Higher Reoperation Rate Research Articles

Revision of failed reverse total shoulder arthroplasty with reverse: short-term clinical outcomes

The prevalence of failed reverse total shoulder arthroplasty (rTSA) is increasing. This can often present a challenging clinical situation with substantial bone loss and limited reconstruction options. This study reports a single tertiary referral center's experience with revision of failed rTSA managed with revision rTSA of bone-interfacing components. Following institutional review board approval, all revision shoulder arthroplasty cases performed at a single institution between 2012 and 2020 were reviewed. Cases in which rTSA was revised to a new rTSA construct with revision of at least one bone-interfacing implant (humeral stem and/or baseplate) with a minimum two-year follow-up were identified. Characteristics of revision cases-including indications, bony stock, revised components, and use of bone graft-were collected. All patients were contacted for patient-reported outcome measures at a minimum of two-years following surgery. In addition, the incidence and indication for any reoperation following revision were determined. Thirty-three patients with an average age of 66 years (range: 46-82) 19 (58%; 19/33) being female met inclusion criteria and had a mean follow-up of 4.2 years (range: 2-8). The most common indication for revision rTSA included humeral component loosening (33%; 11/33), baseplate loosening (27%; 9/33), and instability (21%; 7/33). Pre-revision infectious workup demonstrated no cases of periprosthetic shoulder infection. Thirteen cases had massive bone loss-five treated with humeral allograft prosthetic composite, five with glenoid bone grafting, and three with custom glenoid implant. In total, 10 cases (30%; 10/33) required re-operation at mean of 13 months (range: 1-44) for instability (4), humeral loosening (2), infection (1), baseplate loosening (1), or periprosthetic fracture (1). The re-operation rate for patients with revised baseplates only, humerus only, or combined was 23% (3/13), 28% (5/18), and 27% (3/11), respectively. Overall, VAS pain improved from 6.5 preoperatively to 2.0 (p<0.001) and the ASES score improved from 30.7 to 67.5 (p<0.001). However, postoperative SANE score averaged only 51.2% (range: 2-100). This study demonstrates that failed rTSA can be salvaged with a revision rTSA. However, patient expectations for functional improvements should be tempered and a high re-operation rate should be expected.

Influence and risk factors of postoperative infection after surgery for ischemic cardiomyopathy.

Studies on postoperative infection (POI) after surgery for ischemic cardiomyopathy are still lacking. This study aimed to investigate the risk factors of POI and its influence on clinical outcomes in patients undergoing ischemic cardiomyopathy surgery. The Surgical Treatment for Ischemic Heart Failure (STICH) trial randomized patients with ischemic cardiomyopathy [coronary artery disease (CAD) with left ventricular ejection fraction ≤35%] to surgical and medical therapy. In this study, a post hoc analysis of the STICH trial was performed to assess the risk factors and clinical outcomes of POI in those undergoing coronary artery bypass graft (CABG). Patients were divided according to whether POI developed during hospitalization or within 30 days from operation. Of the 2,136 patients randomized, 1,460 patients undergoing CABG per-protocol was included, with a POI rate of 10.2% (149/1,460). By multivariable analysis, POI was significantly related to patients' age, body mass index, depression, chronic renal insufficiency, Duke CAD Index, and mitral valve procedure. Compared to patients without POI, patients with POI had significantly longer durations of intubation, CCU/ICU and hospital stay, and higher rates of re-operation, in-hospital death and failed discharge within 30 days postoperatively. In addition, these patients had significantly higher risks of all-cause death, cardiovascular death, heart failure death, and all-cause hospitalization during long-term follow-up. However, the influence of POI on all-cause death was mainly found during the first year after operation, and the influence was not significant for patients surviving for more than 1 year. POI was prevalent after surgery for ischemic cardiomyopathy and was closely related to short-term and long-term clinical outcomes, and the effect of POI mainly occurred within the first postoperative year. This study first reported and clarified the relationship between POI and long-term prognosis and the predictors for POI after surgery for ischemic cardiomyopathy worldwide, which may have certain guiding significance for clinical practice. https://www.clinicaltrials.gov, identifier (NCT00023595).

Fracture pattern and risk factors for reoperation after treatment of 156 periprosthetic fractures around an anatomic cemented hip stem.

