Relationship between probability of future shoulder arthroplasty and outcomes of arthroscopic debridement in patients with advanced osteoarthritis of glenohumeral joint.

BACKGROUND: Arthroscopic glenohumeral debridement for symptom control has shown promising short term results in the young active population, when arthroplasty may not be a practical option due to the recommended activity restrictions, potential for complications and/or early wear, and a need for revision. The purpose of this study was twofold: 1) to examine the impact of arthroscopic debridement with or without subacromial decompression on clinical outcomes in patients with severe glenohumeral osteoarthritis (OA), and 2) to explore the differences in post-debridement outcomes between patients who eventually progressed to arthroplasty vs. those who did not. The role of an active worker's compensation claim was examined. METHODS: Prospectively collected data of patients who were not good candidates for shoulder arthroplasty and had subsequently undergone arthroscopic shoulder debridement were used for analysis. Disability was measured using the relative Constant-Murley score (CMS), the American Shoulder and Elbow Surgeon's (ASES) assessment form, pain free range of motion (ROM), and strength. RESULTS: Fifty-six patients were included in the final analysis. Eighteen (32 %) patients underwent arthroplasty surgery (arthroplasty group) over a period of 11 years. The arthroplasty group was comparable with the non-arthroplasty group prior to debridement but was more disabled at post-debridement surgery follow-up, functioning at less than 50 % of normal based on ASES, relative CMS, and active painfree ROM. In the multivariable analysis, the post-debridement relative CMS was affected by having a compensation claim and having a future arthroplasty. CONCLUSION: Arthroscopic debridement improved clinical outcome in 68 % of patients suffering from advanced OA of glenohumeral joint. Having less than 50 % of normal score in ASES, relative CMS and painfree ROM post- debridement within a period of two years may be an indication for future arthroplasty. Role of worker's compensation claims should not be underestimated.

Sutures versus staples for wound closure in orthopaedic surgery: a pilot randomized controlled trial.

BACKGROUND: In the spectrum of surgical decision-making, wound closure material is often an afterthought. However, the findings of a recent meta-analysis suggest that the rate of surgical site infections (SSIs) is increased by using staples to close surgical wounds. Less clear is the effect of closure material on the incidence of non-infectious wound complications.The aim of this study was to compare sutures and staples in terms of: incidence of wound complications to determine the sample size for a definitive trial comparing wound closure methods. METHODS: Eligible adult orthopaedic patients were randomized to have wounds closed with sutures or staples. Time for skin closure was recorded. Wounds were assessed for complications for six weeks. The incidence of complications was compared using Fisher's exact test. Time to close and pain with removal of closure material were compared using a Student's t-test. RESULTS: The total number of patients reporting a wound complication was 59 of 148 patients completing six-week followup (41%), with no differennce between sutures and staples (RR = 0.77, CI = 0.52-1.14). The time to close wounds was shorter in the staple group (mean=4.8 min, CI = 2.6-7.1) than the suture group (mean=12 min, CI = 7.9-16). Patients in the staple group (mean=3.7, CI =2.8-4.6) reported more pain with removal than suture group (mean=2.5, CI =1.6-3.4). CONCLUSIONS: This study suggests that 42% of patients report a wound complication with no difference between sutures and staples. It was demonstrated that suturing skin requires more time and staples are more painful to remove. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT01146236 (registered June 14, 2010).

Validation of a global assessment of arthroscopic skills in a cadaveric knee model.

PURPOSE: The purpose of this study was to determine whether a global assessment of arthroscopic skills was valid for blinded assessment of cadaveric diagnostic knee arthroscopy. METHODS: A global skills assessment for arthroscopy was created using a published theory of the development of expertise. Faculty surgeons, fellows, and residents were consented and enrolled in this institutional review board-approved validation study. All participants were oriented to the equipment and procedures for diagnostic arthroscopy of the knee. After reviewing the anatomic structures to be visualized, participants were allowed 10 minutes to complete a diagnostic arthroscopy of the knee. The hands and arthroscopic view were recorded during this attempt. Resident participants completed a second filmed diagnostic arthroscopy 1 week after the initial attempt. Five blinded reviewers watched the synchronized videos and assessed arthroscopic skills with a procedure-specific checklist and the newly developed global skills assessment. The agreement between reviewers was determined by intraclass correlation coefficient. Internal consistency was determined with Cronbach's α. Test-retest reliability was measured by correlating repeated arthroscopies by residents. The ability of the global assessment to discriminate skill levels was determined with between-group Mann-Whitney U tests. RESULTS: The agreement between global assessment scores was strong (I.C.C. = 0.80, 95% C.I. 0.68-0.92). The internal consistency of evaluations was excellent (Cronbach's α = 0.97), and the test-retest reliability was strong (r = 0.52). The global assessment score was shown to be able to discriminate between skill levels by an analysis of variance indicating the difference in means among the various levels of training (P < .0001). CONCLUSIONS: The Objective Assessment of Arthroscopic Skills is a useful adjunct to arthroscopic educators and learners and could be used for in-training evaluations. CLINICAL RELEVANCE: The Objective Assessment of Arthroscopic Skills is an instrument that can be employed to measure the impact of skills curricula, including but not limited to simulation.