The Reliability of Remote Patient-Reported Outcome Measures via Mobile Apps to Replace Outpatient Visits After Rotator Cuff Repair Surgery: Repetitive Test-Retest Comparison Study for 1-Year Follow-up.

BACKGROUND: With the development of health care-related mobile apps, attempts have been made to implement remote patient-reported outcome measures (PROMs). In order for remote PROMs to be widely used by mobile apps, the results should not be different depending on the location; that is, remote PROM results performed in locations other than hospitals should be able to obtain reliable results equivalent to those performed in hospitals, and this is very important. However, to our knowledge, there are no studies that have assessed the reliability of PROMs using mobile apps according to the location by comparing the results performed remotely from the hospital and performed at the outpatient visits. OBJECTIVE: The purpose of this study was to evaluate the reliability of remote PROMs using mobile apps compared to PROMs performed during outpatient follow-up visits after arthroscopic shoulder surgery. METHODS: A total of 174 patients who underwent arthroscopic rotator cuff repair completed questionnaires 2 days before visiting the clinic for the 1-, 2-, 3-, 6-, and 12-month follow-ups (test A). The patients completed the questionnaires at the clinic (test B) using the same mobile app and device for the 1-, 2-, 3-, 6-, and 12-month follow-ups. Test-retest comparisons were performed to analyze the differences and reliability of the PROMs according to the period. RESULTS: Comparisons of tests A and B showed statistically significant differences at 1, 2, and 3 months (all Ps<.05 except for the ASES function scale at 3-months) but not 6 or 12 months after surgery (all Ps>.05). The intraclass correlation values between the two groups were relatively low at the 1-, 2-, and 3-month follow-ups but were within the reliable range at 6 and 12 months after surgery. The rate of completion of tests A and B using the mobile app was significantly lower in the group older than 70 years than in the other groups for all postoperative periods (P<.001). CONCLUSIONS: PROMs using mobile apps with different locations differed soon after surgery but were reliably similar after 6 months. The remote PROMs using mobile apps could be used reliably for the patient more than 6 months after surgery. However, it is to be expected that the use of mobile app-based questionnaires is not as useful in the group older than 70 years as in other age groups.

Plate fixation versus titanium elastic nailing in midshaft clavicle fractures based on fracture classifications.

BACKGROUND: The best strategy for implant selection in midshaft clavicular fractures (MCF) remains controversial. The present study aims to determine the optimal strategy for implant selection by comparing plate and Titanium Elastic Nail (TEN) with respect to outcomes and related complications and analyze the results based on fracture patterns. METHODS: A total of 97 patients with MCF who underwent plate (48 patients) or TEN (49 patients) fixation were retrospectively reviewed. Both groups were divided into three subgroups by fracture type using the AO Foundation/Orthopaedic Trauma Association classification: simple fracture (type A), wedge fracture (type B), and multi-fragmentary fracture (type C). The observed outcome measures were bone union rate, related complications, functional scores, and patient satisfaction score. These outcomes were analyzed based on the fracture classification. RESULTS: Both groups demonstrated excellent union rates (p = 0.495) and similar functional scores (p > 0.05). Visual analog scale (VAS) for satisfaction was better in TEN than plate fixation (p < 0.001). In type A and B subgroups, there were no significant difference in functional scores between plate and TEN fixation (p > 0.05). In type C subgroup, however, both VAS for pain and DASH score in TEN fixation were significantly worse than in plate fixation at 2 and 6 weeks postoperatively (p < 0.05). The incidences of clavicle shortening and skin irritation are higher especially in type C subgroup of TEN fixation (p < 0.05). CONCLUSION: Patient satisfaction of TEN fixation was higher than that of plate fixation, but TEN fixation had a higher incidence of early postoperative pain and migration in type C fractures. Therefore, type A and B fractures can successfully be treated with plate or TEN fixation, but type C fractures should be treated with plate fixation.

Paraspinal Lean Muscle Mass Measurement Using Spine MRI as a Predictor of Adjacent Segment Disease After Lumbar Fusion: A Propensity Score-Matched Case-Control Analysis.