The Lubinus SP2 stem has been associated with a very low risk of periprosthetic femoral fractures (PPFFs). We aimed, primarily, to study the radiographic morphology of PPFFs close to a Lubinus SP2 stem. Secondarily, we analyzed whether higher reoperation rate was correlated to the revision method chosen or to the characteristics of the fracture and of the bone. The study included 156 femoral fractures close to a Lubinus cemented stem. These fractures were treated in 40 hospitals in Sweden between 2006 and 2011 and were followed up until 2019. Data from the Swedish Arthroplasty Register was used. Medical records and radiographs were studied. The fractures were classified according to the Vancouver classification. The fracture location and anatomy were delineated. We also measured the remaining attachment index (RAI) and the canal thickness ratio. Vancouver type C (n = 101) and spiral fractures (n = 67, 41 in Vancouver C and 26 in Vancouver B) were the most common fracture types. 4 fractures were avulsion of the greater trochanter. The remaining 51 fractures occurred around the stem (B1: 25, B2: 16, and B3: 10). B fractures were more commonly reoperated on (18 of 51, 35%) than type C fractures (11 of 101, 11%, P = 0.001). In most femurs with type B3 fracture, the fracture line covered an area only around the stem, but in all B1 and in 11 of 16 B2 fractures, it was extended even distal to the stem. ORIF instead of stem revision in B2 fractures, use of short stems or plates, and inadequate reduction of the fractures were risk factors for subsequent reoperations. The higher reoperation rate in type B fractures, compared with fractures distal to the stem, could be caused by their higher degree of complexity and reduced capacity for healing in the region around the stem.

Subperiosteal and Orbital Abscesses: A Comparison of Clinical Features, Management, and Outcomes.

To compare the clinical features, management, and outcomes between orbital cellulitis patients with subperiosteal abscess (SPA) and those with orbital abscess (OA). A retrospective study was conducted at a tertiary care center through medical record search to identify patients with orbital cellulitis from January 1, 2000 to December 31, 2022. Charts were screened for those with radiographic evidence of SPA or OA. Demographic data and presenting clinical features were compared between the 2 cohorts. Primary outcomes compared included rates of surgical intervention, reoperation, and readmission; and length of hospital stay and final vision. A total of 189 patients, 162 with SPA and 27 with OA, met the criteria. The OA group (mean 46.5 ± 18.6 years) was older than the SPA group (mean 19.1 ± 21.4 years). Comorbid sinusitis was significantly more common in the SPA cohort (95.7% SPA; 70.4% OA; p < 0.001), while OA was more likely to occur with orbital trauma (29.6% vs. 8.0%; p = 0.003), implanted hardware (11.1% vs. 0.6%; p = 0.005), and comorbid diabetes (22.2% vs. 4.3%; p = 0.001). OA patients more often presented with a relative afferent pupillary defect (21.7% vs. 3.9%; p = 0.005), vision worse than 20 of 50 (42.3% vs. 16.2%; p = 0.005), and methicillin-resistant Staphylococcus aureus infection (20.8% vs. 5.8%; p = 0.036). OA was associated with a higher reoperation rate (47.8% vs. 21.3%; p = 0.019), readmission rate (18.5% vs. 5.6%, p = 0.047), and limited extraocular motility at follow-up (4.3% vs. 25%; p = 0.013); while mean length of hospital stay and final visual acuity were similar. OA may affect an older population with a divergent risk factor profile compared with SPA. OA may cause more severe functional impairment on presentation, warranting more aggressive management to achieve visual outcomes similar to SPA.

Plate Fixation of Proximal Humerus Fractures: How to Get It Right and Future Directions for Improvement.

Open reduction and internal fixation with locking plates (ORIF-LP) has been used for decades for the surgical management of proximal humerus fractures. Despite good outcomes have been widely published in the literature, unacceptably high rates of complications (up to 40%), many of them yielding poor outcomes and requiring reoperation (up to 25%), have also been reported, especially in elderly patients. Most common complications are related to implant failure, with intra-articular screw penetration as the most frequent and devastating. Advances in patient selection and surgical technique, and implementation of bone or cement augmentation, have been developed to hopefully decrease complication rates. Mayo-FJD Classification offers prognostic information that can aid in the decision-making process for proximal humeral fractures. Displaced valgus impacted fractures seem to be associated with well over a 10% rate of avascular necrosis after ORIF-LP. A principle-based and stepwise surgical technique combining anatomic reduction and a short screw configuration can provide good outcome in most patients, even the elderly, decreasing implant failures to less than 10%. Acrylic cement augmentation has the potential to further decrease implant failure rate to 1%. Reoperation rates are higher partly due to the need to remove hardware for painful subacromial conflict. However, no studies to date definitively demonstrated the superiority of ORIF-LP compared to non-operative treatment, intramedullary nailing, or reverse shoulder arthroplasty. ORIF-LP can provide good results for the surgical management of displaced proximal humerus fractures even in elderly patients provided adequate patient selection and a principle based and stepwise surgical technique, supplemented with bone graft or acrylic cement when needed. Poor outcomes and high complication and reoperation rates should be expected when these recommendations are not followed.

