Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 471 | Issue 11 | Nov, 2013

Editorial: Active Management of Financial Conflicts of Interest on the Editorial Board of CORR

Seth S. Leopold MD, Lee Beadling BA, Matthew B. Dobbs MD, Mark C. Gebhardt MD, Paul A. Lotke MD, Clare M. Rimnac PhD, Montri D. Wongworawat MD

Conditional Survival Is Greater Than Overall Survival at Diagnosis in Patients With Osteosarcoma and Ewing’s Sarcoma

Benjamin J. Miller MD, MS, Charles F. Lynch MD, MS, PhD, Joseph A. Buckwalter MD, MS

Conditional survival is a measure of the risk of mortality given that a patient has survived a defined period of time. These estimates are clinically helpful, but have not been reported previously for osteosarcoma or Ewing’s sarcoma.

Integrating Patient-reported Outcomes Into Orthopaedic Clinical Practice: Proof of Concept From FORCE-TJR

David C. Ayers MD, Hua Zheng PhD, Patricia D. Franklin MD, MBA, MPH

Good orthopaedic care requires a knowledge of the patient’s history of musculoskeletal pain and associated limitations in daily function. Standardized measures of patient-reported outcomes (PROs) can provide this information. Integrating PROs into routine orthopaedic patient visits can provide key information to monitor changes in symptom severity over time, support shared clinical care decisions, and assess treatment effectiveness for quality initiatives and value-based reimbursement.

Stakeholders in Outcome Measures: Review From a Clinical Perspective

Mark R. Brinker MD, Daniel P. O’Connor PhD

Modern interest in patient-reported outcomes measures (PROMs) in orthopaedics dates back to the mid-1980s. While gradual growth of activity in this area has occurred over the past 25 years, the extent to which this research methodology is applied in clinical practice to improve patient care is unclear.

Challenges in Outcome Measurement: Discrepancies Between Patient and Provider Definitions of Success

Philip C. Noble PhD, Sophie Fuller-Lafreniere MPH, Morteza Meftah MD, Maureen K. Dwyer PhD

Some orthopaedic procedures, including TKA, enjoy high survivorship but leave many patients dissatisfied because of residual pain and functional limitations. An important cause of patient dissatisfaction is unfulfilled preoperative expectations. This arises, in part, from differences between provider and patient in their definition of a successful outcome.

Measuring Expectations in Orthopaedic Surgery: A Systematic Review

Michael G. Zywiel MD, Anisah Mahomed, Rajiv Gandhi MSc, MD, Anthony V. Perruccio PhD, Nizar N. Mahomed MD, ScD

Advances in the surgical treatment of musculoskeletal conditions have resulted in an interest in better defining and understanding patients’ expectations of these procedures, but the best ways to do this remain a topic of considerable debate.

Commonalities, Differences, and Challenges With Patient-derived Outcome Measurement Tools: Function/Activity Scales

Philip C. Noble PhD, Maureen Dwyer PhD, ATC, Adam Brekke BA

There is a critical need to evaluate the success of orthopaedic treatments through valid outcome measures. Previous attempts to express patient outcomes using a single aggregate score led to scores that were ambiguous, often insensitive to change, and poorly correlated with the patient’s assessment of the outcome of surgical procedures.

Validation of PROMIS® Physical Function Computerized Adaptive Tests for Orthopaedic Foot and Ankle Outcome Research

Man Hung PhD, MSTAT, MED, Judith F. Baumhauer MD, MPH, L. Daniel Latt MD, PhD, Charles L. Saltzman MD, Nelson F. SooHoo MD, Kenneth J. Hunt MD

In 2012, the American Orthopaedic Foot & Ankle Societyestablished a national network for collecting and sharing data on treatment outcomes and improving patient care. One of the network’s initiatives is to explore the use of computerized adaptive tests (CATs) for patient-level outcome reporting.

Health Policy Implications of Outcomes Measurement in Orthopaedics

John Philip Andrawis MD, MBA, Kate Eresian Chenok MBA, Kevin J. Bozic MD, MBA

An emphasis on “value” over volume in health care is driving new healthcare measurement, delivery, and payment models. Orthopaedic surgery is a major contributor to healthcare spending and, as such, is the focus of many of these new models.

Incorporating Patient-reported Outcomes in Total Joint Arthroplasty Registries: Challenges and Opportunities

Patricia D. Franklin MD, MBA, MPH, Leslie Harrold MD, MPH, David C. Ayers MD

Total joint arthroplasty (TJA) registries traditionally have focused on implant longevity and rates of revision surgery. Registries would benefit from the addition of standardized patient-reported outcomes (PROs) such as pain relief and improved physical function. However, PROs have not been routinely adopted, and their incorporation into TJA registries presents challenges.

