Reoperation Rate Research Articles

More intraoperative complications but similar revision rate in primary total hip arthroplasties using direct anterior approach in supervised trainees-a retrospective cohort study.

There are conflicting data regarding the safety of the direct anterior approach (DAA) for primary total hip arthroplasty (THA) during the learning process. The aim of this study was to evaluate the intra- and postoperative complication rates of DAA THA performed by supervised trainees compared with senior surgeons. A retrospective cohort study was conducted using a prospectively maintained arthroplasty database of patients who underwent primary THA via the DAA between 01/08/2013 and 31/12/2022. We compared all cemented and cementless DAA THR using one implant system operated by senior surgeons (n = 6044) and supervised trainees (n = 385) with regard to operative time, intraoperative complications, and re-operation rate. Data were compared using Mann-Whitney-U-testing or t-tests and Pearson's chi-squared test or Fisher's exact test, as appropriate. The Kaplan-Meier method with 95% confidence intervals (CI) was used to determine septic- and aseptic-free implant survival. After a median follow-up of 3.9 (IQR: 2.4-5.9) years, there was no significantly higher rate of septic- or aseptic-revisions (supervised trainees: 2.6% vs senior surgeons: 1.7%; p = 0.529). There was a significant higher rate of intraoperative complication in the trainee group (supervised trainees: 2.6% vs senior surgeons: 1.3%; p = 0.036). Senior surgeons operated on more complex cases; however, the operative time of the trainees was significantly longer than that of the senior surgeons, 88 (IQR: 78-103) min vs. 61 (IQR: 50-79) min, respectively (p < 0.001). Patient demographics showed no significant differences between the two groups except for BMI, which was significantly higher in the trainee group (p = 0.008). Although the operating time and intraoperative complication rates are higher for supervised trainees, there is no significantly higher rate of postoperative septic or aseptic revisions. These findings highlight the importance of structured training programs in ensuring patient safety and surgical competence among trainees.

Short-term outcomes of periacetabular osteotomy versus periacetabular osteotomy with concomitant femoral osteochondroplasty: a propensity matched analysis

Abstract This study compared outcomes of periacetabular osteotomy (PAO) with and without femoral osteochondroplasty (OCP) in treating symptomatic acetabular dysplasia through propensity score matching. Data from a prospective multicenter cohort of patients undergoing PAO from 2007 to 2014 were analyzed. Inclusion criteria were a lateral center edge angle &amp;lt;25°. The exclusion criteria were history of previous procedure and age &amp;gt;45 years. A 2- to 5-year follow-up interval was utilized; patients outside this follow-up window were excluded. Propensity matching variables included sex, baseline hip internal rotation at 90° flexion, preoperative alpha angle, lateral center edge angle, modified Harris Hip score (mHHS), and arthroscopy at the time of surgery. Propensity scores were calculated using logistic regression with treatment as the dependent variable. Clinical failure was defined as failure to meet the minimal clinically important difference and patient acceptable symptom state for mHHS or a need for reoperation. There were 219 patients that met the inclusion criteria. Of these, 116 patients were matched, representing 58 pairs (PAO/OCP = 58; PAO without OCP = 58). Preoperative functional scores were similar between groups. At mean 4.1 years follow-up, there were no significant differences in the rates of clinical failure or reoperation between the two groups [PAO/OCP = 13 (22%), PAO without OCP = 8 (14%); P = .23] Similarly, the final mHHS was 83.2 ± 16.2 for the PAO/OCP group and 84.1 ± 15.9 for the isolated PAO group, with no significant difference (P = .74). In the treatment of symptomatic acetabular dysplasia, isolated PAO is noninferior to combined PAO/OCP at short-term follow-up in patients who are likely to be treated by either method.