OBJECTIVE. The purpose of this study was to compare paraspinal muscle mass between patients with and without adjacent segment disease (ASD) after lumbar fusion. MATERIALS AND METHODS. Fifty patients with ASD (mean age, 61.4 years; ratio of male to female patients: 13:37; mean body mass index [BMI; weight in kilograms divided by the square of height in meters], 25.1) were matched to 50 control patients on the basis of age, sex, BMI, and fusion segment. The total cross-sectional area (CSA) and functional CSA (FCSA; i.e., the area containing lean muscle tissue only) of the paraspinal muscle group (the multifidus and erector spinae muscles) and the psoas muscles were measured on preoperative MRI. The ratio of the FCSA to the total CSA and the skeletal muscle index (SMI; calculated as muscle area [expressed as centimeters squared] divided by the square of the patient's height in meters]) were calculated and compared between the two groups with use of the independent-sample t test. RESULTS. The mean FCSA (2178.6 mm2 vs 2594.0 mm2; p = 0.004), the ratio of the FCSA to the total CSA (45.4% vs 52.2%; p = 0.001), and the SMI of the FCSA (8.8 vs 10.6; p = 0.001) of the paraspinal muscle group were significantly smaller in patients with ASD compared to the control group. When the paraspinal and psoas muscle groups were combined, the mean FCSA (3680.8 mm2 vs 4268.2 mm2; p = 0.013), the ratio of FCSA to total CSA (53.3% vs 58.6%; p = 0.004), the SMI of the total CSA (27.7 vs 29.3; p = 0.049), and the SMI of the FCSA (14.9 vs 17.3; p = 0.002) were significantly lower in patients with ASD than in control patients. CONCLUSION. Patients with ASD had smaller lean muscle mass (FCSA), a lower ratio of FCSA to total CSA, and a lower SMI of the FCSA of the paraspinal muscle group on pre-operative MRI, compared with control patients.

Does Lordotic Angle of Cage Determine Lumbar Lordosis in Lumbar Interbody Fusion?

STUDY DESIGN: Retrospective, radiological analysis. OBJECTIVE: To determine that 15° lordotic angle cages create higher lumbar lordosis in open transforaminal lumbar interbody fusion (TLIF) than 4° and 8° cages. SUMMARY OF BACKGROUND DATA: Restoration of lumbar lordosis is important to obtain good outcome after lumbar fusion surgery. Various shapes and angles of cages in interbody fusion have been used; however, it is not proved that lordotic angle of cages determine lumbar lordosis. METHODS: Sixty-seven patients were evaluated after TLIF using 15° cages and screw instrumentation. For comparison, TLIF using 4° lordotic angle cages in 65 patients and 8° cages in 49 patients were analyzed. Lumbar lordosis angles, segmental lordosis angles, disc height, and bony union rate were measured on the radiographs. RESULTS: The lumbar lordosis was 31.1° preoperatively, improved to 42.9° postoperatively, and decreased to 36.4° at the last follow-up in the 15° group. It was 35.8° before surgery, corrected to 41.5° after surgery, and changed to 33.6° at the last follow-up in the 4° group. In the 8° group, it was 32.7° preoperatively, improved to 39.1° postoperatively, and decreased to 34.5° at the last follow-up. These changes showed statistical significances (P < 0.001). The segmental lordosis at L4-5 was 6.6° before surgery, 13.1° after surgery, and 9.8° at the last follow-up in the 15° group. It was 6.9°, 9.5°, and 6.2° in the 4° group and 6.7°, 9.8°, and 8.1° in the 8° group, respectively (P < 0.001). The disc height restoration was better in the 15° group than in the 4° and 8° groups (P < 0.001). Bony union rate was not significant among the three groups (P = 0.087). CONCLUSION: The lordotic angle of the cages determined restoration of lumbar lordosis after TLIF. Cages with sufficient lordotic angle showed better restoration of lumbar lordosis and prevention of loss of correction. LEVEL OF EVIDENCE: 4.

Total knee replacement arthroplasty with Buechel and Pappas knee: minimum 2-year follow-up.

BACKGROUND: Clinical and radiologic evaluation and analyses of the surgeries using Buechel and Pappas (B-P) knee implants. METHODS: The study was conducted on 60 patients who underwent 94 total knee replacement arthroplasty with B-P knee implants from May 2009 to December 2010. The results were compared to the results of 41 patients who underwent 60 knee joint surgeries using NexGen-LPS implants from January 2008 to August 2009. RESULTS: The American Knee Society score of the B-P knee group increased from an average of 66.9 (clinical score) and 65.5 (functional score) to 93.4 and 90.3, respectively; while those for the NexGen-LPS group increased from an average of 68.8 (clinical score) and 62.4 (functional score) to 86.3 and 76, respectively. The average ranges of motion of the B-P knee group and the NexGen-LPS group were 119.1° and 114.8°, respectively, before surgery and improved to 121.0° and 123.0° at final follow-up after the surgery. The visual analogue scale scores for the B-P knee group and the NexGen-LPS group improved from 4.7 and 4.6 to 1.4 and 1.8, respectively. The flexion contracture also improved from 5.1° and 6.3° to 0.64° and 1.72°. The tibio-femoral angle for the B-P knee group and the NexGen-LPS group also improved greatly after the surgery, from varus 0.34° and 0.73° each to valgus 6.7° and 6.9°, respectively. CONCLUSIONS: The evaluation of more than 2 years of total knee replacement arthroplasty using B-P knee implants showed good results. B-P knee implants showed a relatively higher degree of satisfaction in clinical knee score and less intraoperative bone mass removal than NexGen-LPS implants.