Prevalence and Characteristics of Lumbar Spondylolysis in White and Black Patients.

STUDY DESIGN: Retrospective case series. OBJECTIVE: To the best of our knowledge, the prevalence of lumbar spondylolysis in white and black populations has never been studied using computed tomography (CT). The purpose of this study was to examine and compare the prevalence and characteristics of lumbar spondylolysis in white and black patients. METHODS: This study is a cross sectional study. Patients aged 20-79 who underwent abdominal and pelvic CT for trauma screening in the New York City area and whose race was classified as "white" and "black" on the questionnaire were recruited to the study. A total of 1200 white patients (600 women, 600 men) and 1200 black patients (600 women, 600 men) were included for the analysis. The presence of lumbar spondylolysis, level, unilateral/bilateral, and the presence of spondylolisthesis at lumbar spondylolysis level were evaluated using CT. RESULTS: The prevalence of lumbar spondylolysis was 3.0% (n = 36) for white patients and .8% (n = 10) for black patients, with 3.3% (n = 20) and 1.0% (n = 6) for white and black females, respectively; and 2.7% (n = 16) and .7% (n = 4) for white and black males, respectively. The prevalence of lumbar spondylolysis was significantly higher in white patients compared with that in black patients (P < .0001). Lumbar spondylolysis was at L5 in 44/46 patients (95.7%) and bilateral in 41/46 patients (89.1%). Spondylolisthesis at lumbar spondylolysis level was found in 40/46 patients (87.0%). CONCLUSIONS: The prevalence of lumbar spondylolysis was 3.0% for white patients and .8% for black patients. The prevalence of lumbar spondylolysis was significantly higher in white patients compared with that in black patients.

Does preoperative corticosteroid injection increase the risk of periprosthetic joint infection after reverse shoulder arthroplasty?

BACKGROUND: Corticosteroid injections (CSIs) are used for the symptomatic management of osteoarthritis. However, their use may contaminate the joint space and pose an increased risk of periprosthetic joint infection (PJI) following reverse shoulder arthroplasty (RSA). Therefore, the purpose of this study was to assess whether there is any association between the timing of CSI and the incidence of PJI at 90 days, 1 year, and 2 years postoperatively. Specifically, we assessed the risk of PJI in patients who received CSI <1 month, 1-2 months, 2-3 months, and >3 months prior to RSA, as well as associated risk factors for PJI with CSI. METHODS: We queried a national, all-payer database to identify patients who underwent RSA from October 1, 2015, to October 31, 2020 (1.5 million patients). Patients who received an osteoarthritis diagnosis prior to RSA were selected, whereas those with bilateral RSA or >1 injection on the same side were excluded. This resulted in 5 cohorts: cohort receiving CSI within 4 weeks of RSA (n = 5607), cohort receiving CSI 1-2 months prior to RSA (n = 3024), cohort receiving CSI 2-3 months prior to RSA (n = 1572), cohort receiving CSI >3 months prior to RSA (n = 16,302), and control cohort with no injection prior to RSA (n = 21,938). Bivariate χ2 analyses of outcomes were conducted, in addition to multivariate regressions performed to adjust for comorbidities, as well as to assess associated risk factors. RESULTS: The adjusted analyses demonstrated a significantly increased risk of PJI at 90 days in patients who received CSI within 1 month of RSA (P < .001). Additionally, the PJI risk was increased at 1 year postoperatively in patients who received CSI within 1 month of RSA (P = .015). However, no significant increase in the PJI risk was noted at any time point for patients who received CSI >1 month before RSA (all P ≥ .088). Furthermore, alcohol abuse, chronic kidney disease, and depression were identified as risk factors that increased the risk of PJI. CONCLUSION: Intra-articular shoulder CSIs <4 weeks prior to RSA are associated with increased risks of PJI at 90 days and 1 year postoperatively as compared with patients who did not receive CSIs. RSA should be deferred ≥4 weeks after a patient receives a CSI.

Prevalence and characteristics of thoracic ossification of the posterior longitudinal ligament in 3299 Black patients: a cross-sectional study of a prospectively registered database.