NAVIO RATKA shows similar rates of hemoglobin-drop, adverse events, readmission and early revision vs conventional TKA: a single centre retrospective cohort study.

Despite widespread adoption of NAVIO robotic-assisted total knee arthroplasty (NAVIO RATKA) in clinical practice, clinical outcome in terms of adverse events and complications remains unclear. The purpose of this study was to compare adverse events, length of stay, surgical time, hemoglobin drop, early readmission rate and revision rate between conventional TKA (CTKA) and NAVIO RATKA. This single-centre retrospective cohort analysis compared 230 NAVIO RATKA patients to 489 CTKA patients with a minimal follow-up of 12 months. Baseline demographic and comorbidity parameters were collected, as well as length of stay, revision rate and reason for revision, early readmission rate (< 6w) and reason for readmission, post-operative hemoglobin levels, adverse events, surgical time and operating room time. Data were compared using Mann-Whitney U test for continuous data without normal distribution and ordinal data, categorical variables were compared using the Chi-square or Fisher exact test. There were no clinically relevant baseline demographic or comorbidity differences between groups. CTKA had shorter length of stay than NAVIO RATKA (5.0 days vs 5.4 days, p = 0.010) but trended towards a higher reoperation rate (4.1% vs 1.7%, p = .144, n.s). No differences were found in hemoglobin drop, readmission rate or overall incidence of adverse events, but CTKA showed more hematoma formation (1.6% vs 0%, p = .044) and higher incidence of periprosthetic joint infection (PJI) (1% vs 0%, p = n.s.), whilst NAVIO RATKA showed more periprosthetic fractures and persistent wound drainage (0.4% vs 2.2%, p = .038 and 0.6% vs 4.3%, p = .001, respectively). Surgical time remained significantly longer in NAVIO RATKA during all 230 cases (87 min vs 67.6 min) and showed a continuous downward trend. This study further validates the usage of NAVIO RATKA as a safe method to perform TKA, with comparable short term outcomes to CTKA in terms of early revisions and adverse events. Surgeons should be mindful of the differing adverse event profile in NAVIO RATKA and adjust their patient selection accordingly to ensure optimal outcomes. In addition, surgeons using NAVIO RATKA should expect a linear learning curve and a surgical time exceeding that of CTKA. Level III (therapeutic retrospective cohort study).

Primary single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus sleeve gastrectomy to SADI conversions: a comparison study of prevalence and safety.

Conversion from sleeve gastrectomy (SG) to single anastomosis duodeno-ileal bypass (SADI) is becoming increasingly common, but data regarding safety is of these conversions is scarce. As such, the objective of this study was to compare the 30-day rate of serious complications and mortality of primary SADI (p-SADI-S) with SG to SADI (SG-SADI) conversions. This retrospective cohort study analyzed the MBSAQIP database.Patients undergoing p-SADI-S and SG-SADI were included. Data collection was limited to 2020 and 2021. A multivariable logistic regression analysis was performed between groups to determine if SG-SADI was an independent predictor of 30-day serious complications or mortality. A total of 783 patients were included in this study, 488 (62.3%) underwent p-SADI-S and 295 (37.6%) underwent SG-SADI. The mean body mass index (BMI) at the time of surgery was lower in the SG-SADI cohort (45.1 vs 51.4kg/m2, p < 0.001). Indications for revision in the SG-SADI cohort included weight recurrence (50.8%), inadequate weight loss (41.0%), other (3.0%), GERD (2.7%), and persistent comorbidities (2.5%). SG-SADI had longer operative times (156.7 vs 142.1min, p < 0.001) and was not associated with a higher rate of serious complications (5.7 vs 6.9%, p = 0.508) compared to p-SADI-S. p-SADI-S was associated with a higher rate of pneumonia (1.2 vs 0.0%, p < 0.001), and SG-SADI was not correlated with higher rates of reoperation (3.0 vs 3.2%, p = 0.861), readmission (5.4 vs 5.5%, p = 0.948) and death (0.0 vs 0.2%, p = 0.437). On multivariable analysis, SG-SADI was not independently predictive of serious complications (OR 0.81, 95% CI 0.43 to 1.52, p = 0.514) when adjusting for age, sex, BMI, comorbidities, and operative time. The prevalence of SG-SADI is high, representing 37.6% of SADI-S procedures. Conversion from sleeve to SADI, is safe, and as opposed to other studies of revisional bariatric surgery, has similar 30-day complication rates to primary SADI-S.

