Hip Disability and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index Values in Asymptomatic and Arthritic Cohorts.

The primary aim of this study was to determine whether an electronic, multicenter data collection system could be used to establish normal population reference values for the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The secondary aim was to investigate differences in asymptomatic HOOS and WOMAC values reported in 2 geographically distinct English-speaking countries and compare these with a symptomatic arthritic patient cohort. A total of 552 participants were recruited. Asymptomatic Australian and Canadian cohorts were compared; combined asymptomatic cohorts were compared with an arthritic cohort. There was a statistically significant association between age and asymptomatic HOOS (P<.0001) and WOMAC (P<.0001) values; as age increased, values worsened. Females had worse HOOS and WOMAC values (P<.0001). When compared with age- and sex-matched asymptomatic participants, arthritic participants had worse scores (P<.0001). Asymptomatic Australians had a statistically significant 3.8% better (higher) HOOS (P<.0001) in all age groups (P<.0001). When compared with age- and sex-matched asymptomatic participants, younger arthritic participants reported worse activities of daily living and sports and recreation HOOS values. This observational study established an electronic HOOS and WOMAC patient-reported outcome measures database of asymptomatic individuals in 2 geographically distinct countries. An asymptomatic control group should be sourced from the same country of origin as the proposed study. Factors that should be considered when recording the HOOS and WOMAC include age, sex, geographic location, history of an inactive hip problem, contralateral hip disease, and active knee, ankle, or foot problems. [Orthopedics. 2019; 42(2):e216-e224.].

Asymptomatic reference values for the Disability of Arm, Shoulder and Hand and Patient-Rated Wrist/Hand Evaluation - electronic data collection and its clinical implications.

The purpose of this study was to establish normal asymptomatic population values for the Disability of Arm, Shoulder and Hand and Patient-Rated Wrist/Hand Evaluation in healthy, asymptomatic individuals of different age, gender, ethnicity, handedness and nationality, using electronic data collection. Two-hundred and ninety-two Australian and 293 Canadian citizens with no active wrist pain, injury or pathology in their dominant hand, were evaluated. Participants completed an electronically administered questionnaire and were assessed clinically. There was no statistically significant association between both wrist scores and nationality. There was a statistically significant association between both wrist scores and age, demonstrating that as age increased, normal wrist function declined. This study has established an electronic, asymptomatic control group for future studies using these scores. When using the Disability of Arm, Shoulder and Hand and Patient-Rated Wrist/Hand Evaluation, the control group can be sourced from a pre-established control group within a database, without necessarily being sourced from the same country of origin. Level of evidence: II.

Asymptomatic population reference values for three knee patient-reported outcomes measures: evaluation of an electronic data collection system and implications for future international, multi-centre cohort studies.

OBJECTIVES: The aim was to assess whether the Knee Society Score, Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were comparable in asymptomatic, healthy, individuals of different age, gender and ethnicity, across two remote continents. The purpose of this study was to establish normal population values for these scores using an electronic data collection system. HYPOTHESIS: There is no difference in clinical knee scores in an asymptomatic population when comparing age, gender and ethnicity, across two remote continents. METHODS: 312 Australian and 314 Canadian citizens, aged 18-94 years, with no active knee pain, injury or pathology in the ipsilateral knee corresponding to their dominant arm, were evaluated. A knee examination was performed and participants completed an electronically administered questionnaire covering the subjective components of the knee scores. The cohorts were age- and gender-matched. Chi-square tests, Fisher's exact test and Poisson regression models were used where appropriate, to investigate the association between knee scores, age, gender, ethnicity and nationality. RESULTS: There was a significant inverse relationship between age and all assessment tools. OKS recorded a significant difference between gender with females scoring on average 1% lower score. There was no significant difference between international cohorts when comparing all assessment tools. CONCLUSIONS: An electronic, multi-centre data collection system can be effectively utilized to assess remote international cohorts. Differences in gender, age, ethnicity and nationality should be taken into consideration when using knee scores to compare to pathological patient scores. This study has established an electronic, normal control group for future studies using the Knee society, Oxford, and KOOS knee scores. LEVEL OF EVIDENCE: Diagnostic Level II.