OBJECTIVES: To the best of our knowledge, the prevalence of thoracic ossification of the posterior longitudinal ligament (T-OPLL) in the Black population has never been studied and is still unknown. The purpose of this study was to examine the prevalence and characteristics of T-OPLL in the Black patients. METHODS: This is a cross-sectional study. All patients who underwent chest CT for the trauma screening and whose race was classified as 'Black' on the questionnaire were recruited in the study from March 2019 to March 2020. Demographic data, including age, sex, body mass index (BMI) and presence of diabetes mellitus (DM), were recorded. T-OPLL was defined as ectopic OPLL of more than 2 mm thickness in the axial plane image of the CT scan. The prevalence and characteristics of T-OPLL, and the association of T-OPLL with BMI and DM were evaluated. RESULTS: A total of 3299 Black patients (1507 women and 1792 men) were included for the analysis. The prevalence of T-OPLL was 1.5% (50 patients), with 2.4% for females and 0.8% for males. The highest prevalence was observed in patients at the age of 70 years (3.8%). Thickness of T-OPLL was between 2 and 3 mm in 46% (23/50) of the patients, and the largest thickness was 6.1 mm. T-OPLL was significantly associated with female sex and the presence of DM. CONCLUSIONS: The prevalence of T-OPLL was 1.5% in the 3299 Black patients who underwent chest CT for the trauma screening, with 2.4% for females and 0.8% for males.

Preoperative Opioid Use in Patients Undergoing Common Hand Surgeries.

BACKGROUND: The objectives of this study were to determine the baseline patient characteristics associated with preoperative opioid use and to establish whether preoperative opioid use is associated with baseline patient-reported outcome measures in patients undergoing common hand surgeries. METHODS: Patients undergoing common hand surgeries from 2015 to 2018 were retrospectively reviewed from a prospective orthopedic registry at a single academic institution. Medical records were reviewed to determine whether patients were opioid users versus nonusers. On enrollment in the registry, patients completed 6 Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), the Brief Michigan Hand Questionnaire (BMHQ), a surgical expectations questionnaire, and Numeric Pain Scale (NPS). Statistical analysis included multivariable regression to determine whether preoperative opioid use was associated with patient characteristics and preoperative scores on patient-reported outcome measures. RESULTS: After controlling for covariates, an analysis of 353 patients (opioid users, n = 122; nonusers, n = 231) showed that preoperative opioid use was associated with higher American Society of Anesthesiologists class (odds ratio [OR], 2.88), current smoking (OR, 1.91), and lower body mass index (OR, 0.95). Preoperative opioid use was also associated with significantly worse baseline PROMIS scores across 6 domains, lower BMHQ scores, and NPS hand scores. CONCLUSIONS: Preoperative opioid use is common in hand surgery patients with a rate of 35%. Preoperative opioid use is associated with multiple baseline patient characteristics and is predictive of worse baseline scores on patient-reported outcome measures. Future studies should determine whether such associations persist in the postoperative setting between opioid users and nonusers.

Prevalence and characteristics of thoracic diffuse idiopathic skeletal hyperostosis in 3299 black patients.

The purpose of this study was to examine the prevalence and characteristics of thoracic diffuse idiopathic skeletal hyperostosis (T-DISH) in the Black patients using the computed tomography (CT) analysis. This study is a cross-sectional study. All patients who underwent chest CT for the trauma screening and whose race was categorized as "Black" on the questionnaire were recruited in the study from Mar 2019 to Mar 2020. Demographic data, including age, sex, body mass index (BMI), and presence of diabetes mellitus (DM), were recorded. A total of 3299 Black patients (1507 women and 1792 men) were included for the analysis. The prevalence of T-DISH was 7.7% (255 patients), with 8.6% for females and 7.0% for males. The highest prevalence was observed in patients at the age of 70 years (11.7%), followed by the age of 80 years (10.5%). The highest prevalence level of T-DISH segment was at T8, followed by T9, and T7. The most frequent number of contiguous vertebrae was seven (21%). BMI was not associated with T-DISH. The presence of DM was significantly higher in male patients with T-DISH than those without T-DISH (P = 0.02).

Preoperative opioid use in patients undergoing shoulder surgery.