Elevated HbA1c is not associated with reoperation following arthroscopic rotator cuff repair in patients with diabetes mellitus

Hyperglycemia is a known risk factor for tendon degeneration due to oxidative stresses from production of advanced glycosylation end products. In patients with Diabetes Mellitus (DM), analysis of glycated hemoglobin (HgA1c) provides a 3-month window into a patient's glucose control. No guidelines exist for ideal preoperative HgA1c and glucose control prior to arthroscopic rotator cuff repair. This study evaluated if a critical HgA1c level is associated with reoperation following arthroscopic rotator cuff repair. We retrospectively evaluated patients with DM who underwent primary arthroscopic rotator cuff repair from January 2014 to December 2018 at a single institution. Patients required a preoperative Hg1Ac within 3 months of surgery. Medical records were queried to evaluate for reoperation and identify the subsequent procedures performed. Univariate statistical analysis was performed to assess factors associated with reoperation (p< 0.05 considered significant). Threshold, area under the curve (AUC), analysis was performed to assess if a critical HgA1c value was associated with reoperation. 402 patients met inclusion criteria. Patients had an average age of 65.5 years (range 40-89) at time of surgery; 244 (60.6%) patients were male; and average BMI was 32.96 +/- 5.81. Mean HgA1c was 7.36 (Range 5.2 to 12). Thirty-three patients (8.2%) underwent subsequent reoperation. Six patients (1.5%) underwent capsular release and lysis of adhesions, 20 (5.0%) patients underwent a revision rotator cuff surgery, combination revision rotator cuff repair and lysis of adhesions, graft augmented revision repair, or superior capsular reconstruction, and 7 (1.7%) patients underwent revision to reverse shoulder arthroplasty (1.7%). There were no cases of reoperation for infection. On AUC analysis, no critical HgA1c value was identified to predispose to reoperation. Interestingly, elevated preoperative ASA (2.8 vs 2.28, p = 0.001) was associated with a higher reoperation rate. In patients with DM, preoperative HgA1c is not a predictive factor for surgical failure requiring reoperation. Stable glycemic control is important to a patient's overall health and may play a role in minimizing postoperative medical complications, but an elevated preoperative HgA1c should not be a strict surgical contraindication for arthroscopic rotator cuff repair. In patients with DM, an elevated ASA score is associated with an increased rate of subsequent reoperation; diabetic patients should be counselled accordingly.

Do all roads lead to Rome? A retrospective analysis on surgical technique in sleeve gastrectomy.

New York University Langone Health has three accredited bariatric centers, with 10 different bariatric surgeons. This retrospective analysis compares surgeon techniques in laparoscopic or robotic sleeve gastrectomy (SG) to identify associations with perioperative morbidity and mortality. All adults who underwent SG between 2017 and 2021 at NYU Langone Health were evaluated via EMR and MBSAQIP 30-day data. We also surveyed all 10 bariatric surgeons and compared their techniques and total adverse outcomes. Bleeding, SSI, mortality, readmission, and reoperation were specifically sub-analyzed via logistic regression. 86 (2.77%) out of 3,104 patients who underwent SG encountered an adverse event. Lower adverse outcomes were observed with a laparoscopic approach, 40-Fr bougie, buttressing, not oversewing the staple line, using hemostatic agents, stapling 3-cm from pylorus, and no routine UGI series. Lower bleeding rates were observed in a laparoscopic approach, 40-Fr bougie, buttressing, not oversewing the staple line, using hemostatic agents, stapling 3-cm from pylorus, no routine UGI series, and not proceeding with SG if hiatal hernia is present. Lower SSI rates were observed with ViSiGi™ bougie, no hemostatic agents, and routine EGD. Lower readmission rates were observed with 40-Fr bougie, buttressing, not oversewing, and stapling 3-cm from pylorus. Hemostatic agents had higher reoperation rates. It was not feasible to test for mortality given the low incidence. Certain surgical techniques in SG among our bariatric surgeons had a significant effect on the rates of adverse outcomes, bleeding, readmission, reoperation, and SSI. Our findings warrant further investigation into these techniques via multivariate regression or prospective design. This study was limited by its retrospective and univariate design. We did not account for interaction. The sample size was small, and follow-up of 30 days was relatively short. We did not include patient characteristics in the model or control for surgeon skill.

