Introduction: SF-36 is a validated 36-item questionnaire that measures eight dimensions of quality of life(QoL): physical functioning(PF), role physical(RP), role emotional(RE), social functioning(SF), mental health(MH), energy/vitality(EV), bodily pain(Pain) and general health perception(GHP). The primary aim of the study was to evaluate QoL outcomes after total hip replacement(THR) using SF-36.

Methods: From 5/1/1998 until 16/8/2005, we prospectively collected data on 569 patients who had THR in Fife. 30 of them had bilateral THR. Each patient was assessed pre-operatively and was reviewed at 6 months, 18 months, 3 years and 5 years post-operatively. A SF-36 was filled in at each appointment.

Results: During the period, 6 patients died, 4 had revision, 19 were lost to follow-up and 46 did not attend their 5-year review. Subsequently, 494 patients had a 5-year review but 46 of them did not fill in the questionnaire. Analysis was performed on the remaining 448 patients (male=179, female=269).

Mean scores of PF, RP, RE, SF, EV and Pain improved significantly following THR. The improvement remained significant throughout the follow-up (p< 0.0005). MH was the only dimension which did not change significantly after THR. There was a significant decline in GHP (p< 0.0005).

Females reported lower scores in all dimensions apart from GHP. They were also significantly older than the males (66.66±9.41 vs. 64.69±10.27 years; p< 0.037).

Patients who had unilateral or bilateral THR reported similar scores preoperatively and in the initial follow-up. Significant differences were only noted at 3 and 5 years with the bilateral group reported a higher score.

Discussion: THR improved QoL and the benefit was still evident at 5 years post-operatively. However the perception of general health continued to deteriorate, probably due to the effects of aging. More advanced age of females might partly contribute to their lower scores.

Aims

Lower limb reconstruction (LLR) has a profound impact on patients, affecting multiple areas of their lives. Many patient-reported outcome measures (PROMs) are employed to assess these impacts; however, there are concerns that they do not adequately capture all outcomes important to patients, and may lack content validity in this context. This review explored whether PROMs used with adults requiring, undergoing, or after undergoing LLR exhibited content validity and adequately captured outcomes considered relevant and important to patients.

Introduction. Transfemoral osseointegration (TFOI) for amputees has substantial literature proving superior quality of life and mobility versus a socketed prosthesis. Some amputees have hip arthritis that would be relieved by a total hip replacement (THR). No other group has reported performing a THR in association with TFOI (THR+TFOI). We report the outcomes of eight patients who had THR+TFOI, followed for an average 5.2 years. Materials & Methods. Our osseointegration registry was retrospectively reviewed to identify all patients who had TFOI and also had THR, performed at least two years prior. Six patients had TFOI then THR, one simultaneous, one THR then TFOI. All constructs were in continuity from hip to prosthetic limb. Outcomes were: complications prompting surgical intervention, and changes in subjective hip pain, K-level, daily prosthesis wear hours, Questionnaire for Persons with a Transfemoral Amputation (QTFA), and Short Form 36 (SF36). All patients had clinical follow-up, but one patient did not have complete mobility and quality of life survey data at both time periods. Results. Four (50%) were male, average age 52.7±14.8 years. Three patients (38%) had amputation for trauma, three for osteosarcoma, one each (13%) infected total knee and persistent infection after deformity surgery. One patient died one year after THR+TOFA from subsequently diagnosed pancreatic cancer. One patient had superficial debridement for infection with implant retention after five years. No implants were removed, no fractures occurred. All patients reported severe hip pain preoperatively versus full relief of hip pain afterwards. K-level improved from 0/8=0% K>2 (six were wheelchair-bound) to 5/8=63% (p=.026). At least 8 hours of prosthesis wear was reported by 2/7=29% before TOFA vs 5/7=71% after (p=.286). The QTFA improved in all categories, but not significantly: Global (40.0±21.6 vs 60.0±10.9, p=.136), Problem (50.2±33.2 vs 15.4±8.4, p=.079), and Mobility (35.9±26.8 vs 58.3±30.7, p=.150). The SF36 also improved minimally and not significantly: Mental (53.6±12.0 vs 54.7±4.6, p=.849) and Physical (32.5±10.9 vs 36.3±11.2, p=.634). Conclusions. THR+TFOI is a successful reconstruction option for amputees who desire relief from severe pain related to hip joint degeneration, and also the opportunity for improved mobility and quality of life that TFOI typically confers. In our cohort, the procedure proved safe: no associated deaths, no removals, one soft tissue debridement. Mobility improved markedly. Quality of life improved, but not to significant thresholds as measured by the surveys. THR+TFOI appears safe and reasonable to offer to transfemoral amputees with painful hip joint degeneration

