Patients Underwent Revision Surgery Research Articles

Poster 346: Revision Anterior Cruciate Ligament Reconstruction with an All-Soft Tissue Quadriceps Tendon Autograft Produces Similar Outcomes to Index Surgery

Objectives: Anterior cruciate ligament reconstruction (ACLR) using all-soft tissue quadriceps tendon (QT) autograft has not yet been studied as a viable revision option in the pediatric population. This study aimed to compare short- to mid-term outcomes between patients undergoing revision ACLR and primary ACLR using all-soft tissue QT autograft. Methods: A retrospective review of prospectively collected data included patients aged 8-18 years old who underwent revision ACLR using an all-soft tissue QT autograft over a ten-year period (2011-2021). One-to-two matching by age and gender was performed to select a control group of patients who underwent primary ACLR utilizing all-soft tissue QT autograft during the same period. All procedures were performed by a single surgeon using a minimally invasive graft harvest technique and suspensory fixation. Subjective assessment of knee function was obtained pre- and postoperatively with the International Knee Documentation Committee (IKDC) survey. Postoperative knee laxity was measured with a KT1000 arthrometer at 6 weeks, 3 months, and 6 months. Isokinetic quadriceps strength at 60° and 180° was collected at 6 months and 12 months. Complications, including hematomas, infections, graft failures, and the need for subsequent surgery were recorded. To determine clinical significance ( p≤0.05), outcomes were compared using two-sided Student t-tests and Pearson’s chi-squared tests. Results: Thirty-nine patients underwent revision ALCR (59% female; 15.67±1.6 years old; BMI 23.7±4.6) and 78 underwent primary ACLR (59% female; 15.73±1.46 years old; BMI 23.5±3.9) with all-soft tissue QT autograft ( p=1.00 for gender; p=0.83 for age; p=0.82 for BMI). Length of follow up was 20.9 months (revision) and 23.4 months (primary) ( p=0.543). Mean IKDC scores improved significantly in both groups (Revision: 59.17±16.4 vs. 85.87±10.57, p<0.001; Index: 55.85±16.8 vs. 88.38±14.2 p<0.001). Mean time to postoperative IKDC for revision and primary ACLR was 14.67±5.7 months and 15.22±6.5 months, respectively ( p=0.865). There were no significant differences in mean pre- or postoperative IKDC scores between the index and revision groups (Table 1, p>0.05). However, postoperative knee laxity was significantly greater after revision surgery at 6 weeks ( p=0.006) and 6 months ( p=0.009) (Table1). Contrarily, patients undergoing primary surgery had a greater isokinetic quadriceps strength deficit during both time points at 60° and 180°, which was statistically significant at full extension at 12 months postoperatively ( p<0.039) (Table 1). Finally, although patients undergoing revision surgery exhibited fewer complications, this difference was not statistically significant (Table 2). Conclusions: Patient reported outcomes after ACLR revision surgery using all-soft tissue QT autograft in the paediatric population is equivocal to those undergoing primary reconstruction. Despite minor differences in the progression of postoperative isokinetic strength and knee laxity, a history of previously failed ACLR does not seem to portend inferior outcomes or increased risk for complications in pediatric patients undergoing revision surgery with all-soft tissue QT autograft. [Table: see text][Table: see text]

Paper 58: Against Surgeons’ Advice: The Return to Sport in High Demand Weightlifters Following Anatomic Total Shoulder Arthroplasty at Average 3.6 Years Follow-up

Objectives: Return to sport in high-demand weightlifters following total shoulder arthroplasty has rarely been investigated, as most surgeons recommend against returning to heavy lifting postoperatively. The purpose of this study is to determine the incidence of return to sport, patient reported outcomes, patient satisfaction, performance, and failures in a specific population of high demand weightlifters that continue lifting after undergoing total shoulder arthroplasty. Methods: Retrospective review of a specific population of high demand weightlifters that underwent anatomic total shoulder arthroplasty with minimum one-year clinical follow up was conducted. Prospective surveys determining pre- and postoperative participation in weightlifting included maximum weight, frequency, and duration of workouts, Single Assessment Numeric Evaluation (SANE), patient satisfaction, and post-operative range of motion were collected. Secondary outcomes included failure, revision surgery, risk factors for not returning to weightlifting, and performance measured as percentage of prior maximum bench press. Bivariate and multivariate analysis was performed to compare cohorts and identify risk factors, respectively. Results: Forty-two shoulders in 36 patients who met inclusion criteria (avg age 57.9 years, 97% male). No patient underwent revision surgery at average 3.6 year follow up (1 to 7 years, SD 1.9 years). The majority of patients (23/42 shoulders) report returning to heavy weightlifting postoperatively against senior surgeon’s recommendations. Mean SANE score for current weightlifters and retired weightlifters were 86.9 and 91.6, respectively (P = 0.148). In the weightlifting cohort, only 78.3% of patients achieved patient-acceptable symptom state (PASS) threshold for SANE compared to 89.5% of patients (p = .332) in the retired cohort. Patient satisfaction and return to sport satisfaction in current weightlifting shoulders were good-to-excellent in 91.3% (P= 0.922) and 82.6% (P = 0.972) respectively. Patients who continued lifting reported substantially decreased maximum weight in all lifts compared to pre symptomatic maximum. Conclusions: This data provides insight for surgeons on the expected activity level of prior high demand weightlifters. Against their surgeon’s recommendations, most patients who participated in preoperative weightlifting returned to high demand weightlifting after surgery, but patients demonstrated lower lifting performance postoperatively. There were no early clinical catastrophic failures with high patient reported outcomes. While caution is still advised with returning to heavy weightlifting, the current data highlights the advances of modern fixation techniques, fourth generations implants, and diminished lifting capacity after surgery, which likely play a role in the high implant survivorship in this cohort.

