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Outcomes & Care

Postoperative foot & ankle outcomes: factors influencing success, common complications, and strategies for patient-reported outcome measurement.

Overview

Longer survival after treatment of metastatic bone disease is likely attributable to improvements in both medical and surgical treatments [2]. Clinically weighted outcome assessment systems reflect how clinicians value individual aspects of outcome as determinants of overall outcome and help guide future treatment and evaluation [4]. Measuring only the outcome dimension of quality may result in incomplete evaluation and monitoring of the quality of care [6]. There is an ever-increasing demand for high-quality clinical outcome research to guide decision making [44]. A framework for specifying a study's patient population, interventions, comparisons, and outcomes of interest (the PICO framework) has become vital to understanding the design and interpretation of clinical studies [44].

Clinically important outcome values allow physicians to provide patients with more realistic expectations regarding their treatment that are based on their specific demographics [13]. Evidence supports a broadening of the indications for unicondylar knee arthroplasty (UKA) in patients with severe deformity, though further follow-up is needed to assess longer-term durability [14]. A formal same-day discharge total joint arthroplasty program may no longer be necessary at an institution with well-established evidence-based protocols with strong success and experience with value-based care [24]. The patients' characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair [9].

Arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren’s disease shows high patient satisfaction, fairly rapid return to function, and no requirement for revision surgery in the long term [18]. Further research is needed to assess larger patient cohorts and compare outcomes to size-matched approaches for arthroscopic treatment of off-track Hill-Sachs lesions using fresh osteochondral allograft plugs [40]. There was no difference in final outcomes between patients with shoulder periprosthetic joint infection and those revised for noninfectious indications in a three-stage revision protocol [45].

Anatomy & Pathophysiology

Kinematics and Alignment

Hallux valgus deformity severity correlates positively with the magnitude of anteroposterior postural sway [87]. Lower extremity mechanical alignment strongly influences both the rate and subregional location of knee osteoarthritis progression [101]. In ambulatory patients with cerebral palsy, calcaneal lengthening osteotomy for planovalgus foot deformity demonstrates a tendency toward overcorrection, evidenced by increased pressure exerted on the lateral midfoot [85].

Functional Outcomes and Biomechanics

Hallux valgus negatively impacts self-reported foot pain, function, concerns about foot appearance, and footwear selection in otherwise healthy adults [103]. Both nonoperatively and surgically treated clubfeet exhibit significant limitations in ankle plantar flexion, resulting in decreased range of motion, moment, and power compared with controls [91]. Ankle function following joint distraction declines over time [88]. Functional outcomes in poly-traumatic multi-ligament knee injuries are influenced by factors beyond the knee itself, including concomitant injuries and psychosocial factors [107].

Injury Mechanisms and Pathophysiology

Injury mechanisms in high school pole vaulters indicate that many injuries could be avoided by using proper technique, particularly during the landing phase [106]. Protected weightbearing in an orthopedic device can reduce the risk for complications in acute Charcot neuroarthropathy (CN) of the foot and ankle [104]. Early operative treatment has the potential to restore anatomical alignment and improve function in diabetic patients with stage-I Charcot arthropathy [99].

Classification

Clinical Outcome Weighting: A clinically weighted approach to outcome assessment in radial polydactyly reflects how clinicians value individual aspects of outcome as determinants of overall outcome [4]. This approach helps guide future treatment and evaluation [4]. Measuring only the outcome dimension of quality may result in incomplete evaluation and monitoring of the quality of care [6].

Treatment-Based Classification: Treatment-based classification focuses on identifying clusters of findings from the history and clinical examination that predict a more favorable outcome with a specific treatment approach [10]. This method may assist clinicians in predicting which intervention is likely to be most effective for individual patients with low back pain [10]. However, the overall classification accuracy associated with predictors of response to prefabricated foot orthoses or rocker-sole footwear in individuals with first metatarsophalangeal joint osteoarthritis is not sufficient for identifying individuals who are most likely to benefit from these interventions [71].

Periprosthetic Joint Infection (PJI) Tiers: A standardized, four-tier outcome-reporting tool for periprosthetic joint infection treatment categorizes outcomes from infection control to death [81]. This tool aims to improve transparency and guide the definition of success [81].

Fibrous Dysplasia Classification: Treatments based on the radiographic classification of fibrous dysplasia of the proximal femur were effective [92].