BACKGROUND: Opioids are commonly used to manage pain from acute injury or chronic degenerative diseases. The objective of this study was to assess the prevalence of preoperative opioid use in patients undergoing shoulder surgery and the clinical factors associated with preoperative opioid use. METHODS: This was an analytical cross-sectional study of 175 patients undergoing shoulder surgery at an urban hospital from June 2015 to June 2017. Multivariable regression models were used to determine independent associations. RESULTS: Fifty-three patients reported preoperative opioid use, which was significantly associated with primary procedure performed (Current Procedural Terminology [CPT]), higher body mass index (BMI), unemployment, lower income, smoking, higher American Society of Anesthesiologists score, greater number of previous surgeries, higher comorbidity burden, and decreased expectations to exercise and do recreational activities (p < 0.05). Preoperative opioid use was independently associated with worse scores on the: Numeric Pain Scale, ASES, IPAQ, and PROMIS domains of Physical Function, Pain Interference, and Social Satisfaction (p < 0.05). CONCLUSION: More than one in four patients reported preoperative opioid use. Several health measures, including worse pain, function, and social satisfaction were independently associated with preoperative opioid use. These findings suggest that orthopaedic surgeons need to identify patients using opioids preoperatively in order to effectively establish and execute a plan for pain management, which may include weaning off opioids prior to surgery, managing psychological distress, and optimizing coping strategies.Level of Evidence: III.

Diagnosing a periprosthetic shoulder infection: A systematic review.

INTRODUCTION: The aim of this study was to systematically review the literature regarding accurate shoulder prosthetic joint infection (PJI) diagnosis. METHODS: Using PRISMA guidelines, we analyzed 25 studies reporting on 5535 patients and 646 infections. RESULTS: Cutibacterium acnes (C. acnes) cultures were positive in 60% of patients. Serum markers WBC, CRP, ESR, and IL-6 appear to lack diagnostic reliability. Synovial IL-6 and alpha-defensin may be more accurate in detecting infections. CONCLUSION: Synovial IL-6 and alpha-defensin appear to have greater utility than serum markers. These may be incorporated into new criteria to accurately diagnose shoulder PJI. LEVEL OF EVIDENCE: IV.

Predictors of postoperative pain using PROMIS pain interference two-years following knee surgery.

INTRODUCTION: The purpose of this study was to identify preoperative factors associated with worse PROMIS Pain Interference (PI) two years following knee surgery. METHODS: Participants completed surveys preoperatively and two years postoperatively. Data collected included demographics, medical history, and multiple patient-reported outcomes measures, including PROMIS PI. RESULTS: After controlling for confounders, lower income, smoking, worse PROMIS Anxiety, worse Numeric Pain Score body pain, and worse Marx Activity Rating Scale were independent predictors for worse PROMIS PI two years after surgery. CONCLUSION: Worse PROMIS PI two years after elective knee surgery is associated with multiple socio-demographic patient identifiers.

Impact of pre-operative recreational marijuana use on outcomes two years after orthopaedic surgery.

PURPOSE: The purpose of this study was to investigate the relationship between recreational marijuana use and patient-reported outcomes two years after orthopaedic surgery. We hypothesized that pre-operative recreational marijuana use would be associated with less pain, better function, and better mental health measures two years after orthopaedic surgery. METHODS: Patients were retrospectively analyzed from a prospective orthopaedic registry at a single urban institution. A total of 1710 patients completed the pre-operative assessment and 1103 patients (64.5%) completed the two-year follow-up questionnaires. The cohort was then divided into two groups based on reported preoperative recreational marijuana usage, and statistical analysis was performed to determine if marijuana use was associated with two-year outcomes. Multivariable analysis was used to control for confounding variables. RESULTS: Marijuana use was reported by 47 (4.3%) patients. Significantly worse scores for two-year PROMIS Anxiety (53.2 vs. 49.2, p = 0.005), PROMIS Depression (51.1 vs. 46.5, p = 0.001), Met Expectations (63.1 vs. 74.4, p = 0.024), Surgical Satisfaction Questionnaire-8 (71.7 vs. 80.4, p = 0.005), and Numeric Satisfaction Scale (75.6 vs. 83.1, p = 0.041) were associated with marijuana use. Marijuana users also had less improvement of Numeric Pain Scores at the operative site (- 1.8 vs. - 2.7, p = 0.037) and greater decrease in Marx activity scores for lower extremities (- 12.3 vs. - 3.9, p = 0.024). Marijuana use was not an independent predictor of any outcome measure in the multivariable analysis. CONCLUSION: Marijuana use was associated with worse mental health scores, lower activity level, less pain relief, and worse satisfaction two years after orthopaedic surgery. However, after controlling for confounding variables, marijuana use was not predictive of any two-year outcome measure. STUDY DESIGN: Cross-sectional study.

