Rate Of Revision Surgery Research Articles

Minimally Invasive Surgical Decompression without Fusion for the Treatment of Lumbar Synovial Cysts: Feasibility and Long-Term Outcomes.

Lumbar synovial cysts (LSCs) can cause painful radiculopathy and sensory and/or motor deficits. Historically, first-line surgical treatment has been decompression with fusion. Recently, minimally invasive laminectomy without fusion has shown equal or superior results to traditional decompression and fusion methods. This study investigates the long-term efficacy of minimally invasive laminectomy without fusion in the treatment of LSC as it relates to the rate of subsequent fusion surgery. A retrospective review was performed over a 10-year period of patients undergoing minimally invasive laminectomy for symptomatic LSCs. The primary end point was the rate of revision surgery requiring fusion. Eighty-five patients with symptomatic LSCs underwent minimally invasive laminectomy alone January 2010-August 2020 at our institution. The most common location was L4-5 (72%). Preoperative imaging identified spondylolisthesis (grade 1) in 43 patients (57%), none of which was unstable on available dynamic radiographs. Average procedure duration was 93 minutes, with 78% of patients discharged home on the same day of surgery. Over 46 months of mean follow-up, 17 patients (20%) required 19 revision operations. Of those operations, 16 were spinal fusions (17.6%). Median time to fusion surgery was 36 months. There were no identifiable risk factors on multivariate regression analysis that predicted the need for fusion. Minimally invasive laminectomy is an effective first-line treatment for symptomatic LSCs and avoids the need for fusion in most treated patients. Of our patients, 18% required a fusion over 46 months, suggesting that further studies are required to guide patient selection.

Senior Military Rank Is Associated With Higher Rates of Return to Running and Unrestricted Activity Among Military Servicemembers After Surgical Repair of Patellar Tendon Rupture at 1-Year Follow-up

To evaluate 1-year outcomes in active-duty servicemembers who underwent patellar tendon rupture repair and to identify baseline variables associated with return to activity. We performed a retrospective review of all active-duty servicemembers undergoing primary patellar tendon rupture repair between 2009 and 2014. All patients had a minimum 12-month follow-up. Demographic variables were recorded, as well as ability to return to impact activities and remain on active-duty status. Rates of recurrent rupture and revision surgery were identified. Univariate analysis was performed to assess relations between outcomes and baseline variables. A total of 123 patients met the inclusion criteria (average age, 33.5 ± 6.6 years; 99% male patients) with a mean follow-up period of 4.3 ± 2.2 years. Whereas 67.4% of patients returned to running at an average of 8.3 months from index surgery, only 42.4% of patients resumed unrestricted occupational function. Higher rates of return to running were observed among patients with senior military rank (P= .046). Senior military rank was also associated with a higher rate of return to unrestricted active-duty status (P= .006). Logistic regression analysis showed an association between postoperative pain (odds ratio [OR], 0.684; 95% confidence interval [CI], 0.56-0.84; P < .001) and return to running, between postoperative pain (OR, 0.77; 95% CI, 0.60-0.98; P= .033) and return to active duty, and between rank (OR, 2.06; 95% CI, 1.04-4.07; P= .037) and return to active duty. Patients who sustained injuries during deployment had a higher rate of recurrent rupture (26.1% vs 9.3%, P= .028). At 1-year follow-up, approximately two-thirds of military servicemembers undergoing primary patellar tendon repair had returned to running after surgery, whereas fewer than one-half returned to full military duty. Younger age and more senior military rank were associated with higher rates of return to running. Additionally, servicemembers of higher rank, particularly officers, had statistically higher rates of return to unrestricted activity. Level IV, therapeutic case series.

Short-term post-operative complications in 207 patients with multi-level degenerative cervical myelopathy: the effect of surgical approach.