Impact of the SARS-CoV-2 Pandemic on Treatment Pathways and Outcomes of Esophagogastric Cancer: A Pre- Versus Post-Pandemic Comparison of International Prospective Cohort Data

Introduction: This study aimed to characterize the outcomes of esophagogastric (OG) cancer patients and compare perioperative outcomes with pre-pandemic data. Methods: Three international prospective cohort studies were included in this analysis. First, COVIDSurg-Cancer (n = 1999) included patients with an OG cancer planned for surgery from the start of the pandemic up to 14th April 2020 with follow-up until 31st August 2020. Treatment pathways and outcomes were compared against patients undergoing treatment for OG cancers before the pandemic, Oesophagogastric Anastomosis Audit (OGAA, n = 2246) and GlobalSurg 3 (n = 1256) study. The surgical composite outcome was defined as in patients achieving margin negative resection, resectability and no postoperative mortality. Results: This study included 1999 patients during the COVID-19 pandemic, of which 32.4% had a change from standard pre-pandemic management. Patients with delay to surgery had significantly higher rates of no surgery (24.7%vs 7.5%, P &lt; .001) and less likely to have achieve a composite outcome (57.8%vs 73.4%, P &lt; .001) than those without any delay in surgery. There was no significant difference in 30-day mortality (3.5% vs 3.4%; OR: 0.98, CI95%: 0.69-1.37) or anastomotic leak rate (10.9% vs 10.2%%; OR: 1.11, CI95%: 0.90-1.37) but higher reoperation rates (13.6% vs 10.4%; OR: 1.59, CI95%: 1.30-1.92) in patients between pre-pandemic and pandemic cohorts. Conclusion: The pandemic appears to have led to widespread changes in management pathways affecting one-third of patients. Developing elective surgical pathways resilient to periods of system “stress” are key to minimizing future harm from treatment delay for OG cancer patients.

Effects of Bone Cross-Link Bridging on Fracture Mechanism and Surgical Outcomes in Elderly Patients with Spine Fractures.

This study adopted a cross-sectional study design. This study was designed to investigate the effects of bone cross-link bridging on fracture mechanism and surgical outcomes in vertebral fractures using the maximum number of vertebral bodies with bony bridges between adjacent vertebrae without interruption (maxVB). The complex interplay of bone density and bone bridging in the elderly can complicate vertebral fractures, necessitating a better understanding of fracture mechanics. We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2-8), and maxVB (9-18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2-8) group had less A4 and more B1 and B2 fractures. The maxVB (9-18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2-8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9-18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9-18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.

Use of blockchain technology for smart health-care services: a critical perspective of ethnic minority group

Purpose The essence of blockchain governance is a far departure from the cryptocurrency or Bitcoin that has led to innovation and changing the outline of medical services. The major challenge in medical services is the lack of accessibility of medical services and lack of awareness. A large group of the population belonging to an ethnic minority has a high rate of complications, re-operation and graft rejection. To connect with a minority group and address privacy and safety issues, blockchain-based e-health-care services have massive potential in the medical industry, especially from the perspective of the social aspect. Design/methodology/approach The study proposed a framework that describes the complex interplay of different stated factors, including perceived ease of use, trust, perceived usefulness and perceived security and privacy. The paper uses structural equation modeling to understand the ethnic minority group’s readiness to adopt blockchain-based e-health-care services. Findings It was found that all the direct relationships between variables are supported by the findings and have a significant positive relationship with the adoption intention. The tested framework will help regulatory bodies and marketers to develop support health-care service mechanisms for ethnic minority groups by addressing their issues related to security and privacy. Originality/value Blockchain-based e-health-care services have massive potential in the medical industry, although, its actual diffusion has not been explored much, with particular reference to an ethnic minority group. This study will explore the diffusion of smart health-care services with respect to ethnic minority group.

A systematic review and meta-analysis of risk factors for reoperation after degenerative lumbar spondylolisthesis surgery