MID-TERM RESULTS OF AUTOLOGOUS MATRIX-INDUCED CHONDROGENESIS (AMIC) USED FOR LARGE CHONDRAL DEFECTS IN FEMOROACETABULAR IMPINGEMENT HIPS

Femoroacetabular impingement is a prearthritic deformity frequently associated with early chondral damage. Several techniques exist for restoring larger cartilage defects. While AMIC proved to be an effective treatment in knee and ankle, there are only short-term data available in hip. This study aimed to investigate the mid-term clinical outcome of patients with chondral lesions treated by AMIC and evaluate the quality of repair tissue via MRI.This retrospective, single center study includes 18 patients undergoing surgical hip dislocation for FAI between 2013 and 2016. Inclusion criteria were: cam or pincer-type FAI, femoral or acetabular chondral lesions > 1 cm2, (IRCS III-IV). Due to exclusion criteria and loss-to-follow-up 9 patients (10 hips) could be included. Patient reported outcome measures included Oxford Hip Score (OHS) & Core Outcome Measure Index (COMI)). MRIs were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score.None of the patients underwent revision surgery except screw removals from the greater trochanter. Followup data indicate a satisfactory to good hip function at 5 years: PROMS improved from pre- to postop at 5 years: OHS from 38.1 to 43.4, COMI from to 1.8 and UCLA from 4 to 8.1 respectively. MOCART score was 67.5 postoperatively. Subgrouping showed slightly better results for acetabular defects (Ø 69.4) compared femoral defects (Ø 60).Based on the reported mid-term results, we consider AMIC as a valuable treatment option for larger chondral defects of the hip.

Spinal fusion for single-level SPECT/CT positive lumbar degenerative disc disease: the SPINUS I study.

With current imaging modalities and diagnostic tests, identifying pain generators in patients with non-specific chronic low back pain (CLBP) is difficult. There is growing evidence of the effectiveness of SPECT/CT examination in diagnosing the source of pain in the spine. The study aims to investigate the effect of posterior interbody fusion on a single-level SPECT/CT positive lumbar degenerative disc disease (DDD). This is a prospective study of patients with chronic low back pain (CLBP) operated on for a single-level SPECT/CT positive DDD. Primary outcomes were changes in visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Secondary outcomes were complications, return to work, satisfaction and willingness to re-undergo surgery. During a 3-year period, 38 patients underwent single-level fusion surgery. The mean preoperative VAS score of 8.4 (± 1.1) decreased to 3.2 (± 2.5, p < 0.001) and the mean preoperative ODI of 51.5 (± 7.3) improved to 20.7 (± 14.68, p < 0.001) at a 2-year follow-up. A minimum clinically important difference (30% reduction in VAS and ODI) was achieved in 84.2% of patients. Some 71% of patients were satisfied with the surgery results and 89.4% would undergo surgery again. There were four complications, and two patients underwent revision surgery. Some 82.9% of patients returned to work. Fusion for one-level SPECT/CT positive lumbar DDD resulted in substantial clinical improvement and satisfaction with surgical treatment. Therefore, SPECT/CT imaging could be useful in assessing patients with CLBP, especially those with unclear MRI findings. ClinicalTrials.gov Identifier: NCT04876586.

Excision and primary anastomotic urethroplasty

Objective: To retrospectively review patients with strictures (&lt;3 cm) of the bulbous urethra who had Undergone urethroplasty with excision of the stenotic segment and end-to-end anastomosis. Patients and Methods: One hundred patients were analyzed, all males with ages ranging from 18 to 60 who were treated for strictures between 5 and 30 mm in length between 2007 and 2021. Endoscopic internal urethrotomy was used in the treatment of 65 patients (%), and three patients (20()) had internal urethrotomy performed on them twice. The removal &amp; primary anastomotic urethroplasty were performed on all patients. With the patient in a lithotomy posture, the stenotic segment was removed and the stumps spatulated for end-to-end anastomosis through a perineal incision. The average (range) time of an operation was 119 (75-150) minutes. Although one patient underwent revision surgery for a perineal urine fistula, the surgery itself and the time spent in the position of lithotomy were both uneventful. Results: After a median of 12 months of observation, 95% of patients were deemed cured since the stricture had not returned. Perineal urinary fistula and recurring stricture occurred in one case. No other adverse events occurred as a result of the treatment.