Cartiform Implantation for focal cartilage defects in the knee: A 2-year clinical and magnetic resonance imaging follow-up study.

The purpose of this study was to evaluate clinical and magnetic resonance imaging (MRI) outcomes in patients who underwent cryopreserved viable osteochondral allograft (CVOCA) implantation for focal cartilage defects in the knee at a minimum of 2-years postoperatively. This is a retrospective follow-up study of twelve patients who underwent CVOCA implantation from 2013 to 2015 by a single surgeon for a International Cartilage Repair Society (ICRS) grade 3 or 4 chondral defect. Patient-reported outcome (PRO) measurements and MRI were obtained 2-years postoperatively. Collected PRO measures included: International Knee Documentation Committee (IKDC) form; Visual Analog Scale (VAS) pain score; Veterans RAND 12-Item Health Survey (VR-12); Knee Injury and Osteoarthritis Outcome Score (KOOS); and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Patients completed a standard return to work and sports/recreation survey. A blinded, fellowship-trained musculoskeletal radiologist independently evaluated each MRI to determine the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Mean follow-up was 2.1 years (2.0-2.3). There were 6 women and 6 men with a mean age of 46.2 ± 11.9 years. Mean PRO scores were: IKDC 72.6 ± 17.4; VAS 2.9 ± 2.8; WOMAC 84.2 ± 15.1; KOOS- Pain 83.8 ± 18.5, Symptoms 77.6 ± 16.0, ADL 88.0 ± 16.9, Sports/Rec 67.7 ± 33.3, QOL 54.8 ± 24.2; and VR-12 PCS 45.0 ± 8.5 and MCS 51.1 ± 9.5. The mean MOCART score was 59.5 ± 12.9. To our knowledge, this is the largest study to report clinical and MRI outcomes of CVOCA implantation in the knee. With positive functional outcomes and lack of failures at 2-year follow-up, CVOCA is a promising treatment option for focal chondral defects in the knee. STUDY DESIGN: Retrospective case series, Level of evidence 4.

Preoperative Expectations of Patients Undergoing Knee Surgery.

There is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee surgery at an urban academic medical center. We utilized the Musculoskeletal Outcomes Data Evaluation and Management System to measure preoperative expectations. Multiple legacy PRO measures were recorded, as well as the new Patient-Reported Outcomes Measurement Information Systems (PROMIS) Computer Adaptive Testing. Nonparametric statistical analyses were performed to determine significance. Overall, patients undergoing knee surgery had high expectations, with a mean of 88.0 (95% confidence interval [CI], 86.7-89.3) and median of 91.7 (95% CI, 89.2-94.3). Greater preoperative expectations of knee surgery were associated with higher income, surgically naïve knee, lower Charlson Comorbidity Index, better PROMIS Depression and Anxiety scores, greater Marx knee activity scores, and lower total body pain (p < 0.05). Preoperative expectations of patients undergoing knee surgery are associated with a history of prior knee surgery, income, general and mental health, activity, and pain. Expectations were also found to be associated with PRO measures of function and psychological well-being. These findings may have implications for patient education and shared decision-making preoperatively. The level of evidence for the study is IV.

Predictors of early postoperative pain interference following orthopaedic surgery.

