Patients undergoing RTSA had an 85% rate of return to 1 or more sporting activities at an average of 5.3 months after surgery. Age greater than 70 years was a significant predictor of decreased return to activities. The present study offers valuable information to help manage patient and surgeon expectations.
The average retirement age is increasing, and the indications for reverse total shoulder arthroplasty (RTSA) are being broadened. The goal of the current study was to determine objective findings for rate of return to work and time to return to work after RTSA. The authors performed retrospective data collection for consecutive patients who underwent RTSA at their institution between 2007 and 2013. All patients were asked to complete a questionnaire about their work history and their ability to participate in work-related activities. A total of 40 patients reported working before surgery. Average patient age was 74.7 years (range, 56-82 years). Average follow-up was 2.6 years (range, 1-4.7 years). Average American Shoulder and Elbow Surgeons score improved from 34.0 to 81.7 (P<.001). Average visual analog scale pain score decreased from 6.5 to 0.7 (P<.001). Most patients (65.4%) classified their job as sedentary, 34.6% classified their job as light work, and no patients classified their job as heavy work. Of patients who worked preoperatively, 65% (n=26) returned to work after RTSA. Only a previous diagnosis of heart disease affected return to work (P=.04). Overall, average time to return to work was 2.3 months (range, 0.5-11 months). Patients with sedentary jobs returned to work more quickly (1.4 months) than those with light work (4.0 months). A total of 96.2% of patients reported good to excellent surgical outcomes. Of patients who worked before RTSA, 65% were still working at final follow-up. Only 5% of patients retired for reasons attributed to the operated shoulder. On average, patients returned to work less than 3 months after surgery.
This study evaluated clinical and patient-reported outcomes and return to sport after surgical treatment of medial epicondylitis with suture anchor fixation. Consecutive patients were evaluated after undergoing debridement and suture anchor repair of the flexor-pronator mass for the treatment of medial epicondylitis. Demographic variables, a short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Oxford Elbow Score (OES), and 10-point pain and satisfaction scales were collected. Ability and time to return to sport after surgery were evaluated, and the relationship between predictor variables and both elbow function and return to sport was investigated. Median age at the time of surgery was 55 years (range, 29-65 years), with median follow-up of 40 months (range, 12-67 months). Median QuickDASH score and OES at final follow-up were 2.3 (range, 0-38.6) and 45 (range, 22-48), respectively. Most patients returned to premorbid sporting activities at a median of 4.5 months (range, 2.5-12 months), whereas 4 patients (14%) reported significant limitations at final follow-up. Older age at the time of surgery was predictive of better QuickDASH score and OES (P=.05 and P=.02, respectively). Patients who underwent surgery after a shorter duration of symptoms had better outcomes, but the difference did not reach statistical significance (QuickDASH, P=.09; OES, P=.10). Surgical treatment of recalcitrant medial epicondylitis with suture anchor fixation offers good pain relief and patient satisfaction, with little residual disability. Older age at the time of surgery predicts a better outcome.
Background: Bacteriophage therapy is a potential adjunctive treatment for periprosthetic joint infections (PJIs) given the capabilities of bacteriophages to degrade biofilms, self-replicate, and lyse bacteria. However, many aspects of this therapeutic are ill-defined, and the narrow spectrum of bacteriophage activity along with limited available bacteriophage strains curb potential use for specific bacteria such as Staphylococcus aureus at the present time. Therefore, the aim of this study was to determine the feasibility of using bacteriophages for PJI by (1) categorizing the causative organisms in hip and knee PJI at a tertiary academic center and (2) evaluating in vitro activity of a group of bacteriophages against clinical S. aureus PJI isolates.Methods: Patients with chronic hip or knee PJI after undergoing the first stage of a 2-stage revision protocol from 2017 to 2020 were identified retrospectively by a query of the hospital billing database. The causative pathogens in 129 cases were reviewed and categorized. From this cohort, preserved S. aureus isolates were tested against a library of 15 staphylococcal bacteriophages to evaluate for bacterial growth inhibition over 48 hours.Results: S. aureus was the most common pathogen causing PJI (26% [33] of 129 cases). Of 29 S. aureus samples that were analyzed for bacteriophage activity, 97% showed adequate growth inhibition of the predominant planktonic colonies by at least 1 bacteriophage strain. However, 24% of the 29 samples demonstrated additional smaller, slower-growing S. aureus colonies, none of which had adequate growth inhibition by any of the initial 14 bacteriophages. Of 5 secondary colonies that underwent subsequent testing with another bacteriophage with enhanced biofilm activity, 4 showed adequate growth inhibition.Conclusions: Effective bacteriophage therapeutics are potentially available for S. aureus PJI isolates. The differences in bacteriophage activity against the presumed small-colony variants compared with the planktonic isolates have important clinical implications. This finding suggests that bacteriophage attachment receptors differ between the different bacterial morphologic states, and supports future in vitro testing of bacteriophage therapeutics against both planktonic and stationary states of PJI clinical isolates to ensure activity.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G934).
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