Other Considerations: Core Outcome Sets: Consensus supported a five-domain core outcome set for hip fracture trials comprising mortality, pain, activities of daily living, mobility, and health-related quality of life [105]. Demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores in numerous scoring systems devised to evaluate patients with knee symptoms [111]. Measuring aspects of care that often go without assessments, such as communication, can maximize care quality as defined by patients in hand surgery [112].

Resource and Care Level Tiers: Tiers of care can be applied to quality measures to incorporate resource and capacity limitations when assessing their performance in hand surgery outreach trips to low and middle-income countries [94]. A subpopulation of 30-day readmissions after elective total knee and hip arthroplasty does not require a level of care consistent with inpatient admission services [100]. More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes in hand therapy [7].

Clinical Presentation

Early diagnosis and treatment are essential to achieve good outcomes in acute Lisfranc injury [1]. For soft tissue sarcoma of the extremity or trunk, a time to treatment initiation of more than 30 days after diagnosis is independently associated with poorer overall survival after definitive surgery [17]. Aggressive disease-specific surgical and multidisciplinary treatment can yield long disease-free survival, overall survival, and good functional outcomes for soft tissue sarcoma of the hand [3].

Prognostic Stratification: The prognosis for Perthes’ disease is poor for those in whom the diagnosis is made after a certain age with a Herring group B and above [15]. Predictive biomarkers are needed to better assess clinical course and treatment efficacy to enable individualized therapy [41]. Machine learning models offer valuable prognostic insights that can aid in optimizing patient management and clinical outcomes for conservative treatment failure in thoracolumbar burst fractures [29].

Functional Assessment: Functional outcomes following unstable pelvic fractures have improved with modernised diagnostic and therapeutic modalities, but lack of these modalities in poor resource settings makes management challenging and affects functional outcome [5]. Active patients achieve better absolute outcomes than inactive patients following total hip arthroplasty, but increasing activity levels do not incrementally improve patient-reported outcome measures [16]. Distinct activity outcomes clusters based on baseline patient characteristics were identified after hip arthroplasty, and knowing this can help inform patients' expectation and meaningful discussions with clinicians about treatment decisions [33].

Patient-Reported Outcomes (PROs): Clinically important outcome values allow physicians to provide patients with more realistic expectations regarding their treatment that are based on their specific demographics [13]. Patient-reported outcomes are highly useful when they inform other relevant outcomes, such as predicting return to sport, and psychological factors are potentially modifiable, allowing for early identification and intervention to improve final outcomes [28]. Clinical improvement is associated with smaller magnitudes of change on PROMIS Physical Function when patients present with better reported function in distal radius fractures [36].

Specific Pathologies: Outcomes scores confirm a significant improvement in functional parameters following sesamoid excision in athletes [20]. Patient-reported measures of pain and function did not appear to deteriorate over time after Silastic replacement of the trapezium for osteoarthritis, suggesting that radiographic deterioration, if it occurs, may not be important for the clinical outcome [11]. Overall clinical outcomes following proximal interphalangeal joint nonconstrained arthroplasties demonstrated no significant change in range of motion, and most patients had mild or no pain [38].

Diagnostic & Therapeutic Guidance: Treatment-based classification, which focuses on identifying clusters of findings from the history and clinical examination that predict a more favorable outcome with a specific treatment approach, may assist clinicians in predicting which intervention is likely to be most effective for individual patients with low back pain [10]. Understanding the influence of preoperative diagnosis on reverse total shoulder arthroplasty outcomes can assist clinicians with preoperative risk stratification as well as managing patient expectations [34]. The proposed clinically weighted assessment system for radial polydactyly reflects how clinicians value individual aspects of outcome as determinants of overall outcome and helps guide future treatment and evaluation [4]. More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes in hand therapy [7]. Further research is warranted to study the specific response of different diagnostic groups to intervention using the model of advanced practice occupational therapy–led care for chronic hand conditions [37].

Investigations

Plain radiography: Early diagnosis is essential to achieve good outcomes in acute Lisfranc injury management [1]. Radiographic classifications used for displaced intra-articular calcaneal fractures are prognostically correlated with clinical outcomes [77]. In the context of distal radius fractures, better final radiological and objective physical results are associated with better patient-perceived outcome, as measured by the DASH score [62]. For traumatic ankle fractures, omitting routine radiography after the initial 2-week follow-up does not affect outcomes [66]. Similarly, for nonsurgical pelvic ring injuries, the need for change in treatment plan or further imaging should be based on the patient's clinical progress with weight bearing, rather than routine postmobilization imaging [55].

MRI: MRI findings of varying injury grades did not significantly correlate with final functional outcomes in patients with calf muscle strain injuries [31]. In older populations, protective clinical parameters and quantitative and semi-quantitative MR-imaging parameters are associated with maintaining radiographically normal knee joints over 8 years [79].