Degenerative cervical myelopathy (DCM) is a common condition often treated by surgical decompression and fusion. The objective of this paper was to compare short-term post-operative complication rates of patients with multi-level DCM treated with decompression and fusion using either an anterior or a posterior cervical approach. A retrospective evaluation of patients' charts, imaging studies and operative reports of patients operated for multilevel subaxial DCM from 2011 to 2016 at a single institution was performed. Patients who were operated upon for the treatment of three stenosed spinal levels or above and who underwent anterior cervical discectomy and fusion, or anterior cervical corpectomy and fusion, or posterior cervical laminectomy and fusion, were included. Short-term post-operative complications were compared between the anterior and posterior approaches. Overall, 207 patients were included in this study. 156 were operated via an anterior approach and 51 via a posterior approach. The mean number of treated levels was 3.4 and 4.3 for the anterior and posterior approach groups, respectively (p < 0.001). In the posterior approach group, the proportion of stenosed spinal levels within all operated levels was significantly lower than in the anterior approach group (p = 0.025). Early post-operative neurological status change was favourable for both groups. Deep wound infection rate was significantly higher in the posterior approach group (7.8% vs. none; p = 0.001). Posterior cervical laminectomy and fusion is significantly associated with an increased rate of deep wound infection and wound revision surgery compared to the anterior approach. We recommend the anterior approach as the valid option in treating multi-level DCM.

Factors associated with acetabular degeneration and protrusion in bipolar hip hemiarthroplasty

Purpose&#x0D; This study aims to investigate the effect of some factors such as the diameter of bipolar prosthetic heads, body mass index (BMI), age, gender, bone mineral density (BMD) and leg length discrepancy (LLD) on the acetabular protrusion in elderly patients who had hip bipolar hemiarthroplasty (BHA) after femoral neck fractures.&#x0D; Methods&#x0D; The study included a total of 209 patients with a mean age of 77.4 ± 6.0 years who underwent BHA. The difference between the femoral head diameter of the patients and the diameter of the bipolar prosthetic head was divided into two groups, ranging from 0 to -2 mm (same and 1,2 mm small size) . Acetabular enlargement and cartilage degeneration were followed by standard AP pelvis radiographs and clinical outcomes were evaluated by the Harris Hip Score (HHS) after surgery and during 5 years of follow-up.&#x0D; Results&#x0D; During the 5-year follow-up, while HHS values decreased, acetabular diameter increased. Acetabular protrusion developed in 21 (10%) patients, acetabular revision surgery was performed for 36 (17%) patients, the difference between native femoral head diameter and prosthetic head diameter was significantly higher in these groups, as was mean LLD (p = 0.0001). Mean T scores obtained with BMD were lower in these groups (p = 0.0001).&#x0D; Conclusion&#x0D; It is safer and more reliable to use a bipolar prosthetic head the same size as the patient’s native femoral head in BHA. When considering the acetabular protrusion and revision surgery rate in this study, small-size bipolar prosthetic head implantation is not recommended and may cause devastating complications.

Stress Shielding and Bone Resorption of Press-Fit Polyether-Ether-Ketone (PEEK) Hip Prosthesis: A Sawbone Model Study.

Stress shielding secondary to bone resorption is one of the main causes of aseptic loosening, which limits the lifespan of the hip prostheses and increases the rates of revision surgery. This study proposes a low stiffness polyether-ether-ketone (PEEK) hip prostheses, produced by fused deposition modelling to minimize the stress difference after the hip replacement. The stress shielding effect and the potential bone resorption of the PEEK implant was investigated through both experimental tests and FE simulation. A generic Ti6Al4V implant was incorporated in this study to allow fair comparison as control group. Attributed to the low stiffness, the proposed PEEK implant showed a more natural stress distribution, less stress shielding (by 104%), and loss in bone mass (by 72%) compared with the Ti6Al4V implant. The stiffness of the Ti6Al4V and the PEEK implant were measured through compression tests to be 2.76 kN/mm and 0.276 kN/mm. The factor of safety for the PEEK implant in both static and dynamic loading scenarios were obtained through simulation. Most of the regions in the PEEK implant were tested to be safe (FoS larger than 1) in terms of representing daily activities (2300 N), while the medial neck and distal restriction point of the implant attracts large von Mises stress 82 MPa and 76 MPa, respectively, and, thus, may possibly fail during intensive activities by yield and fatigue. Overall, considering the reduction in stress shielding and bone resorption in cortical bone, PEEK could be a promising material for the patient-specific femoral implants.

Short-Term Outcomes Following Cemented Versus Cementless Robotic-Assisted Total Knee Arthroplasty.

