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16. Self-reported preoperative anxiety and depression associated with worse patient-reported outcomes for periacetabular osteotomy and hip arthroscopy surgery.

Author

Richey, Ann E, Segovia, Nicole, Hastings, Katherine, Klemt, Christian, and Pun, Stephanie Y

Abstract

Adverse mental health status has been linked to less successful surgical outcomes across several orthopaedic subspecialties. Mental health represents a modifiable risk factor that can be optimized preoperatively to maximize outcomes for hip preservation surgery. This study examines the relationship between preoperative mental health status and preoperative and postoperative outcomes for adolescent and adult patients undergoing hip preservation surgery. A prospectively enrolled registry of patients undergoing periacetabular osteotomy or hip arthroscopy at a single institution between 2013 and 2021 was retrospectively reviewed to collect demographics and outcomes before and after surgery. We identified patients self-reporting anxiety/depression or no anxiety/depression preoperatively based on responses to the EuroQol-5D anxiety/depression dimension and compared their preoperative and postoperative Hip disability and Osteoarthritis Outcome Scores (HOOSs) using multivariable linear models and multivariable mixed effects models. Seventy-three patients were included, 40 patients with no anxiety/depression and 33 patients with anxiety/depression. Patients with anxiety/depression had worse preoperative HOOS pain (b  = −12.5, P  = .029), function in daily living (b  = −12.0, P  = .045), function in sports and recreational activities (b  = −15.1, P  = .030), and quality of life (b  = −16.3, P  = .005) as compared to patients with no anxiety/depression. Patients with anxiety/depression had worse postoperative HOOS compared to patients with no anxiety/depression, but these associations were not statistically significant after adjusting for preoperative HOOS. There were no significant differences between both groups for percent achieving minimal clinically important difference. Patients who reported anxiety/depression preoperatively had worse preoperative pain and function before hip preservation surgery, with both groups achieving similar levels of clinical effectiveness. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Musculoskeletal shoulder modelling for clinical applications

Author

Klemt, Christian and Bull, Anthony M. J.

Subjects
660.6
Abstract

The shoulder is the most commonly dislocated joint in the human body, with the vast majority of these dislocations being located anteriorly. Anterior shoulder dislocations are commonly associated with capsuloligamentous injuries and osseous defects. Recurrent anterior instability is a common clinical problem and understanding the influence of structural damage on joint stability is an important adjunct to surgical decision-making. Clinical practice is guided by experience, radiology, retrospective analyses and physical cadaver experiments. As the stability of the shoulder is load dependent, with higher joint forces increasing instability, the aim of this thesis was to develop and validate computational shoulder models to simulate the effect of structural damage on joint stability under in-vivo loading conditions to aid surgical decision-making for patients with anterior shoulder instability. The UK National Shoulder Model, consisting of 21 upper limb muscles crossing 5 functional joints, was customised to accurately quantify shoulder loading during functional activities. Ten subject-specific shoulder models were developed from Magnetic Resonance Imaging and validated against electromyographic signals. These models were used to identify the best combination of anthropometric parameters that yield best model outcomes in shoulder loading through linear scaling of personalised shoulder models. These parameters were gender and the ratio of body height to shoulder width (p < 0.04) and these model predictions are significantly improved (p < 0.02) when compared to the generic model. The forces derived from the modelling were used in two subject-specific finite element models with an anatomically accurate representation of the labrum, to assess shoulder stability through concavity compression under physiological joint loading for pathologies associated with anterior shoulder instability. The key results from these studies were that there is a high risk of shoulder dislocation under physiological joint loading for patients with a 2 mm anterior or 4 mm anteroinferior osseous defect. The loss in anterior shoulder stability in overhead throwing athletes with intact glenoid following biceps tenodesis is compensated by a non-significant increase in rotator cuff muscle force which maintain shoulder stability across all overhead throwing sports, except baseball pitching, where biceps tenodesis has significantly decreased (p < 0.02) anterior shoulder stability. The work in this thesis has advanced the technology of musculoskeletal modelling of the shoulder through the inclusion of concavity compression and has applied this to various relevant clinical questions through the further development of an anatomical atlas, and an atlas of tasks of daily living. The applications of such modelling are broader than those addressed here and therefore this work serves as the foundation for potential further studies, including the bespoke design of arthroplasty or other soft tissue procedures.

Published
2018
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