Background To our knowledge, outcomes of patients undergoing staged, bilateral total hip arthroplasty (THA) via dissimilar surgical approaches have not yet been investigated. This study examined demographics, implant selection, technology utilization, and component positioning between hips in patients who underwent one THA via posterior and one via direct anterior approach and secondarily evaluated patient-reported outcomes. Methods There were 36 patients (72 hips) who underwent staged, bilateral, primary, elective THAs via different approaches from January 2012 to December 2023. Patient demographics, intraoperative technology utilization, implants used, and preoperative and postoperative Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement scores were recorded. The hip center of rotation, acetabular height and anteversion, and metaphyseal canal fill were measured on postoperative radiographs. Femoral stem coronal and sagittal plane angulation following both approaches were also compared on postoperative radiographs. Results There were 15 (41.7%) patients who underwent posterior THA first. The mean time between operations was 5 years (range, 0.93 to 10.2). Intraoperative technology utilization was more common for the anterior THA (P = 0.002). There were no significant differences in hip center of rotation (P = 0.292), acetabular anteversion (P = 0.428), or acetabular height (P = 0.935) between patients’ anterior and posterior approach THAs. The proportion of patients who had posterior stem angulation was significantly greater following anterior THA; neutral stem angulation was seen more frequently following posterior THA (P = 0.005). Lipped liners (P < 0.001), high offset femoral stems (P = 0.007), and dual or triple-taper stems (P < 0.001) were more commonly utilized in posterior THAs. For patients who had preoperative and postoperative Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement for each hip, there was no significant difference in postoperative score improvement between anterior and posterior THAs (P = 0.697), with a mean follow-up time of 2.4 years (range, 0.3 to 9.28) for posterior and 6.1 years (range, 2.8 to 10.3) for anterior THAs (P = 0.249). Conclusions Patients undergoing staged, bilateral THAs via different surgical approaches exhibit radiographic characteristics likely attributable to technical challenges for each approach. However, these differences related to approach do not seem to impact short-term clinical and patient-reported outcomes.

Background The purpose of this systematic review was to evaluate the impact of mental health disorders (MHDs) on the clinical and functional outcomes following total ankle arthroplasty (TAA) for the treatment of end-stage ankle arthritis. Methods A systematic review of the EMBASE, MEDLINE, and Cochrane Library databases was conducted in April 2024 following PRISMA guidelines. Data collected included patient demographics, clinical outcomes, complications, and failures. Results Six studies published between 2019 and 2023 were included, involving a total of 8,772 patients who underwent TAA. Among these, 1,076 patients (12.3%) had a pre-operative MHD. The weighted mean age was 64.1 ± 4.9 years, and the mean postoperative follow-up was 4.6 ± 7.2 months. There were inferior subjective clinical outcomes in patients with an associated MHD, as demonstrated by lower scores in the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), Visual Analogue Scale (VAS), and American Orthopaedic Foot and Ankle Society (AOFAS) scores compared to patients without a MHD. Additionally, patients with MHDs had high complication rates (23.7%), including 76 prosthetic complications (6.1%) and 15 cases (1.2%) requiring revision procedures. However, no significant differences in objective outcomes such as joint mobility or implant failure rates were found between those with and without MHDs. Conclusion MHDs adversely affect subjective outcomes and complications following TAA, highlighting the need for integrated mental health management in preoperative and postoperative care. Further research is needed to understand the precise role of mental health in TAA outcomes.

INTRODUCTION:Discharge disposition after total joint arthroplasty may be predictable. Previous literature has attempted to improve upon models such as the Risk Assessment and Prediction Tool (RAPT) in an effort to optimize postoperative planning. The purpose of this study was to determine whether preoperative laboratory values and other previously unstudied demographic factors could improve the predictive accuracy of the RAPT. METHODS:All patients included had RAPT scores in addition to the following preoperative laboratory values: red blood cell count, albumin, and vitamin D. All values were recorded within 90 days of surgery. Demographic variables including marital status, American Society of Anesthesiologists (ASA) scores, body mass index, Charlson Comorbidity Index, and depression were also evaluated. Binary logistic regression was used to determine the significance of each factor in association with discharge disposition. RESULTS:Univariate logistic regression found significant associations between discharge disposition and all original RAPT factors as well as nonmarried patients ( P < 0.001), ASA class 3 to 4 ( P < 0.001), body mass index >30 kg/m 2 ( P = 0.065), red blood cell count <4 million/mm 3 ( P < 0.001), albumin <3.5 g/dL ( P < 0.001), Charlson Comorbidity Index ( P < 0.001), and a history of depression ( P < 0.001). All notable univariate models were used to create a multivariate model with an overall predictive accuracy of 90.1%. CONCLUSIONS:The addition of preoperative laboratory values and additional demographic data to the RAPT may improve its PA. Orthopaedic surgeons could benefit from incorporating these values as part of their discharge planning in THA. Machine learning may be able to identify other factors to make the model even more predictive.

