Article RETRACTED due to malpractice Instability Burden Across Joints: A Patient-Reported Outcomes Measurement Information System (PROMIS)-Based Comparison of Hip Dysplasia, Knee, and Shoulder Instability
DOI:
https://doi.org/10.47197/retos.v82.119201Keywords:
Hip, Knee, Shoulder, Instability, Dysplasia, Physical Function, Patient-Reported Outcomes MeasurementAbstract
Purpose: The burden of joint instability on the patient’s general health has been well recognized in the shoulder and knee but not as much in the hip. This study compares patients who have undergone corrective surgery for instability of the hip knee, and shoulder to better understand their relative impact on quality of life.
Methods: 230 instability correction procedures performed between 1-Jun-2018 and 31-Jan-2023 were included in the analysis: 62 dysplastic hips [Mean Age 31(16-47), BMI 25(18-33), ASA 2.0 (1-3) and 7 Males (11%)], 112 knees with ligamentous injuries [Mean Age 34(18-61), BMI 27(16-48), ASA 1.6(1-3) and 62 Males (55%)], and 56 unstable shoulders [Mean Age 38(18-67), BMI 27(20-37), ASA 2.0(1-3) and 39 Males (70%)]. Intra-operative surgical details including, arthroscopic treatment, as well as labral, cartilage, and bone corrections, were collected. Pre-operative and 1-year post-operative Physical and Mental PROMIS patient-reported outcome measures were also compiled.
Results: In the hip group surgeries were: periacetabular osteotomy (PAO) (71%), PAO with scope (23%), and Arthroscopy alone (6%); in the shoulder group: 61% of patients received a scope, and 39% received open surgery; in the knee group: 85% of patients received ACL surgery alone while 15 received both ACL and Meniscus treatment. All patients improved their functional score with hip instability having the worst physical outcomes pre- and postoperatively. Mean Pre-operative Physical Health PROMIS score was [Hip 40.1 (SD 6.9); Knee 48.3 (SD 7.7); Shoulder 46.6 (SD 8.0)] and 12 months post-operative was [Hip 45.2 (SD 7.6); Knee 50.4 (SD 6.2); Shoulder 48.8 (SD 7.7)].
Conclusion: Joint instability carries a significant burden on patients’ both physical and mental quality of life. More importantly, instability from a bony deformity i.e. hip dysplasia is as impactful as soft tissue/ligamentous instability of the shoulder and knee. This analysis adds validity to instability as the leading pathomechanism of hip dysplasia.
References
References
1. Kalisvaart, M. M., & Safran, M. R. (2015). Microinstability of the hip—it does exist: etiology, diagnosis and treatment. Journal of hip preservation surgery, 2(2), 123-135. https://doi.org/10.1093%2Fjhps%2Fhnv017
2. Kraeutler, M. J., Garabekyan, T., Pascual-Garrido, C., & Mei-Dan, O. (2016). Hip instability: a review of hip dysplasia and other contributing factors. Muscles, ligaments and tendons journal, 6(3), 343. https://doi.org/10.11138%2Fmltj%2F2016.6.3.343
3. Canham, C. D., Yen, Y. M., & Giordano, B. D. (2016). Does femoroacetabular impingement cause hip instability? A systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 32(1), 203-208. https://doi.org/10.1016/j.arthro.2015.07.021
4. Larson, C. M., Stone, R. M., Grossi, E. F., Giveans, M. R., & Cornelsen, G. D. (2015). Ehlers-Danlos syndrome: arthroscopic management for extreme soft-tissue hip instability. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 31(12), 2287-2294. https://doi.org/10.1016/j.arthro.2015.06.005
5. Ganz, R., Leunig, M., Leunig-Ganz, K., & Harris, W. H. (2008). The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clinical Orthopaedics and Related Research®, 466(2), 264-272. https://doi.org/10.1007%2Fs11999-007-0060-z
6. Pompe, B., Daniel, M., Sochor, M., Kralj-Iglič, V., & Iglič, A. (2003). Gradient of contact stress in normal and dysplastic human hips. Medical Engineering & Physics, 25(5), 379-385. https://doi.org/10.1016/S1350-4533(03)00014-6
7. Kolb, A., Schweiger, N., Mailath-Pokorny, M., Kaider, A., Hobusch, G., Chiari, C., & Windhager, R. (2016). Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. International orthopaedics, 40, 123-127. https://doi.org/10.1007/s00264-015-2799-2
8. Kakarlapudi, T. K., & Bickerstaff, D. R. (2000). Knee instability: isolated and complex. British Journal of Sports Medicine, 34(5), 395-400. https://doi.org/10.1136%2Fewjm.174.4.266
