The influence of patient resilience and health status on satisfaction after total hip and knee arthroplasty.

BACKGROUND AND PURPOSE: Our research aimed to identify and characterise relationships between patient resilience, health status, and satisfaction following total hip and knee arthroplasty (THA/TKA). A secondary aim was to compare two frequently used instruments for measuring patient satisfaction: The Satisfaction Visual Analogue Scale (Satis VAS) and the Net Promoter Score (NPS). METHODS: 140 patients (mean age 69, 60% female) underwent primary THA or TKA at a centre in regional Australia and were recruited to complete questionnaires about their resilience, health status, and satisfaction following arthroplasty. We selected validated instruments to measure patient-reported outcomes: Satis VAS, NPS, EuroQol Group 5D-5L, EuroQol Group Visual Analogue Scale, and the Connor-Davidson 10-item Resilience Scale. RESULTS: Our research demonstrates a strong positive correlation between patient resilience and patient-reported health status. A moderate positive correlation exists between resilience and satisfaction (both Satis VAS and NPS). Resilient patients demonstrated higher health scores and higher satisfaction (by both measures) than lower-resilience patients. CONCLUSIONS: Patient satisfaction following arthroplasty, captured by Satis VAS and NPS, may be partly predicted by patient resilience post operatively, with higher-resilience patients demonstrating less dissatisfaction than lower-resilience patients.

Isolated Bioinductive Arthroscopic Repair of Partial-Thickness Rotator Cuff Tears Using a Resorbable Collagen Implant.

Over 300,000 rotator cuff repairs are performed annually in the United States, where the annual financial burden of managing shoulder pain has been estimated to be $3 billion. Despite advances in surgical techniques, retear rates range from 39% to 94%4. Partial-thickness tears are approximately twice as common as full-thickness tears and can lead to considerable pain and loss of function. Although some partial-thickness tears can be treated nonoperatively, spontaneous healing is unlikely when >50% of the bursal/articular-sided tendon thickness is involved, and thus nonoperative treatment would be unsuccessful1-4. Regeneten (Smith & Nephew) is a bioinductive type-1 collagen implant that can be utilized to repair a partial-thickness rotator cuff tear without formal tendon-bone reattachment. Because this implant does not require tendon-bone reattachment, treatment does not typically entail prolonged rehabilitation. At 2 years postoperatively, this implant has been shown to significantly improve functional outcomes and tendon thickness without any serious adverse events4. Description: A diagnostic arthroscopy is performed via a posterior viewing portal, paying particular attention to the insertion of the posterosuperior rotator cuff onto the humeral head. The subacromial space is entered posteriorly and visualized. With use of electrocautery through a lateral portal, all soft tissue is cleared from the undersurface of the acromion and from the superficial rotator cuff. The coracoacromial ligament is released from the underside of the acromion, and an acromioplasty is performed if indicated. The partial-thickness rotator cuff tear is visualized and examined for tissue quality, tear area, and residual tendon thickness. The size of the tear is measured, and an appropriate implant size is chosen. The lateral portal is enlarged so that the graft can be inserted and unfolded with use of a specialized delivery guide. The implant is centered over the tear, ensuring that it covers as much of the lateral footprint as possible. To complete the procedure, the implant is secured to the tendon with use of soft-tissue staples and to the lateral osseous footprint with use of bone staples. Alternatives: First-line treatment is often nonoperative and entails activity modification, pharmacological therapies, and targeted physiotherapy directed toward strengthening parascapular muscles and the remaining rotator cuff. Surgical treatment is considered for persistent symptoms. Conventional operative strategies include subacromial decompression, rotator cuff debridement, in situ repair, and conversion to a full-thickness defect and repair. Rationale: Partial-thickness tears substantially increase intratendinous strain. This increased strain leads to further tissue degeneration and tear enlargement5, likely influencing the high rate of tear propagation observed with nonoperative treatment and nonanatomic operative treatment, such as subacromial decompression. Isolated bioinductive repair of partial-thickness tears with use of a resorbable collagen implant does not involve tendon excision or repair of the tendon to the bone, which can sometimes be challenging. This technique offers a simple solution to a complex problem and has the benefit of an accelerated rehabilitation program compared with formal rotator cuff repair. Accordingly, patient satisfaction with the procedure is high, making this treatment an appealing option4. Expected Outcomes: Short and midterm results following isolated bioinductive repair of partial-thickness tears demonstrate that it is a safe procedure associated with a reduction in pain, increased range of motion, and improvement in functional outcomes. Patients should be counselled regarding the safety of a resorbable collagen patch and its potential to promote healing and improve symptoms4-6. Important Tips: If the tear is articular, it should be marked with a needle so that the graft can be centered over the tear within the subacromial space.When positioning the implant, ensure that it covers the defect and the lateral footprint.Position the cannulas so that they allow the staples to enter the tissue perpendicular to the tendon and osseous footprint.To prevent tearing of the patch, do not depress the staples with excessive force. Acronyms and Abbreviations: MRI = magnetic resonance imagingPEEK = polyetheretherketoneVAS = visual analogue scaleASES = American Shoulder and Elbow Surgeons Shoulder Score.

