Patient-centric periodontal research:A pioneering application of patient-reported outcome measures

Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.

HIPPO artificial intelligence:Correlating automated radiographic femoroacetabular measurements with patient-reported outcomes in developmental hip dysplasia

BACKGROUND Hip dysplasia(HD)is characterized by insufficient acetabular coverage of the femoral head,leading to a predisposition for osteoarthritis.While radiographic measurements such as the lateral center edge angle(LCEA)and Tönnis angle are essential in evaluating HD severity,patient-reported outcome measures(PROMs)offer insights into the subjective health impact on patients.AIM To investigate the correlations between machine-learning automated and manual radiographic measurements of HD and PROMs with the hypothesis that artificial intelligence(AI)-generated HD measurements indicating less severe dysplasia correlate with better PROMs.METHODS Retrospective study evaluating 256 hips from 130 HD patients from a hip preservation clinic database.Manual and AI-derived radiographic measurements were collected and PROMs such as the Harris hip score(HHS),international hip outcome tool(iHOT-12),short form(SF)12(SF-12),and Visual Analogue Scale of the European Quality of Life Group survey were correlated using Spearman's rank-order correlation.RESULTS The median patient age was 28.6 years(range 15.7-62.3 years)with 82.3%of patients being women and 17.7%being men.The median interpretation time for manual readers and AI ranged between 4-12 minutes per patient and 31 seconds,respectively.Manual measurements exhibited weak correlations with HHS,including LCEA(r=0.18)and Tönnis angle(r=-0.24).AI-derived metrics showed similar weak correlations,with the most significant being Caput-Collum-Diaphyseal(CCD)with iHOT-12 at r=-0.25(P=0.042)and CCD with SF-12 at r=0.25(P=0.048).Other measured correlations were not significant(P>0.05).CONCLUSION This study suggests AI can aid in HD assessment,but weak PROM correlations highlight their continued importance in predicting subjective health and outcomes,complementing AI-derived measurements in HD management.

Improved patient reported outcomes with functional articulating spacers in two-stage revision of the infected hip

BACKGROUND Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties.Interval spacers can be functional articulating or prefabricated.Functional results of these spacers have scarcely been reported.AIM To compare retrospectively the patient reported outcome and infection eradication rate after two-stage revision arthroplasty of the hip with the use of a functional articulating or prefabricated spacer.METHODS All patients with two-stage revision of a hip prosthesis at our hospital between 2003 and 2016 were included in this retrospective cohort study.Patients were divided into two groups;patients treated with a functional articulating spacer or with a prefabricated spacer.Patients completed the Hip Osteoarthritis Outcome Score and the EQ-5D-3L(EQ-5D)and the EQ-5D quality of life thermometer(EQVAS)scores.Primary outcomes were patient reported outcome and infection eradication after two-stage revision.The results of both groups were compared to the patient acceptable symptom state for primary arthroplasty of the hip.Secondary outcomes were complications during spacer treatment and at final follow-up.Descriptive statistics,mean and range are used to represent the demographics of the patients.For numerical variables,students’t-tests were used to assess the level of significance for differences between the groups,with 95%confidence intervals;for binary outcome,we used Fisher’s exact test.RESULTS We consecutively treated 55 patients with a prefabricated spacer and 15 patients with a functional articulating spacer of the hip.The infection eradication rates for functional articulating and prefabricated spacers were 93%and 78%,respectively(P>0.05).With respect to the functional outcome,the Hip Osteoarthritis Outcome Score(HOOS)and its subscores(all P<0.01),the EQ-5D(P<0.01)and the EQVAS scores(P<0.05)were all significantly better for patients successfully treated with a functional articulating spacer.More patients in the functional articulating spacer group reached the patient acceptable symptom state for the HOOS pain,HOOS quality of life and EQ-VAS.The number of patients with a spacer dislocation was not significantly different for the functional articulating or prefabricated spacer group(P>0.05).However,the number of dislocations per patient experiencing a dislocation was significantly higher for patients with a prefabricated spacer(P<0.01).CONCLUSION Functional articulating spacers lead to improved patient reported functional outcome and less perioperative complications after two-stage revision arthroplasty of an infected total hip prosthesis,while maintaining a similar infection eradication rate compared to prefabricated spacers.