INTRODUCTION:Previous studies have attempted to validate the risk assessment and prediction tool (RAPT) in primary total hip arthroplasty (THA) patients. The purpose of this study was to: (1) identify patients who had an extended length of stay (LOS) following THA; and (2) compare the accuracy of 2 previously validated RAPT models. METHODS:We retrospectively reviewed all primary THA patients from 2014 to 2021 who had a completed RAPT score. Youden's J computational analysis was used to determine the LOS where facility discharge was statistically more likely. Based on the cut-offs proposed by Oldmeadow and Dibra, patients were separated into high- (O: 1 to 5 versus D: 1 to 3), medium- (O: 6 to 9 versus D: 4 to 7), and low- (O: 10 to 12 versus D: 8 to 12) risk groups. RESULTS:We determined that an LOS of greater than 2 days resulted in a higher chance of facility discharge. In these patients (n = 717), the overall predictive accuracy (PA) of the RAPT was 79.8%. The Dibra model had a higher PA in the high-risk group (D: 68.2 versus O: 61.2% facility discharge). The Oldmeadow model had a higher PA in the medium-risk (O: 78.7 versus D: 61.4% home discharge) and low-risk (O: 97.0 versus D. 92.5% home discharge) groups. CONCLUSIONS:As institutions continue to optimize LOS, the RAPT may need to be defined in the context of a patient's hospital stay. In patients requiring an LOS of greater than 2 days, the originally established RAPT cut-offs may be more accurate in predicting discharge disposition. LEVEL OF EVIDENCE:III Retrospective Cohort Study.

Background: The periacetabular osteotomy (PAO) was developed to treat acetabular dysplasia and avoid the progression of osteoarthritis. Prior research has correlated demographic and radiographic variables with postoperative patient outcomes but with limited focus on patient expectations and correlation with satisfaction. The purpose of this study was to determine whether any such associations exist with the PAO. Methods: An anonymous, de-identified satisfaction survey was applied to patients undergoing a PAO between April 2017 and April 2019. Forty patients (26 females) who underwent PAOs were included in the final analysis. The average age of the cohort was 22.0 + 5.1 years of age. All patients had a minimum of 12 months of follow-up from the date of surgery. Patient demographics, diagnosis, and complications were recorded. Radiographs were then analyzed to determine preand postoperative lateral center edge angle (LCEA) and T & ouml;nnis roof angle, and correlations between satisfaction and radiographic analyses were performed. Statistical analysis included non-parametric Spearmans' correlation and receiver operator characteristic. Statistical significance was set at p < 0.05. Results: Thirty (75%) patients were satisfied with their outcome. There were no statistically significant associations between patient age or sex and postoperative satisfaction (p > 0.05). The average LCEA was 10.9 degrees + 6.9 degrees preoperatively and 26.0 degrees + 4.2 degrees postoperatively with an average change of 15.1 degrees + 5.6 degrees. The average T & ouml;nnis angle was 18.8 degrees + 3.3 degrees preoperatively, decreasing to 11.6 degrees + 3.2 degrees postoperatively with an average change of-7.2 degrees + 3.2 degrees. Interobserver reliability was high, ranging from r = 0.782, p < 0.001 for postoperative T & ouml;nnis angle to r = 0.958, p < 0.001 for preoperative LCEA. Preoperative LCEA correlated positively with satisfaction, r = 0.351, p = 0.027. Logistic regression demonstrated that for every increasing degree of preoperative LCEA, odds of postoperative satisfaction increased by 1.13 (95% CI: 1.01 to 1.27), p = 0.034. Conclusion: This study suggests that postoperative patient satisfaction after PAO may be associated with preoperative patient demographics such as LCEA. It also suggests that more dysplastic hips may have lower rates of postoperative satisfaction than patients with less severe deformity. These associations warrant further study, which may yield prognostic value for future surgery.