Other Considerations: Lack of modernised diagnostic modalities in poor resource settings makes management of unstable pelvic fractures challenging and affects functional outcomes [5]. For enchondromas and atypical cartilaginous tumors of the long bones, surgery did not prove superior to conservative clinical and radiological observation [27]. In patients with stemless humeral head replacements with hollow screw fixation, radiological changes detected in 37.0% of patients did not influence clinical results [72]. Despite radiographic subsidence, clinical outcomes in Easytech stemless rTSA remained unaffected, suggesting mild early subsidence may represent a benign self-stabilization process [76]. Radiological outcomes and complication rates in distal radius fracture fixation appear unaffected by the number of surgeons [75]. There were no notable differences in radiographic outcomes between orthopaedic surgeons with and without trauma fellowship training for rotational ankle fractures [56].

For trapezial osteoarthritis managed with Silastic replacement, radiographic deterioration may not be important for clinical outcome, as patient-reported measures of pain and function did not deteriorate over time [11]. Continued improvement in pain and function, as well as minor progression of radiographic osteolysis, may be expected between 2- and 5-year follow-up for total shoulder arthroplasty for glenohumeral arthritis associated with posterior glenoid bone loss [73]. Favourable clinical outcome after prosthetic inlay resurfacing as a salvage procedure for failed cartilage repair was not confirmed by radiographical findings, as significant osteoarthritic changes were observed [82].

MRI demonstrated complete regeneration of subchondral bone and cartilage in all patients treated with a Platelet-Rich Plasma Scaffold for Hepple Stage V Osteochondral Lesion of the Talus, accompanied by significant improvement in functional scores [50]. The Lima SMR stemless reverse shoulder implant shows promising short-term results in clinical, functional, and radiologic outcomes [54]. Nonoperative treatment for rotator cuff tears should be performed early for optimal outcomes [19]. Sesamoid excision in athletes results in significant improvement in functional parameters [20].

Treatment

Early diagnosis and treatment are essential to achieve good outcomes in acute Lisfranc injuries [1]. For enchondromas and atypical cartilaginous tumors of the long bones, surgery did not prove superior to conservative clinical and radiological observation [27]. Nonoperative treatment for rotator cuff tears should be performed early for optimal outcomes [19]. Nonsurgical treatment with early unrestricted mobilization is noninferior to surgical treatment for displaced metacarpal spiral fractures at midterm follow-up [30]. Non-surgical treatment for 3- and 4-part proximal humerus fractures results in fewer complications and additional surgeries compared to open reduction internal fixation [69]. More than half of participants with carpal tunnel syndrome who received additional conservative treatment still progressed to surgery [86].

Operative

Indications: Evidence supports a broadening of the indications for unicondylar knee arthroplasty (UKA), though further follow-up is needed to assess longer-term durability [14]. Contraindications to UKA regarding flexion contracture may not be as absolute as previously thought [48]. The success of unicompartmental knee arthroplasty relies on appropriate patient selection, yet considerable challenges persist in predicting patient-specific success due to variations in patient characteristics and healthcare practices [63]. Inactivated autograft should be applied with caution for primary malignant musculoskeletal tumors, selecting patients with strict surgical indications [39].

Surgical Approach / Technique: Dermofasciectomy is efficacious and durable in managing advanced Dupuytren disease, particularly with appropriate postoperative care [51]. Both capsular management strategies (unrepaired capsulotomy and capsular repair) resulted in statistically significant improvements in all patient-reported outcomes at a minimum of 2 years after arthroscopic hip preservation surgery [74].

Pain Management: Greater self-efficacy was the best determinant of satisfaction with pain relief after fracture surgery, correlating with opioid use [49].

Adjuncts: Limiting routine follow-up after plate fixation of midshaft clavicle fractures is safe and could be cost-effective for the healthcare system [47].

Other Considerations: Aggressive disease-specific surgical and multidisciplinary treatment can yield long disease-free survival, overall survival, and good functional outcomes in soft tissue sarcoma of the hand [3]. Understanding the current evidence and appropriate indications of emerging technologies in orthopaedic trauma is critical for their utilization [42]. Results for AC-joint instability treatment remain imperfect with frequent complications, and there is a lack of high-level evidence for non-operative treatment, leaving numerous open questions regarding the best approach [84].

Complications

Infection (PJI): Screening patients with a history of past hospitalization, a history of admission in a long-term care facility, and older than 75 years may reduce surgical site infections [89].