Functional Dart-Throwing Motion: A Clinical Comparison of Four-Corner Fusion to Radioscapholunate Fusion Using Inertial Motion Capture.

Background Dart-throwing motion (DTM) is an important functional arc of the wrist from radial extension to ulna flexion. An aim of partial fusion surgery of the wrist is to maintain maximal functional motion while addressing the pathology. The radioscapholunate (RSL) fusion, accompanied with partial resection of the distal scaphoid, is thought to allow better DTM than other partial wrist fusions such as the four-corner fusion (4CF). Question Does an RSL fusion allow better functional DTM than 4CF, and how does this range compare with healthy wrists and the patient's contralateral wrist? Patients and Methods Patients who have undergone an RSL fusion or 4CF at our tertiary center were identified and invited to present to have their DTM arc measured. To accurately measure DTM, a previously validated inertial measurement device was used. Patient's functional DTM arc was measured in both unrestrained (elbow and shoulder free to move) and restrained (elbow and shoulder immobilized) fashions. This was compared with their contralateral wrist and a group of healthy control volunteers. Results Overall five RSL fusions, 10 4CF and 24 control patients were enrolled in the study. There was no significant difference between functional DTM when 4CF and RSL fusion were compared. Both had significantly reduced functional DTM arc than control patients. There was no significant difference between the operated wrist compared with the patient's contralateral unoperated wrist. Conclusion RSL fusion is not significantly better at maintaining functional DTM when compared with 4CF. Both surgeries result in decreased functional DTM arc when compared with control patients. This is a cohort study and reflects a level of evidence IV. Level of Evidence This is a Leve IV, cohort study.

Colour difference of subcutaneous fat and palmar fat pad in open carpal tunnel release.

BACKGROUND: Carpal tunnel syndrome is the most common compression neuropathy of the extremity. The most frequent occurring post-operative complication of open carpal tunnel release is the incomplete release of the transverse carpal ligament. A constant pad of palmar fat pad has been found to provide a reliable indicator of the distal extent of the surgical decompression of the transverse carpal ligament. We investigated the colour difference between subcutaneous fat and palmar fat pad. METHODS: This is a prospective case series of 15 patients undergoing open carpal tunnel release. Digital images of the patients' subcutaneous and palmar fat were taken. The colour of each type of fat was described in a device independent, objective manner using the CIELab colour space. The colour difference was measured using ΔE, the Euclidean distance between the CIELab coordinates of the colours. Wilcoxon signed-rank test was used to compare colour character differences between subcutaneous and palmar fat. The colour difference, ΔE, was assessed and reported with 95% confidence intervals (CI). RESULTS: There is a visually detectable colour difference between subcutaneous and palmar fat. The minimum ΔE was 4.45. The mean ΔE was 13.03 (95% CI 9.79-16.27). The palmar fat pad is more yellow than the subcutaneous fat (P = 0.002). CONCLUSIONS: Our findings can assist in the identification of the palmar fat pad to ensure safer and a complete release of the transverse carpal ligament in carpal tunnel release.

Increased incidence of postoperative cognitive dysfunction 24 hr after minor surgery in the elderly.

PURPOSE: Postoperative cognitive dysfunction (POCD) is evident in 26% of elderly patients seven days after major non-cardiac surgery. Despite the growing popularity of day surgery, the influence of anesthetic techniques on next day POCD has not been investigated. Therefore, we evaluated the incidence of POCD and changes in serum markers of neuronal damage (S-100ss protein and Neuron-Specific Enolase), 24 hr after single-agent propofol or sevoflurane anesthesia in elderly patients undergoing minor surgery. METHODS: Patients (n = 30, mean age 73, range 65-86 yr) coming for cystoscopy or hysteroscopy, were randomized, in an observer-blind design, to receive either single-agent propofol or sevoflurane anesthesia. Changes in neuropsychological tests (the Stroop test and the modified Word-Recall Test), 24 hr postoperatively were compared with age-matched control subjects (n = 15) using Z-score analysis. Changes in S-100beta protein and Neuron-Specific Enolase levels were also documented. RESULTS: POCD was present in 7/15 [47% (95% confidence interval (CI) 21 to 72%)] patients who received propofol and 7/15 [47% (95% CI 21 to 72%)] patients who received sevoflurane, compared with 1/15 [7% (95% CI 6 to 19%)] control patients, P = 0.03. S-100beta protein and Neuron-Specific Enolase levels were not significantly different in anesthetized patients postoperatively compared with preoperative values. CONCLUSION: The incidence of POCD in elderly patients on the first day after minor surgery is higher than previously reported for seven days after major surgery, and is increased after both propofol and sevoflurane anesthesia, compared with age-matched controls. S-100beta protein and Neuron-Specific Enolase levels were unaffected by anesthetic technique.