Minimum 10-Year Outcomes After Arthroscopic Repair of Partial-Thickness Supraspinatus Rotator Cuff Tears

Background: The prevalence of partial-thickness rotator cuff tears (PTRCTs) has been reported to be 13% to 40% within the adult population, accounting for 70% of all rotator cuff tears. Approximately 29% of PTRCTs will progress to full-thickness tears if left untreated. The long-term clinical course after arthroscopic repair of PTRCTs is not well known. Purpose: To investigate minimum 10-year patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (RCR) of the supraspinatus tendon and to report reoperation and complication rates. Study Design: Case series; Level of evidence, 4. Methods: Patients were included who underwent arthroscopic RCR of a PTRCT performed by a single surgeon between October 2005 and October 2011. Arthroscopic RCR was performed with a transtendon repair of partial, articular-sided supraspinatus tendon avulsions, bursal-sided repair, or conversion into a full-thickness tear and repair. PRO data were collected preoperatively and at a minimum 10 years postoperatively. PRO measures included the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, the shortened version of Disabilities of the Arm, Shoulder and Hand score (QuickDASH), the 12-Item Short Form Health Survey Physical Component Summary, and patient satisfaction. Subanalyses were performed to determine if tear location or age was associated with outcomes. Retears, revision surgery, and surgical complications were recorded. Results: In total, 33 patients (21 men, 12 women) at a mean age of 50 years (range, 23-68) met criteria for inclusion. Follow-up was obtained in 28 (87.5%) of the 32 eligible patients ≥10 years out from surgery (mean, 12 years; range, 10-15 years). Of the 33 PTCRTs, 21 were articular sided and 12 were bursal sided. Of the 33 patients, 26 underwent concomitant biceps tenodesis. At follow-up, the mean PROs were significantly improved when compared with preoperative levels: American Shoulder and Elbow Surgeons score from 67.3 to 93.7 (P < .001), Single Assessment Numeric Evaluation from 70.9 to 91.2 (P = .004), QuickDASH from 22.3 to 6.6 (P < .004), and 12-Item Short Form Health Survey Physical Component Summary from 44.8 to 54.2 (P < .001). Median postoperative satisfaction was 10 (range, 5-10). No patient underwent revision surgery. Conclusion: Arthroscopic repair of PTRCTs results in excellent clinical outcomes and high patient satisfaction at minimum 10-year follow-up. Furthermore, the procedure is highly durable, with a clinical survivorship rate of 100% at 10 years.

Management of External Auditory Canal Anterior Wall Defect: A Case Series and Literature Review.

Although rare in etiology, anterior bony wall defects of the external auditory canal (EAC) accompanied by temporomandibular joint herniation may cause various otologic symptoms. Surgical treatment can be considered based on symptom severity because many previous case reports have highlighted its efficacy. This study aimed to review the long-term results of surgical treatment of EAC anterior wall defect and to suggest a stepwise approach when creating a treatment plan. We performed a retrospective review of 10 patients who underwent surgical management to address the EAC anterior wall defect and its associated symptoms. Medical records, temporal bone computed tomography scans, audiometry, and endoscopic examination findings were analyzed. The primary repair of the EAC defect was the first to be surgically addressed in most cases, excluding one case with a severe combined infection. Of the 10 cases, 3 patients exhibited either postoperative complications or symptom recurrence. Six patients had resolved symptoms consequent to primary surgical repair, and four patients underwent revision surgery undergoing a more invasive procedure, such as canalplasty or mastoidectomy. Primary repair of the anterior wall defect of the EAC seems to be overpromoted for lasting results but is not as promising as previously noted. We therefore propose to create a novel treatment flowchart regarding the surgical treatment of anterior wall defects of the EAC based on clinical experience. IV.

(105) A Multicenter Analysis of the AUA Recommended Antibiotic Prophylaxis for Penile Implantation Results in Higher, not Lower, Infection Risk

Abstract Introduction The American Urological Association (AUA) recommendations on antibiotic prophylaxis in penile implant surgery are based on low quality evidence and expert opinion. Recent evidence suggests the recommended regimens may be suboptimal. Objective To determine if the AUA recommended antibiotic regimen (vancomycin + gentamicin) for primary penile implant surgery is associated with a higher infection risk than non-standard regimens. Methods We performed a multicenter, retrospective cohort study of patients undergoing primary IPP surgery. Patients undergoing revision surgery or with a history of IPP placement were excluded. Additionally, patients who underwent concomitant procedures for Peyronie’s disease or stress urinary incontinence were excluded. Patients were divided into those receiving standard AUA antibiotic prophylaxis (vancomycin + gentamicin) and those receiving any other (non-standard) antibiotic prophylaxis. The time to postoperative device explanation due to infection via a Cox regression model, the microorganisms involved, and the management of patients with device infection were evaluated. A subgroup analysis to identify the appropriate dosage of gentamicin was also performed. Results 4,161 patients underwent primary IPP placement (2,411 received vancomycin + gentamicin and 1,750 received other regimens). The infection rate was similar between groups, 1.0 vs 1.2% for standard vs non-standard prophylaxis. In the multivariate Cox regression analysis, the use of vancomycin + gentamicin (HR: 2.74, 95%CI: 1.38-5.41, p=0.004) and diabetes (HR: 1.87, 95%CI: 1.03-3.39, p=0.04) were significantly associated with higher risk of device explantation due to infection. Concomitant infusion of antifungals (HR: 0.08, 95%CI: 0.03-0.19, p&amp;lt;0.001) was associated with lower risk of infection. Staphylococcus aureus and Escherichia coli were the most frequently cultured microorganisms. Device infection was most commonly managed with salvage using a malleable prosthesis (40.4%). In patients of both groups receiving gentamicin as part of perioperative antibiotic prophylaxis, the use of weight-based gentamicin compared to 80 mg gentamicin was associated with similar risk of device explantation due to infection (HR: 2.88, 95% CI: 0.83 to 10, p = 0.1). Conclusions Vancomycin + gentamicin for antibiotic prophylaxis in primary penile implant surgery is independently associated with a higher infection risk than non-standard antibiotic regimens while antifungal use is associated with lower infection risk. There does not appear to be a difference in weight-based vs low dose (80mg) gentamicin on infection risk. Our results further demonstrate the importance of antifungal use in prophylaxis regimens. Additionally, a critical review of the recommended prophylactic regimens is needed. Tailoring individual regimens to local antibiograms may provide the best infection prevention. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Antares Pharma, Clarus Therapeutics, Cynosure, Promescent, Sprout, Viome.