Thromboembolism: Reported adverse outcome rates for pulmonary embolism prophylaxis in total knee arthroplasty are far lower than historically reported regardless of the prophylactic regimen chosen [102].

Other Considerations: Early diagnosis and treatment of acute Lisfranc injury are essential to achieve good outcomes [1]. Survivorship for patients with borderline dysplasia undergoing primary hip arthroscopy was 98.2% at midterm follow-up and 76.3% at long-term follow-up [8]. Failure in younger patients with femoral neck fractures is associated with inferior long-term function and health-related quality of life [21]. Long-term follow-up of type BIIIa rotationplasty in children shows good functional and oncological outcomes without the need for additional surgical procedures [22]. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur did not provide a measurable benefit in the quality of life of survivors at long-term follow-up [23]. A formal same-day discharge total joint arthroplasty program may not be necessary at an institution with well-established evidence-based protocols with strong success and experience with value-based care [24]. The natural history of Achilles tendinopathy is typically a long protracted course where management focuses on physiotherapy, and 40% of patients report ongoing pain even after five years of therapy [25]. Implant survivorship for silicone metacarpophalangeal arthroplasty for osteoarthritis is 97% (clinical) and 88% (radiographic) in long-term follow-up [26]. Patients strongly care about long-term complications, which are 3.4 times more important than short-term complications [43]. Further studies are warranted to assess the long-term outcomes of patellofemoral arthroplasty [60]. Patients with obstructive sleep apnea may experience higher rates of medical complications in the short term following total shoulder arthroplasty, but no difference in orthopedic or mortality outcomes in the long term [64]. Opioid-related adverse drug events were significantly associated with increased length of stay and discharge to extended care facilities [68]. There is a dramatic reduction in complications across early and late cohorts of unicompartmental knee arthroplasty, with the largest improvements seen among outpatients [93]. The rate of surgical complications and related hospital admissions following shoulder arthroplasty remained meaningful during the entire year after surgery, suggesting a postoperative follow-up period longer than the traditional 90 days may be warranted [96]. Deliberate and careful treatment decisions for calcaneus fractures can improve outcomes and minimize complications [110]. Patient age, comorbidities, and gender appear to have influence on the treatment chosen for Dupuytren disease, likely due to their effects on surgical risk and the importance of timely return to activity [113]. Longer survival after treatment of metastatic bone disease is likely attributable to improvements in both medical and surgical treatments [2]. Further research is warranted to determine if outcomes for anatomical total shoulder arthroplasty with augmented glenoid components remain similar in the long term [12].

Recovery

Light activity (weeks): Early diagnosis and treatment of acute Lisfranc injury are essential to achieve good outcomes [1]. For acetabular fractures, recovery trajectory is often elongated, with persistent disability noted long after initial mobilization [53]. In Dupuytren’s disease, better patient treatment experiences are associated with better postoperative results, explaining up to 12% of the variance in outcome [115].

Full activity (months): Long-term outcomes for arthrodesis in severe recurrent proximal interphalangeal joint contractures from Dupuytren’s disease show fairly rapid return to function [18]. Survivorship for patients with borderline dysplasia undergoing primary hip arthroscopy was 98.2% at midterm follow-up [8]. Implant survivorship for silicone metacarpophalangeal arthroplasty for osteoarthritis is 97% clinically and 88% radiographically in long-term follow-up [26].

Complete recovery / outcome plateau (months): Recovery following surgically treated acetabular fractures is often elongated beyond one year, with two-thirds of patients displaying persistent clinically relevant long-term disability [53]. The natural history of Achilles tendinopathy is typically a long protracted course; while exercises improve function in the majority, 40% of patients report ongoing pain even after five years of therapy [25]. Long-term follow-up for type BIIIa rotationplasty in children shows good functional outcomes without the need for additional surgical procedures [22].

Rehabilitation protocol: Management of Achilles tendinopathy focuses on physiotherapy, with exercises improving function in the majority of patients [25]. For Dupuytren’s disease, arthrodesis allows for fairly rapid return to function with no requirement for revision surgery [18].

Functional milestones: Failure in younger patients with femoral neck fractures is associated with inferior long-term function and health-related quality of life [21]. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur did not provide a measurable benefit in the quality of life of survivors at long-term follow-up [23]. Clinical results for oncological scapula resections are quite good in short- and long-term follow-up [57].