Mid-term outcomes of atrioventricular valve repair in functional single ventricle patients

BackgroundSurgical treatment of functional single ventricle combined with atrioventricular valve regurgitation remains a clinical challenge. The outcomes of atrioventricular valve repair in patients with single ventricle are limited.MethodsA retrospective study was conducted of all 28 patients with functional single ventricle treated with single-ventricle palliation who underwent atrioventricular valve operation at the First Hospital of Tsinghua University between April 2007 and October 2022.ResultsIn our cohort, the female/male ratio was 7:21, with an average age of 8.7 ± 6.0 (0.75–26) years. Half of patients (50%) were right-ventricle type for single-ventricle morphology. 18 patients (64.3%) were with a common atrioventricular valve. Twenty-three patients (82.1%) were combined with heterotaxy syndrome. Pre-operatively, twenty-four patients (85.7%) were diagnosed with severe atrioventricular valve regurgitation. AVV was repaired at the Glenn (n = 16, 57.1%), Glenn-Fontan (n = 2, 7.1%) and Fontan (n = 10, 35.7%) stage, respectively. Valve plastic techniques included valve annulus/commissure constriction (n = 24), clefts repair (9 cases), edge-to-edge suturing (13 cases) and common atrioventricular valve separation (4 cases). The early mortality was 3.6% (1/28). All survival patients were observed with improved regurgitation situations. Twenty-two patients (78.5%) were observed with no more than mild regurgitation postoperatively. The mean follow-up time was 5.4 ± 2.9 years (range, 3.08–11.83 years), with late mortality of 11.1% (3/27). All these three cases were observed with a severe regurgitation by echocardiogram in the last follow-up. Besides, reoperation rate of this cohort was 3.6% (1/28).ConclusionsAVV repair could significantly improve AVV function in SV patients combined with severe AVVR, with satisfactory mid-term results. Part of the cohort showed poor prognosis due to repeated AVVR. Regular follow-up by echocardiogram is critically important for these patients.

Aortitis Increases the Risk of Surgical Complications and Re-Operations After Major Aortic Surgery

Aortitis, defined as inflammation of the aorta, can lead to aneurysms and dissections. Intra-operative sampling is essential for diagnosis, with many cases presenting asymptomatically as clinically isolated aortitis. Previous studies investigating aortitis in major aortic surgery have been limited by low intra-operative sampling. We performed an 11-year, retrospective, cross-sectional study to investigate the true prevalence of aortitis in thoracic aortic aneurysms and dissections by analysing all major aortic operations performed in a single centre. We collected medical histories, histological reports, post-operative outcomes and follow-up data; 537 patients met the inclusion criteria, representing an 88% histological sampling rate. The prevalence of aortitis was 10.6% (n = 57), of which 75% were clinically isolated. The re-operation rate in aortitis was twice that of non-aortitis patients (17.5% vs. 9.4%, p = 0.054). Multivariate logistic regression identified increased age, female sex, current smoking, and other inflammatory diseases as significantly associated with aortitis, with a bicuspid aortic valve associated with a significantly decreased likelihood of aortitis. The true prevalence of aortitis is likely higher than reported in previous studies, with our study showing twice the prevalence found in previous studies with lower sampling rates. Due to the increased re-intervention in aortitis, specialist multi-disciplinary follow-up and aortitis centres should be formed.

Time to Amputation After Traumatic Digital Injury Does Not Affect Complication Rates: A Retrospective Multi-Institutional Analysis.

Revisionary digital amputations are often performed after partial or full traumatic digital amputation to minimize complications while preserving as much length and functionality as possible. Many surgeons attempt revisionary procedures swiftly after initial injury. The aim of this study was to investigate the effects of time from injury to surgery on rate of complications and reoperation in revisionary traumatic digital amputations. This was a retrospective chart review of all patients undergoing revisionary digital amputation for initial traumatic amputation at a single hospital from January 1, 2007 to December 31, 2021. Demographics, comorbidities, surgical details, complications, and time from injury to surgery were collected. Five-factor modified fragility index scores were also computed for each patient. Primary outcomes of interest included complications and need for additional procedures. Secondary outcomes of interest included development of neuroma, phantom limb, and referral to a long-term pain specialist. A total of 97 patients were identified as meeting all inclusion criteria. The average time to surgery was 14.4 days. Body mass index, comorbidities, and time to surgery were not associated with increased risk of complication. Increasing time to surgery was not significantly associated with increased risk of complications, development of neuroma, phantom limb, or a referral to long-term pain service. The only factors which were significantly associated with reoperation were absence of diabetes and hypertension. Increasing time to surgery after initial injury was not significantly associated with increased risk of complications or reoperation. Surgeons should consider this when assessing urgency of surgery in patients after traumatic digital amputation.