Introduction. Transtibial osseointegration (TFOI) for amputees has limited but clear literature identifying superior quality of life and mobility versus a socketed prosthesis. Some amputees have knee arthritis that would be relieved by a total knee replacement (TKR). No other group has reported performing a TKR in association with TTOI (TKR+TTOI). We report the outcomes of nine patients who had TKR+TTOI, followed for an average 6.5 years. Materials & Methods. Our osseointegration registry was retrospectively reviewed to identify all patients who had TTOI and who also had TKR, performed at least two years prior. Four patients had TKR first the TTOI, four patients had simultaneous TKR+TTOI, and one patient had 1 OI first then TKR. All constructs were in continuity from hinged TKR to the prosthetic limb. Outcomes were: complications prompting surgical intervention, and changes in daily prosthesis wear hours, Questionnaire for Persons with a Transfemoral Amputation (QTFA), and Short Form 36 (SF36). All patients had clinical follow-up, but two patients did not have complete survey and mobility tests at both time periods. Results. Six (67%) were male, average age 51.2±14.7 years. All primary amputations were performed to manage traumatic injury or its sequelae. No patients died. Five patients (56%) developed infection leading to eventual transfemoral amputation 36.0±15.3 months later, and 1 patient had a single debridement six years after TTOI with no additional surgery in the subsequent two years. All patients who had transfemoral amputation elected for and received transfemoral osseointegration, and no infections occurred, although one patient sustained a periprosthetic fracture which was managed with internal fixation and implant retention and walks independently. The proportion of patients who wore their prosthesis at least 8 hours daily was 5/9=56%, versus 7/9=78% (p=.620). Even after proximal level amputation, the QTFA scores improved versus prior to TKR+TTOI, although not significantly: Global (45.2±20.3 vs 66.7±27.6, p=.179), Problem (39.8±19.8 vs 21.5±16.8, p=.205), Mobility (54.8±28.1 vs 67.7±25.0, p=.356). SF36 changes were also non-significant: Mental (58.6±7.0 vs 46.1±11.0, p=.068), Physical (34.3±6.1 vs 35.2±13.7, p=.904). Conclusions. TKR+TTOI presents a high risk for eventual infection prompting subsequent transfemoral amputation. Although none of these patients died, in general, TKR infection can lead to patient mortality. Given the exceptional benefit to preserving the knee joint to preserve amputee mobility and quality of life, it would be devastating to flatly force transtibial amputees with severe degenerative knee joint pain and unable to use a socket prosthesis to choose between TTOI but a painful knee, or preemptive transfemoral amputation for transfemoral osseointegration. Therefore, TTOI for patients who also request TKR must be considered cautiously. Given that this frequency of infection does not occur in patients who have total hip replacement in association with transfemoral osseointegration, the underlying issue may not be that linked joint replacement with osseointegrated limb replacement is incompatible, but may require further consideration of biological barriers to ascending infection and/or significant changes to implant design, surgical technique, or other yet-uncertain factors