Evaluation of patient reported outcome measures post urethroplasty:Piloting a“Trifecta”approach

BACKGROUND Buccal mucosal graft urethroplasty is the gold standard treatment for urethral stricture disease.Toowoomba has obtained a fellowship trained urethroplasty surgeon who has been performing urethroplasties for the last two years.Patient reported outcome measure(PROM)questionnaires allow for a detailed and standardized analysis of success and morbidity post urethroplasty and can be used as a reference point against which urethral surgeons can benchmark their performance.AIM To assess whether patient compliance rates improved with the use of an abridged PROM questionnaire.METHODS Our database of urethroplasty patients was searched to identify patients who had completed the original PROM.This is routinely requested to be completed at the 3-,6-and 12-mo mark.All patients are asked to complete the questionnaire and to bring it back to their next appointment.Our original PROM consists of the international prostate symptom score,the sexual health index measure and the Global Response Assessment.An abridged version of the questionnaire was derived focusing on urinary flow,sexual function and overall quality of life and consisted of three questions.RESULTS Sixty-six patients were included in our study.Fifty-four patients had been invited to complete the original PROM with an overall compliance rate of 30%.Compliance rates improved to 91%with the introduction of the modified PROM.No correlation between non-compliance and patient factors were found.There was also no significant difference in patient reported quality of life when comparing urinary flow and sexual function.CONCLUSION We recommend the use of PROMs pre-and post-operatively to accurately determine the level of patient satisfaction.We acknowledge the aversion of patients in completing PROMs due to the length of these questionnaires.We propose a simplistic version aimed at the“Trifecta”of urethroplasty comprising of three questions focusing each on urinary flow,sexual function and quality of life.Our modified PROM demonstrated markedly improved compliance rates and can be used as a screening tool to identify patients who might have had a poor outcome and who require a more in-depth assessment.

Patient-Reported Outcomes in Prostate Cancer: Prospective Changes Analysis for Prognosis Prediction

Prostate cancer is affecting a higher proportion of male population. Health Related Quality of Life assessment can guide the development of an interdisciplinary and patient-centered care intervention. This study is aimed to assess Health Related Quality of Life in prostate cancer patients. Relationships between socio-demographic, clinical characteristics and patient-reported outcomes have been considered. Consecutive outpatients with prostate cancer, admitted at the Urology Clinic of the Instituto Português de Oncologia do Porto, were studied (n = 300). Health Related Quality of Life was assessed as part of the routine practice. The European Organisation for Research and Treatment of Cancer general questionnaire, QLQ-C30, and its specific module for prostate cancer patients, QLQ-PR25, were used. Evolution along time (elapsed since diagnosis, and up to 5 years) was considered in order to search for a prognosis prediction in prostate cancer patients. This study confirms the feasibility of a systematic Health Related Quality of Life assessment. Global Health Related Quality of Life was found to be higher 6 months after diagnosis, decreasing then until the second year after diagnosis and improving thereafter. A peak with better scores was identified at the fifth year after diagnosis. Social and physical dimensions revealed a similar pattern. Clinical significance was found 6 months and 5 years after diagnosis. The prospective analysis of Health Related Quality of Life changes is able to explore the patients’ outcomes in order to find patterns and relationships for prognosis prediction along the disease course. Such approach might promote patient confidence and thus a better cancer experience.