9. Hauser, R. A., Steilen-Matias, D., Lackner, J. B., Rawlings, B. R., Mann, J., Grogan, T., & Phillips, A. (2023). Ligamentous knee joint instability: Association with chronic conditions of the knee and treatment with prolotherapy. The Open Pain Journal, 16(1). http://dx.doi.org/10.2174/0118763863267142231023052404
10. Hasegawa, A., Otsuki, S., Pauli, C., Miyaki, S., Patil, S., Steklov, N., ... & Lotz, M. K. (2012). Anterior cruciate ligament changes in the human knee joint in aging and osteoarthritis. Arthritis & Rheumatism, 64(3), 696-704. https://doi.org/10.1002%2Fart.33417
11. Moya-Angeler, J., Jiménez-Soto, C., Maestre-Cano, D., de la Torre-Conde, C., Sánchez-Jimenez, R. M., Serrano-García, C., ... & León-Muñoz, V. J. (2023). Early Identification and Treatment of Trochlear Knee Dysplasia. Journal of Personalized Medicine, 13(5), 796. https://doi.org/10.3390%2Fjpm13050796
12. Zlotnicki, J. P., Naendrup, J. H., Ferrer, G. A., & Debski, R. E. (2016). Basic biomechanic principles of knee instability. Current reviews in musculoskeletal medicine, 9, 114-122. https://doi.org/10.1007%2Fs12178-016-9329-8
13. Lin, W., Kang, H., Niu, Y., Niu, J., Fan, C., Feng, X., & Wang, F. (2022). Cartilage degeneration is associated with activation of the PI3K/AKT signaling pathway in a growing rat experimental model of developmental trochlear dysplasia. Journal of Advanced Research, 35, 109-116. https://doi.org/10.1016/j.jare.2021.04.006
14. Nkosi, C. S., & Chauke, N. Z. (2023). Quality of life following an open Latarjet-Bristow procedure in a general population with recurrent anterior shoulder instability. JSES international, 7(2), 201-205. https://doi.org/10.1016/j.jseint.2022.12.003
15. Fernández-Matías, R., Lluch-Girbés, E., Bateman, M., & Requejo-Salinas, N. (2024). Assessing the use of the frequency, etiology, direction, and severity classification system for shoulder instability in physical therapy research–A scoping review. Physical Therapy in Sport. https://doi.org/10.1016/j.ptsp.2024.01.010
16. Araujo, I. L. A., Castro, M. C., Daltro, C., & Matos, M. A. (2016). Quality of life and functional independence in patients with osteoarthritis of the knee. Knee surgery & related research, 28(3), 219. https://doi.org/10.5792%2Fksrr.2016.28.3.219
17. Cecchi, F., Mannoni, A., Molino-Lova, R., Ceppatelli, S., Benvenuti, E., Bandinelli, S., ... & Ferrucci, L. (2008). Epidemiology of hip and knee pain in a community based sample of Italian persons aged 65 and older. Osteoarthritis and Cartilage, 16(9), 1039-1046. https://doi.org/10.1016/j.joca.2008.01.008
18. Dominick, K. L., Ahern, F. M., Gold, C. H., & Heller, D. A. (2004). Health-related quality of life among older adults with arthritis. Health and Quality of life Outcomes, 2, 1-8. https://doi.org/10.1186/1477-7525-2-5
19. Mili, F., Helmick, C. G., & Moriarty, D. G. (2003). Health related quality of life among adults reporting arthritis: analysis of data from the Behavioral Risk Factor Surveillance System, US, 1996-99. The Journal of rheumatology, 30(1), 160-166.
20. Hajewski, C. J., Baron, J. E., Glass, N. A., Duchman, K. R., Bollier, M., Wolf, B. R., & Westermann, R. W. (2020). Performance of the patient-reported outcome measurement information system in patients with patellofemoral instability. Orthopaedic journal of sports medicine, 8(4), 2325967120915540. https://doi.org/10.1177%2F2325967120915540
21. Hays, R. D., Schalet, B. D., Spritzer, K. L., & Cella, D. (2017). Two-item PROMIS® global physical and mental health scales. Journal of patient-reported outcomes, 1, 1-5. https://doi.org/10.1186/s41687-017-0003-8
22. Rafiq, R. B., Yount, S., Jerousek, S., Roth, E. J., Cella, D., Albert, M. V., & Heinemann, A. W. (2023). Feasibility of PROMIS using computerized adaptive testing during inpatient rehabilitation. Journal of patient-reported outcomes, 7(1), 44. https://doi.org/10.1186%2Fs41687-023-00567-x
23. Bernstein, D. N., Houck, J. R., & Hammert, W. C. (2019). A comparison of PROMIS UE versus PF: correlation to PROMIS PI and depression, ceiling and floor effects, and time to completion. The Journal of Hand Surgery, 44(10), 901-e1. https://doi.org/10.1016/j.jhsa.2018.12.006
24. Gulledge, C. M., Smith, D. G., Ziedas, A., Muh, S. J., Moutzouros, V., & Makhni, E. C. (2019). Floor and ceiling effects, time to completion, and question burden of PROMIS CAT domains among shoulder and knee patients undergoing nonoperative and operative treatment. JBJS Open Access, 4(4), e0015. https://doi.org/10.2106/JBJS.OA.19.00015
