Does the Addition of PROMIS Pain Instruments Improve the Sensitivity of PROMIS Upper Extremity Scores Following Arthroscopic Rotator Cuff Repair?

INTRODUCTION: Though Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (P-UE) has been validated in upper extremity orthopedics, it's ability to capture a patient's functional recovery after arthroscopic rotator cuff repair (aRCR), as measured by its responsiveness, is minimal in the early postoperative period. The primary purpose of this study is to determine if addition of PROMIS Pain Intensity (P-Intensity) or Pain Interference (P-Interference) scores to PROMIS UE improves the responsiveness throughout the one-year postoperative period after aRCR. METHODS: This prospective, longitudinal study included 100 patients who underwent aRCR. Patients completed P-UE, P-Interference, P-Intensity, American Shoulder and Elbow Surgeons (ASES), and Western Ontario Rotator Cuff Index (WORC) scores preoperatively and at 2-weeks, 6-weeks, 3 months, 6-months and 12-months after surgery. Responsiveness at each time-point relative to preoperative baseline and one-way analysis of variance with post-hoc analysis was conducted for each PROM. Responsiveness of the outcome score was determined using the effect size (ES), graded as small (0.2), medium (0.5), or large (0.8). The Pearson correlation coefficient (r) was determined between these instruments at each time-point. RESULTS: In isolation, P-UE, P-Interference, and P-Intensity showed a medium-large ability to detect change (positive and negative) throughout the one-year postoperative period. The addition of PROMIS pain scores to P-UE improved the responsiveness of the instrument (from medium to a large effect size) starting at 3 months and continued throughout the 12 month follow-up period. Though the addition of pain scores increases the response burden for PROMIS, this was still lower when compared to the response burden for the legacy outcome scores (p<0.05). CONCLUSION: The addition of PROMIS pain instruments improves the responsiveness of the P-UE function score in patients undergoing aRCR.

Analysis of factors associated with patient-reported outcome (PRO) score completion rate one year after shoulder surgeries.

Background: Patient-reported outcome measurements (PROMs) are important metrics for monitoring improvements following shoulder surgery. Despite the easy accessibility of electronic PROM surveys, completion rates vary, and factors predictive of survey completion for patients enrolled in medical survey follow-up after shoulder surgery remain largely unknown. The purpose of this study is to investigate survey completion rates for common shoulder procedures and identify factors predictive of PROM completion at one-year postoperatively. We hypothesize that the response rate to shoulder PROMs may vary by the shoulder procedure type after surgery. Methods: Patients undergoing total shoulder arthroplasty (TSA), rotator cuff repair (RCR), and instability surgery (Latarjet procedure [LP], and arthroscopic Bankart repair [ABR]) from 2019 to 2021 were prospectively enrolled. Each patient was administered PROM surveys via email preoperatively and at 2-weeks, 6-weeks, 3-months, 6-months, and 12-months following surgery. Demographics and socioeconomic characteristics were collected from our institutional database. The primary outcome studied was survey completion rate by procedure. Multivariable logistic regression was performed to identify factors predictive of completing 12-month follow-up. Results: A total of 514 (251 TSA, 194 RCR, and 69 instability surgery (35 LP, 34 ABR)) patients with an average age of 58 ± 15 years were included in this study. Overall, the 12-month survey completion rate for all procedures was 57.2%. TSA had the highest completion rate (64.9%), followed by RCR (52.1%), ABR (44.2%), and LP (42.9%). ABR and LP demonstrated more than a 50% drop in survey response at 2 weeks, and the RCR cohort demonstrated an increased attrition in survey response at the 6-month mark. Patients who completed the 12-month follow-up survey were older [61 ± 14 vs. 54 ± 17; P < .001], less frequently self-identified as Hispanic [13% vs. 23%; P = .009], less frequently single [32% vs. 44%; P = .008], and most frequently classified as the American Society of Anesthesiology [ASA] score II [65%, P = .001]. Conclusion: Postoperative PROM survey completion rates vary significantly among commonly performed shoulder procedures during the first year after surgery. Hispanic ethnicity and younger age were all predictive of a lower propensity, and the TSA procedure is predictive of higher odds for PROM survey completion at the 12-month follow-up.

Clinical outcomes of open Latarjet-Patte procedures performed for recurrent anterior shoulder instability with primary bone loss versus failed arthroscopic Bankart repair.

BACKGROUND: This study compares the outcomes of Latarjet-Patte procedures (LPs) performed for primary glenohumeral instability in the setting of critical bone loss (LP-BL) versus salvage surgery performed after a failed arthroscopic Bankart repair (LP-FB). METHODS: LP's performed by senior author from 2017 to 2021 were separated into cohorts by LP indication. Data abstracted from electronic medical records included demographic information, preoperative clinical scores, radiological imaging, and complications. Postoperative clinical outcome scores collected after a 2-year minimum follow-up included: patient-reported outcomes measurement information system (PROMIS) upper extremity (UE), PROMIS pain interference, PROMIS pain intensity, American Shoulder and Elbow Surgeons (ASES), and visual analog scale pain scores. RESULTS: A total of 47 patients (LP-BL: n=29, LP-FB: n=18) with a mean age of 29 years (range, 15-58 years) were included in this study. Both cohorts achieved good upper extremity functionality without significant differences as indicated by mean PROMIS UE (LP-BL: 52.6±10.0 vs. LP-FB: 54.6±7.6, P=0.442) and ASES score (LP-BL: 89.9±15.7 vs. LP-FB: 91.5±14.4, P=0.712). However, the LP-FB cohort reported lower levels of pain (LP-FB: 0.5±1.1 vs. LP-BL: 1.9±2.7, P=0.020) at their latest follow-up. There were no significant differences in complication rates including re-dislocation between cohorts (LP-BL: 2/29 [6.9%] vs. LP-FB: 2/18 [11.1%], P=0.629). CONCLUSIONS: When performed after failed Bankart repair, the LP results in similar postoperative functional outcomes and similar rates of complications and re-dislocations when compared to the primary indication of recurrent glenohumeral instability in the setting of critical bone loss. Level of evidence: III.

The Role of External Fixation in the Treatment of Distal Radius Fractures.

There are numerous internal fixation (IF) options available for distal radius fractures (DRFs). The choice of fixation method depends on factors such as fracture morphology, soft tissue integrity, the patient's clinical status, and the surgeon's training. While volar plate fixation has become the primary approach for addressing these fractures, alternative IF methods like K-wire fixation, fragment-specific fixation, and dorsal bridge plating continue to be effective. Despite the versatility of IF, there are certain clinical situations where prompt and conclusive management through open reduction and internal fixation (ORIF) is not suitable. These instances include the treatment of polytraumatized patients, individuals with compromised soft tissues, or those medically unstable to tolerate lengthy anesthesia. In such cases, proficiency in closed reduction and external fixation (EF) proves invaluable. Being able to identify these clinical scenarios and comprehend the efficacy and safety of EF in addressing DRFs is valuable for any surgeon handling such injuries.