Clinical study inpatient-reported outcomes after binocular implantation of aspheric intraocular lens of different negative spherical aberrations

Objective: To compare patient-reported outcomes after implantation of the ZA9003 intraocular lens(IOLs), or the MCX11 ASP IOLs or the spherical IOLs(HQ-201HEP). Methods: Prospective nonrandomized controlled trial was used. A total of 105 patients(210 eyes) were divided into three groups according to the type of IOLs: ZA9003(35 patients, 70 eyes), MCX11 ASP(35 patients, 70 eyes) or HQ-201HEP(35 patients, 70 eyes). The main outcome was scores of Catquest nine-item short-form questionnaire. Additional outcome was best corrected visual acuities, spherical aberration(SA) and total higher-order aberrations(HOAs). Results: The global score was significantly lower in the spherical IOL group than the aspherical IOL group of-020 μm SA(P < 0.05) and the aspherical IOL group of-027 μm SA(P < 0.05), and no significant difference was found in the global score between the aspherical IOL group of-020 μm SA than the aspherical IOL group of-027 μm SA(P > 0.05). Significant differences were also found in question 2, question 5, question 6 and question 8 between the spherical IOLs and the aspherical IOLs. Conclusion: Implantation of an aspherical IOL could improve vision-related quality of life compared with a spherical IOL. However, there were no statistically significant differences in vision-related quality of life between aspheric IOLs with different negative spherical aberrations.

Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis out

AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.

Are the data on quality of life and patient reported outcomes from clinical trials of metastatic non-small-cell lung cancer important?

Majority of the patients with advanced non-small-cell lung cancer(NSCLC)experience two or more disease related symptoms,which may have a negative impact on their health-related quality of life(HR QOL).These patients prefer a therapy that would improve disease related symptoms,as opposed or treatment that slightly prolongs their survival without improving symptoms.The improvements of the symptoms augment the significance of improved response rates or progression free survivals.The choice of the questionnaires to evaluate patients-reported outcomes(PROs)and HRQOL benefits and methods of collecting the data and their interpretations are very important and are discussed in this manuscript.PROs and HR QOL outcomes are important in patients with advanced NSCLC only when the data are collected and analyzed correctly.Then they can be viewed as components of the total value of a treatment,providing a comprehensive picture of the benefits and risks of anticancer therapies.Enabling the patients to feel during the last months of their lives more comfortable and not be dependent on their loved ones is a very important task in the treatment of advanced NSCLC.

Patient-Reported Outcomes of Surgery of Non-Small Cell Lung Cancer: Evaluation Based on the Questionnaires of Anti-Aging Quality of Life and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire

Background: Patient-reported outcomes of the quality of life (QOL) after an open thoracotomy have not been studied. To determine the physical and mental changes in surgical patients is very important for medical staffs. The surgical patient’s satisfaction and overall healthy changes were evaluated by the patient-self assessment questionnaires. Materials and Methods: From July 2007 to April 2008, 26 patients with non-small cell lung cancer (NSCLC) underwent surgical resection. The outcome of the QOL was evaluated by using two kinds of questionnaire surveys from the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the anti-aging QOL assessment (AA-QOL). The EORTC QLQ-C30 consisted of five domains (physical, role, cognitive, emotional, and social functionings) and global QOL. The AA-QOL contained 51 items;30 physical and 21 mental symptoms regarding the elderly and the aging population. The patients replied to the two questionnaires at two different times, i.e., at pre-surgery (baseline) and at post-surgery (2 weeks after the operation). The obtained data of these scores were averaged and compared between the two points of the pre-surgery and post-surgery. Results: Regarding the outcomes of the EORTC QLQ-C30, the physical and social functioning became significantly worse after the surgery. In contrast, the global QOL significantly became better after the surgery. For the symptom at post-surgery, three of which were “nausea and vomiting”, “pain”, and “appetite loss”, became significantly worse compared to those at pre-surgery. Regarding the outcomes of the AA-QOL, the physical symptoms (muscular pain/stiffness, palpitations, dyspnea, no feeling of good health, anorexia, and coughing and sputum) became significantly worse after the surgery. Regarding the mental symptoms, there were no significant differences. Conclusions: Regarding the outcomes based on the changes in the QOL after surgery, the physical symptoms became worse compared to the mental symptoms. To clarify the perioperative healthy changes of the QOL reported by patients with lung cancers is very important for multidisciplinary teamwork, which should play a role in providing the appropriate care and treatment and useful information for a preoperative patient’s decision making of receiving surgical treatment.