Cemented fixation during total knee arthroplasty (TKA) has long been the gold standard due to excellent survivorship and clinical outcomes.With recent biomaterial advancements, cementless fixation has gained renewed interest.Most studies demonstrate similar clinical outcomes and survivorship between these two fixation methods, without consensus regarding the optimal method of fixation during TKA.Outcomes following TKA also depend upon the proper alignment and positioning of components.Robotic-assisted TKA has been shown to improve outcomes related to component positioning, overall lower limb alignment, and soft tissue balancing.No study to date has investigated the role of robotic-assisted surgery on postoperative outcomes following cementless versus cemented TKA. This is a retrospective cohort study of patients 18 years of age and older who underwent primary robotic-assisted TKA performed by a single fellowship-trained arthroplasty surgeon. Oxford Knee Scores and Short Form Health Survey scores were obtained preoperatively and at a two-year follow-up. Complications such as DVT, infection, arthrofibrosis requiring manipulation, and revision surgery were collected. Three hundred eighty knees in the cementless cohort and 72 cemented knees were included for analysis. There were no statistically significant differences between the two cohorts in terms of SF-12, Oxford Knee Scores, complications, or revision surgery rates. Cementless fixation during TKA offers an alternative to cemented fixation with similar short-term results in terms of patient-reported outcomes, complication rates, and revision surgery rates. Further research is warranted to better understand long-term outcomes and survivorship following cementless versus cemented fixation during robotic-assisted TKA.

Smoking cessation prior to total shoulder arthroplasty: A systematic review of outcomes and complications.

We conducted a review of current literature to examine the effects of smoking and smoking cessation on shoulder arthroplasty surgery. A literature search was performed using the search terms "shoulder arthroplasty AND [smoke OR smoking OR tobacco OR nicotine]." Studies included English-language clinical outcomes studies on anatomic total shoulder arthroplasty (TSA), reverse TSA, and partial shoulder arthroplasty with evidence levels 1 through 4. Descriptive statistics calculated in the included studies were used during the analysis. Categorical variables were reported as proportions, while continuous variables were reported as means with minimum to maximum absolute ranges. Twenty-four studies were included and analyzed. Following TSA, patients who quit smoking at least 1 month preoperatively had improved outcomes compared to current smokers. Current smokers had statistically significant higher pain scores or opioid use. Five studies found increased rates of revision surgery in smokers. Smokers were significantly (p < 0.05) more likely to have increased rates of surgical, wound, superficial, and deep surgical site complications. Former smokers had lower complication rates and visual analog scale scores when compared to current users. A period of four weeks or more of preoperative smoking cessation is recommended. Level III, Systematic Review.

Total Hip and Knee Arthroplasty in Solid Organ Transplant Patients: Perioperative Optimization and Outcomes.

The success of renal, liver, cardiac, pulmonary, and other solid organ transplantation (SOT) has resulted in increasing volume of transplant procedures and recipient survivorship. Subsequently, many SOT patients develop end-stage degenerative joint disease and are presenting for total hip or total knee arthroplasty more frequently. Surgeons must be aware of the medical complexities and prepare for the perioperative risks associated with these immunocompromised patients. Preoperative evaluation should be conducted in coordination with transplant specialists to ensure optimization, including appropriate surgical timing and advanced, organ-specific medical assessments. Although often unable to be modified, the transplant patient's antirejection medication regimens should be reviewed with understanding of inherent risks of poor wound healing or acute infection. Despite higher rates of complications, revision surgeries, and mortality compared with the general population, SOT recipients continue to demonstrate markedly improved pain relief, function, and quality of life. An ongoing multidisciplinary approach is required throughout the perioperative process and beyond to deliver successful outcomes after total joint arthroplasty in the SOT population.

A novel classification of cement distribution patterns based on plain radiographs associated with cement filling rate and relevance to the clinical results of unipedicle vertebroplasty.

Cement distribution pattern following unipedicle percutaneous vertebroplasty (UVP) for osteoporotic vertebral compression fractures (OVCFs) has been reported in association with clinical results. The present retrospective study aimed to classify the bone cement distribution types following UVP and investigate the differences in clinical efficacy and related complications. We retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent UVP. Cement distribution patterns were divided into the diffuse, block, double band, and single band types according to the plain radiographs and further by cement filling rate (CFR) based on a three-dimension reconstruction of post-operative CT. The cutoff values of CFR were > 34% for the diffuse, block between 34 and 20%, and each band of the double or single band < 20%. Clinical efficacy and related complications were compared among the four cement distribution types 24h after the operation and the last follow-up. A total of 155 patients with an average follow-up time of 20.3months were included. The diffuse type included 26 patients; block, 87; double band, 18; and single band, 24. The VAS and ODI after operation improved significantly in all four groups. The diffuse and block types had similar clinical results. The clinical outcomes in the single band group were the poorest at the last follow-up. The patients with single band type also had the highest rates of body re-collapse and revision surgery for the index level. Diffuse and block groups can better maintain the height of the vertebral body and reduce the risk of vertebral body recompression. The single band has the poorest results, and intraoperative immediate contralateral vertebroplasty was highly recommended.