INTRODUCTION: Despite the increasing incidence of orthopaedic surgeries, there is a lack of data reporting on patient experience and recovery following surgery. As such, there is a need to better characterize the natural history of pain interference (PI) after orthopaedic surgery to better manage patients' expectations and recovery. PURPOSE: To identify factors associated with greater pain interference two weeks following orthopaedic surgery. METHODS: All patients undergoing elective outpatient orthopaedic surgery at a single urban academic institution were evaluated preoperatively from August 2016 to March 2018. Patients completed a baseline assessment consisting of demographic information, PROMIS computer adaptive testing in 6 domains including Pain Interference (PI), Physical Function, Social Satisfaction, Fatigue, Anxiety, and Depression. Two weeks following surgery, patients completed the same questionnaires along with assessments of Improvement and Satisfaction. Bivariate and multivariable regression analyses were performed. Categorical data was compared with ANOVA and continuous data was compared with Spearman's correlation coefficient (rs). RESULTS: 435 patients (age = 41.1 ± 15.7, 47% female) were studied. Mean PI was 60.1 ± 7.0 prior to surgery and 61.7 ± 7.6 at 2 weeks postoperative. Worse 2 week PROMIS PI was associated with lower extremity surgery, prior surgery on the joint, preoperative opioid use, depression, lower income, lower education, and higher ASA score (p < 0.05). Better 2 week PROMIS PI was correlated with better baseline and better 2 week scores on all outcome measures. Multivariable analysis demonstrated that lower extremity surgery, worse preoperative pain scores, and worse preoperative pain interference were independent predictors of worse pain interference after surgery. CONCLUSION: Early postoperative pain interference is associated with function, demographic, and psychosocial factors.

Early patient satisfaction following orthopaedic surgery.

BACKGROUND: The healthcare industry is shifting its focus from traditional clinical outcome measures to patient satisfaction metrics. This change has caused orthopaedic surgeons to become increasingly interested in factors influencing patient satisfaction, which would allow them to potentially modify these factors in an effort to increase postoperative satisfaction. The objective of this study was to identify factors associated with patient satisfaction two weeks following extremity orthopaedic surgery. METHODS: Patients completed questionnaires preoperatively to assess demographics, activity, pain, expectations, and Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing for Physical Function, Pain Interference, Social Satisfaction, Depression, Anxiety, and Fatigue. Two weeks after their operation, patients completed the same questionnaires in addition to an Improvement Survey and Met Expectations. Satisfaction was assessed with the Surgical Satisfaction Questionnaire. RESULTS: Greater surgical satisfaction two weeks following orthopaedic surgery was associated with higher education, alcohol use, better scores on all PROMIS domains at baseline and two weeks, greater activity levels at baseline and two weeks, less bodily pain at baseline and two weeks, less pain in the surgical site at two weeks, greater met expectations, and greater improvement (p < 0.05). CONCLUSION: This study provides important information about patient satisfaction two weeks after orthopaedic surgery.

Preoperative expectations and early postoperative met expectations of extremity orthopaedic surgery.

BACKGROUND: Preoperative patient expectations and met expectations are likely associated with the outcome of treatment. However, there is a lack of data regarding the preoperative expectations and early postoperative met expectations of patients undergoing extremity orthopaedic surgery. The purpose of this study was to identify the predictors of early postoperative met expectations in a cohort of patients undergoing extremity orthopaedic surgery and to assess the relationship between patient expectations and patient-reported outcome (PRO) measures. We hypothesized that patients with higher preoperative expectation scores and higher postoperative met expectation scores would have better early postoperative outcomes. METHODS: Four hundred thirty-five patients age seventeen and older who underwent extremity orthopaedic surgery at one institution were prospectively enrolled in this study. Each patient completed a preoperative questionnaire that included an assessment of demographics, pain, function, general health, treatment expectations, activity level, and Patient-Reported Outcome Measurement Information System (PROMIS) computer adaptive testing. Expectations were evaluated using the Expectations Domain of the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire. Patients completed a follow-up questionnaire two weeks after surgery that also assessed MODEMS met expectations and satisfaction (Surgical Satisfaction Questionnaire (SSQ-8)). RESULTS: The mean preoperative expectation score was 86.95 ± 16.59, and the mean postoperative met expectation score was 55.02 ± 27.63 (0-100 scale with 100 representing the highest level of expectations). Greater met expectations were significantly associated with white race (p = 0.025), college degree (p = 0.011), and higher income (p = 0.002). Greater met expectations were also significantly associated with greater postoperative physical function, social satisfaction, activity level, and subjective improvement, as well as lower pain interference, joint pain, body pain, fatigue, anxiety, and depression (p < 0.01 for each). Multivariable analysis results found that less postoperative joint pain and greater postoperative social satisfaction, improvement, and physical function were all significant independent predictors of greater met expectations at two weeks postoperative (p < 0.01 for each). CONCLUSION: Greater preoperative expectations are associated with better activity and less pain two weeks after surgery. Met expectations of extremity orthopaedic surgery were associated with postoperative physical function, social satisfaction, activity, pain, anxiety, depression, and subjective improvement. These results may have implications for preoperative counseling and risk factor modification.