Saving time and effort:Best practice for adapting existing patientreported outcome measures in hepatology

It is increasingly recognised that collecting patient reported outcome measures(PROMs)data is an important part of healthcare and should be considered alongside traditional clinical assessments.As part of a more holistic view of healthcare provision,there has been an increased drive to implement PROM collection as part of routine clinical care in hepatology.This drive has resulted in an increase in the number of PROMs currently developed to be used in various liver conditions.However,the development and validation of a new PROM is time-consuming and costly.Therefore,before deciding to develop a new PROM,researchers should consider identifying existing PROMs to assess their appropriateness and,if necessary,make adaptations to existing PROMs to ensure their rigour when used with the target population.Little is written in the literature on how to identify and adapt the existing PROMs in hepatology.This article aims to provide a summary of the current literature and guidance regarding identifying and adapting existing PROMs in clinical practice.

Patient reported outcome measures in anterior cruciate ligament rupture and reconstruction:The significance of outcome score prediction

BACKGROUND Numerous anterior cruciate ligament(ACL) clinical outcome measures exist.However,the result of one score does not equate to the findings of another even when evaluating the same patient group.AIM To investigate if statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with ACL rupture before and after reconstruction.METHODS Fifty patients with ACL rupture were evaluated using nine clinical outcome measures.These included Tegner Activity Score,Lysholm Knee Score,Cincinnati Knee Score,International Knee Documentation Committee(IKDC) Objective Knee Score,Tapper and Hoover Meniscal Grading Score,IKDC Subjective Knee Score,Knee Outcome Survey-Activities of Daily Living Scale(KOS-ADLS),Short Form-12 Item Health Survey and Knee Injury and Osteoarthritis Outcome Score.Thirtyfour patients underwent an ACL reconstruction and were reassessed post-operatively.RESULTS The mean total of each of the nine outcome scores appreciably differed from each other.Significant correlations and regressions were found between most of the outcome scores and were stronger post-operatively.The strongest correlation was found between Cincinnati and KOS-ADLS (r=0.91,P<0.001).The strongest regression formula was also found between Cincinnati and KOS-ADLS (R~2=0.84,P<0.001).CONCLUSION The formulae produced from this study can be used to predict the outcome of one knee score when the results of the other are known.These formulae could facilitate the conduct of systematic reviews and meta-analysis in studies relating to ACL injuries by allowing the pooling of substantially more data.

The Effects of Sex on Patient Reported Outcomes in Inflammatory Arthritis and Connective Tissue Diseases

Background: It was thought that women report higher pain than men. We studied if there was a sex difference for several patient reported outcomes (PROs) in rheumatic diseases. Materials and Methods: Health Assessment Questionnaire disability index (HAQ-DI) as well as 100 mm Visual Analogue Scale (VAS) for pain, fatigue, sleep disturbance, and patient global assessment were compared cross-sectionally between the sexes for ankylosingspondylitis (AS), psoriatic arthritis (PsA), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). Data were collected using standardized forms administered during routine care. Results: The sample included 136 patients (97 males) with AS, 200 (83 males) with PsA, 232 (40 males) with RA, 199 (12 males) with SLE, and 113 (17 males) with SSc. There were no significant differences in AS. There were sex differences in PsA for HAQ (0.85 females, 0.57 males;p s, 36.8 males;p s, 31.6 males;p s, 36.0 males;p s, 33.1 males;p whereas, in SSc, men had a higher global assessment (52.9 males, 38.1 females;p Conclusions: A significant sex difference was observed in PsA with females reporting worse symptoms. In SSc, global assessments were worse in males possibly due to proportionately more diffuse cutaneous SSc. Sex differences for PROs are not consistent between rheumatic inflammatory diseases in prevalent patients.