Other Considerations: Longer survival after treatment of metastatic bone disease is likely attributable to improvements in both medical and surgical treatments [2]. Aggressive disease-specific surgical and multidisciplinary treatment of soft tissue sarcoma of the hand can yield long disease-free survival, overall survival, and good functional outcomes [3]. A time to treatment initiation of more than 30 days after diagnosis is independently associated with poorer overall survival after definitive surgery for localized high-grade soft-tissue sarcoma in the extremity or trunk [17]. With limited survival in nonagenarians with soft-tissue sarcoma, follow-up can be rationalized on a patient-by-patient basis using alternative means [114]. Further research is warranted to determine if outcomes for anatomical total shoulder arthroplasty with augmented glenoid components remain similar in the long term [12]. Further studies with long-term follow-up are needed to determine whether the grafted area maintains structural and functional integrity over time for autologous matrix-induced chondrogenesis treatment of focal cartilage defects in the knee [70]. Early reimplantation (abbreviated two-stage) provides similar outcomes to traditional two-stage exchange, though optimal timing and selection criteria remain undefined [116]. Ethanol sclerotherapy reduces pain in symptomatic musculoskeletal hemangiomas, but the short follow-up requires additional long-term studies to assess the duration of the results [118]. The success of pulsed electromagnetic fields for the treatment of tibial delayed unions and nonunions is not associated with specific fracture or patient-related variables and cannot be clearly considered a time-dependent phenomenon [119].