Satellite Rod Fixation around Rod-fracture Area in Revision Surgery after Three-column Osteotomy for Severe Kyphoscoliosis.

Three-column osteotomy (3CO) is considered valuable and increasingly utilized in the surgical treatment of severe spine deformity while associated with high implant-related complications and revision risks. This study aims to evaluate the feasibility and clinical outcomes of satellite rod fixation used around the rod-fracture area in revision surgery due to rod fracture after 3CO. Twenty-five patients applying satellite rod fixation in revision surgery from August 2012 to May 2016 were retrospectively reviewed as the SR group. Patients undergoing revision surgery with traditional strategy after 3CO due to rod-fracture were selected as the TR group. Cobb angle, distance between C7 plumb line and center sacral vertical line (C7 PL-CSVL), global kyphosis (GK) and sagittal vertical axis (SVA) were assessed. Patients were required to fulfill the Scoliosis Research Society-22 questionnaire (SRS-22) at pre-revision and the last follow-up. The paired t test was used to analyze the difference among pre-revision, post-revision and last follow-up. There was no statistical difference in terms of age, gender, body mass index (BMI), fusion level at 1st surgery, and follow-up period between SR and TR group (all P > 0.05). The operation time (1.5 ± 0.7 h vs 3.2 ± 0.9 h, P < 0.001) and intraoperative blood loss (178 ± 51 mL vs 324 ± 96 mL, P < 0.001) were significantly higher in the TR group. Patients in both groups obtained obvious deformity correction after revision surgery. For patients in SR group, the coronal Cobb angle significantly improved from 27.9 ± 21.5° at pre-revision to 21.8 ± 16.6° at post-revision (P = 0.034). The C7 PL-CSVL decreased from 22.6 ± 14.3 mm to 21.3 ± 10.9 mm (P = 0.719). Similarly, improvement was attained in post-revision GK (25.8 ± 17.0° vs 20.2 ± 15.1°, P = 0.061). SVA was corrected from 35.6 ± 33.9 mm to 30.8 ± 24.3 mm after revision (P = 0.182). At the last follow-up, no significant correction loss was observed in both coronal and sagittal parameters (all P > 0.05). All patients responded to the SRS-22 questionnaire and all the domains showed improvements in different levels. As compared to the TR group, the SR group had significantly better pain and management satisfaction scores (all P < 0.05). Additionally, there was no reoccurrence of implant failure during follow-up and all patients achieved solid bony fusion in SR group. Satellite rod fixation around rod-fracture area is indicated for patients in the requirement of revision surgeries due to rod fracture after 3CO. Compared with traditional revision strategies, revision surgery with satellite rods, if patients are selected adequately, is a simpler procedure with less intraoperative blood loss and shorter operating time.

Total hip arthroplasty for failed internal fixation of femoral neck fracture: a retrospective study with 2–14 years’ follow-up of 345 patients

ObjectivesThe purpose of this study was to analyze mid- to long-term outcomes of total hip arthroplasty (THA) following failed internal fixation of femoral neck fracture.MethodsThis study retrospectively analyzed 345 patients with femoral neck fracture who underwent THA after failure of internal fixation at our hospital between January, 2003 and December, 2019. Patients older than 55 years (n = 175) and patients no older than 55 years (n = 170) were compared in terms of complications and survival rates during follow-up, which lasted a mean of 6 years.ResultsThe two age groups showed similarly low incidence of complications and similarly long periods of survival without revision surgery. Only three younger patients and two older patients underwent revision surgery during follow-up. The two groups showed similarly high survival rates at the end of follow-up (> 93%). Younger patients showed significantly bettter Harris hip score at last follow-up (90.2 vs. 88.1 points, p < 0.001) without clinically significant difference, but they required THA significantly earlier after internal fixation (4.4 vs. 6.8 years, p < 0.001).ConclusionsTHA after failed internal fixation of femoral neck fracture is a well tolerated and effective procedure in older and younger patients.

The Impact of Spray Cryotherapy on Lesion-Induced Osteitis in a New Murine Experimental Model.