Study of The Effect of Model Geometry and Body Mass Index on The Elastohydrodynamic Lubrication Performance of Metal-on-Metal Hip Joints

This study aims to provide benefits on the manufacturing side in considering design parameters for optimization of total hip arthroplasty based on body mass index (BMI) categories. The femoral and cup geometries in Total Hip Arthoplasty (THA) are modeled in a simple ball-on-plane form to analyze the pressure and thickness of the lubricant film in the elastohydrodynamic lubrication of artificial hip joints with vertical loads and parameters based on body mass index using the finite element method. The factor of being overweight is one of the causes of increasing the maximum load during activities. This study applies a maximum load based on BMI which is divided into two categories, namely normal and high BMI to obtain the distribution of contact pressure and fluid pressure on the bearing surfaces that are in contact with each other so that the thickness of the lubricating film formed can be determined. Validation of contact pressure and film thickness was carried out. The femoral head sizes applied were 24mm and 28mm with a radial clearance of 15μm, 30μm and 100μm using CoCrMo metal material. From the simulation the load at high BMI shows an increase by a large enough difference reaching 16.89MPa at contact pressure, 19.88MPa at fluid pressure and 0.004μm at the thickness of the lubricant film compared to normal BMI. This simple modeling provides the benefit of analyzing the effect of body mass index on tribological THA performance and can help reduce the growth rate of THA implantation failure revision surgery.

Low postoperative complication rate with high survival rate and good clinical outcome 9 years after autologous chondrocyte transplantation of the knee joint

PurposeTo investigate postoperative complications and associated risk factors for failure following autologous chondrocyte transplantation (“ACT”) as well as its long-term survival and clinical function. It was hypothesized that ACT is a safe technique for cartilage repair with a low incidence of postoperative complications and rare rates of revision surgery combined with a high long-term survival and good to excellent clinical outcome in long-term-follow-up.MethodsAll patients undergoing ACT-Cs of the knee joint between 2006 and 2012 at the author’s institution were included in this retrospective study. Concomitant procedures had been performed if necessary. Early postoperative complications, revision surgeries, failure and risk factors for those events were evaluated 6 months after the surgery. Long-term clinical outcome was assessed using the Lysholm Score, the Tegner Score, a 10-grade scale for satisfaction and the Visual Analogue Scale (VAS) at a minimum follow-up of 9 years postoperatively. Long-term survival was calculated using revision surgeries, clinical failures and conversion procedures to create a Kaplan–Meier analysis. A subgroup analysis for different defect locations was performed. 139 patients were included in this study (27% female/ 73%male; age 26.7 [21.7; 35.2] years). The median defect size was 4.0 [3.0; 6.0] cm2 (40% medial femoral condyle (MFC), 17% lateral femoral condyle (LFC), 36% patella, 19% trochlea). 97 (70%) of the patients had undergone previous surgery and 84 (60%) underwent concomitant procedures.ResultsPostoperatively, 8% of patients had complications (4% bleeding, 2% arthrofibrosis, 2% infection), 7% of patients needed revision surgery. 12% of patients had a prolonged deficit in ROM, that did not require revision surgery. No significant difference in terms of complications was found between the patellofemoral and femorotibial group. Patients demonstrated good patient reported long-term outcomes 9–15 years after the index surgery (Tegner: 4.7 ± 1.8; VAS: 2.4 ± 2.1; Lysholm: 80 ± 14; satisfaction with operation: 7.3 ± 1.9). Survival rates were 88% at 9 years, 85% at 11 years, and 85% at 13 years after the index procedure. Reasons for failure included debridement of ACT (n = 4; 5%), revision ACT (n = 3, 3%), conversion to total knee arthroplasty (n = 3, 3%) and conversion to High tibial osteotomy (HTO) (n = 1; 1%)).ConclusionThe present study indicates ACT as an effective treatment option for femorotibial- as well as patellofemoral cartilage defects with a high long-term survival and low conversion rate as well as good long-term results regarding knee function and satisfaction. Postoperative complications needing revision surgery are rare. Prolongated deficits of range of motion appear frequently up to six months especially in patellofemoral defects, but can often be successfully addressed by intensified physiotherapy without requiring an arthrolysis.Level of evidenceLevel III.