An international, multicenter cohort study comparing 6 shoulder clinical scores in an asymptomatic population.

HYPOTHESIS: The study purpose was to assess 6 shoulder patient-reported outcome measure (PROM) values in asymptomatic, healthy, pathology-free individuals. We hypothesized that there would be no difference in PROM values in pathology-free individuals when considering sex, age, ethnicity, and geographical location. METHODS: Electronic questionnaires were completed by 635 individuals (323 Australians and 312 Canadians) without dominant shoulder pathology for the American Shoulder and Elbow Surgeons (ASES) shoulder score; Constant-Murley Shoulder Score (CSS); Oxford Shoulder Score (OSS); University of California, Los Angeles (UCLA) shoulder score; Shoulder Pain and Disability Index (SPADI); and Stanmore Percentage of Normal Shoulder Assessment (SPONSA). Shoulder range of motion and strength were assessed. RESULTS: No difference was identified between subjective-only and subjective-objective PROMs. Handedness and a current elbow or wrist problem were not associated with differences in PROM values. Poorer PROM values were associated with a history of an inactive shoulder problem and increasing age. Female participants tended to report similar or poorer PROM scores. No significant difference was found between ethnicities. Geographical location was associated with differences in the ASES shoulder score, UCLA shoulder score, and SPADI but not the CSS, SPONSA, and OSS. CONCLUSIONS: Differences in sex, age, and geographical location will affect PROM shoulder scores in pathology-free individuals and should be taken into consideration when PROMs are being used to compare patient outcomes. This study has established normative values for the ASES shoulder score, CSS, OSS, UCLA shoulder score, SPADI, and SPONSA. Future studies assessing a pathologic patient cohort should perform comparisons against a sex- and age-matched control cohort, ideally sourced from the same geographical location.

Smartphone applications for the evaluation of pathologic shoulder range of motion and shoulder scores-a comparative study.

HYPOTHESIS AND BACKGROUND: Accurate measurement of range of motion (ROM) is important in evaluating a pathologic shoulder and calculating shoulder scores. The aim of this study was to establish the reliability and validity of different smartphone applications (apps) in assessing pathologic shoulder ROM and to determine whether differences in recorded ROM measurements affect calculated shoulder scores. The authors hypothesized that there is no difference between shoulder ROM assessment methods and calculated shoulder scores. METHODS: In this nonrandomized controlled clinical trial, ROM of 75 participants with a history of shoulder disease (21 women, 54 men) was assessed using a smartphone inclinometer and virtual goniometer, a standard goniometer, and clinicians' visual estimation. Shoulder strength was assessed, and Constant-Murley (CM) and University of California-Los Angeles (UCLA) shoulder scores were calculated. RESULTS: Independent of diagnosis or operation, all cases (except for passive glenohumeral abduction of unstable shoulders) showed excellent intraclass correlation coefficients (>0.84). Interobserver reliability was excellent for all ROM measures (intraclass correlation coefficient > 0.97). All modalities had excellent agreement to values attained with the universal goniometer. There were no differences for the calculated CM or UCLA scores between the modalities employed to measure ROM. CONCLUSIONS: A smartphone inclinometer or virtual goniometer is comparable to other clinical methods of measuring pathologic shoulder ROM. Clinicians can employ smartphone applications with confidence to measure shoulder ROM and to calculate UCLA and CM scores. The apps are also available to patients and may be a useful adjunct to physiotherapy, especially in cases of limited access to health care services.

Normal population reference values for the Oxford and Harris Hip Scores - electronic data collection and its implications for clinical practice.

