Patient Expectations of Hip and Knee Joint Replacement Surgery and Postoperative Health Status

ObjectiveObjective To explore the relationship between preoperative patient expectations and postoperative health status in patients undergoing joint replacement surgery, with particular emphasis on the types of expectations held by patients. Abstract: MethodsMethods Respondents completed the Hospital for Special Surgery (HSS) Hip/Knee Replacement Expectations Questionnaires pre-surgery, in addition to the Western Ontario and McMaster Osteoarthritis Index (WOMAC™) and the Short-Form 36-Item (SF-36) Health Survey and the Arthritis Self-Efficacy Scale. The WOMAC™ Index and SF-36 were also completed 3 and 6 months post-surgery. Abstract: ResultsResults A total of 106 patients (total hip replacement [THR] - 28; total knee replacement [TKR] - 78) completed questionnaires. No differences were seen in overall expectations between males and females or older or younger patients, although some differences between the age groups were seen for individual expectations on the HSS expectations questionnaires. For THR, a higher rating of the importance of expectations was correlated with a lesser improvement in pain from pre-surgery to 3 months post-surgery, whereas for TKR, a higher rating of expectations was associated with a greater improvement in function to 6 months post-surgery. Abstract: ConclusionsConclusions Patients have high expectations of surgery, which are correlated with post-surgery pain and function. Identifying the broad range of expectations may be helpful in preparation for surgery and gaining greater satisfaction with outcomes.

Unsatisfactory Accuracy With VISIONAIRE Patient-Specific Cutting Jigs for Total Knee Arthroplasty

This is in response to the letter to the editor regarding our article entitled 'Unsatisfactory Accuracy as Determined by Computer Navigation of Visionaire Patient-Specific Instrumentation for Total Knee Arthroplasty'. We thank the writer for the time taken to consider our work and appreciate the opportunity to continue the discussion through this forum. We have considered the questions in the original letter and include a series of responses below

Patient expectations of hip and knee joint replacement surgery and postoperative health status

AB Objective: To explore the relationship between preoperative patient expectations and postoperative health status in patients undergoing joint replacement surgery, with particular emphasis on the types of expectations held by patients. Methods: Respondents completed the Hospital for Special Surgery (HSS) Hip/Knee Replacement Expectations Questionnaires pre-surgery, in addition to the Western Ontario and McMaster Osteoarthritis Index (WOMAC(TM)) and the Short-Form 36-Item (SF-36) Health Survey and the Arthritis Self-Efficacy Scale. The WOMAC(TM) Index and SF-36 were also completed 3 and 6 months post-surgery. Results: A total of 106 patients (total hip replacement [THR] = 28; total knee replacement [TKR] = 78) completed questionnaires. No differences were seen in overall expectations between males and females or older or younger patients, although some differences between the age groups were seen for individual expectations on the HSS expectations questionnaires. For THR, a higher rating of the importance of expectations was correlated with a lesser improvement in pain from pre-surgery to 3 months post-surgery, whereas for TKR, a higher rating of expectations was associated with a greater improvement in function to 6 months post-surgery. Conclusions: Patients have high expectations of surgery, which are correlated with post-surgery pain and function. Identifying the broad range of expectations may be helpful in preparation for surgery and gaining greater satisfaction with outcomes

Frontal Knee Alignment: Three-dimensional Marker Positions and Clinical Assessment

We assessed the validity of the hip-knee-ankle angle measured statically during three-dimensional (3-D) gait analysis and the tibial angle using an inclinometer compared with the mechanical axis on radiographs. Eleven individuals (20 knees) with radiographic knee osteoarthritis (OA) participated in this study. We determined the following: the lower-limb mechanical axis using weightbearing long-leg radiographs; hip-knee-ankle angle using the techniques of 3-D gait analysis in a static standing position; and tibial alignment using an inclinometer. The mean mechanical axis (± standard deviation) for this cohort was 0.7° ± 7.2° (range, −13°−16°). The tibial alignment and hip-knee-ankle angle correlated with the mechanical axis but the correlation between the mechanical axis and the hip-knee-ankle angle was stronger. Our data suggest the inclinometer and 3-D gait analysis are valid ways to estimate mechanical alignment of the knee

Interobserver reliability of the international society of arthroscopy, knee surgery and orthopaedic sports medicine (ISAKOS) classification of meniscal tears

Background: Consistency of arthroscopic evaluation and documentation in meniscal tears between investigators is essential to the validity of multicenter studies. A group of experts developed a classification of meniscal tears that may be used internationally. Hypothesis: The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears provides sufficient interobserver reliability for pooling of data from international clinical trials designed to evaluate the outcomes of treatment for meniscal tears. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: A pilot study was performed by having 8 members of the committee grade 10 arthroscopic videos for classification of tear depth, rim width, location, tear pattern, and quality of the tissue. The results of the pilot study were used to change the instruction sheet and evaluation form. International interobserver reliability was determined by having 8 orthopaedic surgeons who practice in different countries evaluate 37 arthroscopic videos selected to represent different meniscal tear characteristics. The Spearman rho correlation coefficient was used to compare the area of the meniscus excised, as drawn on the diagram, with the numeric percentage of meniscus excised. Results: There was an 87% agreement for anterior-posterior location of the tear (kappa=.65); 79% agreement for tear pattern (kappa=.72); 88% agreement for tear depth (kappa=.52); 68% agreement for anterior, middle, and posterior location of the tear (kappa=.46); and 72% agreement for tissue quality (kappa=.47). There was 54% agreement for the rim width (kappa=.25) and 67% agreement if the tear was central to the popliteal hiatus (kappa=.36). Based on the Landis and Koch criteria for kappa coefficients, there was substantial agreement for anterior-posterior location of the tear and tear pattern; moderate agreement for tear depth, anterior, middle, and posterior location of the tear, and tissue quality; and fair agreement for rim width and if the tear was central to the popliteal tear. Interobserver reliability based on the intraclass correlation coefficient (ICC) was good for tear length (ICC=.83) and moderate for percentage of meniscus that was excised (ICC=.65). The mean rho for all raters was .92 (95% confidence interval [CI],.89-.94) comparing the values for percentage of meniscus excised with the area on the diagrams. Conclusion: The ISAKOS classification of meniscal tears provides sufficient interobserver reliability for pooling of data from international clinical trials designed to evaluate the outcomes of treatment for meniscal tears