Statistical Considerations in the Psychometric Validation of Outcome Measures

Alla Sikorskii PhD, Philip C. Noble PhD

The evaluation of the outcomes of total knee arthroplasty requires measurement tools that are valid, reliable, and responsive to change. However, the accuracy of any outcome measurement is determined by the validity and reliability of the instrument used. To ensure this accuracy, it is imperative that each instrument used in orthopaedics is free of biases leading to inaccurate estimates of treatment effects.

Challenges in Outcome Measurement: Clinical Research Perspective

Daniel P. O’Connor PhD, Mark R. Brinker MD

Comparative effectiveness research evaluates treatments as actually delivered in routine clinical practice, shifting research focus from efficacy and internal validity to effectiveness and external validity (“generalizability”). Such research requires accurate assessments of the numbers of patients treated and the completeness of their followup, their clinical outcomes, and the setting in which their care was delivered. Choosing measures and methods for clinical outcome research to produce meaningful information that may be used to improve patient care presents a number of challenges.

Coronal Limb Alignment and Indications for High Tibial Osteotomy in Patients Undergoing Revision ACL Reconstruction

Ho Hyun Won MD, Chong Bum Chang MD, PhD, Min Soo Je MD, Moon Jong Chang MD, Tae Kyun Kim MD, PhD

Failed ACL reconstruction frequently is accompanied by irreparable medial meniscal tear and/or visible osteoarthritis (OA) in the medial tibiofemoral joint. Thus, assessment for the presence of varus malalignment is important in caring for patients in whom revision ACL reconstruction is considered.

Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors

Shigehito Kuroda MD, Noriyuki Ishige MD, Motohiko Mikasa MD

Although arthroscopic anchor suturing is commonly used for rotator cuff repair and achieves good results, certain shortcomings remain, including difficulty with reoperation in cases of retear, anchor dislodgement, knot impingement, and financial cost. In 2005, we developed an anchorless technique for arthroscopic transosseous suture rotator cuff repair.

Bariatric Orthopaedics: Total Knee Arthroplasty in Super-obese Patients (BMI > 50 kg/m2 ). Survivorship and Complications

Qais Naziri MD, Kimona Issa MD, Arthur L. Malkani MD, Peter M. Bonutti MD, Steven F. Harwin MD, Michael A. Mont MD

Some studies have suggested that patients who are super obese (BMI > 50 kg/m) may have poorer outcomes and more frequent complications when undergoing TKA compared with those who have lower BMI, however, the literature on this is scant.

The Oxford Unicompartmental Knee Fails at a High Rate in a High-volume Knee Practice

William C. Schroer MD, C. Lowry Barnes MD, Paul Diesfeld PA, Angela LeMarr RN, Rachel Ingrassia RN, Diane J. Morton MS, Mary Reedy RN

The Oxford knee is a unicompartmental implant featuring a mobile-bearing polyethylene component with excellent long-term survivorship results reported by the implant developers and early adopters. By contrast, other studies have reported higher revision rates in large academic practices and in national registries. Registry data have shown increased failure with this implant especially by lower-volume surgeons and institutions.

Trabecular Metal in Total Knee Arthroplasty Associated with Higher Knee Scores: A Randomized Controlled Trial

Mariano Fernandez-Fairen MD, PhD, Daniel Hernández-Vaquero MD, PhD, Antonio Murcia MD, PhD, Ana Torres MD, PhD, Rafael Llopis MD, PhD

Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup.

Does Vitamin D Improve Osteoarthritis of the Knee: A Randomized Controlled Pilot Trial

Divya Sanghi PhD, Abhishek Mishra MSc, Amar Chandra Sharma MSc, Ajai Singh MS, S. M. Natu PhD, Sarita Agarwal PhD, Rajeshwar Nath Srivastava MS

Animal, epidemiologic, and human clinical studies suggest a putative role for vitamin D in osteoarthritis (OA). Inadequate sunlight exposure and lower serum levels of 25(OH)D appear in some reports to be associated with an increased risk for progression of knee OA.

Translation and Validation of the Dutch New Knee Society Scoring System©

Catherine Van Der Straeten MD, Erik Witvrouw PT, PhD, Tine Willems PT, PhD, Johan Bellemans MD, PhD, Jan Victor MD, PhD

A new version of The Knee Society Knee Scoring System(KSS) has recently been developed. Before this scale can be used in non-English-speaking populations, it has to be translated and validated for a particular population.

Do Monoblock Cups Improve Survivorship, Decrease Wear, or Reduce Osteolysis in Uncemented Total Hip Arthroplasty?

Jelle J. Halma MD, H. Charles Vogely MD, PhD, Wouter J. Dhert MD, PhD, Steven M. Gaalen MD, PhD, Arthur Gast MD, PhD

Monoblock acetabular components used in uncemented total hip arthroplasty (THA) have certain mechanical characteristics that potentially reduce acetabular osteolysis and polyethylene wear. However, the degree to which they achieve this goal is not well documented.