BACKGROUND: The aim of this study was to assess whether the Harris Hip Score (HHS) and the Oxford Hip Score (OHS) were comparable in normal, healthy, pathology-free individuals of different age, gender, ethnicity, handedness and nationality. The purpose of this study was to establish normal population values for the HHS and OHS using an electronic data collection system. METHODS: 317 Australian and 310 Canadian citizens with no active hip pain, injury or pathology in the ipsilateral hip corresponding to their dominant arm, were evaluated. Participants completed an electronically-administered questionnaire and were assessed clinically. Chi-square tests, Fisher's exact test and Poisson regression models were used where appropriate, to investigate the association between hip scores, ethnicity, nationality, gender, handedness and age. RESULTS: There was a statistically significant association between the OHS and age (p<0.0001) and the HHS and age (p = 0.0006); demonstrating that as age increased, normal hip scores decreased. There was no statistically significant association between the HHS and gender (p = 0.1389); or HSS and nationality, adjusting for age (p = 0.5698) and adjusting for gender (p = 0.6997). There was no statistically significant association between the OHS and gender (p = 0.1350). Australians reported a statistically significant 4.2% higher overall OHS value compared to Canadians (p = 0.0490). There was no statistically significant association between the OHS and nationality in age groups 18-79 years. Participants >80 years reported a statistically significant association between the OHS and nationality (p<0.0001). CONCLUSIONS: Studies using an electronic control group should consider differences in gender, age, ethnicity and nationality when using the HHS and OHS to assess patient outcomes. This study has established an electronic, normal control group for studies using the HHS and OHS. When using the OHS, the control group should be sourced from the same country of origin. When using the HHS, the control group should be sourced from a pre-established control group within a database, without necessarily being sourced from the same country of origin.

A Pronator Teres-sparing Volar Approach for Osteosynthesis of Midshaft Diaphyseal Radius Fractures.

Henry's approach is widely considered the "workhorse" for exposing the volar radius and has not really changed since his original description in 1945. We describe a pronator teres-sparing volar approach to the forearm, for osteosynthesis of midshaft diaphyseal radius fractures. We believe this approach is safe, simple, and reproducible, and has several practical and theoretical advantages over Henry's original description.

A modified ulnar translocation reconstruction technique for Campanacci grade 3 giant cell tumors of the distal radius using a clover leaf plate.

BACKGROUND: Campanacci grade 3 giant cell tumors of the distal radius are locally aggressive and in close proximity to the median nerve, articular cartilage, flexor and extensor tendons, and the radial artery. Although several reconstructive techniques have been described, it is unclear to what degree these procedures restore function. DESCRIPTION OF TECHNIQUE: We present a modified ipsilateral ulna translocation technique using a clover leaf plate, for reconstruction of en bloc resected distal radius. This has the theoretical advantage of ensuring a solid, pain-free wrist arthrodesis, while preserving the forearm rotational axis and minimizing functional loss, without the associated donor site morbidity or allograft rejection issues of other reconstructive techniques. PATIENTS AND METHODS: Between 2006 and 2013, 3 patients underwent this procedure for Campanacci grade 3 giant cell tumors. All patients were right hand-dominant females, aged 24, 35, and 46 years, respectively. Two cases involved the right radius. Patients were reviewed retrospectively with clinical examination, functional assessment [the Toronto Extremity Salvage Score (TESS) for upper limb], and radiographs. The review period was 30, 51, and 41 months, respectively. RESULTS: The length of distal radius resected was 70, 50, and 35 mm, respectively. All achieved clear margins. There were no complications and there have been no recurrences. All ulnocarpal translocations achieved radiographic fusion. Patient's averaged 80-degree pronation, 70-degree supination, and clinical TESS scores of 86 at most recent follow-up. CONCLUSIONS: This technique achieved a painless and functional wrist arthrodesis with partially restored wrist motion, without complications. This technique has the advantage of negating remote donor site morbidity and/or allograft rejection issues of other techniques. LEVEL OF EVIDENCE: Level III, therapeutic study.

Repair of the acutely unstable elbow: use of tensionable anchors.

Acute ruptures of the medial or lateral collateral ligaments of the elbow associated with elbow dislocations have traditionally been repaired back to their respective epicondyles using suture anchors or transosseous sutures. Tensioning of those ligaments using conventional techniques had been difficult because of the need to maintain tension while tying and securing sequential knots. Tensionable anchors are a new generation of anchors that have been used for rotator cuff repair, but can be employed for the repair of collateral ligaments and capsular tears. It allows fine control and sequential tensioning of the ligament repair, and on-table assessment of stability before locking the anchor. We present a modified surgical technique for the repair of collateral ligaments repair using tensionable anchors in acute elbow dislocations or fracture dislocations.