PROMIS physical function two weeks following orthopaedic surgery.

Many patients opt for elective orthopaedic procedures to regain physical function. However, little data exist about patient-reported early postoperative function. PURPOSE: To characterize physical function two weeks postoperative from upper and lower extremity orthopaedic surgery and to determine pre-operative factors that are associated with physical function two weeks following surgery. METHODS: Patients 17 years and older undergoing elective orthopaedic surgery at one institution were enrolled prospectively and completed questionnaires prior to surgery and again two weeks postoperatively. The questionnaires included: six of the PROMIS computer adaptive questionnaires: Physical Function (PF), Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression; a joint-specific function questionnaire, a joint numeric pain scale, and a body numeric pain scale. Physical activity levels were measured using Tegner, IPAQ, and Marx. Responses were analyzed using Spearman's correlation coefficient, ANOVA, and multivariate linear stepwise regression with two-week PF as the dependent variable. RESULTS: 435 patients (47% female) with mean age 41.1 ± 15.7 were included in our final analysis. Mean baseline PF score was 42.1 and mean two-week PF score was 35.5 (p < .0001). Patients undergoing upper extremity surgery had higher PF at two weeks than those undergoing lower extremity surgery (39.1 vs 32.2, p < .0001). Younger age, Hispanic ethnicity, preoperative narcotic use, injury prior to surgery, and procedure all had a significant relationship with lower 2-week postoperative PF score (p < 0.05). Numerous baseline and 2-week measures were correlated with postoperative PF score, with 2-week Social Satisfaction demonstrating the strongest correlation (rs = 0.604, p < .0001). Multivariable regression confirmed that the better preoperative PF score and upper extremity surgery were independent preoperative predictors of better 2-week PF scores. CONCLUSIONS: Patients have a significant decline in physical function following orthopaedic surgery, with those undergoing lower extremity surgery having a significantly greater decline. Many factors are associated with activity levels, including mental health, pain, and satisfaction. This information can be used to help manage patients' short-term expectations.

Evaluation of preoperative pain in patients undergoing shoulder surgery using the PROMIS pain interference computer-adaptive test.

OBJECTIVE: The purpose of this study was to evaluate the Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive testing Pain Interference (PROMIS PI) item bank in patients undergoing shoulder surgery. We hypothesized that PROMIS PI would exhibit a strong positive correlation with the numerical pain scale for the operative shoulder (shoulder NPS) with less floor and ceiling effects. Secondary study aims included assessing the relationships between patient characteristics and PROMIS PI. DESIGN: Analytical cross-sectional study. SETTING: Urban academic medical center. PATIENTS: One-hundred and ninety-five patients undergoing shoulder surgery between June 2015 to June 2017. MAIN OUTCOME MEASURES: All patients completed a series of patient-reported outcomes measures, including PROMIS PI and NPS. Non-parametric tests were used for bivariate analysis. Multivariable regression models were used to determine independent associations. RESULTS: There was a moderate correlation between the PROMIS PI and shoulder NPS scores (rs = 0.53; p < 0.001). PROMIS PI had no ceiling or floor effects while shoulder NPS had 26 patients (13.3%) at either the floor or the ceiling. PROMIS PI demonstrated a strong correlation with PROMIS Physical Function (rs = -0.65; p < 0.001), ASES total score (rs = -0.67; p < 0.001), and PROMIS Fatigue (rs = 0.64; p < 0.001). CONCLUSIONS: The strong association noted between PROMIS PI and psychosocial and behavioral factors, versus that of NPS, demonstrates that PROMIS Pain Interference may be a more appropriate choice as an outcome measure where the surgeon is concerned about a patient's improvement of functioning and decrease in the impact of pain in other aspects of wellbeing following shoulder surgery. LEVEL OF EVIDENCE: IV.

Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response.