Cost-Effectiveness of Cement Augmentation Versus No Augmentation for the Fixation of Unstable Trochanteric Fractures.

A previous randomized controlled trial (RCT) demonstrated a trend toward a reduced risk of implant-related revision surgery following fixation with use of a Proximal Femoral Nail Antirotation (PFNA) with TRAUMACEM V+ Injectable Bone Cement augmentation versus no augmentation in patients with unstable trochanteric fractures. To determine whether this reduced risk may result in long-term cost savings, the present study assessed the cost-effectiveness of TRAUMACEM V+ cement augmentation versus no augmentation for the fixation of unstable trochanteric fractures from the German health-care payer's perspective. The cost-effectiveness model comprised 2 stages: a decision tree simulating clinical events, costs, and utilities during the first year after the index procedure and a Markov model extrapolating clinical events, costs, and utilities over the patient's lifetime. Sources of model parameters included the previous RCT, current literature, and administrative claims data. Outcome measures were incremental costs (in 2020 Euros), incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Model uncertainty was assessed with deterministic and probabilistic sensitivity analyses. The base-case analysis showed that fixation with cement augmentation was the dominant strategy as it was associated with cost savings (€50.3/patient) and QALY gains (0.01 QALY/patient). Major influential parameters for the ICER were the utility of revision, rates of revision surgery within the first year after fixation surgery, and the costs of augmentation and revision surgery. Probabilistic sensitivity analyses demonstrated that estimates of cost savings were more robust than those of increased QALYs (66.4% versus 52.7% of the simulations). For a range of willingness-to-pay thresholds from €0 to €50,000, the probability of fixation with cement augmentation being cost-effective versus no augmentation remained above 50%. Fixation with use of cement augmentation dominated fixation with no augmentation for unstable trochanteric fractures, resulting in cost savings and QALY gains. Given the input parameter uncertainties, future analyses are warranted when long-term costs and effectiveness data for cement augmentation are available. Economic and Decision Analysis Level II . See Instructions for Authors for a complete description of levels of evidence.

Preclinical Study of Human Bone Marrow-Derived Mesenchymal Stem Cells Using a 3-Dimensional Manufacturing Setting for Enhancing Spinal Fusion.

Spinal fusion surgery is a surgical technique that connects one or more vertebrae at the same time to prevent movement between the vertebrae. Although synthetic bone substitutes or osteogenesis-inducing recombinant proteins were introduced to promote bone union, the rate of revision surgery is still high due to pseudarthrosis. To promote successful fusion after surgery, stem cells with or without biomaterials were introduced; however, conventional 2D-culture environments have resulted in a considerable loss of the innate therapeutic properties of stem cells. Therefore, we conducted a preclinical study applying 3D-spheroids of human bone marrow-dewrived mesenchymal stem cells (MSCs) to a mouse spinal fusion model. First, we built a large-scale manufacturing platform for MSC spheroids, which is applicable to good manufacturing practice (GMP). Comprehensive biomolecular examinations, which include liquid chromatography-mass spectrometry and bioinformatics could suggest a framework of quality control (QC) standards for the MSC spheroid product regarding the identity, purity, viability, and potency. In our animal study, the mass-produced and quality-controlled MSC spheroids, either undifferentiated or osteogenically differentiated were well-integrated into decorticated bone of the lumbar spine, and efficiently improved angiogenesis, bone regeneration, and mechanical stability with statistical significance compared to 2D-cultured MSCs. This study proposes a GMP-applicable bioprocessing platform and QC directions of MSC spheroids aiming for their clinical application in spinal fusion surgery as a new bone graft substitute.

