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Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_9 | Pages 60 - 60
1 Oct 2020
Yousef M Franklin P Zheng H Ayers DC
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Introduction

Patient satisfaction is an important outcome measure after total knee arthroplasty (TKA) and is the ultimate goal of surgery. However, patient satisfaction reflects a complex construct of the patient's personal expectations and preferences in addition to subjective evaluation of outcome after TKA. Multiple studies have found a patient dissatisfaction rate of approximately 20% at 1 year after TKA. The purpose of this study is to determine whether there is an association between a single-item validated TKA satisfaction score and patient-reported outcome measures (PROMs) at 3 time points (1, 2, and 5 years after TKA) and to determine if dissatisfaction rate after TKA varies over time.

Methods

A multi-center, prospective cohort of 12,952 patients (8,078 patients were assessed at 1-year, 702 patients at 2-year, and 4,172 patients at 5-year) undergoing primary TKA were enrolled by 230 surgeons in 28 states between 2012–2015. Surgeons practices varied in size, reimbursement models, and geographic setting ensuring that the cohort included diverse patient populations and delivery models. Surgeons agreed to invite all TKA patients to participate and sporadic audits of surgical logs validated that all patients were invited and > 90% of patients were included. Demographic and clinical data [age, gender, body mass index (BMI), and modified Charlson co-morbidity index (CCI)] were collected. Patient-reported outcome measures (PROMs) were collected pre-op and post-op at 1, 2, and 5 years using an internet-based platform including the KOOS (total score, and pain, ADL, QoL sub scores), KOOS Jr, SF-36 (PCS and MCS). We used the single-item satisfaction scale which was tested and validated by the Swedish Knee Arthroplasty Registry. The patients' responses were made on 5-point Likert scale (very satisfied, somewhat satisfied, neutral, somewhat dissatisfied, very dissatisfied). Patients were classified into 2 categories: satisfied group for patients who answered satisfied or very satisfied and dissatisfied group for patients answered neutral, somewhat dissatisfied, or very dissatisfied. Univariate analysis of the difference between the satisfied and dissatisfied patients' groups was performed using Mann-Whitney U test for continuous variables and chi-square test for categorical variables. Logistic regression model was performed to study the correlation between the satisfaction and PROMs with 95% confidence interval.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_I | Pages - 5
1 Mar 2002
Fehily M Fleming P Yousef M Khan R Mohoklar K Borton D
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Open reduction and internal fixation is the treatment of choice for patients with displaced fractures of the lateral and medial malleoli. Ideally, operative treatment restores sufficient stability to allow full mobility at the ankle joint. However, because of the necessity to protect the ankle from weight-bearing and other forces, we routinely immobilise the ankle in a below-knee cast because of our concerns about patient compliance. We carried out a prospective study to assess patient compliance with instructions on non-weight bearing following ORIF of ankle fractures.

All 30 patients at our hospital who were treated for an ankle fracture over a 14 month period were included in our study. 22 of these underwent ORIF. A below knee cast was applied in all cases, and patients were instructed not to put any weight on the injured limb. A pressure sensitive film (Fuji Prescale Film, Sensor Products Inc., NJ, USA) was incorporated into the cast beneath the heel pad. Patients were informed that this was being done to measure the pressure within the cast, for the purposes of a trial. The cast was changed (including the pressure sensitive film) at two-week intervals over a six week period, providing three separate measurements of pressure on the heel. The sole of the cast was also examined, to complement the findings on the pressure film. At each visit, the patients level of pain was assessed using a visual analogue score, and the wound (if present) was examined.

There was a remarkable variation in the amount of weight bearing performed by the patients in this study, but several trends could be observed. In most cases, patient compliance was greatest in the first four weeks following cast application, but patients tended to put significant weight on the limb in the 4–6 week period. Female patients tended to comply better than males. Patients with a history of alcohol or drug abuse complied poorly. Compliance was lower in those individuals with lower pain scores. Of interest, the degree of weight bearing did not significantly affect the radiological or clinical outcome at the 6-week mark in any case. We conclude that patient compliance with non-weight bearing is generally poor, although the effect of this poor compliance on the long-term outcome requires further study.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_I | Pages - 7
1 Mar 2002
Fleming P Bermingham N Fehily M Khan R Yousef M Fenelon G O’Leary J
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Background: Non-union of fractures is a common problem faced by orthopaedic surgeons. Although the basic processes of fracture healing have been better elucidated in recent years, in terms of their cellular and molecular biology, the pathogenesis of fracture non-union remains poorly understood.

Aims: To examine the pattern of cytokine expression in established non-unions, in particular the inflammatory cytokines interleukin 1 and tumour necrosis factor alpha.

Materials and Methods: Tissue was taken from 7 non united fractures at the time of a surgical procedure aimed at effecting union. Part of the tissue was snap-frozen in liquid nitrogen, and a portion of the sample was processed for routine histology. Normal bone tissue was taken from the femoral shaft at the time of arthoplasty, to provide normal control tissue. Total RNA was extracted from the frozen tissue by means of a mortar and pestle and a modified phenol-chloroform extraction protocol. Cytokine expression patterns were examined using the Cytokine Gene Expression plate I (PE Biosystems) and analysed using the Sequence Detection Software and Microsoft Excel.

Results: A consistent pattern of cytokine expression was seen in all non-union tissue samples. There was marked suppression of interleukin 1 beta, interleukin 8, interleukin 10 and TNF-alpha when compared to resting bone. This environment is thus one where the stimulus for bone resorption is suppressed, with consequent loss of stimulation of bone formation (theory of “bone coupling”), directly and also possibly through interaction with prostaglandin production. In addition, collagen production is stimulated preferentially. These findings argue against the traditional definitions of fracture non-union, and suggest a possible adjunctive role for the administration of interleukins in the treatment of non-united fractures.