Purpose: The purpose of this study was to compare the clinical outcomes of patients with patellofemoral osteoarthritis (PFOA) treated non -operatively with those treated operatively with an unloading anteromedialization tibial tubercle osteotomy (TTO). Methods: A retrospective chart review was performed to identify patients with isolated PFOA who were either managed non -operatively or surgically with a TTO and who had a minimum follow-up of 2 years. Patients were surveyed with the visual analog scale (VAS) for pain, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), Anterior Knee Pain scale (Kujala), and Tegner Activity scale. Statistical analysis included two -sample ttesting, one-way ANOVA, and bivariate analysis. Results: The clinical outcomes of 49 non -operatively managed patients (mean age: 52.7 +/- 11.3 years; mean follow-up: 1.7 +/- 1.0 years) and 35 operatively managed patients (mean age: 31.8 +/- 9.4 years; mean follow-up: 3.5 +/- 1.7 years) were assessed. The mean VAS improved significantly in both groups [6.12 to 4.22 (non -operative), p < 0.0001; 6.94 to 2.45 (TTO); p < 0.0001], with operatively treated patients having significantly lower postoperative pain than non -operatively managed patients at the time of final follow-up [2.45 (TTO) vs. 4.22 (non -operative), p < 0.001]. The mean KOOS-JR score was significantly greater in the operative group at time of final follow-up [78.7 +/- 11.6 (TTO) vs. 71.7 +/- 17.8 (non -operative), p = 0.035]. There was no significant difference in Kujala or Tegner scores between the treatment groups. Additionally, there was no significant relationship between the number of intra-articular injections, duration of NSAID use, and number of physical therapy sessions on clinical outcomes in the non -operatively treated group (p > 0.05). Conclusions: An unloading anteromedialization TTO provides significantly better pain relief and restoration of function compared to non -operative management in the treatment of symptomatic PFOA.

Purpose: The purpose of this study was to compare regimens of eccentric exercise and dry-needling, with and without an ultrasound-guided leukocyte-poor platelet-rich plasma (LP-PRP) injection, in patients with patellar tendinopathy. Methods: Patients with symptomatic patellar tendinopathy based on physical examination and magnetic resonance imaging and who had failed at least 6 weeks of nonoperative treatment were enrolled and randomized at two centers to receive ultrasound-guided dry-needling (DN) alone or in addition to an injection of LP-PRP coupled with standardized eccentric strengthening exercises. Participants completed patient-reported outcome surveys at baseline and at 3, 6, 9, 12, and 26 weeks post-treatment. The primary outcome measure was the Victorian Institute of Sports Assessment (VISA) score for patellar tendinopathy (VISA-P) at 12 weeks, and secondary measures included the visual analog scale (VAS) for pain, Tegner activity scale, Lysholm knee scale (Lysholm), and Veterans Rand 12-Item Health Survey (VR12) questionnaire at 12 and 26 weeks. Results: Thirty-one subjects were enrolled in the study (15 DN, 16 LP-PRP). Twenty-three patients were available for follow-up at all time points. There were no statistically significant differences between the two groups at baseline. At 12 weeks post-treatment, both the LP-PRP and DN groups demonstrated statistically significant (p < 0.05) improvements from baseline with respect to Lysholm score (34.5 + 15.1 and 31.7 + 18.4), VAS pain scale (-1.58 + 2.1 and-2.8 + 1.9, respectively), and VISA score (19.2 + 15.9 and 28.4 + 19.4, respectively). At 26 weeks post-treatment both groups demonstrated statistically significant (p < 0.05) improvements in Lysholm score (23.6 + 23.1 and 24.5 + 17.3, respectively) and VAS pain score (-1.67 + 2.3 and-2.18 + 2.9, respectively). The LP-PRP group failed to show significance for VISA-P score from 0 to 26 weeks, though the DN group did (22.0 +/- 14.6). There were no statistically significant differences between the two groups in mean VISA, VAS, Lysholm, or the Short Form Health Survey (SF-12) scores at either the 12 week or 26-week follow-up time points. Conclusion: The results of the current study demonstrate that both DN and DN plus LP-PRP are effective treatment options in the management of symptomatic patellar tendinopathy, however, LP-PRP did not add any additional improvement over DN alone.