Transmetatarsal Amputation Results in Higher Frequency of Revision Surgery and Higher Ambulation Rates Than Below- Knee Amputation

Category: Diabetes; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: The level of amputation in patients with severe lower extremity pathology often presents a challenge. Surgeons are often confronted with deciding between a transmetatarsal amputation (TMA) or below-knee amputation (BKA). Certainly, in cases where patients are candidates for a TMA, the decision might seem rather straightforward. However, the literature has demonstrated that minor foot amputations, like TMAs, often have high rates of revision and often necessitate a higher level of amputation. This study compared revision rates, need for higher level of amputation, post-operative ambulatory rates, and the demographics between patients undergoing either TMA or BKA. Methods: This was a retrospective analysis of patients who underwent BKA or TMA and received follow-up care at a single academic medical center from January of 2013 to May of 2021. Demographic and medical historical data was collected and compared between patients undergoing BKA or TMA. A binary logistic regression model was used to evaluate independent predictors for necessitation of revision surgery and/or higher levels of amputation between the two groups. Secondary outcomes included hospital length of stay, as well as ambulatory and wound status at last patient follow-up. Statistical significance was defined as p&lt;.05. Results: A total of 367 patients underwent either BKA (n=293) or TMA (n=74). On binary logistic regression, significant independent predictors of needing surgical revision were undergoing TMA (OR 2.29, CI 1.23-4.27, p=.009) and peripheral arterial disease (PAD) (OR 2.28, CI 1.12-4.6, p=.023). Similarly, significant independent predictors of needing higher level amputation were undergoing TMA (OR 4.4, CI 2.01-9.63, p&lt;.001) and presence of PAD (OR 6.18, CI 2.12- 17.98, p&lt;.001). Secondary outcomes showed that more TMA patients were ambulatory (56.8%) on last follow-up compared to BKA patients (30.9%). Hospital length of stay was significantly greater in the BKA group (17.3 +- 21.2) vs the TMA group (13.6 +- 10.9) (p=.04). There was no significant difference between BKA and TMA groups with respect to healed incisions at last follow-up (58.3% and 51.4% respectively). Conclusion: This study found transmetatarsal amputations to have a higher risk of re-operation and need for revision amputation compared to below-knee amputations. Transmetatarsal amputations had a higher chance of returning patients to independent ambulation. These findings are consistent with the literature suggesting higher reoperation rates in minor foot amputations. Patients with peripheral arterial disease are at a higher risk of revision surgery and higher-level amputation with both operations warranting further vascular work-up for patients with severe PAD and absent pulses.

Revision Cochlear Implantation in Baghdad Medical City: A Retrospective Study

Background: Revision cochlear implant surgeries are uncommon but they represent a challenging issue for surgeons. Thoughtful preparation and evaluation of patients with proper counseling are mandatory.Objectives: To identify the rate of revision surgeries and re-implantations, evaluate the causes, and analysis of clinical and operative findings.Patients & Methods: A retrospective study including 46 cases underwent revision surgeries out of 1144 patients had cochlear implantation in the department of otolaryngology/Baghdad Medical City in the period from March 2009 to November 2019. The data were collected from 3 statistical record sources (the otolaryngology department records, operative theatre records, and hospital’s main statistic department). Results: Revision cochlear implantation ratio was 4%. It was found that most of the cases were from pediatric age group (98% of cases with mean age of 6.77 years) with no difference between males and females (male to female ratio was 1.1:1). The most common causes for revision surgeries were non-device related (63%) while device related causes counted (37%). Re-implantation rate was (24%). Conclusion: Revision cochlear implant surgeries in our center were within lower limits of the universal revision rates. Most commonly encountered cause for revision was wound infection with/without dehiscence followed by hard device failure. No significant complications recorded per and post operatively.

Safety and Accuracy of Freehand Pedicle Screw Placement and the Role of Intraoperative O-Arm: A Single-Institution Experience.

