Proximal humerus fractures account for approximately 4–6
PURPOSE:The aim of our study was to perform a cost-utility analysis comparing trapeziometacarpal joint (TMJ) implant arthroplasty with resection-suspension-interposition arthroplasty (RSIA) during 1 year after surgery. METHODS:We compared 80 working patients undergoing TMJ implant arthroplasty with 39 working patients receiving RSIA. Over 1 year, we assessed return to work, costs because of loss of productivity, quality-adjusted life-years (QALYs), and direct medical costs. Sensitivity analyses were conducted to extrapolate data over 5 years as well as to account for the data of nonworking patients. RESULTS:Implant arthroplasty patients returned to work significantly faster (mean 52 vs 84 days), leading to reduced costs due to productivity loss. Patients with TMJ implant arthroplasty had significantly higher QALYs (0.89 vs 0.85) and lower total costs (USD 26,809 vs USD 33,953), resulting in a negative incremental cost-effectiveness ratio. At a threshold of USD 110,000 per QALY, implant arthroplasty was found to be cost effective with 99% probability. Sensitivity analyses showed that implant arthroplasty was cost effective over 5 years, despite higher revision risks and also if nonworking patients were included in the population. CONCLUSIONS:The study indicates that TMJ implant arthroplasty is less expensive and improves quality of life more effectively than RSIA. TYPE OF STUDY/LEVEL OF EVIDENCE:Economic 1c.
No prior study could be identified that combined qualitative and quantitative methods to analyse the long-term psychosocial and functional state of Idiopathic Scoliosis (IS) patients treated during adolescence. This study aimed to comprehensively evaluate the long-term health status of these patients and to identify and contextualize the key factors influencing it by using a multimethod approach. A multimethod approach was used. Qualitative data included recording, transcription, coding and content analysis of focus groups and semi-structured interviews. For the quantitative analysis, patients completed questionnaires. Fifty-seven patients were recruited. Two focus groups and 44 individual interviews were performed. All of them completed the questionnaires. Quantitative analyses showed significant age-related differences in ODI, SRS22-Function, SRS22-Pain, SRS22-Self Image and trunk deformity perception, with older patients showing poorer results. Trunk deformity perception was the only domain associated with treatment received, with conservatively treated patients scoring worse. Qualitative findings highlighted psychosocial impacts of IS and its treatments during adolescence, particularly related to bracing, which was often associated with discomfort and social stigma. However, these effects generally did not persist into adulthood. In contrast, surgical treatment was generally viewed positively, associated with deformity correction, improved self-image and the elimination of bracing, all contributing to better social integration and overall well-being. Qualitative factors influencing current self-image, self-esteem and overall well-being varied by both age and treatment type. While IS may significantly impact adolescents’ psychosocial health, particularly when it is treated with bracing, the effect tends not to persist into adulthood. In adulthood, age becomes the primary determinant of psychosocial health and general well-being. This multimethod approach revealed distinct factors influencing each domain studied and offered a deeper understanding of their interconnections, highlighting the complex interplay between social, physical, and psychological factors. These findings underscore the importance of a holistic, patient-centered approach in managing IS, with greater emphasis on psychosocial aspects including self-image, self-esteem, and sexual health, throughout treatment planning and long-term follow-up.
To identify postoperative radiographic parameters independently associated with clinically meaningful pain improvement one year after surgery in a selected cohort of adolescents with idiopathic scoliosis (AIS) reporting substantial preoperative pain. This was a retrospective analysis of a prospectively collected multicenter database including 378 AIS patients treated with posterior spinal fusion. Patients with substantial preoperative pain (SRS-22 pain ≤ 4.0) and ≥ 1-year follow-up were included. A 0.6-point MCID in SRS-22 pain defined meaningful improvement. Groups were compared and significant postoperative radiographic variables plus preoperative pain entered a multivariate logistic regression model. Nagelkerke R² and ROC-AUC assessed performance. Eighty-eight patients met the inclusion criteria (mean age 14.7 ± 1.8 years; 77 females). Sixty-four patients (72.7