What Is Normal Femoral Head/Neck Anatomy? An Analysis of Radial CT Reconstructions in Adolescents

Amir A. Jamali MD, Walter Mak MD, Ping Wang BS, Lynn Tai BS, John P. Meehan MD, Ramit Lamba MBBS, MD

Cam morphology in femoroacetabular impingement has been implicated in the development of osteoarthritis. The alpha angle and femoral head/neck offset are widely used to determine femoral head asphericity. To our knowledge, no study has evaluated the alpha angle circumferentially using three-dimensional imaging in a population of healthy individuals of adolescent age.

Improved Survival of Uncemented versus Cemented Femoral Stems in Patients Aged < 70 Years in a Community Total Joint Registry

John Wechter MD, Thomas K. Comfort MD, Penny Tatman MPH, Susan Mehle BS, Terence J. Gioe MD

Aseptic loosening of the femoral stem remains a significant reason for revision in total hip arthroplasty (THA). Although stem fixation methods have changed over time, there is relatively little evidence supporting cemented or uncemented stems as more durable constructs.

Low Wear of a Second-generation Highly Crosslinked Polyethylene Liner: A 5-year Radiostereometric Analysis Study

Stuart A. Callary BAppSc, John R. Field DVSc, PhD, David G. Campbell BM, BS, FRACS, PhD

A sequentially irradiated and annealed, second-generation highly crosslinked polyethylene (XLPE) liner was introduced clinically in 2005 to reduce in vivo oxidation. This liner design has also been shown to reduce wear in vitro when compared with conventional and first-generation crosslinked liners. To date, there is only one study reporting an in vivo wear rate of this liner at 5 years’ followup. However, that study used measurements made from plain radiographs, which have limited sensitivity, particularly when monitoring very low amounts of wear.

Image Guided Core Needle Biopsy of Musculoskeletal Lesions: Are Nondiagnostic Results Clinically Useful?

Manjiri M. Didolkar MD, MS, Megan E. Anderson MD, Mary G. Hochman MD, MBA, Julia G. Rissmiller MD, Jeffrey D. Goldsmith MD, Mark G. Gebhardt MD, Jim S. Wu MD

The clinical utility of nondiagnostic core needle biopsies is not fully understood. Understanding the clinical and radiologic factors associated with nondiagnostic core needle biopsies may help determine the utility of these nondiagnostic biopsies and guide clinical decision making.

Risk Factors for Significant Wound Complications Following Wide Resection of Extremity Soft Tissue Sarcomas

Adam Schwartz MD, Alanna Rebecca MD, Anthony Smith MD, William Casey MD, Jonathan Ashman MD, PhD, Leonard Gunderson MD, Kelly Curtis MD, Yu-Hui H. Chang MPH, PhD, Christopher Beauchamp MD

Wound complications following resection of a localized soft tissue sarcoma have been associated with lower extremity location, large tumor volume, and use of preoperative radiation. Some of these wounds, however, show the potential for healing with local wound care and nonsurgical techniques. We are unaware of any published data establishing factors associated with nonhealing wounds that ultimately are treated with local or free vascularized tissue transfer.

The Phosphaturic Mesenchymal Tumor: Why is Definitive Diagnosis and Curative Surgery Often Delayed?

Cameron K. Ledford MD, Nicole A. Zelenski BS, Diana M. Cardona MD, Brian E. Brigman MD, PhD, William C. Eward DVM, MD

Tumor-induced osteomalacia is a paraneoplastic syndrome resulting in renal phosphate wasting and decreased bone mineralization. Phosphaturic mesenchymal tumors represent a rare etiology of tumor-induced osteomalacia. Nonspecific symptoms of fatigue, bone pain, and musculoskeletal weakness make the diagnosis elusive and lead to a delay in surgical treatment.

Amount of Torque and Duration of Stretching Affects Correction of Knee Contracture in a Rat Model of Spinal Cord Injury

Hideki Moriyama PhD, Yoshiko Tobimatsu PhD, Junya Ozawa PhD, Nobuhiro Kito PhD, Ryo Tanaka PhD

Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions.

Does Rewording MRI Reports Improve Patient Understanding and Emotional Response to a Clinical Report?

Jeroen K. J. Bossen MD, Michiel G. J. S. Hageman MD, John D. King BA, David C. Ring MD, PhD

Diagnostic MRI reports can be distressing for patients with limited health literacy. Humans tend to prepare for the worst particularly when we are in pain, and words like “tear” can make us feel damaged and in need of repair. Research on words used in provider-patient interactions have shown an affect on response to treatment and coping strategies, but the literature on this remains relatively sparse.