Aims. Optimal exposure through the direct anterior approach (DAA) for total hip arthroplasty (THA) conducted on a regular operating theatre table is achieved with a standardized capsular releasing sequence in which the anterior capsule can be preserved or resected. We hypothesized that clinical outcomes and implant positioning would not be different in case a capsular sparing (CS) technique would be compared to capsular resection (CR). Methods. In this prospective trial, 219 hips in 190 patients were randomized to either the CS (n = 104) or CR (n = 115) cohort. In the CS cohort, a medial based anterior flap was created and sutured back in place at the end of the procedure. The anterior capsule was resected in the CR cohort. Primary outcome was defined as the difference in patient-reported outcome measures (PROMs) after one year. PROMs (Harris Hip Score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and Short Form 36 Item Health Survey (SF-36)) were collected preoperatively and one year postoperatively. Radiological parameters were analyzed to assess implant positioning and implant ingrowth. Adverse events were monitored. Results. At one year, there was no difference in HSS (p = 0.728), HOOS (Activity Daily Life, p = 0.347; Pain, p = 0.982; Quality of Life, p = 0.653; Sport, p = 0.994; Symptom, p = 0.459), or SF-36 (p = 0.338). Acetabular component inclination (p = 0.276) and anteversion (p = 0.392) as well as femoral component alignment (p = 0.351) were similar in both groups. There were no dislocations, readmissions, or reoperations in either group. The incidence of psoas tendinitis was six cases in the CS cohort (6%) and six cases in the CR cohort (5%) (p = 0.631). Conclusion. No clinical differences were found between resection or preservation of the anterior capsule when performing a primary THA through the DAA on a regular theatre table. In case of limited visibility during the learning curve, it might be advisable to resect a part of the anterior capsule. Cite this article: Bone Joint J 2021;103-B(2):321–328

Aims. Using tibial shaft fracture participants from a large, multicentre randomized controlled trial, we investigated if patient and surgical factors were associated with health-related quality of life (HRQoL) at one year post-surgery. Methods. The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) trial examined adults with an open or closed tibial shaft fracture who were treated with either reamed or unreamed intramedullary nails. HRQoL was assessed at hospital discharge (for pre-injury level) and at 12 months post-fracture using the Short Musculoskeletal Functional Assessment (SMFA) Dysfunction, SMFA Bother, 36-Item Short Form 36 (SF-36) Physical, and SF-36 Mental Component scores. We used multiple linear regression analysis to determine if baseline and surgical factors, as well as post-intervention procedures within one year of fracture, were associated with these HRQoL outcomes. Significance was set at p < 0.01. We hypothesize that, irrespective of the four measures used, prognosis is guided by both modifiable and non-modifiable factors and that patients do not return to their pre-injury level of function, nor HRQoL. Results. For patient and surgical factors, only pre-injury quality of life and isolated fracture showed a statistical effect on all four HRQoL outcomes, while high-energy injury mechanism, smoking, and race or ethnicity, demonstrated statistical significance for three of the four HRQoL outcomes. Patients who did not require reoperation in response to infection, the need for bone grafts, and/or the need for implant exchanges had statistically superior HRQoL outcomes than those who did require intervention within one year after initial tibial fracture nailing. Conclusion. We identified several baseline patient factors, surgical factors, and post-intervention procedures within one year after intramedullary nailing of a tibial shaft fracture that may influence a patient’s HRQoL. Cite this article: Bone Jt Open 2021;2(1):22–32

We report on the 5 year results of a randomized study comparing TKR performed using conventional instrumentation versus electromagnetic computer-assisted surgery. This study analysed patient reported outcome measures (PROMs) at 5 years utilising the American Knee Society Score (AKSS), Oxford Knee Score (OKS), the Short Form 36 score and range of motion (ROM). Of the 200 patients enrolled 125 completed 5 year follow up, 62 in the navigated group and 63 in the conventional group. There were 28 deceased patients, 29 withdrawals and 16 lost to follow-up. There was improvement in clinical function in most PROMs from 1-5 year follow up across both groups. OKS improved from a mean of 26.6 (12–55) to 35.1 (5–48). AKSS increased from 75.3 (0–100) to 78.4 (−10–100), SF36 from 58.9 (2.5–100) to 53.2 (0–100). ROM improved by an average 7 degrees from 110 degrees to 117 degrees (80–135). There was no statistically significant difference in PROMs between the groups at 5 years. Patients undergoing revision surgery were identified from the dataset and global PACS. There were no revisions within 5 years in the navigated group and 3 revisions in the conventional group, two for infection and one for mid-flexion instability, giving an all cause revision rate of 3.06% at 5 years for this group. There appears to be no significant advantage in clinical function for patients undergoing TKR for OA of the knee with electromagnetic navigation when compared to conventional techniques. There may be an advantage in reducing early revision rates using this technology

