This study aims to determine satisfaction rates after hip and knee arthroplasty in patients who did not initially respond to PROMs, characteristics of non-responders, and contact preferences to maximise response rates. We performed a prospective cohort study of 709 patients undergoing THA and 737 patients undergoing TKA in a single centre in 2018. EQ-5D health related quality of life score and Oxford Hip/knee scores (OHS/OKS) were completed preoperatively and at 1year postoperatively via post when satisfaction was also assessed. Univariate, multivariate and receiver operator curve analysis were performed. 151/709 (21.2%) hip patients were non-responders, 83 (55.0%) of whom were contactable. 108/737 (14.6%) knee patients were non-responders, 91 (84.3%) of whom were contactable. There was no difference in satisfaction after arthroplasty between initial non-responders and responders for hips (74/81 vs 476/516, p=0.847) or knees (81/93 vs 470/561, p=0.480). Initial and persistent non-response was associated with younger age, higher BMIs and significantly worse preoperative PROMS for both hip and knee patients (p=0.05). Multivariate analysis demonstrated that younger age, higher BMI and poorer pre-operative OHS were independently associated with persistent non-response to hip PROMs (p<0.05). For the entire cohort (n=1352) patients <67 years were less likely to respond to postal PROMs with OR 0.63 (0.558 to 0.711). Using a threshold of >66.4 years predicted a preference for contact by post with 65.4% sensitivity and 68.1% specificity (AUC 0.723 (0.647-0.799 95%CI, p<0.001)). Most initial non-responders were ultimately contactable with effort. Satisfaction rates were not inferior in patients who did not initially respond to PROMs.
There is minimal published data regarding the long-term functional outcome in pyogenic spinal infection. Previous studies have used heterogeneous, unreliable and non-validated measure instruments, or neurological outcome alone, yielding data that is difficult to interpret. We aim to assess long-term adverse outcome using standardised measures, Oswestry disability index (ODI) and MOS short form-36 (SF-36). All cases of pyogenic spinal infection presenting to a single institution managed operatively and non-operatively from 1994-2004 were retrospectively identified. Follow-up was by clinical review and standardised questionnaires. Inclusion in each case was on the basis of consistent clinical, imaging and microbiology criteria.Background
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Nonagenarian patients with hip fractures present many challenges to the clinician, both in terms of their advanced age and medical co-morbidities with potential orthopaedic complications. Our aims were to assess outcome of hip fractures in a nonagenarian population with respect to pre-operative predictors of outcome, immediate and long-term morbidity, and survival rates. Nonagenarian patients with a hip fracture admitted between January 2000 and December 2003 were considered. Eighty-one patients were included, the majority being female (M: F 14: 67). Ages ranged from 90 to 98 years for female patients (mean 92.5 years, SD 2.2) compared to 90 to 95 years for male patients (mean 92.7 years, SD 2).Introduction
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