Key Evidence

  • [L4] Early diagnosis and treatment are essential to achieve good outcomes. (10.1302/0301-620x.106b12.bjj-2024-0581.r1)
  • [L4] Longer survival is likely attributable to improvements in both medical and surgical treatments. (10.5435/jaaos-d-23-00332)
  • [L2] Aggressive disease-specific surgical and multidisciplinary treatment can yield long disease-free survival and overall survival, and good functional outcomes. (10.1016/j.jhsa.2024.05.003)
  • [L3] The proposed assessment system reflects the way clinicians value individual aspects of outcome as determinants of overall outcome and helps guide future treatment and evaluation. (10.1177/1753193415601336)
  • [L3] Although functional outcomes following unstable pelvic fractures have improved with modernised diagnostic and therapeutic modalities, this is not the case in poor resource settings where the lack of these modalities makes management challenging, consequently affecting the functional outcome. (10.1186/s13018-022-03088-3)
  • [L3] An implication of this is that measuring only the outcome dimension of quality may result in incomplete evaluation and monitoring of the quality of care. (10.1186/s12891-022-05271-3)
  • [L1] More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes. (10.1016/j.jht.2017.05.018)
  • [L4] Survivorship at midterm follow-up was 98.2% and 76.3% at long-term follow-up. (10.1016/j.arthro.2022.12.030)
  • [L3] The patients' characteristics and indications for surgery were not described in a majority of clinical outcome studies of rotator cuff repair. (10.1007/s11999-008-0585-9)
  • [Paper] Treatment-based classification, which focuses on identifying clusters of findings from the history and clinical examination that predict a more favorable outcome with a specific treatment approach, may assist clinicians in predicting which intervention is likely to be most effective for individual patients with low back pain. (10.1016/j.csm.2008.03.002)
  • [L4] Patient-reported measures of pain and function did not appear to deteriorate over time, suggesting that radiographic deterioration, if it occurs, may not be important for the clinical outcome. (10.1177/1753193411419433)
  • [L2] Further research is warranted to determine if such outcomes remain similar in long term. (10.1177/17585732231192991)
  • [L5] Clinically important outcome values allow physicians to provide patients with more realistic expectations regarding their treatment that are based on their specific demographics. (10.2106/jbjs.19.00817)
  • [L3] This study supports a broadening of the indications of UKA, though further follow-up is needed to assess longer-term durability. (10.1007/s00167-014-3464-9)
  • [L3] However, the prognosis for those in whom the diagnosis is made after this age, with a Herring group B and above, was poor. (10.1302/0301-620x.107b5.bjj-2024-1160.r2)
  • [L3] Active patients achieve better absolute outcomes than inactive patients; however, increasing activity levels do not incrementally improve patient-reported outcome measures. (10.1016/j.arth.2022.03.009)
  • [L3] A time to treatment initiation of more than 30 days after diagnosis was independently associated with poorer survival. (10.1302/0301-620x.103b6.bjj-2020-2087.r1)
  • [L4] The long-term outcomes show high patient satisfaction, fairly rapid return to function with no requirement for revision surgery. (10.1177/1753193420960309)
  • [L2] The results suggest that nonoperative treatment should be performed early for optimal outcomes. (10.1177/2325967118788531)
  • [L4] Outcomes scores confirm a significant improvement in functional parameters. (10.1177/2325967116s00065)
  • [L3] Failure was associated with inferior long-term function and health-related quality of life. (10.2106/jbjs.23.00582)
  • [L4] Long-term follow-up shows good functional and oncological outcomes, without the need for additional surgical procedures. (10.1302/0301-620x.108b1.bjj-2025-0309.r1)
  • [L3] However, it did not provide a measurable benefit in the quality of life of survivors at the time of the long-term follow-up. (10.2106/00004623-199405000-00004)
  • [L3] Therefore, a formal program may no longer be needed at an institution with well-established evidence-based protocols with strong success and an experience with value-based care. (10.1016/j.arth.2022.02.081)
  • [L4] Implant survivorship is 97% (clinical) and 88% (radiographic) in long-term follow-up. (10.1016/j.jhsa.2017.10.010)
  • [L3] Surgery did not prove superior compared to conservative clinical and radiological observation. (10.1186/s12891-019-2502-7)
  • [L5] Patient-reported outcomes are highly useful when they inform other relevant outcomes, such as predicting return to sport, and psychological factors are potentially modifiable, allowing for early identification and intervention to improve final outcomes. (10.1016/j.arthro.2022.11.028)
  • [L3] These models offer valuable prognostic insights that can aid in optimizing patient management and clinical outcomes in this specific patient population. (10.1186/s12891-024-08045-1)
  • [L2] Nonsurgical treatment with early unrestricted mobilization remains noninferior to surgical treatment at the midterm follow-up. (10.1016/j.jhsa.2025.06.018)
  • [L3] MRI findings of varying injury grades did not significantly correlate with the final functional outcomes in this non-athletic population. (10.1186/s12891-024-08119-0)
  • [L3] Distinct activity outcomes clusters based on baseline patient characteristics were identified and knowing this can help inform patients' expectation and meaningful discussions with clinicians about treatment decisions. (10.1186/s12891-025-09024-w)
  • [L4] Understanding the influence of preoperative diagnosis on rTSA outcomes can assist clinicians with preoperative risk stratification as well as managing patient expectations. (10.1016/j.jseint.2025.06.002)
  • [L4] Clinical improvement is associated with smaller magnitudes of change on PROMIS Physical Function when patients present with better reported function. (10.1016/j.jhsa.2019.02.015)
  • [L3] Further research is warranted to study the specific response of different diagnostic groups to intervention using this model of care. (10.1016/j.jht.2019.08.003)