BackgroundConsidering the high reoperation rate in degenerative lumbar spondylolisthesis (DLS) patients undergoing lumbar surgeries and controversial results on the risk factors for the reoperation, we performed a systematic review and meta-analysis to explore the reoperation rate and risk factors for the reoperation in DLS patients undergoing lumbar surgeries.MethodsLiterature search was conducted from inception to October 28, 2022 in Pubmed, Embase, Cochrane Library, and Web of Science. Odds ratio (OR) was used as the effect index for the categorical data, and effect size was expressed as 95% confidence interval (CI). Heterogeneity test was performed for each outcome effect size, and subgroup analysis was performed based on study design, patients, surgery types, follow-up time, and quality of studies to explore the source of heterogeneity. Results of all outcomes were examined by sensitivity analysis. Publication bias was assessed using Begg test, and adjusted using trim-and-fill analysis.ResultsA total of 39 cohort studies (27 retrospective cohort studies and 12 prospective cohort studies) were finally included in this systematic review and meta-analysis. The overall results showed a 10% (95%CI: 8%-12%) of reoperation rate in DLS patients undergoing lumbar surgeries. In surgery types subgroup, the reoperation rate was 11% (95%CI: 9%-13%) for decompression, 10% (95%CI: 7%-12%) for fusion, and 9% (95%CI: 5%-13%) for decompression and fusion. An increased risk of reoperation was found in patients with obesity (OR = 1.91, 95%CI: 1.04–3.51), diabetes (OR = 2.01, 95%CI: 1.43–2.82), and smoking (OR = 1.51, 95%CI: 1.23–1.84).ConclusionsWe found a 10% of reoperation rate in DLS patients after lumbar surgeries. Obesity, diabetes, and smoking were risk factors for the reoperation.

Paper 29: Untreated Type 4 Ramp Injuries at Index Anterior Cruciate Ligament Reconstruction Surgery Result in Higher Rates of Revision ACL-R within the First 2 Years

Objectives: Ramp lesions are commonly associated with ACL tears and recent studies have identified these lesions in 17-42% of patients undergoing treatment with ACL reconstruction. In addition to its association with ACL tears, there is increasing recognition that ramp lesions lead to significant biomechanical changes in the knee. Our study seeks to investigate whether patients with type 4 ramp lesions at the time of initial ACL reconstruction have higher rates of reoperation, specifically revision ACL-R, compared to those that undergo ACL-R without a ramp lesion. Methods: Retrospective chart review was conducted on all patients surgically treated with ACL reconstruction at level I academic center from January 2015 to December 2019. Type 4 ramp lesions were diagnosed on preoperative MRIs by two MSK-trained radiologists blinded to clinical information. Demographic, associated injuries, intra-operative, clinical data, and re-operations were extracted from our ACL-R database. Statistical analysis using Students T-test and chi x2 for comparing cohorts. Cox Regression with covariates for re-operation surgery was used. Risk factors evaluated for revision surgery included patient age, sex, BMI, treatment of ramp, timing to surgery. Inter-reliability coefficient correlation was used for MRI reliability. Results: A total of 255 patients ACL-R were identified that met inclusion. There were 170 patients with ACL-R without a ramp present and 85 patients with ACL-R + type 4 ramp lesion. Revision ACL-R occurred in 10.5% in ramp group compared to 2.4% without ramp (P&lt;0.005). Around 75% of the revision ACL-R for the ramp group occurred within the first 2 and half years after surgery. Risk factor associated with revision ACL-R included untreated ramp (HR 10.46 (CI: 2.13-109.70) p=0.01). Conclusions: Meniscal ramp lesions with ACL-R result in higher revision ACL-R when compared to no ramp ACL-R. Most significantly untreated type 4 ramp lesions with concomitant ACL-R were associated with increased risk of ACL-R revision surgery . Standard portals are not sufficient in diagnosing and assessing stability of ramp lesions intra-operatively. [Table: see text]

Management of Very Distal Ulna Fractures: A Systematic Review.

To synthesize all-cause complications and reoperations data, as well as secondary clinical, functional and radiographic outcomes following the management of very distal ulna fractures (VDUFs) either nonoperatively or operatively. MEDLINE, Embase and Web of Science, were searched for English-language articles from inception to February 17, 2022. Studies reporting the nonoperative or operative management of VDUFs were eligible for inclusion. VDUFs were defined as either being Q2 to Q5 distal ulna fractures using the AO Comprehensive Classification of Fractures for distal ulna fractures associated with distal radius fractures or being amenable to characterization by Biyani et al.'s classification system for ulnar head, neck and metaphyseal fractures. Two reviewers independently extracted data from included studies. Study validity was assessed using the methodological index for non-randomized studies. Seventeen studies (512 VDUFs) were included for analysis. There were 209, 237 and 66 fractures in the nonoperative, ORIF and distal ulna resection groups, respectively. Descriptive statistics including weighted means, standard deviations and 95% confidence intervals were calculated. The treatment of VDUFs with either nonoperative management, ORIF or distal ulna resection may all be acceptable treatment options in specific patient populations. Nonoperative management of VDUFs is a promising treatment strategy even for complex fracture patterns in patients 65 years of age or older. Despite higher reoperation rates, ORIF may be considered for the younger, high-demand patient. Distal ulna resection presents with very favorable functional outcomes in patients 65 years of age or older presenting with a complex VDUF with the lowest reoperation rate across all groups.