BACKGROUND:Postoperative return to recreational activity is a common concern among the increasingly active total knee arthroplasty (TKA) patient population, though there is a paucity of research characterizing sport-specific return and function. This study aimed to assess participation level, postoperative return to activity, sport function, and limitations for recreational athletes undergoing TKA. METHODS:A survey of recreational sports participation among primary, elective TKA patients from a single academic center between June 2011 and January 2022 was conducted. Of the 10,777 surveys administered, responses were received from 1,063 (9.9%) patients, among whom 784 indicated being active in cycling (273 [34.8%]), running (33 [4.2%]), jogging (68 [8.7%]), swimming (228 [29.1%]), tennis (63 [8.0%]), skiing (55 [7.0%]), or high-impact team sports (64 [8.2%]) between two years preoperatively and time of survey administration, and were included for analyses. RESULTS:Cycling (62.3% at two years preoperatively vs. 59.0% at latest follow-up) and swimming (62.7% at two years preoperatively vs. 63.6% at latest follow-up) demonstrated the most favorable participation rate changes, while running (84.0% at two years preoperatively vs. 48.5% at latest follow-up) and skiing (72.7% at two years preoperatively vs. 45.5% at latest follow-up) demonstrated the least favorable participation rate changes. The majority of respondents were "satisfied" or "very satisfied" with their return across all sports, though dissatisfaction was highest among runners and joggers. For cycling, running, jogging, and swimming, respondents most commonly reported no change in speed or distance capacity, though among these cyclists reported the highest rates of improved speed and distance. The majority of returning skiers reported improved balance, form, and ability to put on skis. CONCLUSION:Return to sport is feasible following TKA with high satisfaction. Swimming and cycling represent manageable postoperative activities with high return-rates, while runners and joggers face increased difficulty returning to equal or better activity levels. Patients should receive individualized, sports-specific counseling regarding their expected postoperative course based on their goals of treatment.

PURPOSE:This study sought to determine the clinical outcomes of patients that underwent hip arthroscopy for femoroacetabular impingement (FAI) and concomitant arthroscopic iliotibial (IT) band lengthening with trochan- teric bursectomy (TB group) as well as a matched cohort of patients undergoing hip arthroscopy for isolated FAI symptoms (NTB group) from baseline to a minimum of 2-year follow-up. METHODS:Patients who were diagnosed with FAI and symptomatic trochanteric bursitis and who failed con- servative measures and underwent hip arthroscopy and arthroscopic IT band lengthening with trochanteric bur- sectomy were identified. These patients were matched by age, sex, and body mass index (BMI) to a group of patients who underwent surgery for FAI without trochanteric bur- sitis symptoms. Patients were separated into two groups: iliotibial band lengthening with trochanteric bursectomy (TB) and non-trochanteric bursectomy (NTB). The patient reported outcomes (PROs) recorded were the modified Har- ris Hip Score (mHHS) and Non-Arthritic Hips Score (NAHS), which were obtained with a minimum of 2-years follow-up. RESULTS:Each cohort was composed of 22 patients. The TB cohort was composed of 19 females (86%) with a re- ported mean age of 49.3 ± 11.6 years. The NTB cohort was composed of 19 females (86%) with a reported mean age of 49.0 ± 11.7 years. Both cohorts showed significant improve- ment from baseline in the mHHS and NAHS. There was no significant difference in the mHHS and NAHS between the two groups. There was no significant difference between TB and NTB groups with respect to achieving minimal clinically important difference (MCID), [19 (86%) vs. 20 (91%), p > 0.99] or patient acceptable symptom state (PASS), [13 (59%) vs. 14 (64%), p = 0.76]. CONCLUSIONS:There was no difference in PROs of patients with FAI and trochanteric bursitis who underwent hip ar- throscopy with concomitant arthroscopic IT band lengthen- ing with trochanteric bursectomy compared to patients with isolated FAI who underwent hip arthroscopy.

Background: Prior research has demonstrated that the prescription of opioid medications may be associated with the desire to treat pain in order to achieve favorable patient satisfaction. The purpose of the current study was to investigate the effect of decreased opioid prescribing following total knee arthroplasty (TKA) on survey-administered patient satisfaction scores.Method: This study is a retrospective review of prospectively collected survey data for patients who underwent primary elective TKA for the treatment of osteoarthritis (OA) between September 2014 and June 2019. All patients included had completed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) survey information. Patients were stratified into two cohorts based on whether their surgery took place prior to or subsequent to the implementation of an institutional-wide opioid-sparing regimen.Results: Of the 613 patients included, 488 (80%) were in the pre-protocol cohort and 125 (20%) in the post-protocol cohort. Rate of opioid refills (33.6% to 11.2%; p<0.001) as well as length of stay (LOS, 2.40 + 1.05 to 2.13 + 1.13 days; p=0.014) decreased significantly after protocol change while rate of current smokers increased significantly (4.1% to 10.4%; p=0.011). No significant difference was observed in “top box” percentages for satisfaction with pain control (Pre: 70.5% vs Post: 72.8%; p=0.775).Conclusions: Protocols calling for reduced prescription of opioids following TKA resulted in significantly lower LOS and rate of opioid refills while causing no statistically significant deleterious changes in patient satisfaction, as measured by HCAPS survey.