Previous studies revealed the close relation of anxiety and low back pain. Among people with chronic low back pain, anxiety is the most commonly reported mental disorder. Thus, in the literature, there are several studies considering the anxiety as a risk factor for chronic low back pain. The authors also documented a significant differences between sexes in anxiety and quality of life due to low back pain. US National Institute of Mental Health reports that the lifetime prevalence of an anxiety disorder is 60 % higher in women than in men and that the onset, severity, clinical course, and treatment response of anxiety disorders differ significantly in women. In addition, literature has showed that women may have a worse quality of life when they have low back pain. University students may undergo an undue amount of stress, with negative outcomes in terms of academic resuşts and personal, emotional or health, consequences. Moreover, stress can be experienced at different time periods, not only during university life, but also before, during the transition from undergraduate to professional level, and after, during the transition to the life work. After all these literature knowledge, we designed the study to compare the anxiety and quality of life levels of female and male specifically university students with low back pain aged between 18–26. In this study, 100 female and male university students with low back pain aged between 18–26 were included. The low back pain level were measured by Visual Analogue Scale (VAS) and the disability level due to the pain was measured by Revised Oswestry Low Back Pain Disability Questionnaire (ODI). Beck Anxiety Inventory (BAI) was used to evaluate the anxiety level and also, Short Form 36 survey (SF-36) was used to understand the quality of life for subjects. These questionnaires were asked to participants on online platform via Google Forms between March 2020 and May 2020. SPSS Version 25.0 program was used for statistical analyses. The result of the study showed that there was a statistically significant difference between female and male students on anxiety levels (p<0.05). There were no statistically differences between female and male students on ODI and VAS (p>0.05). In female group, BAI and “Physical function” and “General Health” subgroups of SF-36 have negative correlations (p<0.05). When we correlated BAI and all subgroups of SF-36 in male group, the statistical results were showed that negative correlation with all subgroups (p<0.05) except “Energy and Fatigue” subgroup (p>0.05). We conclude that female university students with low back pain have higher anxiety levels than male students. Future studies can work on young students to cope with the psychological problems for well-being

Aims. The widely used and well-proven Palacos R (a.k.a. Refobacin Palacos R) bone cement is no longer commercially available and was superseded by Refobacin bone cement R and Palacos R + G in 2005. However, the performance of these newly introduced bone cements have not been tested in a phased evidence-based manner, including roentgen stereophotogrammetric analysis (RSA). Patients and Methods. In this blinded, randomised, clinical RSA study, the migration of the Stanmore femoral component was compared between Refobacin bone cement R and Palacos R + G in 62 consecutive total hip arthroplasties. The primary outcome measure was femoral component migration measured using RSA and secondary outcomes were Harris hip score (HHS), Hip disability and Osteoarthritis Outcome Score (HOOS), EuroQol 5D (EQ-5D) and Short Form 36 (SF-36). Results. Femoral component migration was comparable between Refobacin bone cement R and Palacos R + G during the two-year follow-up period with an estimated mean difference of 0.06 mm of subsidence (p = 0.56) and 0.08° of retroversion (p = 0.82). Five hips (three Refobacin bone cement R and two Palacos R + G) showed non-stabilising, continuous migration; the femoral cement mantle in these hips, was mean 0.7 mm thicker (p = 0.02) and there were more radiolucencies at the bone-cement interface (p = 0.004) in comparison to hips showing stabilising migration. Post-operative HHS was comparable throughout the follow-up period (p = 0.62). HOOS, EQ5D, and SF-36 scores were also comparable (p-values >  0.05) at the two-year follow-up point. Conclusion. Refobacin bone cement R and Palacos R + G show comparable component migration and clinical outcome during the first two post-operative years. Hips showing continuous migration are at risk for early failure. However, this seems to be unrelated to cement type, but rather to cementing technique. Cite this article: Bone Joint J 2016;98-B:1333–41