Retrospective cohort study. The aim was to investigate the accuracy of pedicle screw placement by freehand technique and to compare revision surgery rates among three different imaging verification pathways. Studies comparing different imaging modalities in freehand screw placement surgery are limited. A single-institution retrospective chart review identified adult patients who underwent freehand pedicle screw placement in the thoracic, lumbar or sacral levels. Patients were stratified into three cohorts based on the intraoperative imaging modality used to assess the accuracy of screw position: intraoperative X-rays (cohort 1); intraoperative O-arm (cohort 2); or intraoperative computed tomography (CT)-scan (cohort 3). Postoperative CT scans were performed on all patients in cohorts 1 and 2. Postoperative CT scan was not required in cohort 3. Screw accuracy was assessed using the Gertzbein-Robbins grading system. A total of 9179 pedicle screws were placed in the thoracic or lumbosacral spine in 1311 patients. 210 (2.3%) screws were identified as Gertzbein-Robbins grades C-E on intraoperative/postoperative CT scan, 137 thoracic screws, and 73 lumbar screws ( P <0.001). Four hundred and nine patients underwent placement of 2754 screws followed by intraoperative X-ray (cohort 1); 793 patients underwent placement of 5587 screws followed by intraoperative O-arm (cohort 2); and 109 patients underwent placement of 838 screws followed by intraoperative CT scan (cohort 3). Postoperative CT scans identified 65 (2.4%) and 127 (2.3%) malpositioned screws in cohorts 1 and 2, respectively. Eleven screws (0.12%) were significantly malpositioned and required a second operation for screw revision. Nine patients (0.69%) required revision operations: eight of these patients were from cohort 1 and one patient was from cohort 2. When compared to intraoperative X-ray, intraoperative O-arm verification decreased the revision surgery rate for malpositioned screws from 0.37% to 0.02%. In addition, our analysis suggests that the use of intraoperative O-arm can obviate the need for postoperative CT scans.

Clinical Outcomes and Complications of Corrective Fusion Surgery Down to L4, L5, and the Pelvis for Adult Scoliosis in Patients Younger than 50 Years.

Corrective fusion for adult scoliosis often requires fusion from the thoracic spine to the lower lumbar spine or pelvis. However, it is often difficult to determine the lowest instrumented vertebrae (LIV), especially in younger patients. The purpose of this study was to summarize the clinical outcomes and revision surgery rates after corrective fusion for adult scoliosis at different LIV levels in patients under 50 years of age. We retrospectively analyzed 25 patients with adult scoliosis (mean age, 38 years; mean follow-up, 65 months) who underwent corrective fusion from the thoracic spine to L4, L5, or pelvis between 2010 and 2018. Preoperative and at least 2 years' postoperative radiographic parameters, patient-reported outcomes (Scoliosis Research Society-22r [SRS-22r]), mechanical complications, and revision surgery were investigated, and comparisons were made between two groups: the L4 and L5 (L) group (n=14) and the pelvic group (n=11). Both groups showed a significant improvement in the SRS-22r domains of Self-image and Subtotal postoperatively compared with the baseline (P<0.05). The incidence of rod fracture was significantly higher in the pelvic group (5 patients, 45%) than in the L group (0 patients, 0%) (P=0.001). In addition, revision surgery was performed five times in 4 patients (36%) in the pelvic group compared with 0 in the L group (P=0.068). In the L group, clinical outcomes improved in the medium term, with no patients requiring revision surgery. In the pelvic group, the rod fracture rate was higher, but the clinical outcomes improved.

Soft Cervical Orthosis Use Does Not Improve Fusion Rates After One-Level and Two-Level Anterior Cervical Discectomy and Fusion

To determine if postoperative soft cervical orthosis use affects arthrodesis rates on a per-level or construct basis after 1-level and 2-level anterior cervical discectomy and fusion (ACDF). Electronic medical records were queried for 1-level and 2-level primary ACDF between 2016 and 2019 at a single academic center. Surgeons prescribed either a soft cervical orthosis or no orthosis. Pseudarthrosis rates were evaluated by dynamic cervical spine radiographs with arthrodesis defined by <1 mm of interspinous motion. Continuous and categorical data were compared using analysis of variance or χ2 tests. Multivariate logistic regression analysis was used to examine independent predictors of pseudarthrosis. A total of 316 unique patients (504 instrumented levels) met the inclusion criteria. Eighty-four percent of patients were prescribed a soft cervical orthosis. Overall, arthrodesis occurred at 344 (80.9%) and 62 (78%) levels in patients with and without cervical orthosis, respectively. When evaluating patients placed in a cervical orthosis versus those who were not, there were no differences in pseudarthrosis or revision rates. Further, there were no differences in pseudarthrosis on a per-level basis. Further, cervical orthosis use was not an independent predictor of pseudarthrosis (odds ratio, 0.86; 95% confidence interval, 0.47-1.57; P=0.623) on multivariate analysis. Postoperative placement of soft cervical orthoses after 1-level or 2-level ACDF was not associated with improved arthrodesis or reduced rate of revision surgery.