BACKGROUND: There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies. METHODS: The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears. The criteria of the Methodological Index for Non-randomized Studies were used to assess study quality. Primary outcome measures were patient-reported outcome scores as well as failure, complication, and reoperation rates. To quantify patient response to treatment, we compared changes in the Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score with previously reported minimal clinically important difference (MCID) thresholds. RESULTS: No level I or II studies that met the inclusion and exclusion criteria were found. Physical therapy was associated with a 30% failure rate among the included patients, and another 30% went on to undergo surgery. Partial repair was associated with a 45% retear rate and 10% reoperation rate. Only graft interposition was associated with a weighted average change that exceeded the MCID for both the Constant-Murley score and ASES score. Latissimus tendon transfer techniques using humeral bone tunnel fixation were associated with a 77% failure rate. Superior capsular reconstruction with fascia lata autograft was associated with a weighted average change that exceeded the MCID for the ASES score. Reverse arthroplasty was associated with a 10% prosthesis failure rate and 8% reoperation rate. CONCLUSION: There is a lack of high-quality comparative studies to guide treatment recommendations. Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate.

Use of a custom website by orthopaedic sports medicine surgical patients: If you build it, will they come?

BACKGROUND: Internet use is nearly ubiquitous, and orthopaedic patients are increasingly utilizing the Internet for medical information. The quality of resources available to patients is variable, and patients may benefit from physician guidance. A recent study showed only 11% of orthopaedic trauma patients accessed a custom-designed website developed by a physician. The purpose of this study was to determine whether orthopaedic sports medicine patients would use a custom-designed website and what factors would be associated with website use. METHODS: A prospective study was conducted of patients undergoing eight common orthopaedic sports medicine procedures from April 2017 to December 2017.108 patients were enrolled and provided access to the website that allowed tracking of each patient's website use. The sports medicine cohort was compared to a previously published trauma cohort using the same methodology in a similar population at the same institution. The custom-designed website was replicated from the previous trauma study, but with the patient information now focused on sports medicine conditions and procedures. Patients' access to the website, tracking of website use, data collection, and analysis was identical to the previous trauma cohort. Bivariate and multivariate analyses were performed to determine which patient factors were associated with website use. RESULTS: 33 orthopaedic sports medicine patients (31%) accessed the website, and of those, 96% found the website helpful or very helpful. Orthopaedic sports medicine patients were nearly 3 times more likely to use the designated website than orthopaedic trauma patients (31% vs. 11%; p = 0.0004). Higher education predicted website use (p = 0.006). Age, gender, race, employment status, and household income were not predictive of use (p = 0.49, 0.27, 0.23, 0.15, 0.58; respectively). Anterior cruciate ligament (ACL) reconstruction was associated with website use as compared to meniscus and cartilage surgery (42% vs. 20%; p = 0.037). Nominal logistic regression analysis confirmed higher level of education (p = 0.00001) and ACL reconstruction (p = 0.0005) independently predicted website use. CONCLUSION: Orthopaedic sports medicine surgical patients are more likely to use a custom-designed informational website than orthopaedic trauma patients. However, only 31% of sports medicine patients accessed the website. Inherent differences between groups may account for the differences in website use. Higher level of education is predictive of website use, as is ACL reconstruction for knee surgery patients. Physicians should work to direct patients to high quality Internet resources given the vast amount of potentially unreliable information available.

Factors associated with early postoperative survey completion in orthopaedic surgery patients.

PURPOSE: To determine factors associated with survey compliance 2-weeks postoperatively. METHODS: 1269 patients age 17-years and older participating in the Maryland Orthopaedic Registry from August 2015-March 2018 were administered a baseline questionnaire preoperatively and emailed a follow-up questionnaire 10-days postoperatively. Demographics were self-reported and medical records reviewed for relevant medical history. RESULTS: 609 patients (48.0%) completed both the baseline and 2-week surveys. A decreased likelihood of 2-week survey completion was seen in patients who identified as black, smokers, patients without a college education, patients who were unmarried, unemployed, had a lower income, or covered by government-sponsored insurance (p < 0.05). Other preoperative variables significantly associated with decreased likelihood of completion included surgery on the right side, upper extremity surgery, preoperative opioid use, no specific injury leading to surgery, lower preoperative expectations, depression and fatigue symptoms, and worse pain, function, and activity scores (p < 0.05). Multivariable analysis confirmed race, operative extremity, education, insurance status, smoking, activity level, and pain scores were independent predictors of survey completion. CONCLUSION: Several demographic and preoperative variables are associated with survey completion 2-weeks post-orthopaedic surgery. The results provide insight into patient populations that may be targeted in order to assure higher survey compliance and improve analysis of patient-reported outcomes.