In order to compare the outcome from surgical repair and physiotherapy, 103 patients with symptomatic small and medium-sized tears of the rotator cuff were randomly allocated to one of the two approaches. The primary outcome measure was the Constant score, and secondary outcome measures included the self-report section of the American Shoulder and Elbow Surgeons score, the Short Form 36 Health Survey and subscores for shoulder movement, pain, strength and patient satisfaction. Scores were taken at baseline and after six and 12 months by a blinded assessor. Nine patients (18%) with insufficient benefit from physiotherapy after at least 15 treatment sessions underwent secondary surgical treatment. Analysis of between-group differences showed better results for the surgery group on the Constant scale (difference 13.0 points, p − 0.002), on the American Shoulder and Elbow surgeons scale (difference 16.1 points, p < 0.0005), for pain-free abduction (difference 28.8°, p = 0.003) and for reduction in pain (difference on a visual analogue scale −1.7 cm, p < 0.0005)

We present data relating to the Bryan disc arthroplasty for the treatment of cervical spondylosis in 46 patients. Patients with either radiculopathy or myelopathy had a cervical discectomy followed by implantation of a cervical disc prosthesis. Patients were reviewed at six weeks, six months and one year and assessment included three outcome measures, a visual analogue scale (VAS), the short form 36 (SF-36) and the neck disability index (NDI). The results were categorised according to a modification of Odom’s criteria. Radiological evaluation, by an independent radiologist, sought evidence of movement, stability and subsidence of the prosthesis. A highly significant difference was found for all three outcome measurements, comparing the pre-operative with the post-operative values: VAS (Z = 6.42, p < 0.0001), SF-36 (mental component) (Z = −5.02, p < 0.0001), SF-36 (physical component) (Z = −5.00, p < 0.0001) and NDI (Z = 7.03, p < 0.0001). The Bryan cervical disc prosthesis seems reliable and safe in the treatment of patients with cervical spondylosis

Introduction. The management of early OA in young patients with joint preservation techniques utilizing cartilage repair remains challenging and a suitable treatment remains unclear. The management of bipolar chondral lesions in the patello-femoral (PF) and in the tibio-femoral (TF) compartment with cartilage repair is especially troublesome. The purpose of this study was to evaluate the clinical outcomes and survivorship after ACI for the treatment of bipolar chondral lesions in the PF and TF compartment. Methods. This was an IRB approved, prospectively collected case series, level 4 study. We evaluated 115 patients. 58 patients who had ACI for the treatment of symptomatic bipolar chondral lesions in the PF compartment and 57 in the TF compartment with a minimum 2-year follow up. A single surgeon performed all the surgeries between October 1995 and June 2014. In the PF group, all 58 patients (60 knees; mean age, 36.6 years) were included, and for the TF group one patient did not return for follow-up, 56 patients (58 knees) were included. For the PF group, an average size of the patella and trochlea lesions were 5.6 ± 2.7 cm2 and 4.2 ± 2.8 cm2, respectively. For the TF group, an average of 3.1 lesions per knee were treated, representing a total surface area of 16.1 cm2 (range, 3.2 – 44.5 cm2) per knee. Patients were evaluated with the modified Cincinnati Knee Rating Scale, Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index, and the Short Form 36. Patients also answered questions regarding self-rated knee function and satisfaction with the procedure. Standard radiographs were evaluated for progression of OA. Results. Patients did well for bipolar ACI in both compartments. In the PF compartment overall, the survival rate was 83% and 79% at 5 and 10 years, respectively. Of the 49 (82%) knees with retained grafts, all functional scores significantly improved postoperatively with a very high satisfaction rate (88%) at a mean of 8.8 years after ACI (range, 2 – 16 years). Outcomes for 11 patients were considered as failures at a mean of 2.9 years. In the TF group, the overall survival rate was 80% at 5 years and 76% at 10 years. Significantly better survival rate in patients with the use of collagen membrane than periosteum (97% vs. 61% at 5 years, P = 0.0014) was found. Of 46 knees with retained grafts, all functional scores significantly improved postoperatively with a very high satisfaction rate (85%) at a mean of 8.3 years after ACI (range, 2–20 years). Outcomes for 12 patients were considered as failures at a mean of 4.1 years. Of them, 9 patients were converted to a partial or total knee arthroplasty at a mean of 4.4 years. Two patients had revision ACI at 5 and 17 months. The other one patient did not require a revision surgery. At the most recent follow-up for both groups there was no radiographic progression to OA. Conclusions. Our study showed that ACI for the treatment of bipolar chondral lesions in the PF and TF compartments provided successful clinical outcomes in patients with retained grafts and could possibly prevent or delay OA progression. The best results in the PF joint are as primary repairs and not after failed osteotomy or cartilage repair with a 91% 10-year survival. Collagen membrane is more encouraging than periosteum for bipolar lesions in both the PF and TF compartments. ACI could be an adequate salvage procedure for bipolar chondral lesions in the TF compartment for the relatively young arthritic patient who wishes to avoid an arthroplasty