Should nails be locked dynamically or statically in atypical femoral fractures? – A radiological analysis of time to union and reoperations in 236 displaced fractures with 4 years average follow-up

IntroductionAtypical femoral fractures (AFFs) are associated with delayed union and higher reoperation rates. Axial dynamization of intramedullary nails is hypothesized to reduce time-to-union (TTU) and fixation failure as compared to static locking. MethodsConsecutive acutely displaced AFFs fixed with long intramedullary nails across five centres between 2006 and 2021 with a minimum postoperative follow-up of three months were retrospectively reviewed. The primary outcome was TTU, compared between AFFs treated with dynamically or statically locked intramedullary nails. Fracture union was defined as a modified Radiographic Union Score for Tibial fractures score of 13 or greater. Secondary outcomes involved revision surgery and treatment failure, defined as non-union beyond 18 months or revision internal fixation for mechanical reasons. ResultsA total of 236 AFFs (127 dynamically locked and 109 statically locked) were analysed with good interobserver reliability of fracture union assessment (intraclass correlation coefficient = 0.89; 95% CI = 0.82–0.98). AFFs treated with dynamized nails had significantly shorter median TTU (10.1 months; 95% CI = 9.24–10.96 vs 13.0 months; 95% CI = 10.60–15.40) (log-rank test, p = 0.019). Multivariate Cox regression revealed that dynamic locking was independently associated with greater likelihood of fracture union within 24 months (p = 0.009). Reoperations were less frequent in the dynamic locking group (18.9% vs 28.4%), although the difference was not statistically significant (p = 0.084). Static locking was an independent risk factor for reoperation (p = 0.049), as were varus reduction and lack of teriparatide use within three months of surgery. Static locking also demonstrated a higher frequency of treatment failure (39.4% vs 22.8%, p = 0.006) and was an independent predictor of treatment failure in logistic regression (p = 0.018). Other factors associated with treatment failure included varus reduction and open reduction. ConclusionsDynamic locking of intramedullary nails in AFFs is associated with faster time to union, lower rate of non-union, and fewer treatment failures.

Surgical reintervention requirements following GreenLight PVP: A single-center experience using three different laser device models

ABSTRACT Objective To assess the incidence, risk factors, and timing of specific causes of reoperations following PVP. Material and Methods A retrospective analysis of data on men who underwent GreenLight PVP between 2004 and 2019 in a single center and required surgical intervention for bladder neck contracture (BNC), urethral stricture (US), or persistent/recurrent prostate adenoma. Results The overall rate of reoperations was 13.8% during a 61-month median follow-up of 377 patients. Reoperations were due to BNC, US, and adenoma in 7.7%, 5.6%, and 4.8% of cases, respectively. The median interval until reoperation for US (11 months) was significantly shorter. None of the risk factors had any relevance to US. In patients who underwent reoperation for BNC, lasing time and energy were significantly lower, and the prostate volume was smaller; however, the multivariate analysis only identified shorter lasing time as a predictor. In patients who had reoperation for persistent/recurrent adenoma, the PSA was increased, while the prostate volume was non-significantly high, and performance by less-experienced surgeons was associated with a higher rate of reoperations (p < 0.05). A longer lasing time predicted an increased risk of reoperation for adenoma in multivariate analysis. Conclusions An unselective utilization of PVP may result in a relatively high rate of reoperations. The correlation of BNC with shorter lasing time may imply a higher risk after PVP of smaller prostates. A longer lasing time predicts an increased risk of reoperation due to persistent/recurrent adenoma, which may be related to higher prostate volumes and inefficient PVP by less-experienced surgeons.

Outcomes and reoperation rates of adult spinal deformity patients with baseline sagittal malalignment based on the cranial axis to the hip at 2 years postoperatively.

