Crosswalks Between Knee and Hip Arthroplasty Short Forms: HOOS/KOOS JR and Oxford.

BACKGROUND: The Oxford Knee Score (OKS); Oxford Hip Score (OHS); Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR); and Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) are well-validated and widely used short-form patient-reported outcome measures (PROMs) for assessing outcomes after total knee arthroplasty (TKA) and total hip arthroplasty (THA). We are not aware of the existence of any crosswalks to convert scores between these PROMs. We aimed to develop and validate crosswalks that will permit the comparison of scores between studies using different PROMs and the pooling of results for meta-analyses. METHODS: We retrospectively analyzed scores from patients (486 in the knee cohort and 340 in the hip cohort) from the Syracuse Orthopedic Specialists Joint Registry who had completed the appropriate PROMs (OKS and KOOS JR in the knee cohort and OHS and HOOS JR in the hip cohort) as the standard of care before undergoing primary TKA or unicompartmental knee arthroplasty (UKA) between January 9, 2016, and June 19, 2017, or primary THA or hip resurfacing between November 29, 2010, and October 30, 2017, or when returning for postoperative care. Using the equipercentile equating method, we created 4 crosswalks: OKS to KOOS JR, KOOS JR to OKS, OHS to HOOS JR, and HOOS JR to OHS. To assess validity, Spearman coefficients were calculated using bootstrapping methods, and means for actual and crosswalk-derived scores were compared. RESULTS: There were minimal differences between the means of the known and crosswalk-derived scores. As calculated with the use of bootstrapping methods, Spearman coefficients between the actual and derived scores were strong and positive for both knee arthroplasty crosswalks (0.888 to 0.889; 95% confidence interval [CI], 0.887 to 0.891) and hip arthroplasty crosswalks (0.916 to 0.918; 95% CI, 0.914 to 0.919). CONCLUSIONS: We successfully created 4 crosswalks that allow conversion of Oxford scores to KOOS and HOOS JR scores and vice versa. These crosswalks will allow harmonization of PROMs assessment regardless of which of the short forms are used, which may facilitate multicenter collaboration or allow sites to switch PROMs without loss of historic comparison data. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.

One-year experience with day-of-surgery pregnancy testing before elective orthopedic procedures.

BACKGROUND: Elective surgery is generally postponed in pregnancy. A policy of testing for urine human chorionic gonadotropin (hCG) in all women of childbearing age on the day of surgery was initiated at an elective orthopedic surgery facility. This is a retrospective report of our 1 yr experience and the associated costs. METHODS: Records were reviewed from January 3, 2005, through January 2, 2006, to determine the number of urine hCG tests performed, and the disposition of all patients with a positive result. Costs were calculated using the charges for testing supplies and laboratory labor. RESULTS: During the first year of policy implementation, 2588 of 2595 women of childbearing age underwent urine hCG testing. Five patients had a positive result, and surgery was cancelled. Of these five, three were previously unrecognized pregnancies, one an unrecognized asymptomatic ectopic pregnancy, and one a false-positive result in a perimenopausal woman. Three other women had a "weak positive" urine result, followed by a negative serum hCG. Surgery proceeded in all three. The calculated cost was $5.03 per urine test, and $3273 for each true positive result. CONCLUSIONS: A policy of routinely performing urine hCG pregnancy tests in women of childbearing age on the day of surgery was effective in detecting unrecognized pregnancy. This resulted in a postponement of elective surgery in all cases. Of 2588 women tested, one had surgery postponed because of a false-positive result. The cost of $3273 per true positive test must be compared with the benefit.

A new approach to preanesthetic site verification after 2 cases of wrong site peripheral nerve blocks.

OBJECTIVE: We discuss the importance of a "preanesthetic site verification" and highlight 2 significant modifications to a policy developed at our institution in 2003. CASE REPORT: The report describes 2 cases of wrong site peripheral nerve blocks that initiated protocol amendments to address shortcomings of the original policy. Two specific limitations were identified to improve upon. First, the practitioner must not overlook the site verification as it is essential prior to every block. Second, time delays between the verification and block performance should be minimized. CONCLUSIONS: The "preanesthetic site verification" is an integral part of preventing wrong site block and surgery. To ensure that it is carried out before every peripheral nerve block, a unique multidisciplinary approach was adopted in which the block needles were removed from anesthesia carts and transferred to a separate container in the area of the circulating nurse. The anesthesiologist must now request a block needle from the circulating nurse immediately prior to block performance and confirm the site at that time. This safety process emulates the presurgical site verification that takes place before a scalpel is passed to a surgeon. Furthermore, the circulating nurse must remain at the bedside until block initiation to make sure that delays between site verification and block performance do not impinge on correct site placement.