Extracorporeal Shock Wave Therapy Is Effective In Treating Chronic Plantar Fasciitis: A Meta-analysis of RCTs

Adeel Aqil MRCS, Muhammad R. S. Siddiqui MRCS, Matthew Solan FRCS, David J. Redfern FRCS, Vivek Gulati MRCS, Justin P. Cobb FRCS

Plantar fasciitis is the most common cause of heel pain. It may remain symptomatic despite conservative treatment with orthoses and analgesia. There is conflicting evidence concerning the role of extracorporeal shock wave therapy (ESWT) in the management of this condition.

No Effect of Hole Geometry in Microfracture for Talar Osteochondral Defects

Aimee Claire Kok MD, Gabrielle J. M. Tuijthof PhD, Steven Dunnen MSc, Jasper Tiel MD, Michiel Siebelt MD, Vincent Everts PhD, C. Niek Dijk PhD, MD, Gino M. M. J. Kerkhoffs PhD, MD

Débridement and bone marrow stimulation is an effective treatment option for patients with talar osteochondral defects. However, whether surgical factors affect the success of microfracture treatment of talar osteochondral defects is not well characterized.

Bone Microarchitecture of the Talus Changes With Aging

Matthias Krause MD, Martin Rupprecht MD, Marcus Mumme MD, Klaus Püschel MD, Michael Amling MD, Florian Barvencik MD

Fractures of the talus in the elderly are rare and usually result from high-impact injuries, suggesting only minor age-related bone structure changes. However, total ankle replacement failures with age often result from talar subsidence, suggesting age-related bone loss in the talus. Despite a number of histological analyses of talar microarchitecture, the effects of age and sex on talar microarchitecture changes remain poorly defined.

Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection

María Eugenia Portillo MD, PhD, Margarita Salvadó MD, PhD, Albert Alier MD, Lluisa Sorli MD, Santos Martínez MD, Juan Pablo Horcajada MD, PhD, Lluis Puig MD, PhD

The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI).

Have Levels of Evidence Improved the Quality of Orthopaedic Research?

Brian P. Cunningham MD, Samuel Harmsen MD, Chris Kweon MD, Jason Patterson MD, Robert Waldrop MD, Alex McLaren MD, Ryan McLemore PhD

Since 2003 many orthopaedic journals have adopted grading systems for levels of evidence (LOE). It is unclear if the quality of orthopaedic literature has changed since LOE was introduced.

What Is the Current Status of Global Health Activities and Opportunities in US Orthopaedic Residency Programs?

R. Carter Clement MD, MBA, Yoonhee P. Ha MSc, Bartholt Clagett BA, Ginger E. Holt MD, John P. Dormans MD

Interest in developing national health care has been increasing in many fields of medicine, including orthopaedics. One manifestation of this interest has been the development of global health opportunities during residency training.

Case Reports: Treatment of Traumatic Triradiate Cartilage Epiphysiodesis: What is the Role of Bridge Resection?

Alina Badina MD, Raphael Vialle MD, PhD, Frank Fitoussi MD, PhD, Jean Paul Damsin MD, PhD

Acetabular fractures are rare in children and can be complicated by premature fusion of the triradiate cartilage resulting in secondary acetabular dysplasia. Early recognition and treatment of a physeal bar in this location can be difficult. The purpose of this case report was to investigate whether early intervention could restore acetabular growth and prevent secondary acetabular dysplasia as measured on plain radiographs.

Letter to the Editor

Catherine J. Minns Lowe PhD, MSc, BSc(Hons), Karen L. Barker PhD, MSCP, David W. Murray MA, MD, FRCS(Orth), Catherine M. Sackley PhD, MCSP

Letter to the Editor

Paul O. Verhoeven MD, MS, Philipe Berthelot MD, PhD, Celine Chapelle MS, Julie Gagnaire PharmD, MS, Florence Grattard MD, PhD, Bruno Pozzetto MD, PhD, Frédéric Farizon MD, PhD, Frederic Lucht MD, PhD, Elisabeth Botelho-Nevers MD, PhD

Does Vitamin D Improve Osteoarthritis of the Knee: A Randomized Controlled Pilot Trial

Divya Sanghi PhD, Abhishek Mishra MSc, Amar Chandra Sharma MSc, Ajai Singh MS, S. M. Natu PhD, Sarita Agarwal PhD, Rajeshwar Nath Srivastava MS

Letter to the Editor

Francisco Ferrero-Manzanal PhD, Raquel Lax-Pérez PhD, Oliver Marín-Peña PhD, Alberto García-Gálvez PhD, Francisco Javier Rincón-Recarey PhD, José Salinas-Gilabert PhD

Reply to the Letter to the Editor

Simon Damian Steppacher MD, Christoph Emanuel Albers MD, Klaus Arno Siebenrock MD, Moritz Tannast MD, Reinhold Ganz MD
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