PURPOSE:Bone tunnel widening (TW) is a well-described complication after anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to evaluate radiographic bone TW and clinical outcomes in patients with ACLR performed with suspensory fixation on both the femoral and tibial tunnels using different soft tissue grafts.METHODS:Patients who underwent primary ACLR with a soft tissue graft (hamstring autograft or allograft or quadriceps autograft) using an all-inside technique were included for analysis. Anterior cruciate ligament tunnel width was measured postoperatively on anteroposterior and lateral plain radiographs at a minimum of 12 months of follow-up. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) subjective knee form as well as assessing patient records for complication data.RESULTS:Fifty patients (15 quadriceps autografts, 24 hamstring autografts, 11 hamstring allografts) were included in this study. The quadriceps autograft cohort was the youngest, (16.6 ± 2.8 years), followed by the hamstring autograft cohort (27.7 ± 9.0 years), and the hamstring allograft cohort (48.2 ± 9.4 years; p < 0.001) for all comparisons. Quadriceps autografts experienced less tibial tunnel-widening (0.6 ± 0.6 mm) than hamstring autografts (2.0 ± 1.1 mm; p = 0.011), which, in turn, experienced less widening than hamstring allografts (3.9 ± 2.3 mm; p < 0.001). Quadriceps autografts also experienced less femoral tunnel widening (0.3 ± 0.6 mm) than hamstring autografts (2.1 ± 1.2 mm; p < 0.001) which, in turn, experienced less tunnel-widening than hamstring allografts (4.0 ± 2.1; p < 0.001). At follow-up, mean IKDC for hamstring autografts, quadriceps autografts, and hamstring allografts were 79.9 ± 17.9, 88.5 ± 7.1, and 77.7 ± 20.4, respectively (p = 0.243). There was no statistically significant difference between groups with respect to postoperative complications; p = 0.874.CONCLUSIONS:Anterior cruciate ligament reconstruction with quadriceps autograft resulted in the least tunnel widening compared to hamstring autograft and allograft when using an all-inside suspensory fixation device. Both autograft groups resulted in less widening than the allograft group. Despite the greatest increased radiographic tunnel widening in the allograft group, there was no significant difference in clinical outcomes or knee laxity.

Background: The COVID-19 pandemic led to health care practitioners utilizing new technologies to deliver health care, including telemedicine. The purpose of this study was to examine the effect of rapidly proliferative use of video visits on opioid prescribing to orthopedic patients at a large academic health system that had existing procedure-specific opioid prescribing guidelines. Methods: This IRB-exempt study examined 651 opioid prescriptions written to patients who had video (visual and audio), telephone (audio only), or in-person encounters at our institution from March 1 to June 1, 2020 and compared them with 963 prescriptions written during the same months in 2019. Prescriptions were converted into daily milligram morphine equivalents (MMEs) to facilitate direct comparison. Chi-square testing was used to compare categorical data, whereas analysis of variance and Mann-Whitney tests were used to compare numerical data between groups. Statistical significance was set at <0.05. Results: Six hundred fifty-one of 1,614 prescriptions analyzed (40.3%) occurred during the pandemic. Patients prescribed opioids during video visits were prescribed 53.3 ± 37 MME, significantly higher than in-person (p = 0.002) or audio visits (p < 0.001) before or during the pandemic. Prepandemic, significantly higher MME were prescribed for in-person versus audio only visits (41.6 ± 89 vs. 30.2 ± 28 MME; p = 0.026); during the pandemic, there was no difference between these groups (p = 0.91). Significantly higher MME were prescribed by Nurse Practitioners and Physician Associates versus MD or DO prescribers for both time periods (51.3 ± 109 vs. 27.9 ± 42 MME; p < 0.001; 42.9 ± 70 vs. 28.2 ± 42 MME; p < 0.001). Conclusion: During crisis and with new technology, we should be vigilant about prescribing of opioid analgesics. Despite well-established protocols, patients received significantly higher MME through video than for other encounter types, including in-person encounters. In addition, significantly higher MME were prescribed by mid-level prescribers compared with DOs or MDs. Institutions should ensure these prescribers are involved during creation of opioid prescribing protocols after orthopedic surgery.