Introduction. Acetabular revision surgery remains a technically demanding procedure with higher failure rates than primary total hip arthroplasty (THA). An acetabular component with three dimensional porous titanium and anatomic screw holes (Figure 1) was designed to allow the cup to be positioned anatomically and provide reliable fixation. Methods. A prospective multicenter study of 193 cases (190 patients) was conducted to assess the midterm clinical outcomes of the revision titanium acetabular shell. Radiographs, demographics, Harris Hip Score (HHS), and Short Form 36 (SF-36) were collected preoperatively, at 6 weeks, 3 months, and annually thereafter to 5 years. The mean duration of follow-up was 3.36 years. The Paprosky classification was assessed intraoperatively. Short Form 6D (SF-6D) utility values were obtained by transforming SF-36 scores through the Brazier method and were analyzed for effect size. Results. At time of surgery, mean patient age was 63.5 years and mean BMI was 28.1. 69 of the 193 cases were graded as 3A or 3B according to the Paprosky classification method. For all cases, Harris Hip Scores improved significantly (p < 0.001) from a preoperative mean score of 53.60 to a mean score of 86.15 at 1 year. These significant gains were maintained through 5 years, with a mean score of 87.35 at the 5-year time point. The Harris Hip Scores for Paprosky 3A and 3B cases also improved significantly (p < 0.001) from a preoperative mean score of 48.11 to a mean score of 85.45 at 1 year. These significant gains were maintained through 5 years, with a mean score of 85.65 at the 5-year time point. Among the radiographs independently reviewed to date, no cup migration or unstable cups have been identified. There were 12 acetabular shell re-revisions reported, for infection (7), aseptic loosening (4) and recurrent dislocation (1). Three of the cases revised for aseptic loosening were Paprosky type 3A, and one was 3B. For all cases, a clinically significant improvement in health utility was achieved by 3 months postoperative, with an effect size of 0.54. Clinically significant scores were maintained throughout the follow-up period, reaching an effect size of 0.64 at 5 years. Effect sizes were larger for cases with Paprosky classifications of 3A and 3B than the overall study population at all time points, reaching clinical significance at 3 months with an effect size of 0.64, and continuing to increase to an effect size of 1.19 at 5 years. Conclusion. Even in patients with severe acetabular defects, next generation highly porous acetabular components with three dimensional porous titanium and anatomic screw holes provide excellent stability, predictable midterm biologic fixation, pain, and reduction, and improved clinical function and health utility

We treated 137 patients with symptomatic lumbar disc prolapse by automated percutaneous lumbar discectomy (APLD). Seventeen (12%) required further operation. At a mean follow-up of 55 months, the success rate was 45%. Of those who had APLD alone, 52% were graded as either excellent or good. In this group, 76% were employed, and the mean Oswestry score was 28.2%. One-third of those patients initially rated as successful had deterioration in symptoms and increased disability from back pain. The Short Form 36 health survey questionnaire revealed that these patients had a chronic ill-health profile