Oral versus topical Ibuprofen for chronic knee pain: a prospective randomized pilot study.

BACKGROUND: Topical ibuprofen provides an alternative treatment to oral ibuprofen for the treatment of chronic knee pain. OBJECTIVE: To compare the efficacy of topical versus oral ibuprofen in chronic knee pain treatment. STUDY DESIGN: Prospective, randomized, unblinded pilot study. SETTING: A private pain management practice. METHODS: Twenty patients received either ibuprofen tablets 3 times daily (2400 mg total) or 4% topical gel 4 times daily (320 mg total) for 2 weeks. Subjects completed the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, the Medical Outcomes Study 12-Item Short Form (SF-12v2) Health Survey, and a satisfaction questionnaire. RESULTS: Comparison of WOMAC and SF-12v2 mean changes from baseline showed no differences between groups. Patient satisfaction and study treatment convenience were rated equivalently between groups. Within the topical group, significant improvements (P < 0.05) were experienced in the mean differences of WOMAC Pain scores from baseline to 2 weeks (-82.6, -158.3 to -6.8), WOMAC Stiffness scores from baseline to one week (-25.3, -50.0 to -0.6) and baseline to 2 weeks (-47.8, -95.7 to 0.1), WOMAC Physical Function scores from baseline to one week (-175.9, -348.6 to -3.2) and baseline to 2 weeks (-312.1, -580.5 to -43.7), and patient satisfaction scores from baseline to one week and baseline to 2 weeks. Within the oral group, significant improvements (P < 0.05) were experienced in mean differences of WOMAC Physical Function from baseline to one week (-342.6, -638.1 to -47.1) and baseline to 2 weeks (-323.2, -637.1 to -9.2). LIMITATIONS: As this was a preliminary investigation, the sample size of 20 subjects is a limitation in this study. CONCLUSION: Treatment of chronic knee pain with topical ibuprofen provided comparable clinical efficacy and patient satisfaction as oral ibuprofen in this pilot study.

Comparison of the transarterial axillary block and the ultrasound-guided infraclavicular block for upper extremity surgery: a prospective randomized trial.

BACKGROUND AND OBJECTIVES: The transarterial axillary block and the ultrasound-guided infraclavicular block are both effective methods of anesthetizing the upper extremity. This study compares these methods with respect to subjective postoperative dysesthesias, block adequacy, patient comfort, and patient satisfaction. METHODS: Two hundred thirty-two patients were randomized to receive an ultrasound-guided infraclavicular block or a transarterial axillary block for upper extremity surgery. Block placement, motor and sensory testing, and block adequacy data were recorded. The subjects were contacted by a blinded research assistant at 2 and 10 days postoperatively to assess for the presence of dysesthesias and pain and to assess patient satisfaction. RESULTS: The 2 techniques were similar with respect to block performance time and adequacy of the block for surgery. There was no significant difference between the blocks in terms of postoperative dysesthesias (23.9% in the axillary group vs 17.1% in the infraclavicular group at 2 days, P = 0.216, and 11.0% vs 6.31% at 10 days, P = 0.214). None of the dysesthesias were permanent. The infraclavicular block had a lower incidence of paresthesias during placement (P = 0.035) and was associated with less pain at the block site (P = 0.010 at 2 days, P = 0.002 at 10 days). More patients were willing to undergo the infraclavicular block as a future anesthetic when compared with the axillary block (P = 0.025 at 10 days). CONCLUSIONS: There is no significant difference between the 2 techniques in terms of adequacy for surgery and subjective postoperative dysesthesias. The ultrasound-guided infraclavicular block is associated with greater patient comfort and willingness to undergo the same anesthetic when compared with the transarterial axillary block.