The aim of this study was to discern whether patients with a cranial sagittal vertical axis to the hip (CrSVA-H) > 2 cm at 2 years postoperatively exhibit significantly worse patient-reported outcomes (PROs) and clinical outcomes compared with patients with CrSVA-H < 2 cm. This was a retrospective, 1:1 propensity score-matched (PSM) study of patients who underwent posterior spinal fusion for adult spinal deformity. All patients had a baseline sagittal imbalance of CrSVA-H > 30 mm. Two-year patient-reported and clinical outcomes were assessed in unmatched and PSM cohorts, including Scoliosis Research Society-22r (SRS-22r) and Oswestry Disability Index scores as well as reoperation rates. The study compared two cohorts based on 2-year alignment: CrSVA-H < 20 mm (aligned cohort) vs CrSVA-H > 20 mm (malaligned cohort). For the matched cohorts, binary outcome comparisons were carried out using the McNemar test, while continuous outcomes used the Wilcoxon rank-sum test. For unmatched cohorts, categorical variables were compared using chi-square/Fisher's tests, while continuous outcomes were compared using Welch's t-test. A total of 156 patients with mean age of 63.7 (SEM 1.09) years underwent posterior spinal fusion spanning a mean of 13.5 (0.32) levels. At baseline, the mean pelvic incidence minus lumbar lordosis mismatch was 19.1° (2.01°), the T1 pelvic angle was 26.6° (1.20°), and the CrSVA-H was 74.9 (4.33) mm. The mean CrSVA-H improved from 74.9 mm to 29.2 mm (p < 0.0001). At the 2-year follow-up, 129 (78%) of 164 patients achieved CrSVA-H < 2 cm (aligned cohort). Patients who had CrSVA-H > 2 cm (malaligned cohort) at the 2-year follow-up had worse preoperative CrSVA-H (p < 0.0001). After performing PSM, 27 matched pairs were generated. In the PSM cohort, the aligned and malaligned cohorts demonstrated comparable preoperative patient-reported outcomes (PROs). However, at the 2-year postoperative follow-up, the malaligned cohort reported worse outcomes in SRS-22r function (p = 0.0275), pain (p = 0.0012), and mean total score (p = 0.0109). Moreover, when patients were stratified based on their magnitude of improvement in CrSVA-H (< 50% vs > 50%), patients with > 50% improvement in CrSVA-H had superior outcomes in SRS-22r function (p = 0.0336), pain (p = 0.0446), and mean total score (p = 0.0416). Finally, patients in the malaligned cohort had a higher 2-year reoperation rate (22% vs 7%; p = 0.0412) compared with patients in the aligned cohort. Among patients who present with forward sagittal imbalance (CrSVA-H > 30 mm), patients with CrSVA-H exceeding 20 mm at the 2-year postoperative follow-up have inferior PROs and higher reoperation rates.

Radial Head Arthroplasty for Fracture: Implant Survivorship and Outcomes at Mean Follow-up of 8 Years

The purpose of this study was to evaluate implant survivorship and clinical outcomes following radial head arthroplasty for fracture at long-term follow-ups. A retrospective analysis was conducted on adult patients who underwent primary uncemented radial head arthroplasty for radial head or neck fractures between 2012 and 2015. Medical records were reviewed to collect information regarding demographics, injury characteristics, reoperations, and revisions requiring implant removal. A bivariate analysis was conducted to identify potential risk factors for reoperation. A Kaplan-Meier curve was created to determine implant survival rates. Eligible patients were contacted to confirm any reoperations and obtain Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups. A total of 89 patients were eligible for analysis and assessed at a mean of 97 months after surgery (range, 81-128). Reoperation rate was 16% (14 of 89 patients), including 5% of patients requiring implant removal or revision. However, 93% of reoperations occurred within the first 12 months of the index surgery. Fracture dislocations of the elbow had a higher rate of reoperation. A Kaplan-Meier curve demonstrated an implant survival rate of 96% at 10-year follow-up. Of the patients who responded, the mean Quick Disability of the Arm, Shoulder, and Hand score was 8.7 ± 10.3, with none requiring additional reoperations or revisions. There were otherwise similar outcome scores among patients requiring reoperation versus those who did not. Although radial head arthroplasty for fractures has a high potential for reoperation within the first year, survival rates with uncemented implants remain high at 10 years, and patients report excellent Quick Disability of the Arm, Shoulder, and Hand scores at long-term follow-ups, despite any need for reoperation. Fractures with associated elbow dislocation may be at a higher risk for reoperation, and it is important to provide this prognostic information to patients who are likely to require arthroplasty for more extensive injuries. Therapeutic IV.

ID: 214307 Real-World Incidence of Reoperation Rates With Interspinous Spacers for Lumbar Spinal Stenosis

The use of interspinous spacers, a less invasive treatment option for patients with moderate Lumbar Spinal Stenosis (LSS), has been increasingly adopted over the past few years. Clinical outcomes in a randomized controlled trial with long-term follow-up to 5-years suggested high overall improvement and low reoperation rate with the use of interspinous spacers.1 Here, we report reoperation rates of an ongoing real-world, prospective, multicenter study of patients using an interspinous spacer for LSS.