The aim of our review was to assess (health related) quality of life ((HR)QoL) after one-stage or two-stage revision for prosthetic joint infection (PJI). Although it is generally accepted that staged revisions are very strenuous for patients, little is known about the (HR)QoL after these procedures. We compared (HR)QoL scores with normative population scores to assess the magnitude of this problem. Two authors performed a computerized systematic search in Embase, Cochrane and Pubmed. We included articles that reported: validated (HR)QoL questionnaires, one-stage or two-stage revision for PJI after total hip arthroplasty (THA), a minimum follow-up of 24 months and a minimum of ten patients. Methodological quality of all papers was assessed using the MINORS score. The systematic review was conducted according to the PRISMA statement. The search produced 11195 hits. After selection, based on title and abstract, 18 full text papers were reviewed. Six articles were excluded. Twelve papers were selected for final assessment. All papers described two-stage revisions. The mean MINORS score for these studies was 9.8, indicating moderate study quality. Seven articles reported WOMAC scores, with a total of 185 patients (74% response rate) having a mean general score of 73, with a mean follow-up of 65 months. The normative total WOMAC score for the general population (age 60–64) is 82.9, with a score of 100 being the best possible outcome. Four articles described Short Form 36 (SF-36) results on a total of 159 patients (71.9% response rate). In these studies the physical component score (PCS) of the SF-36 was on average 39.6 and the mental component score (MCS) was on average 50.9, with a mean follow-up of 41 months. Normative data for the US population (age 55–64) are a PCS of 47.2 and an MCS of 51.8. Four articles reported Short Form 12 (SF-12) scores on a total of 138 patients, with a mean PCS of 33.6 and a mean MCS of 51.7, with a mean follow up of 72.5 months. Normative data for the Dutch population (age 55–65) are a PCS of 48.3 and an MCS of 52.8. A score of 100 represents best possible health for both SF questionnaires. Patients that underwent two-stage revision for hip PJI have substantially lower (physical component) (HR)QoL scores, when compared to the general population

Background and purpose. The musculoskeletal system is a common, but often overlooked, cause of chest pain. Little is known about the efficacy of spinal manipulation for this condition. The purpose of the present study is to evaluate the relative effectiveness of two conservative treatment approaches for acute musculoskeletal chest pain, 1) a spinal manipulation-based therapy as a typical example of chiropractic treatment and 2) self-management as an example of minimal intervention. Methods and results. In a non-blinded, randomised controlled trial set at an emergency cardiology department and four outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to four weeks of chiropractic treatment or self-management, with post-treatment questionnaire follow-up four and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (7-point ordinal scale). Secondary measures included Medical Outcomes Study Short Form 36 (SF-36) scores, change in pain intensity (chest, thoracic spine, neck and shoulder/arm), and self-perceived change in general health. Preliminary results will be available at the time of presentation. Conclusions. This is the first randomised controlled trial assessing chiropractic treatment versus a minimal intervention in patients with musculoskeletal chest pain. Results will indicate whether chiropractic treatment is a useful option for patients with musculoskeletal chest pain, but the design does not allow for standardisation of treatment or identification of potentially active ingredients of care

Objective: To evaluate the use of standard outcome measures in assessing individuals attending a functional restoration programme with chronic back pain. Design: Prospective collection of data from standard outcome measures used to assess patients attending a functional restoration programme. Data was collected before the start of the programme and six weeks, six months and one year after completion of the programme. Subjects: There were 69 individuals (33 males and 36 females) with an average age of 41 years, who attended the programme from February 1999 to February 2001. Outcome measures: Visual Analogue Score (VAS) for pain, Oswestry Disability Index (ODI), Short Form 36 (SF36), the Distress Risk Assessment Measures (MSP and MZDI). Results: During the follow-up period, outcome scores showed only modest improvement compared to pre-programme scores. This was not necessarily reflected in the clinical and functional progress of patients. Conclusions: Standard outcome measure may not necessarily reflect patient response to rehabilitation programmes