  • [L4] Overall clinical outcomes demonstrated no significant change in range of motion, and most patients had mild or no pain. (10.1016/j.jhsa.2011.06.002)
  • [L4] Thus, we should apply this method with caution and choose the patients with strict surgical indication. (10.1186/s13018-015-0324-3)
  • [L4] Further research is needed to assess larger patient cohorts and compare outcomes to size-matched approaches. (10.1016/j.jse.2024.06.008)
  • [Paper] Predictive biomarkers are needed to better assess clinical course and treatment efficacy to enable individualized therapy. (10.1007/s00120-008-1745-y)
  • [L2] Patients strongly care about long-term complications, which are 3.4 times more important than short-term complications. (10.2106/jbjs.24.00204)
  • [L3] There was no difference in final outcomes between patients with shoulder periprosthetic joint infection and those revised for noninfectious indications. (10.1016/j.jse.2018.07.014)
  • [L1] Secondary outcomes and per-protocol analysis indicated additional benefit of the combined treatment, mostly observed in individuals who completed treatment. (10.1186/s12891-019-3009-y)
  • [L3] Limiting routine follow-up is safe and could be cost-effective for the healthcare system. (10.5435/jaaos-d-17-00598)
  • [L3] The contraindications to UKA regarding flexion contracture may not be as absolute as previously thought. (10.5435/jaaos-d-16-00802)
  • [L2] Greater self-efficacy was the best determinant of satisfaction with pain relief. (10.1007/s11999-014-3660-4)
  • [L4] MRI demonstrated complete regeneration of subchondral bone and cartilage in all patients with significant improvement in functional scores. (10.1155/2017/6525373)
  • [L3] These findings underscore the efficacy and durability of dermofasciectomy in managing advanced cases, particularly with appropriate postoperative care. (10.1016/j.jhsa.2025.02.007)
  • [Paper] Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care. (10.1016/j.csm.2014.01.001)
  • [L3] Recovery trajectory is often elongated beyond one year, with two-thirds of our patients displaying persistent clinically relevant long-term disability. (10.1302/0301-620x.106b1.bjj-2023-0499.r2)
  • [L4] The Lima SMR stemless reverse shows promising short-term results in clinical, functional, and radiologic outcomes. (10.1016/j.jseint.2021.07.007)
  • [L4] The need for change in treatment plan or further imaging should be based on the patient's clinical progress with weight bearing. (10.5435/jaaos-d-18-00254)
  • [L3] There were no notable differences in radiographic outcomes between surgeons with and without trauma fellowship training. (10.5435/jaaos-d-16-00687)
  • [L3] In total, the clinical results are quite good in short- and long-term follow-up. (10.1016/j.jse.2021.07.023)
  • [L1] The effectiveness for pain and disability was sustained over 2 years, but the objective measure of walking ability improved in both groups, with no statistical difference between operative and nonoperative groups. (10.2106/jbjs.8908.ebo2)
  • [L1] There were no differences favoring operative treatment over non-operative treatment. (10.1177/2325967120s00511)
  • [L3] However further studies are warranted to assess the long-term outcomes of PFA. (10.1186/s42836-021-00074-8)
  • [L1] This trial will provide results on how multidisciplinary and multifaceted management of patients with OA affects health outcomes and health care costs. (10.1186/1471-2474-11-253)
  • [L3] Better final radiological and objective physical results were associated with a better patient-perceived outcome, as measured by the DASH score, in this patient group. (10.1197/j.jht.2007.06.001)
  • [L5] The success of unicompartmental knee arthroplasty relies on appropriate patient selection, yet considerable challenges persist in predicting patient-specific success due to variations in patient characteristics and healthcare practices. (10.1016/j.jisako.2024.100348)
  • [L3] The findings of this study suggest that patients with OSA may experience higher rates of medical complications in the short term, but no difference in orthopedic or mortality outcomes in the long term. (10.1016/j.jse.2025.03.003)
  • [L1] The number of follow-up radiographs can be reduced by implementing this protocol. (10.2106/jbjs.19.01381)
  • [L2] The use of invalidated or unreliable patient-reported outcome measures may improperly estimate patient pain and functional status, which could affect treatment options, patient satisfaction, reimbursement, and/or quality of life. (10.5435/jaaos-d-16-00303)
  • [L1] Non-surgical treatment results in fewer complications and additional surgeries compared to open reduction internal fixation. (10.1177/1758573219831506)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L1] However, the overall classification accuracy associated with these factors is not sufficient for identifying individuals who are most likely to benefit from these interventions. (10.1186/s12891-017-1558-5)
  • [L2] Radiological changes detected in 37.0% of patients did not influence clinical results. (10.1186/s12891-018-1945-6)
  • [L4] Continued improvement in pain and function, as well as a minor progression of radiographic osteolysis, may be expected between 2- and 5-year follow-up. (10.1016/j.jse.2024.03.038)
  • [L3] Both capsular management strategies (unrepaired capsulotomy and capsular repair) resulted in statistically significant improvements in all patient-reported outcomes at a minimum of 2 years. (10.1016/j.arthro.2014.10.014)
  • [L3] Furthermore, radiological outcomes and complication rates appear unaffected by the number of surgeons. (10.1186/s12891-025-09359-4)
  • [L3] Despite radiographic subsidence, clinical outcomes remained unaffected, suggesting mild early subsidence may represent a benign self-stabilization process. (10.1016/j.jse.2025.09.003)
  • [L3] Finally, our data confirmed the prognostic correlation between the two radiographic classifications used and the clinical outcomes. (10.1186/s13018-016-0426-6)