Background and Objectives: Endoscopic sinus surgery is considered the gold management strategy for difficult-to-treat chronic rhinosinusitis. The inflammatory bony process is incriminated as being involved in the unfavorable evolution and recurrence of the disease. Osteitis is significantly increased in patients that have been previously submitted to surgery, and it is more often present in patients with extended radiological disease and in patients undergoing revision surgery. The aim of the research is to demonstrate the presence of inflammations and neo-osteogenesis associated with nasal mucosal surgical injury and the correlation between their severity and to evaluate the efficacy of low-pressure spray cryotherapy in reducing inflammation and bone remodeling. Materials and Methods: The experimental murine model was conducted over a period of 80 days and included a total of 60 adult female Wistar rats, with three periods of withdrawal of 20 individuals each from the experiment. After inducing a bilateral mechanical injury by brushing, low-pressure spray cryotherapy application was performed unilaterally, and tissue samples were prepared specifically for histological analysis. The scores for inflammation and osteitis were compared over time and between the two nasal fossae. Results: Osteitis and inflammation were induced by a simple mucosal brushing lesion, similar to surgical injury. We identified the presence of inflammation in 95% of the specimens, and it was present over time. Moreover, criteria for bone remodeling were clearly highlighted in a percentage of 72% of the specimens. There was a direct correlation between the severity of inflammation and neo-osteogenesis, with a statistical significance of p = 0.050. Low-pressure spray cryotherapy was safe and effective in reducing inflammation (p = 0.020) and osteitis (p = 0.000) with a safety profile. Conclusions: Low-pressure cryotherapy reduces the severity of mucosal inflammation and osteitis in lesion-induced neo-osteogenesis.

Anatomical Variations of the First Dorsal Compartment in de Quervain Tenosynovitis.

De Quervain tenosynovitis of the wrist is a common pathology. The primary aim of this study is to determine the prevalence of extensor pollicis brevis and abductor pollicis longus (APL) anatomical variations in association with de Quervain tenosynovitis. The secondary aim was to compare additional patient-specific factors associated with de Quervain tenosynovitis. This retrospective study included 172 patients with de Quervain tenosynovitis who underwent first dorsal compartment release and 179 patients with thumb carpometacarpal (CMC) arthritis who underwent thumb CMC arthroplasty between August 1, 2007, and May 1, 2022. The CMC group was chosen as the control group because the study surgeons perform APL suspensionplasty as the primary procedure for thumb CMC arthritis, allowing for a comparison group without de Quervain tenosynovitis. Exclusion criteria included patients undergoing revision surgery, patients undergoing thumb CMC procedure other than APL suspensionplasty, and patients with both CMC and first dorsal compartment diagnoses. Demographics, clinical variables, and intraoperative findings were collected through retrospective chart reviews. Patients in the de Quervain tenosynovitis group tended to be younger (51 years, range: 23-92 years vs 63 years, range: 28-85 years), women (86.1% vs 77.1%), and more commonly of African American or black race (15.7% vs 3.9%) and Asian race (5.2% vs 0%). There was a higher prevalence of tendon subcompartments (79.1% vs 64.2%), but fewer number of APL slips (38.3% vs 20.7% 2 or fewer slips) seen in the de Quervain tenosynovitis group. Anatomical variation exists between patients with and without de Quervain tenosynovitis. The presence of tendon subcompartments but not an increased number of tendon slips is associated with de Quervain tenosynovitis.

Perioperative morbidity and mortality in octogenarians sustaining traumatic osteoporotic type 4 and 5 thoracolumbar and lumbar fractures: a retrospective study with 3 years follow-up

PurposeThis study aimed to guide the more efficient management of type 4 and 5 thoracolumbar or lumbar osteoporotic fractures (OF) in patients aged 80 years and older with an acute onset of neurological decline. This aim was achieved by assessing the clinical course and morbidity and mortality rates and identifying potential risk factors for patient mortalityMethodsElectronic medical records were retrieved from a single institution pertaining to the period between September 2005 and December 2020. Data on patient demographics, neurological conditions, surgical characteristics, complications, hospital course, and 90-day mortality were also collected.ResultsOver a 16-year period, 35 patients aged ≥80 years diagnosed with thoracolumbar and lumbar OF were enrolled in the study. The mean Charlson comorbidity index (CCI) was >6, indicating a poor baseline reserve (9.4 ± 1.9), while cardiovascular diseases were the most prevalent among comorbidities. The mean surgical duration was 231.6 ± 89.3 min, with a mean blood loss of 694.4± 200.3 mL. The in-hospital was 8.6% and 90-day mortality rates at 11.4%. Two patients underwent revision surgery for deep wound infection. Intraoperative and postoperative radiography and computed tomography (CT) imaging revealed correct screw placement. Proper alignment of the thoracolumbar spine was achieved in all the patients. Unique risk factors for mortality included the presence of comorbidities and the occurrence of postoperative complications.ConclusionsEmergent instrumentation in patients with acute onset of neurological decline and potentially unstable spines due to thoracolumbar and lumbar OF improved functional outcomes at discharge. Age should not be a determinant of whether to perform surgery.

