arthroplasty. Additionally, we investigated pain management requirements after the procedure and related complications.

Methods:  56 patients underwent AE for recurrent hemarthrosis between 2015 and 2023. The prevalence of hemarthrosis was 0.6%. The median age of the patients was 70 years (range 42-88), with 41 females and 15 males. 70 embolizations were performed, consisting of 56 initial procedures and 14 repeat procedures. Clinical success was defined as the resolution of hemarthroses.

Results:  Technical success was achieved in 93% of cases. Clinical success improved from 64% to 79% after the second treatment; subsequent sessions did not yield further improvement. 12 patients (21%) required 1 or more reoperations. The majority of patients (86%) relied solely on analgesics for post-treatment pain management. Complications occurred in 7% of treatments, most of which resolved spontaneously.

Conclusion:  AE is effective in the treatment of recurrent hemarthrosis but 21% had reoccurance. Oral analgesics are generally sufficient for managing post-embolization pain. 7% had complications.

Background and purpose:  In contemporary medial unicompartmental knee arthroplasty (mUKA), non-lateral patellofemoral osteoarthritis (PFOA) is not considered a contraindication. However, we still lack knowledge on the association of PFOA severity on patient reported outcome measures (PROMs) after mUKA. We aimed to examine the association between PFOA severity and PROM-score changes after mUKA.

Methods:  We included 549 mobile-bearing mUKAs. PFOA was graded intraoperatively as 0 = normal cartilage, 1-2 = superficial changes or < 50% of depth, and 3-4 = changes of > 50% of depth or to the bone, using the International Cartilage Repair Society (ICRS) cartilage lesion classification system. All patients completed the Oxford Knee Score (OKS), Activity and Participation Questionnaire (APQ), and Forgotten Joint Score (FJS), preoperatively and 3, 12, and 24 months postoperatively. PROM changes were compared using linear regression models adjusted for sex, age, body mass index, and preoperative PROM score.

Results:  We found no significant differences in OKS, FJS, and APQ change when comparing group 3-4 with group 0 at any follow-up. When comparing group 1-2 with 0 we found a statistical but not clinical significantly higher change in OKS scores at 24-month follow-up (2.5, 95% confidence interval [CI] 0.36-4.6) and in APQ scores at 24-month follow-up (10.6, CI 1.2-20.0) in favor of group 1-2.

Conclusion: Severe PFOA, excluding severe lateral facet PFOA, had no negative association on PROM score development following mobile-bearing mUKA.

Background and purpose:  This study updates 2 parallel systematic reviews and meta-analyses from 2012, which established the 1-year radiostereometric (RSA) migration thresholds for tibial components of total knee replacements (TKR) based on the risk of late revision for aseptic loosening from survival studies. The primary aim of this study was to determine the (mis)categorization rate of the 2012 thresholds using the updated review as a validation dataset. Secondary aims were evaluation of 6-month migration, mean continuous (1- to 2-year) migration, and fixation-specific thresholds for tibial component migration.

Methods:  One review comprised early migration data, measured by maximum total point motion (MTPM), from RSA studies, while the other focused on revision rates for aseptic loosening of tibial components from survival studies. Studies were matched based on prosthesis, fixation (i.e., cemented and uncemented, and uncemented with screw fixation), and insert (PFI). For the primary aim, newly included study group combinations were compared with the 2012 RSA thresholds to determine the (mis)categorization rate. For the secondary aims, new thresholds were determined based on revision rates for any reason in national registries (5-year < 3%, 10-year < 5%, 15-year < 6.5%).

Results:  After matching studies on PFI, a total of 157 survival and 82 RSA studies were included, comprising 504 study group combinations, 51 different PFIs, and 186,974 TKRs. We found that the 2012 thresholds were valid, with a misclassification rate of 0.5% at 5 and 0.3% at 10 years. Mean continuous migration could not be used to identify safe or unsafe implants. For cemented TKR, the 6-month mean MTPM was acceptable below 0.30 mm and unacceptable above 1.10 mm. For uncemented TKR, it was acceptable below 1.10 mm and unacceptable above 1.55 mm.

Conclusion:  The updated data reaffirm the 2012 RSA thresholds, confirming their validity in estimating revision risks for tibial component aseptic loosening. The newly proposed fixation-specific 6-month migration thresholds were found to be reliable for early identification of unsafe TKR designs, while 1- to 2-year mean continuous migration data were found not to be reliable for this purpose. These findings support and refine the migration thresholds to improve the evidence-based introduction of new TKR systems.

Background and purpose:  Major lower extremity amputation (MLEA) is associated with complications that may prolong length of hospital stay (LOS) and increase the risk of readmission. We primarily aimed to examine the LOS and risk of readmissions after MLEA in Denmark. Secondarily we investigated the time trends.

Methods:  Using Danish National Patient Registry data, this observational study analyzed 11,205 first-time MLEAs (35% transtibial amputations, 65% transfemoral amputations) performed between January 1, 2010 and December 31, 2021. Total LOS included pre- and postoperative nights. The first readmission within 30 days and 90 days post-discharge was analyzed.

Results:  The median total LOS after a transtibial amputation was 19 days (interquartile range [IQR] 11-30), and decreased from 28 days (IQR 17-41) in 2010 to 14 days (IQR 9-23) in 2021. The median total LOS after a transfemoral amputation was 13 days (IQR 8-22) and decreased from 16 days (IQR 9-27) in 2010 to 11 days (IQR 7-18) in 2021. Post-discharge readmission risks within 30 days were 27% (95% confidence interval [CI] 24-28) for transtibial amputations and 23% (CI 22-24) for transfemoral amputations, with corresponding 90-day risks of 40% (CI 39-42) and 35% (CI 34-36), respectively. The 30-day risk of readmission increased in both groups.

Conclusion:  We observed that MLEA patients' hospital admissions lasted 2-3 weeks and decreased over the study period. A readmission risk of 23-27% within 30 days and 35-40 % within 90 days post-discharge was observed. Readmissions risk increased for both initial transtibial and transfemoral amputations over the study period.