25. Anthony, C. A., Glass, N. A., Hancock, K., Bollier, M., Wolf, B. R., & Hettrich, C. M. (2017). Performance of PROMIS instruments in patients with shoulder instability. The American journal of sports medicine, 45(2), 449-453. https://doi.org/10.1177/0363546516668304
26. Shigley, C., & Green, A. (2022). Shoulder conditions and health related quality of life and utility: a current concepts review. JSES international, 6(1), 167-174. https://doi.org/10.1016/j.jseint.2021.10.006
27. Hays, R. D., Schalet, B. D., Spritzer, K. L., & Cella, D. (2017). Two-item PROMIS® global physical and mental health scales. Journal of patient-reported outcomes, 1, 1-5. https://doi.org/10.1186/s41687-017-0003-8
28. Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., ... & PROMIS Cooperative Group. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of clinical epidemiology, 63(11), 1179-1194. https://doi.org/10.1016/j.jclinepi.2010.04.011
29. Kotlarsky, P., Haber, R., Bialik, V., & Eidelman, M. (2015). Developmental dysplasia of the hip: What has changed in the last 20 years?. World journal of orthopedics, 6(11), 886. https://doi.org/10.5312%2Fwjo.v6.i11.886
30. Schaeffer, J. F., Scott, D. J., Godin, J. A., Attarian, D. E., Wellman, S. S., & Mather III, R. C. (2015). The association of ASA class on total knee and total hip arthroplasty readmission rates in an academic hospital. The Journal of arthroplasty, 30(5), 723-727. http://dx.doi.org/10.1016/j.arth.2014.12.014
31. Wilkin, G. P., Poitras, S., Clohisy, J., Belzile, E., Zaltz, I., Grammatopoulos, G., ... & Beaulé, P. E. (2020). Periacetabular osteotomy with or without arthroscopic management in patients with hip dysplasia: study protocol for a multicenter randomized controlled trial. Trials, 21, 1-12. https://doi.org/10.1186/s13063-020-04592-9
32. Ruzbarsky, J. J., Comfort, S. M., Rutledge, J. C., Shelton, T. J., Day, H. K., Dornan, G. J., ... & Philippon, M. J. (2024). Improved functional outcomes of combined hip arthroscopy and periacetabular osteotomy at minimum 2-year follow-up. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 40(2), 352-358. https://doi.org/10.1016/j.arthro.2023.06.034
33. Sheean, A. J., Schmitz, M. R., Ward, C. L., Barrow, A. E., Tennent, D. J., Roach, C. J., ... & Wilken, J. M. (2017). Assessment of disability related to femoroacetabular impingement syndrome by use of the Patient-Reported Outcome Measure Information System (PROMIS) and objective measures of physical performance. The American journal of sports medicine, 45(11), 2476-2482. https://doi.org/10.1177/0363546517708793
34. Hancock, K. J., Glass, N., Anthony, C. A., Wolf, B. R., Hettrich, C. M., Albright, J., ... & Amendola, A. (2019). PROMIS: a valid and efficient outcomes instrument for patients with ACL tears. Knee Surgery, Sports Traumatology, Arthroscopy, 27, 100-104. https://doi.org/10.1007/s00167-018-5034-z
35. Robins, R. J., Anderson, M. B., Zhang, Y., Presson, A. P., Burks, R. T., & Greis, P. E. (2017). Convergent validity of the patient-reported outcomes measurement information system's physical function computerized adaptive test for the knee and shoulder injury sports medicine patient population. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 33(3), 608-616. https://doi.org/10.1177/2325967115S00147
36. Scott, E. J., Westermann, R., Glass, N. A., Hettrich, C., Wolf, B. R., & Bollier, M. J. (2018). Performance of the PROMIS in patients after anterior cruciate ligament reconstruction. Orthopaedic journal of sports medicine, 6(5), 2325967118774509. https://doi.org/10.1177/2325967118774509
37. Kollmorgen, R. C., Hutyra, C. A., Green, C., Lewis, B., Olson, S. A., & Mather III, R. C. (2019). Relationship between PROMIS computer adaptive tests and legacy hip measures among patients presenting to a tertiary care hip preservation center. The American journal of sports medicine, 47(4), 876-884. https://doi.org/10.1177/0363546518825252
38. Morgan, J. H., Kallen, M. A., Okike, K., Lee, O. C., & Vrahas, M. S. (2015). PROMIS physical function computer adaptive test compared with other upper extremity outcome measures in the evaluation of proximal humerus fractures in patients older than 60 years. Journal of orthopaedic trauma, 29(6), 257-263. https://doi.org/10.1097/BOT.0000000000000280
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Rimmi sen
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.