MP53-12 LONG-TERM FOLLOW-UP IN PATIENTS WITH CONTINENT URINARY AND FECAL CATHETERIZABLE STOMAS IN PEDIATRIC PATIENTS WITH NEUROGENIC BLADDER

You have accessJournal of UrologyCME1 Apr 2023MP53-12 LONG-TERM FOLLOW-UP IN PATIENTS WITH CONTINENT URINARY AND FECAL CATHETERIZABLE STOMAS IN PEDIATRIC PATIENTS WITH NEUROGENIC BLADDER Esteban Tresgallo, Mario Garcia, Marcos Perez-Brayfield, and Carla Marin Esteban TresgalloEsteban Tresgallo More articles by this author , Mario GarciaMario Garcia More articles by this author , Marcos Perez-BrayfieldMarcos Perez-Brayfield More articles by this author , and Carla MarinCarla Marin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Catheterizable stomas have revolutionized the management of neurogenic bladder. Long-term follow up is required due to high complication rates. There is concern with long term usage of the stoma during the transition to adulthood period. The aim of the study was to evaluate long-term functional outcomes and degree of satisfaction in pediatric patients and their caregivers after undergoing Continent Catheterizable Channel (CCC) and/or Malone Antegrade Continence Enema (MACE) procedure. METHODS: We retrospectively reviewed the charts of 32 pediatric patients who had undergone 53 CCC's between 2007 and 2022. Data was analyzed including indication, type of channel, and complications. Patients and caregivers were contacted via telephone and a survey assessing frequency of usage, presence of urinary/fecal incontinence, factors limiting or preventing channel use, and overall degree of satisfaction was conducted. This study was approved by our local IRB committee. RESULTS: 81% (26) patients had a Mitrofanoff channel and 19% (6) a Monti channel. 21 patients also underwent a concomitant MACE procedure. The average age at surgery was 10.4 years, ranging from 5-19 years. The average length of follow up was 6.9 years, with 9 patients followed for more than 10 years. 10 patients underwent revision surgery, 8 due to channel stenosis (5 sub-fascial, 3 supra-fascial). 90% of patients reported the CCC is still in use. In 65% of cases, it is the patient performing CIC. 6 reported incontinence through the CCC, which was mild in all cases. In terms of satisfaction, 84% reported to be “very satisfied” with the procedure/outcomes. In terms of the MACE procedure, 89% reported to still be using the channel and 78% of patients reported complete fecal continence. 3 patients underwent MACE revision due to stenosis (15%). The main performer of ACE is the patient in over 60% of cases and it takes on average 30-40 minutes to perform. 95% of patients reported to be “very satisfied” with the procedure. CONCLUSIONS: Continent catheterizable stomas are feasible and reliable in long term follow up. Despite a high revision rate (33%) associated with CCC, our data shows that functional outcomes and patient/caregiver satisfaction remain high even after transition into early adulthood. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e716 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Esteban Tresgallo More articles by this author Mario Garcia More articles by this author Marcos Perez-Brayfield More articles by this author Carla Marin More articles by this author Expand All Advertisement PDF downloadLoading ...

MP15-19 DETERMINING DIFFERENCES IN CLINICALLY INFECTED VERSUS NONINFECTIOUS BIOFILM AT THE TIME OF REVISION SURGERY USING NEXT GENERATION SEQUENCING

You have accessJournal of UrologyCME1 Apr 2023MP15-19 DETERMINING DIFFERENCES IN CLINICALLY INFECTED VERSUS NONINFECTIOUS BIOFILM AT THE TIME OF REVISION SURGERY USING NEXT GENERATION SEQUENCING Gerard Henry, Caleb Phillips, Jared Wallen, Seth Hollenbach, Niccole Diaz, Joon Yau Leong, and Paul Chung Gerard HenryGerard Henry More articles by this author , Caleb PhillipsCaleb Phillips More articles by this author , Jared WallenJared Wallen More articles by this author , Seth HollenbachSeth Hollenbach More articles by this author , Niccole DiazNiccole Diaz More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , and Paul ChungPaul Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We have known biofilm is present at the time of revision surgery in penile prostheses (PP) for both infectious and noninfectious etiologies with wonderment on what factors caused infections. Next-generation sequencing (NGS) compares DNA to identify isolates and report relative abundances. NGS has become the gold standard for identification of isolates in several other medical specialties. The objective of this study was to determine what makes some biofilms become clinically infected versus staying noninfectious. METHODS: 126 patients from 2 centers underwent PP surgery for infectious and non-infectious reasons. During revision surgery, a swab specimen from the pump space were collected and sent for evaluation at the institutional laboratory and for NGS testing (MicroGenDX, Lubbock, Texas, USA). Species’ relative abundances, sample richness and diversity, and compositional differences among samples were calculated and tested for group differences. The effect of sample variables on inter-sample variation in species richness (number of species detected per sample) was assessed using multiple ANOVA in which surgical indication, physician, race, and time to surgery were simultaneously included as predictors of species richness. RESULTS: 104 (83%) patients underwent revision surgery for non-infectious reasons with 22 (17%) for infectious reasons. The median age was 69 years with a racial breakdown was 84 White, 41 African American, and 1 unknown. Surgical indication was significant (p=0.04) with infectious revision having less specie richness; but greater distance from Group Centroid (p=0.03) as compared to noninfectious patients’ biofilm. The prevalence rates of species within each group were tabulated, and prevalence rates for species that were among the top 10 most frequently observed in either group are shown in Figure 1. Testing was conducted to assess significant prevalence rates in either group: P. aeruginosa was significantly over-represented in infection samples. CONCLUSIONS: Clinically infected PP biofilm using NGS appears to have less specie richness and more compositionally distinct than biofilm from noninfectious patients’ PP. It appears Pseudomonas aeruginosa appears to be a highly likely causative agent for PP infections. Source of Funding: MicroGenDX © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e200 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gerard Henry More articles by this author Caleb Phillips More articles by this author Jared Wallen More articles by this author Seth Hollenbach More articles by this author Niccole Diaz More articles by this author Joon Yau Leong More articles by this author Paul Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