Background: The Comprehensive Care for Joint Replacement requires patient-reported outcome measure (PROM) completion for total knee/hip arthroplasty (TKA/THA) patients. A 90% completion rate to avoid penalties was planned for 2023 but has been delayed. Our analysis compares TKA/THA PROM completion and results across demographics. We hypothesized that minority groups would be less likely to complete PROMs. Methods: A retrospective review was performed from 2018 to 2021 of 16,119 patients who underwent primary elective TKA or THA at a single institution. Pairwise chi-squared tests, t-tests, analysis of variance, and multiple logistic regression analyses were used to compare PROM completion rates and scores across demographics and surgery type (TKA/THA). Results: Comparing patients who had (N = 7,664) and did not have (N = 8,455) documented PROMs, completion rates were significantly lower in patients who were women, Black, Hispanic, less educated, used Medicaid insurance, lived in lower income neighborhoods, spoke non-English languages, required an interpreter, and underwent TKA versus THA. After regression analyses, odds ratios for PROM completion remained significantly lower in non-English speakers, Hispanic and Medicaid patients, lower income groups, and patients undergoing TKA. For the 31.8% of patients who completed both preoperative/postoperative PROMs, women, Black, and non-English speaking patients had significantly lower PROM scores for most measures preoperatively and postoperatively despite similar or better improvements after surgery. Conclusion: Patients undergoing TKA and non-English speaking, ethnic, and socioeconomic minorities are less likely to complete PROMs. Strategies to create, validate, and collect PROMs for these populations are needed to avoid exacerbation of healthcare disparities. (c) 2023 Published by Elsevier Inc.

PURPOSE:Thisstudy sought to assessthe prognostic effect of preoperative symptom severity on hip arthroscopy outcomes for femoroacetabular impingement syndrome (FAI).METHODS:Patients undergoing hip arthroscopy between September 2012 and July 2014 for FAI with a minimum of 5-year clinical outcomes were compiled. Patient reported outcomes (PROs) including modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) were collected. High and low preoperative function (PF) subgroups were created using baseline population median mHHS (43.3) as a threshold with PROs below the median score indicating low preoperative function and vice versa for scores above the median. Kaplan-Meier analysis, Cox proportional modeling, analysis of variance (ANOVA), and linear regressions were used for analysis.RESULTS:One hundred five of 131 eligible patients(80.2% inclusion; age: 42.6 ± 1.4 years; body mass index: 25.3 ± 0.4 kg/m2 ) met the study criteria. The 5-year survival-torevision rate (85% versus 61%, p = 0.013) and survivalto-arthroplasty rate (95% vs. 82%, p = 0.022) were greater in the high versus low PF group. ANOVA demonstrated the high versus low PF group had higher baseline (mHHS: 52.7 ± 1.4 vs. 36.1 ± 1.1, p < 0.001; NAHS: 57.4 ± 1.6 vs. 39.3 ± 1.2, p < 0.001) and 1-year (mHHS: 91.9 ± 1.8 vs. 79.5 ± 2.7, p < 0.001; NAHS: 91.7 ± 1.6 vs. 80.8 ± 2.5, p < 0.001) outcomes. High versus low PF achieved higher Minimal Clinically Important Difference (77% vs. 57%, p = 0.026) at 5-years. High versus low PF achieved higher Patient Acceptable Symptomatic State rates at 1 year (79% vs. 47%, p < 0.001) and 5 years (66% vs. 45%, p = 0.032). Linear regression demonstrated body mass index (mHHS: p = 0.002; NAHS: p = 0.005), pincer resection (mHHS: p = 0.046), and preoperative symptom severity (mHHS: p = 0.001; NAHS: p = 0.002) to be predictors of 5-year change in PROs.CONCLUSION:Preoperative symptom severity is a reliable prognostic indicator of clinical survival rates and PROs after hip arthroscopy for FAI. Subjects with high PF are likely to have increased longevity of the index procedure while maintaining excellent PASS and MCID rates mid-term as opposed to those with low PF.