  • [L2] Overall, this study provides protective clinical parameters as well as quantitative and semi-quantitative MR-imaging parameters associated with maintaining radiographically normal knee joints in an older population over 8 years. (10.1186/s12891-024-07590-z)
  • [L3] Converting from nonoperative to arthroscopic treatment does not significantly increase patient costs compared with initial arthroscopic intervention, but both treatment pathways are roughly 2 times more costly to the patient than isolated nonoperative management. (10.1016/j.arthro.2025.04.027)
  • [L5] The workgroup proposes a standardized, four-tier outcome-reporting tool for periprosthetic joint infection treatment to improve transparency and guide the definition of success, categorizing outcomes from infection control to death. (10.1016/j.arth.2018.09.035)
  • [L4] However, the favourable clinical outcome was not confirmed by the radiographical findings, as significant osteoarthritic changes were observed. (10.1007/s00167-014-2999-0)
  • [L5] Despite improvements in techniques, results remain imperfect with frequent complications, and there is a lack of high-level evidence such as prospective cohort studies or controlled studies for non-operative treatment, leaving numerous open questions regarding the best treatment approach. (10.1007/s00167-019-05666-1)
  • [L3] Furthermore, our findings highlight a noticeable tendency toward the overcorrection of the deformity, as evidenced by increased pressure exerted on the lateral midfoot. (10.2106/jbjs.24.00394)
  • [L2] More than half of the participants who received additional conservative treatment still progressed to surgery. (10.1016/j.jhsa.2014.04.034)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L4] Ankle function following joint distraction declines over time. (10.2106/jbjs.n.00901)
  • [L3] The results of our study suggest screening patients with a history of past hospitalization, a history of admission in a long-term care facility, and older than 75 to reduce SSIs. (10.1186/s12891-023-06471-1)
  • [L3] Compared with controls, both nonoperatively and surgically treated clubfeet had significant limitations in ankle plantar flexion resulting in decreased range of motion, moment, and power. (10.2106/jbjs.18.00317)
  • [L4] The treatments based on this classification were effective. (10.1186/s13018-015-0313-6)
  • [L3] We identified a dramatic reduction in complications across the early and late cohorts, suggesting an improvement in quality over time, with the largest improvements seen among outpatients. (10.2106/jbjs.20.02157)
  • [L4] Tiers of care can be applied to quality measures to incorporate resource and capacity limitations when assessing their performance. (10.2106/jbjs.19.01506)
  • [L3] The finding that the rate of surgical complications and related hospital admissions remained meaningful during the entire year after surgery suggests that a postoperative follow-up period longer than the traditional 90 days may be warranted. (10.1016/j.jses.2017.10.002)
  • [L4] To our knowledge, the present study is the first to demonstrate the potential for early operative treatment to restore anatomical alignment and improve function of diabetic patients with stage-I Charcot arthropathy. (10.2106/00004623-200007000-00005)
  • [L4] A subpopulation of 30-day readmissions does not require a level of care consistent with inpatient admission services. (10.1016/j.arth.2019.05.013)
  • [L1] Based on data from the OAI, the rate and location (subregion) of osteoarthritis progression of the knee is strongly associated with lower extremity mechanical alignment. (10.1007/s00167-019-05434-1)
  • [L3] No matter what prophylactic regimen is chosen, the reported adverse outcome rates are far lower than historically reported. (10.1016/j.arth.2011.04.006)
  • [L4] Hallux valgus negatively impacts self-reported foot pain, function, concerns about foot appearance, and footwear in otherwise healthy adults. (10.1186/1471-2474-13-197)
  • [L3] Protected weightbearing in an orthopedic device can reduce the risk for complications in acute CN of the foot and ankle. (10.1186/s12891-016-1357-4)
  • [L4] Consensus supported a five-domain core outcome set comprising mortality, pain, activities of daily living, mobility, and health-related quality of life. (10.1302/0301-620x.96b8.33766)
  • [L3] Injury mechanisms indicate that many could be avoided by using proper technique, particularly during the landing phase. (10.1177/0363546507313571)
  • [L3] Functional outcomes are influenced by factors other than the knee, including concomitant injuries and psychosocial factors. (10.1007/s00167-017-4784-3)
  • [L5] Nevertheless, deliberate and careful treatment decisions can improve outcomes and minimize complications. (10.5435/jaaos-d-24-00567)
  • [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
  • [L4] Our results suggest that measuring aspects of care that often go without assessments, such as communication, can maximize care quality as defined by patients. (10.1016/j.jhsa.2022.06.014)
  • [L3] Patient age, comorbidities, and gender appear to have influence on the treatment chosen, likely due to their effects on surgical risk and the importance of timely return to activity. (10.1177/1558944716647101)
  • [L4] With limited survival, follow-up can be rationalized on a patient-by-patient basis using alternative means. (10.1302/0301-620x.104b1.bjj-2021-0761.r1)
  • [L2] Experience with the treatment explained up to 12% of the variance in treatment outcome. (10.1177/1753193418780187)
  • [L1] Early reimplation (abbreviated two-stage) provides similar outcomes to traditional two-stage exchange, though optimal timing and selection criteria remain undefined. (10.1016/j.arth.2025.10.075)
  • [L4] However, the short followup of our patients requires additional long-term studies to assess the duration of the results. (10.1007/s11999-009-0919-2)
  • [L3] Its success is not associated with specific fracture or patient related variables and it couldn't be clearly considered a time-dependent phenomenon. (10.1186/1749-799x-7-24)

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Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.