Staged replacement of both hips and both knees in patients with rheumatoid arthritis

BackgroundPatients with rheumatoid arthritis (RA) undergoing bilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) are an uncommon population, and their outcomes are also difficult to predict. The purpose of this study was to evaluate whether both bilateral cementless THA and cemented posterior-stabilized TKA (PS-TKA) can provide reliable outcomes for RA patients.MethodsWe retrospectively reviewed 30 RA patients (60 hips and 60 knees) who underwent both elective bilateral cementless THA and cemented PS-TKA, with a minimum follow-up of 2 years. Clinical, patient-reported, and radiographic data were retrospectively analyzed.ResultsThe mean follow-up was 84 months (range, 24–156). By the last follow-up, the post-operative range of motion, Harris Hip Score, Knee Society Score (KSS) clinical, KSS functional, Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) hip, and WOMAC knee scores were significantly improved compared to the preoperative values. All patients achieved the ability to walk. In addition, overall satisfaction scores on a 100-point scale were 92.5 after THA and 89.6 after TKA. Only one patient underwent revision surgery due to knee joint instability, and all replaced hips and knees were radiographically stable by the assessment of the radiolucent line. The proportion of implants that did not suffer loosening or require revision surgery was 99.2% during the 84-month follow-up, based on Kaplan-Meier analysis.ConclusionsOur study suggests that bilateral cementless THA and cemented PS-TKA provides reliable mid-long-term clinical, patient-reported, and radiographic outcomes in RA patients, with high survivorship and patient satisfaction.

The late-term results in our patients operated for lumbar spine fractures

Aim: The current study aimed to evaluate the late-term results of patients operated for lumbar spine fractures in our clinic. &#x0D; Material and Method: 134 patients from January 2012 to January 2020 were treated with “short-segment pedicle instrumentation” for lumbar fractures in our neurosurgery department. Patients with a burst fracture of a single lumbar vertebra were included. The final sample consisted of 67 patients who were followed up over the years with radiographs before and after surgery and CT scans at the final follow-up. &#x0D; Results: The results showed that 60% of the patients were rated as Denis P1, 35% as P2, and 5% as P3. Screw breakage was observed in seven patients, and 67 patients underwent revision surgery. Furthermore, the fractured vertebral body’s height was improved at the final follow-up stage, and an increase was witnessed from the preoperative figure of 16.4 mm to 25.8 at the final follow-up. At the final follow-up, the average Cobb angle was -11.6° preoperatively, and 6.3° after the operation and the correction loss was 12.1° which was severe in the middle part of the vertebra. By the final follow-up, disc spaces were narrowed below and above the fractured vertebra, and no correlation was found between clinical outcomes and adjacent disc degeneration. &#x0D; Conclusion: We concluded that short-segment pedicle instrumentation produced satisfactory long-term results for lumbar fractures. To achieve adequate outcomes, correct management of complications and evaluation of various factors must be focused on.

Retrograde Tibia Intramedullary Nailing in Tibiotalocalcaneal Arthrodesis

Background: A case series demonstrating the use of a tibia intermedullary nail placed in a retrograde fashion through the calcaneus and talus as a Tibiotalocalcaneal (TTC) arthrodesis salvage technique in three separate patients. Case Presentation: The first case, an 80-year-old female with a previous Total Knee Arthroplasty (TKA) and ipsilateral open tibia shaft fracture developed a septic non-union with hardware failure. Given her multiple comorbidities, she was treated with a long TTC arthrodesis using a retrograde tibial nail to preserve her soft tissue and encourage earlier mobilisation. The second case, was a 55-year-old male with an open right pilon fracture and multiple surgeries due to non-union of his fracture, including failed TTC with hindfoot nail, he was salvaged with a TTC arthrodesis using a long TTC arthrodesis with a retrograde tibial nail. The last patient, a 30-year-old male who fell 25 feet and suffered a right open pilon fracture required multiple surgeries due to septic non-union, and eventually achieved union after a TTC arthrodesis with osteotomy for deformity correction, both of which were stabilized using a retrograde tibial nail. Conclusion: In this case series, the patients underwent revision surgery for non-union using a long TTC arthrodesis construct with a retrograde tibial nail ultimately achieving union. We found that for select patients, a retrograde tibial nail for TTC arthrodesis was a useful option to reduce complications, achieve union, and help to encourage early mobilization and return of function.

What Is the Risk of Dislocation and Revision in Proximal Femoral Replacement with Dual-mobility Articulation After Two-stage Revision for Periprosthetic Hip Infection?