Imaging recognition of morphological variants at the midcarpal joint.

PURPOSE: To compare the imaging methods for identifying the various morphological variations of the articular surfaces at the midcarpal joint. METHODS: Thirteen cadaveric wrists were examined by plain neutral anteroposterior radiographs; 2-dimensional computed tomography (CT); 3-dimensional CT reconstruction, and 3-tesla magnetic resonance imaging (MRI). Carpal measurements were performed, and the parameters that defined the scaphoid, lunate, hamate, and capitate morphological types were investigated, with dissection being used as the definitive measure of morphology. The dissection findings were compared to the results of each imaging technique to determine the accuracy of morphological determination from each technique. RESULTS: Lunate type was the most accurately identified morphological variant amongst all imaging techniques. Lunate type was most accurately determined from coronal MRI. A lunate with a small, cartilaginous ulnar facet (intermediate type) could be differentiated only by coronal MRI and dissection. Scaphoid type could not be determined accurately using any of the imaging modalities described. Capitate type was most accurately determined from coronal MRI. However, flat and spherical-type capitates could not be routinely differentiated from V-shaped capitates. Hamate type was most accurately determined from 3-dimensional CT reconstruction. CONCLUSIONS: Accurate identification of carpal bone morphology is required to improve our understanding of carpal mechanics and pathology. Not all morphological features can be identified radiographically. Direct visualization is required to differentiate types of scaphoid, and to differentiate V-type capitates. MRI provides the most accurate identification of lunate type, and 3-dimensional CT provides the best method of differentiating hamate types.

Translunate fracture with associated perilunate injury: 3 case reports with introduction of the translunate arc concept.

We report 3 cases of translunate fractures with associated perilunate dislocations (or subluxation). We believe the translunate injury reflects a higher-velocity trauma and produces further destabilization of the carpus when compared with the established greater and lesser arc injuries. A modification to Johnson's perilunate injury classification system is proposed: the addition of a translunate arc injury subgroup, which would include all perilunate injuries with translunate fractures.

Influence of lunate type on scaphoid kinematics.

PURPOSE: To assess the influence of lunate type on scaphoid kinematics. METHODS: One hundred normal wrists had fluoroscopic assessment of the wrist in maximal radial, neutral, and ulnar deviation. The shortest distance in a neutral position between the capitate and triquetrum, C-T distance, determined lunate type. A type I lunate had a C-T distance of < or =2 mm, a type II lunate > or =4 mm, and an intermediate group lay between these values. Scaphoid flexion and translation in radial and ulna deviation was measured. RESULTS: There were 18 subjects with a type I lunate, 19 with an intermediate lunate, and 63 with a type II lunate. There was no statistically significant difference between lunate type, subject age, or hand dominance. There was a statistically significant higher proportion of women with a type I lunate. Subjects with a type II lunate had a statistically greater amount of flexion during radioulnar deviation as determined by CR index (0.79 vs 0.91) and scaphoid flexion index (0.21 vs 0.09). Subjects with a type II lunate had statistically less translation during radioulnar deviation as determined by translation ratio (0.22 vs 0.31) and scaphoid inclination index (0.18 vs 0.23). The average scaphoid kinematic index in subjects with a type II lunate was 1.24, intermediate 0.86, and type I 0.42. A scaphoid kinematic index of greater than 1 indicates the scaphoid has more flexion during radioulnar deviation than translation. CONCLUSIONS: Wrists with a type I lunate show statistically greater scaphoid translation with radial deviation. Wrists with a type II lunate show statistically greater scaphoid flexion with radial deviation. Intermediate lunates have intermediate scaphoid mechanics. This allows the surgeon to determine the likely wrist scaphoid mechanics based on the lunate type determined from a single posterior-anterior x-ray.