Interobserver and Intraobserver Reliability in the Radiologic Assessment of Lumbar Interbody Fusion.

STUDY DESIGN: Retrospective cohort study comparing intraobserver and interobserver reliability of 3 different radiologic fusion classifications following uninstrumented single-level anterior lumbar interbody fusion. OBJECTIVE OF THE STUDY: The objective of the study was to compare the intraobserver and interobserver reliability of 3 different radiologic spinal fusion scoring systems. SUMMARY OF BACKGROUND DATA: Knowledge regarding radiologic spinal fusion is crucial when studying patients that were treated with lumbar interbody fusion. The scoring system should be reliable and reproducible. Various radiologic classification systems coexist, but the reliability of these systems has thus far not been compared in a single consecutive group of patients. The aim of the present study was the identification of the most valid scoring system in the assessment of interbody fusion. METHODS: We studied a retrospective consecutive cohort of 50 patients who underwent an anterior lumbar interbody fusion procedure by a single surgeon using a stand-alone cage performed between 1993 and 2002. Plain anterior-posterior, lateral radiographs, and flexion-extension radiographs were made during follow-up visits and were used for analysis. The interbody fusion was scored on these radiographic images using the 3 classification systems (Brantigan, Burkus, and the Radiographic Score) by 2 experienced musculoskeletal radiologists and 2 senior orthopedic spinal surgeons all of whom were blinded to clinical data and outcome. RESULTS: Of the 3 classifications included in the current study, the Burkus classification had a moderate interobserver agreement and a substantial to perfect intraobserver agreement. The other classifications (Bratingan and the Radiographic Score) showed only fair interobserver agreement and moderate to substantial agreement among all observers. No significant differences in reliability between orthopedic surgeons and radiologists were found for all 3 classifications. CONCLUSIONS: The Burkus classification system was classified as most reliable in this, but showed only moderate interobserver agreement. Therefore, the need for a more reliable classification system for the radiographic assessment of lumbar interbody fusion still exists to date.

The Dutch version of the Forgotten Joint Score: test-retesting reliability and validation.

The aim of this study was to translate the Forgotten Joint Score (FJS) into the Dutch language. This -questionnaire was tested for internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficients (ICC)). 159 patients were included in this study; 74 with a total hip arthroplasty (THA) and 85 with a total knee arthroplasty (TKA). The FJS showed a high internal consistency (Cronbach's alpha=0.957; ICC=0.943). The FJS showed a significant correlation (r=0.751) with the WOMAC and low ceiling effects (3.1%). This study proved the Dutch FJS to be highly discriminative in patients treated with a THA or TKA. This makes the FJS a reliable patient related outcome measurement, measuring a new dimension in arthroplasty: the ability to forget an artificial joint in everyday life.

Bridging therapy for oral anticoagulation increases the risk for bleeding-related complications in total joint arthroplasty.

BACKGROUND: Patients scheduled for elective surgery with a high risk of thromboembolism require anticoagulation bridging therapy perioperatively. The purpose of this study was to assess the risk of thromboembolic events and bleeding-related complications after total hip and knee arthroplasty in patients requiring bridging therapy for anticoagulants. METHODS: A retrospective cohort study of all patients with primary total hip or total knee replacement in a 4-year period was performed. Outcome measures were blood loss, thromboembolic and bleeding-related complications and hospital stay. RESULTS: Bridged patients had more blood loss and higher complication rates than the control group. Most complications were bleeding-related, and there were no thromboembolic events. Seven of the 14 (50%) total hip patients bridged with unfractioned heparin required reoperation (three patients with ischial neuropraxia due to hematoma). There were two bleeding-related deaths in total hip patients bridged with low-molecular-weight heparin. Mean hospital stay was significantly longer in unfractioned heparin bridging. CONCLUSION: In this study, there was a significant increase in bleeding-related complications in total joint replacement with bridging therapy compared to prophylaxis. This risk was highest in patients with total hip arthroplasty. There were no thromboembolic events in bridged patients.