Objectives:To compare the efficacy of different dosages of intravenous (IV) tranexamic acid (TXA) in the treatment of traumatic hip fractures against that of the control group of no TXA.Data Sources:This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to perform a network meta-analysis on the use of TXA for the treatment of hip fractures. The study team used Ovid MEDLINE, Cochrane Reviews, Scopus, Embase, and Web of Science databases to perform the search. Studies that were published in English between the years 2010 and 2020 were selected.Study Selection/Data Extraction:For inclusion in this study, selected articles were required to be randomized controlled trials with at least 1 control group that had no antifibrinolytic intervention to serve as a control, and IV formulations of TXA were used as part of the treatment group. Furthermore, all study participants must have undergone surgical intervention for traumatic hip fractures. Studies that did not immediately meet criteria for inclusion were saved for a review by the full investigating team and were included based on consensus.Data Synthesis:All statistical analyses conducted for this study were performed using R software (R Foundation for Statistical Computing, Vienna, Austria). Network meta-analyses were conducted with a frequentist approach with a random-effects model using the netmeta package version 0.9-6 in R. The frequentist equivalent to surface under the cumulative ranking probabilities, termed "P score," was used to rank different treatments.Conclusion:The use of TXA in the surgical management of traumatic hip fractures reduces the number of transfusions and perioperative blood loss, with minimal to no increased incidence of thrombotic events when compared with those in controls. When comparing formulations, no route of administration is clearly superior in reducing perioperative blood loss.

Background: The minimal clinically important difference (MCID) is a term synonymous with orthopaedic clinical research over the past decade. The term represents the smallest change in a patient-reported outcome measure that is of genuine clinical value to patients. It has been derived in a myriad of ways in existing orthopaedic literature. Purpose: To describe the various modalities for deriving the MCID. Study Design: Narrative review; Level of evidence, 4. Methods: The definitions of common MCID determinations were first identified. These were then evaluated by their clinical and statistical merits and limitations. Results: There are 3 primary ways for determining the MCID: anchor-based analysis, distribution-based analysis, and sensitivity- and specificity-based analysis. Each has unique strengths and weaknesses with respect to its ability to evaluate the patient's clinical status change from baseline to posttreatment. Anchor-based analyses are inherently tied to clinical status yet lack standardization. Distribution-based analyses are the opposite, with strong foundations in statistics, yet they fail to adequately address the clinical status change. Sensitivity and specificity analyses offer a compromise of the other methodologies but still rely on a somewhat arbitrarily defined global transition question. Conclusion: This current concepts review demonstrates the need for (1) better standardization in the establishment of MCIDs for orthopaedic patient-reported outcome measures and (2) better study design-namely, until a universally accepted MCID derivation exists, studies attempting to derive the MCID should utilize the anchor-based within-cohort design based on Food and Drug Administration recommendations. Ideally, large studies reporting the MCID as an outcome will also derive the value for their populations. It is important to consider that there may be reasonable replacements for current derivations of the MCID. As such, future research should consider an alternative threshold score with a more universal method of derivation.

PURPOSE:The purpose of this study was to evaluate out- comes of hip arthroscopy for femoroacetabular impingement (FAI) in female patients at 5-year follow-up. The working hypothesis for this study was that increased age and body mass index (BMI) would be associated with poor outcomes. METHODS:This study included all female patients 14 years and older who underwent primary hip arthroscopy for FAI with 5-year patient-reported outcome scores. Patients were separated into three age-based cohorts (< 30 years old, 30 to 45 years old, and > 45 years old) for subsequent statistical analysis. This analysis included a comparison of patient demographic information, intraoperative pathology, and functional outcome scores (modified Harris Hip Score [mHHS] and nonarthritic hip score [NAHS]). Statistically significant values were utilized in a regression-based analy- sis to determine predictors of 5-year outcomes in female patients. A p-value of < 0.05 was considered to be statisti- cally significant. RESULTS:Overall, 97 patients met the inclusion criteria, and there was no significant difference in patient demo- graphics (other than age and BMI) or in intraoperative pathologies identified. There were no significant difference across the three groups for mHHS and NAHS at baseline (p > 0.05). At baseline, there were no statistically significant differences between groups for NAHS scores, however < 30-year-old and 30- to 45-year-old cohorts had superior final NAHS scores relative to the > 45-year-old cohort (p = 0.005). At 5-year follow-up, the NAHS scores were significantly better for patients under 30 and 30 to 45 year olds relative to patients over 45 (84.2 ± 15.1 vs. 86.7 ± 11.0 vs. 71.9 ± 26.8, respectively; p = 0.005). Overall, 88 patients (91%) met the minimal clinically important differ- ence (MCID), and 60 patients (62%) achieved the patient acceptable symptomatic state (PASS). Baseline mHHS and BMI were shown to be statistically significant predictors of achieving MCID at 5 years in multivariate analysis (p < 0.001). CONCLUSION:The results of this study suggest that women generally have good-to-excellent outcomes following hip ar- throscopy, although females older than 45 may have inferior outcomes relative to younger patients, and BMI and baseline mHHS may be utilized to predict long-term improvement.