We have undertaken a prospective evaluation of health-related quality-of-life outcomes in 26 consecutive patients undergoing periacetabular osteotomy with a minimum follow-up of 24 months (24 to 42). The Western Ontario-Macmaster (WOMAC) and Short Form 36 (SF-36) outcome measures were evaluated preoperatively and at follow-up. Secondary outcome measures included retrospective assessment of sports activity and satisfaction with the procedure. Follow-up data were available for 22 patients (85%). A significant improvement in the pain (p < 0.0001) and function (p < 0.0001) scales of the WOMAC and the SF-36 physical score (p < 0.0001) was seen. The mean sports activity score improved from 1.9 to 4.4, with a very high mean satisfaction rating of 89.7/100. A significant improvement in both global and disease-specific health outcomes can be expected after this operation, with a high rate of satisfaction and improvement in sporting activities

Background. The factors that are considered to be associated with successful clinical outcome fallowing cervical arthroplasty surgery are patient selection, absence of facet joint changes and lack of pre-operative kyphosis. Even though many studies have cited the pre-operative demographic details of their patient groups, the effect of associated psychological co-morbidities (Depression/Anxiety), smoking history, gender, social benefits and employment status on the clinical outcome measures have not been reported. The aim of the study was to assess the influence of pre-operative patient characteristics on the clinical outcomes following cervical disc replacement. Methods. We included 126 patients who underwent single or multiple level cervical arthroplasty in our unit were included in the study. The clinical outcome measures such as Visual Analogue Score for neck pain (VAS-NP) and arm pain (VAS-AP); Neck disability Index (NDI), Hospital depression and anxiety scale and Bodily pain component of Short Form 36 questionnaires (SF-36 P) were recorded pre and post operatively. Statistical analysis was completed using SPSS 16.0 statistical package (SPSS Inc, Chicago, IL). Results. There were 60 males and 63 females. Average duration of follow up was 18 months (Range 10–51). Out of 123 patients, 37 patients had a history of anxiety/depression, 25 patients gave history of smoking, 64 were actively working at the time of operation and 27 were receiving social benefits. We have found that gender; smoking status, associated co-morbidities, working and benefit status had no statistically significant contribution to clinical outcome measures in the follow up period. Conclusion. This is has been a first ever attempt to analyse the affect these psychosocial factors on the clinical outcomes following cervical arthroplasty. In our study, contrary to studies related lumbar surgeries, we conclude that there is no statistically significant contribution of associated psychosocial factors on the clinical outcomes in the early follow up period

Introduction. In the last decade, single level cervical arthroplasty has proven its efficacy as one of the surgical treatment option for for patients suffering from cervical degenerative disc disease. Recent published reports on multilevel cervical arthroplasty using single implants have shown statistically significant results when compared to single level surgery. The aim of this study is to compare the clinical outcomes of multilevel cervical arthroplasty to single level cervical arthroplasty, when more than one type of implants were used. Methods. This is a prospective study of consecutive patients who presented to our unit in between June 2006 and November 2009. The maximum follow-up period was 51 months (mean=18 months). Several types of cervical arthroplasty devices have been used in this study. The clinical outcome measures such as Visual Analogue Score for neck pain (VAS-NP) and arm pain (VAS-AP); Neck disability Index (NDI) and the Bodily pain component of Short Form 36 questionnaires were recorded pre and post operatively. After confirming the normality of the data appropriate parametric (paired t-test) were used to assess the statistical significance (p< 0.05) between pre and post-operative values. Two sample T-test was used to assess the significance between the differences in mean scores between each group. Results. A total of 105 patients (37 single level, 68 multi-level) were included in the study. Mean age of patients was 51 years (Range 32–80) with Male: Female ratio of 9:10. All clinical outcome measures showed statistically significant improvement in the post-operative period in single as well as multilevel group. However, there was no statistically significant difference in the improvement in between single and multilevel surgeries. Conclusions. Our study results clearly demonstrate that multilevel cervical arthroplasty offers the similar clinical outcome when compared to single level surgery, despite using different type of implant in multilevel surgeries