Technological developments enable measuring and using patientreported outcomes data in orthopaedic clinical practice

Patient-reported outcomes measures form the backbone of outcomes evaluation in orthopaedics,with most of the literature now relying on these scoring tools to measure change in patient health status.This patient-reported information is increasingly collected routinely by orthopaedic providers but use of the data is typically restricted to academic research.Developments in electronic data capture and the outcome tools themselves now allow use of this data as part of the clinical consultation.This review evaluates the role of patient reported outcomes data as a tool to enhance daily orthopaedic clinical practice,and documents how developments in electronic outcome measures,computer-adaptive questionnaire design and instant graphical display of questionnaire can facilitate enhanced patientclinician shared decision making.

Patient-Reported Outcomes of Chemotherapy Involving Non-Small Cell Lung Cancer: Evaluation by Questionnaires of Quality of Life Regarding Anti-Aging and Anti-Cancer Drugs

Background: Patient-reported outcomes (PROs) of quality of life (QOL) during chemotherapy involving lung cancer are very important for the medical staffs. Patients’ satisfaction and healthy changes were evaluated by the patient-self assessment. Materials and Methods: From July 2007 to April 2008, a total of 19 patients received chemotherapy. The QOL data were collected by using the QOL questionnaire for cancer patients treated with anticancer drugs (QOL-ACD) and the anti-aging QOL assessment (AA-QOL). The AA-QOL contained 51 items: 30 of physical and 21 of mental symptoms of the elderly and the aging population. The patients replied to the questions at two different times, i.e., at pre-chemotherapy (baseline) and at post-chemotherapy (2 weeks after the chemotherapy). Results: Regarding the hematological toxicities, for the grade 3/4 toxicities, there were 12 neutropenia (12/19, 63.2%) and 3 thrombocytopenia (3/19, 15.8%). For the grade 3 febrile neutropenia, there were 5 cases (5/19, 26.3%). Regarding the non-hematological toxicities, there was no grade 3 and grade 4 toxicities. Based on the outcomes of the QOL-ACD, the three items (“physical condition”, “social attitude”, and “overall QOL”) at post-chemotherapy became significantly worse compared to the baseline. Regarding the outcomes of the AA-QOL, 4 items of physical symptoms (“thirst”, “anorexia”, “early satiety”, and “diarrhea”) became significantly worse compared to the baseline. Regarding the mental symptoms, 2 items (“nothing to look forward in life” and “a sense of uselessness”) became significantly worse compared to the baseline. Conclusion: Regarding the PROs of the QOL during the chemotherapy term, both the physical and mental symptoms had become worse. To clarify the changes in the QOL during chemotherapy is very important for multidisciplinary teamwork, which should play the role of providing the appropriate cares and treatment as patient-support.

Unicompartmental knee arthroplasty vs high tibial osteotomy for knee osteoarthritis:A comparison of clinical and radiological outcomes

BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.

Anterior cruciate ligament reconstruction:Effect of graft tunnel position on early to mid-term clinical outcomes

BACKGROUND Patient reported outcome measures(PROMs)can be used to assess knee function following anterior cruciate ligament(ACL)reconstruction.Intra-operatively,femoral and tibial tunnels are created to accommodate the new ACL graft.It is postulated that there is an optimum position and orientation of these tunnels and that outcomes from this procedure are affected by their position.AIM To evaluate the influence of graft tunnel position on early to mid-term clinical outcomes following ACL reconstruction.METHODS Six PROMs were collected following ACL reconstruction which included the Knee Injury and Osteoarthritis Outcome Score(KOOS),International Knee Documentation Committee,Lysholm,Tegner,EuroQol-5 Dimension-5 level,and Short Form 12-item Health Survey.A total of 8 radiological parameters were measured from post-operative X-rays relating to graft tunnel positions.This data was analysed to assess for any correlations between graft tunnel position and postoperative PROMs.RESULTS A total of 87 patients were included in the study with a mean post-operative follow-up of 2.3 years(range 1 to 7 years).Posterior position of tibial tunnel was associated with improved KOOS quality of life(rho=0.43,P=0.002)and EQ-5D VAS(rho=0.36,P=0.010).Anterior position of EndoButton femoral tunnel was associated with an improved EQ-5D index(rho=-0.38,P=0.028).There were no other significant correlations between any of the other radiological parameters and PROM scores.CONCLUSION Overall,graft tunnel position had very little correlation with clinical outcomes following ACL reconstruction.A few(posterior)tibial tunnel and(anterior)EndoButton femoral tunnel measurements were associated with better PROMs.