Dislocation is a major complication of revision THA after two-stage exchange for periprosthetic joint infection (PJI). The likelihood of dislocation can be particularly high if megaprosthetic proximal femoral replacement (PFR) has been performed during a second-stage reimplantation. Dual-mobility acetabular components are an established way of reducing the instability risk in revision THA; however, the likelihood of dislocation for dual-mobility reconstructions in the setting of a two-stage PFR has not been studied systematically, although patients with these reconstructions might be at an increased risk. (1) What is the risk of dislocation and revision for dislocation in patients who underwent PFR with a dual-mobility acetabular component as part of two-stage exchange for hip PJI? (2) What is the risk of all-cause implant revision and what other procedures were performed (apart from revision for a dislocation) in these patients? (3) What potential patient-related and procedure-related factors are associated with dislocation? This was a retrospective study from a single academic center including procedures performed between 2010 and 2017. During the study period, 220 patients underwent two-stage revision for chronic hip PJI. Two-stage revision was the approach of choice for chronic infections, and we did not perform single-stage revisions for this indication during the study period. Thirty-three percent (73 of 220) of patients underwent second-stage reconstruction with a single-design, modular, megaprosthetic PFR because of femoral bone loss, using a cemented stem. A cemented dual-mobility cup was the approach of choice for acetabular reconstruction in the presence of a PFR; however, 4% (three of 73) were reconstructed with a bipolar hemiarthroplasty to salvage an infected saddle prosthesis, leaving 70 patients with a dual-mobility acetabular component and a PFR (84% [59 of 70]) or total femoral replacement (16% [11 of 70]). We used two similar designs of an unconstrained cemented dual-mobility cup during the study period. The median (interquartile range) patient age was 73 years (63 to 79 years), and 60% (42 of 70) of patients were women. The mean follow-up period was 50 ± 25 months with a minimum follow-up of 24 months for patients who did not undergo revision surgery or died (during the study period, 10% [seven of 70] died before 2 years). We recorded patient-related and surgery-related details from the electronic patient records and investigated all revision procedures performed until December 2021. Patients who underwent closed reduction for dislocation were included. Radiographic measurements of cup positioning were performed using supine AP radiographs obtained within the first 2 weeks after surgery using an established digital method. We calculated the risk for revision and dislocation using a competing-risk analysis with death as a competing event, providing 95% confidence intervals. Differences in dislocation and revision risks were assessed with Fine and Gray models providing subhazard ratios. All p values were two sided and the p value for significance was set at 0.05. The risk of dislocation (using a competing-risks survivorship estimator) was 17% (95% CI 9% to 32%) at 5 years, and the risk of revision for dislocation was 12% (95% CI 5% to 24%) at 5 years among patients treated with dual-mobility acetabular components as part of a two-stage revision for PJI of the hip. The risk of all-cause implant revision (using a competing-risk estimator, except for dislocation) was 20% (95% CI 12% to 33%) after 5 years. Twenty-three percent (16 of 70) of patients underwent revision surgery for reinfection and 3% (two of 70) of patients underwent stem exchange for a traumatic periprosthetic fracture. No patients underwent revision for aseptic loosening. We found no differences in patient-related and procedure-related factors or acetabular component positioning for patients with dislocation with the numbers available; however, patients with total femoral replacements had a higher likelihood of dislocation (subhazard ratio 3.9 [95% CI 1.1 to 13.3]; p = 0.03) and revision for a dislocation (subhazard ratio 4.4 [95% CI 1 to 18.5]; p = 0.04) than those who received PFR. Although dual-mobility bearings might be an intuitive potential choice to reduce the dislocation risk in revision THA, there is a considerable dislocation risk for PFR after two-stage surgery for PJI, particularly in patients with total femoral replacements. Although the use of an additional constraint might appear tempting, published results vary tremendously, and future studies should compare the performance of tripolar constrained implants to that of unconstrained dual-mobility cups in patients with PFR to reduce the risk of instability. Level III, therapeutic study.

Cement Augmented Pedicle Screw Instrumentation in Pediatric Spine Surgery

Osteoporosis in pediatric patients is rare. Osteomalacia and osteoporosis are known to develop in syndromic or neuromuscular scoliosis children. Spinal deformity surgery for pediatric patients with osteoporosis is challenging, associated with pedicle screw (PS) failure and compression fractures. Cement augmentation of PS is one several measures to prevent screw failure. It provides additional pull-out strength to the PS in the osteoporotic vertebra. In 2010-2020, an analysis of pediatric patients who had cement augmentation of PS with a minimum follow-up of 2 years was performed. Radiological and clinical evaluations were analyzed. The study included 7 patients (4 girls, 3 boys) with a mean age of 13 years (range, 10-14 years) and mean follow-up of 3 years (range, 2-3 years). Only 2 patients underwent revision surgery. Total number of cement augmented PSs was 52 with an average of 7 per patient. Only 1 patient had lower instrumented vertebra vertebroplasty. There was no PS pull-out in the cement augmented levels, and there were no neurological deficits or pulmonary cement embolisms. One patient developed a PS pull-out in uncemented levels. Two patients developed compression fractures, one, with osteogenesis imperfecta, in the supra-adjacent levels (upper instrumented vertebra+ 1 and upper instrumented vertebra+ 2), and the other, with neuromuscular scoliosis, in the uncemented segments. In this study, all cement augmented PSs provided satisfactory radiological outcomes without PS pull-out and adjacent vertebral compression fracture. In pediatric spine surgery, in osteoporotic patients with a poor bone purchase, cement augmentation may be used, especially in high-risk patients with osteogenesis imperfecta, neuromuscular scoliosis, and syndromic scoliosis.