Study Design: A single-center, retrospective review of prospectively collected data on patients who underwent single-level anterior cervical discectomy and fusions (ACDFs) between October 2014 and October 2019. Objective: To investigate the effect of perioperative narcotic consumption and amount of narcotic prescribed at discharge on patient satisfaction with pain control after single-level ACDF. Summary of Background Data: Prior research has demonstrated that opioid prescription habits may be related to physician desire to produce superior patient satisfaction with pain control. Methods: Patients with complete Press-Ganey Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey information were analyzed. Inpatient opioid prescriptions were recorded and converted to milligram morphine equivalents (MME) and tablets of 5 mg oxycodone. HCAHPS scores were converted to a Likert-type 5-point scale. Results: A total of 47 patients met inclusion criteria for this study. Average age was 48.1 +/- 10.9 y. Average inpatient opioids prescribed was 102 +/- 106 MME. Average opioids prescribed at discharge was 437 +/- 342 MME. No statistically significant correlation was found between satisfaction with pain control and opioid consumption while in the hospital [r=-0.106, P=0.483]. Similarly, there was no statistically significant correlation between satisfaction with pain control and opioids prescribed upon discharge [r=-0.185, P=0.219]. No statistically significant correlation was found between date of surgery and inpatient MME consumption [r=-0.113, P=0.450]. Interestingly, more opioids were prescribed at discharge the earlier the date of surgery [r=-0.426, P=0.003]. For every additional month further along in the study period, the odds of a patient reporting a top box score for satisfaction with pain control increased by 5.5% [P=0.025]. Conclusion: Our study found no correlation between patient satisfaction with pain control and inpatient opioid dosage or outpatient prescription dosage after single-level ACDF. Moreover, satisfaction with pain control increased over time despite a decrease in MME prescribed at discharge. This suggests that factors other than narcotic consumption play a more important role in patient satisfaction with pain control.

The purpose of this study was to determine and establish the MCID for the NAHS at 2 years in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Patients that underwent primary hip arthroscopy for FAIS between 2010 and 2016 were analyzed for eligibility. Data were collected from a single surgeon’s hip arthroscopy database. MCID was calculated for the NAHS utilizing a distribution-based method. The study included 298 patients (184 females) with an average age of 40.4 ± 13.0 years and average body mass index (BMI) of 25.7 ± 4.2 kg/m2. At baseline, the cohort’s average NAHS score was 48.7 ± 13.6 and demonstrated an improvement of 36.5 ± 17.0 for NAHS at follow-up. This resulted in MCID values of + 8.5 for NAHS. This is the first study to report the MCID (+ 8.5) for NAHS following primary hip arthroscopy, and as such, is a valuable contribution to future hip arthroscopy research. IV.

Bulletin of the Hospital for Joint Diseases 2022;80(4):252-6252 Bloom DA, Gonzalez M, Hurley ET, Kingery MT, Carter CW, Jazrawi LM, Strauss EJ. Sex-based differences in outcomes of tibial tubercle anteromedi- alization. Bull Hosp Jt Dis. 2022;80(4):252-6. Abstract Background: Previous research has demonstrated sex- based differences in patient-reported outcomes of orthopedic surgical procedures. The hypothesis of the current study was that females would have inferior patient-reported outcomes to their male peers following a tibial tubercle anteromedial- ization (AMZ) procedure for both patellofemoral instability and cartilage defects.METHODS:Patients who had undergone AMZ for isolated osteochondral defect or patellofemoral instability with a minimum follow-up time of 1 year were identified. They were then asked to complete several patient-reported outcome questionnaires that were then statistically analyzed.RESULTS:Overall, 109 patients were included in this study. Seventy-nine patients (72.5%) were female with a mean follow-up duration of 3.4 ± 2.0 years. Forty-seven females had AMZ for patellar instability while 32 females had AMZ for osteochondral defects. There were no statistically signifi- cant differences between sexes with respect to concomitant procedures performed, visual analog scale (VAS) pain score, or patient reported outcome (PRO) scores at follow-up (p > 0.05). There was no statistically significant difference with respect to outcomes between the sexes for AMZ overall and when isolating the sexes based on indication.CONCLUSION:This study demonstrates that female patients undergoing AMZ have short-term clinical and functional outcomes that are not significantly different to those reported in males.