High-rate of long-term revision surgery due to weight regain after Laparoscopic Gastric Greater Curvature Plication (LGGCP)

PurposeTo present the long-term clinical outcomes of laparoscopic gastric greater curvature plication (LGGCP) in terms of weight loss and revision surgery rate. Material and methodsThis single-center study involved a retrospective analysis of patients that underwent revision surgery after LGGCP due to weight regain. Demographic and anthropometric data, comorbidities, operation time, hospital stays, mortalities, and immediate and long-term postoperative complications were analyzed. Postoperative Body Mass Index (BMI), %total weight loss (TWL), and complications were collected during follow-up. ResultsOf the 75 patients that underwent LGGCP at our hospital from March 2013 to February 2016, 13 (13/75, 17.3%) underwent revision surgery. All patients except one opted for sleeve gastrectomy. The mean interval between LGGCP and revision surgery was 71.0 ± 12.0 months (range, 54.8–93.6), and mean body weight, BMI, and TWL at revision were 89.2 ± 11.3 kg, 33.9 ± 4.2 kg/m2, and 4.7 ± 9.3%, respectively. The main reason for revision was weight regain. Additional problems were chronic intermittent GERD (4/13, 30.8%), dyspepsia (4/13,30.8%), and chronic relapsing melena (1/13, 7.7%). Two patients experienced immediate postoperative complications (Clavien-Dindo II and III). At one year after revision surgery, the mean body weight, BMI, and additional %TWL from revision surgery were 63.0 ± 5.3 kg, 24.0 ± 2.9 kg/m2, and 28.7 ± 8.0%, respectively. One of four patients (1/4, 25%) that complained of GERD before revision surgery, was still on PPI medication at 1 year after revision surgery. ConclusionAlthough LGGCP showed initial acceptable weight loss outcomes, long term (>5 years) follow-up showed that LGGCP is associated with a high rate of revision surgery (17.3%) due to weight regain.

Effect of Anchor Density on Functional Outcomes After Arthroscopic Hip Labral Repair

Background: While labral repair has been widely adopted as the first line treatment for labral injury during hip arthroscopy, there is no widespread consensus on the procedural technique, including the number of anchors that should be used to avoid recurrent instability and revision surgery. Purpose: To determine if anchor density can predict patient-reported outcomes after arthroscopic labral repair in the hip. Study Design: Cohort study; Level of evidence, 3. Methods: Patients aged 18 to 50 years who underwent primary hip arthroscopic surgery with labral repair between January 2011 and December 2016 were identified from a prospectively collected database. Exclusion criteria consisted of previous ipsilateral surgery, osteoarthritis (Tönnis grade >1), and severe cartilage defects (Outerbridge grade III/IV) or concomitant labral reconstruction, capsular reconstruction, or microfracture. Minimum 2-year patient-reported outcomes (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS]–Activities of Daily Living [ADL], HOS–Sport Specific Subscale [SSS], 12-Item Short Form Health Survey [SF-12]), rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) for each score, revision surgery rate, and rate of conversion to total hip arthroplasty (THA) were compared based on anchor density (number of anchors per millimeter of labral tear). Results: A total of 634 hips (575 patients) with a mean age of 30.4 ± 9.5 years (range, 18.0-49.9 years) met inclusion criteria. The mean labral tear size was 31 ± 11 mm (range, 2-70 mm) with a median number of anchors used for labral repair of 3 (range, 1-7) and mean anchor density of 0.11 ± 0.08 anchors (range, 0.03-1.33) per millimeter of labral tear. Hips with a minimum 2-year follow-up (451/634 [71.1%]) had significant improvements on the mHHS, HOS-ADL, HOS-SSS, and SF-12 Physical Component Summary (P < .001 for all). There was no significant correlation detected between anchor density or number of anchors used and postoperative scores (correlation coefficient range, –0.05 to 0.17; P > .05 for all). The rate of revision surgery was 6.4% (28 patients), with 8 hips found to have labral tears and/or deficiency on revision. Additionally, 6 hips (1.3%) had to undergo THA at a mean of 3.6 ± 2.1 years (range, 2.0-5.5 years). Conclusion: Anchor density did not have a correlation with postoperative outcomes, achieving the MCID or PASS, revision hip arthroscopic surgery, complications, or conversion to THA.