Optimizing outcomes:Implementing enhanced recovery after surgery in orthopedic surgery

In the realm of orthopedics,the adoption of enhanced recovery after surgery(ERAS)protocols marks a significant stride towards enhancing patient well-being.By embracing a holistic approach that encompasses preoperative counseling,dietary optimization,minimally invasive procedures,and early postoperative mobilization,these protocols have ushered in a new era of surgical care.Despite encountering hurdles like resistance to change and resource allocation challenges,the efficacy of ERAS protocols in improving clinical outcomes is undeniable.Noteworthy benefits include shortened hospital stays and bolstered improved patient-safety measures.Looking ahead,the horizon for ERAS in orthopedics appears bright,with an emphasis on tailoring care to individual needs,integrating cutting-edge technologies,and perpetuating research endeavors.This shift towards a more personalized,streamlined,and cost-efficient model of care underscores the transformative potential of ERAS in reshaping not only orthopedic surgery but also the journey to patient recovery.This editorial details the scope and future of ERAS in the orthopedic specialty.

Comparison of clinical outcomes between total hip replacement and total knee replacement

BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.

Surgical outcome and patient satisfaction after Z-epicanthoplasty and blepharoplasty

AIM: To evaluate surgical outcomes of modified Z-epicanthoplasty with blepharoplasty that we previously reported from the patient’s perspective using patient-reported outcome measures(PROMs) and patient satisfaction scores.METHODS: A total of patients(n=180) who underwent the surgery between January 2013 and June 2016 were randomly selected. Standardized patient satisfaction forms(total score, 40) and validated PROMs questionnaires(total score, 12) were sent to patients for completion. PROMs assesses the severity of scarring, pain and asymmetry, as well as functional and appearance issues.RESULTS: All patients were female, ranging from 18 to 35 years old(mean=24). The response rate was 73.3%(n=132). The majority of patients reported good or excellent outcomes based on PROM analysis. Patients reported minimum or non-visible scarring at both the double eyelid surgical scar(85.6%) and the inner canthus(80.3%). Issues concerning function and appearance were minimal as 80.3% reported satisfaction with both domains. Notably, the majority of patients reported either a high or very high satisfaction rate to yield a mean score of 104 out of 120(P<0.05).CONCLUSION: Integration of our modified Z-epicanthoplasty with blepharoplasty produces good outcomes based on PROM results, which shows a positive linear relationship with patient satisfaction scores.

High rate of clinically relevant improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis

BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital,Denmark.The patients were evaluated preoperatively and 3 months,6 months,12 months,and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index(WOOS),Oxford Shoulder Score(OSS)and Constant-Murley Score(CMS).The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID.Based on previous literature,MCID for WOOS,OSS,and CMS were defined as 12.3,4.3,and 12.8 respectively.RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis.Mean age at the time of surgery was 66 years(range 49.0-79.0,SD:8.3)and 65%were women.One patient was revised within the two years follow-up.The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points[95%confidence interval(95%CI):39.7-53.3,P<0.005]for WOOS,18.2 points(95%CI:15.5-21.0,P<0.005)for OSS and 37.8 points(95%CI:31.5-44.0,P<0.005)for CMS.Two years postoperatively,41 patients(87%)had an improvement in WOOS that exceeded the MCID,45 patients(94%)had an improvement in OSS that exceeded the MCID,and 42 patients(88%)had an improvement in CMS that exceeded the MCID.CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90%of patients has a clinically relevant improvement.This is a clear message when informing patients about their prognosis.