Factors Influencing Fronto-Orbital Relapse in Patients With Syndromic Craniosynostosis: A 2 Decade Review.

Fronto-orbital retrusion may occur after primary surgical correction of craniosynostosis, particularly in patients with syndromic craniosynostosis. This study investigated reoperation rates and factors contributing to FO relapse among this cohort. A retrospective review evaluated reoperation for FO relapse in patients with syndromic multisuture craniosynostosis who underwent primary fronto-orbital advancement (FOA) + calvarial vault remodeling (CVR) at our institution between 2004 and 2024. Revision surgeries included repeat FOA or monobloc advancement/distraction. FOA advancement distance was measured using postoperative computed tomography and Mimics software. ROC analysis evaluated the accuracy of FOA distance in predicting subsequent FO relapse. Conditional margins identified optimal advancement distances. Logistic regression of predictors of FO relapse adjusted for age at surgery, craniofacial syndrome, posterior vault distraction osteogenesis (PVDO), advancement distance, and postoperative helmet therapy. Fifty-two patients underwent a mean of 2.8±1.9 skeletal craniofacial procedures each. With a mean follow-up time of 9.2±6.5 years, 16 (30.8%) patients required reoperation for FO relapse. Larger advancement distances were the sole significant predictor of relapse, increasing the odds by 49.6% (OR 1.496, 95% CI: 1.085-2.063; P=0.014). Relapse rates were lower with advancements ≤17.2mm (0.0%) than with further advancements (42.0%, P=0.002). Specifically, advancements >18.8mm were associated with significantly higher relapse rates (P<0.05). Almost one-third of patients with multisuture syndromic craniosynostosis underwent FO region readvancement. Advancements <17.2mm during initial FOA appeared to mitigate relapse, while advancing beyond 18.8mm may increase the risk. Investigation of additional protective factors against FO relapse is encouraged to minimize surgical burden.

Primary and revision artificial urinary sphincter for stress urinary incontinence post-radical prostatectomy: a surgery with high rewards but high risks?

To evaluate the efficacy of artificial urinary sphincter (AUS) implantation in men with stress urinary incontinence post-radical prostatectomy and the complication burden with a focus on identifying potential risk factors for reoperation as well as determining the fate of revision surgeries. Retrospective analysis of consecutive patients undergoing primary AUS (pAUS) and revision AUS (rAUS) implantation at a tertiary centre. Logistic regression was employed to identify risk factors for reoperation associated with non-mechanical failures. Kaplan Meier method was applied to generate implant patency curves. Over 11-years, 108 and 28 patients underwent pAUS and rAUS, respectively. Amongst the former group, a 30-day complication rate of 20.4% was found with a complete (zero pad) dryness rate at follow-up of 49.1%. Post-operative infection was the commonest occurring complication in 7.4%. After pAUS, 27.8% underwent reoperation with cuff erosion being the top indication in 46.7%. Diabetes was a significant predictor for reoperation with an associated 3.6-fold increased risk. The 3-year and 5-year device survival rates without reoperation for pAUS were 80% and 76%, respectively. For rAUS, complete dryness rates achieved were lower at 32.1%. The rate of reoperation was higher at 42.9% with a significantly worse survival probability compared to pAUS (p = 0.024). Whilst men may achieve complete dryness after pAUS, the potential complication burden and risk of reoperation are not low, and patients need to be counselled regarding this. Chances of continence success are lower when revision surgery is performed with a worse implant survival probability.

Comparison between in situ fixation and fixation after closed reduction in valgus impacted femoral neck fractures: A Multicenter Study.

The objective of this study was to compare clinical outcomes between in situ fixation and fixation after closed reduction (CR) in patients aged 50 and above with valgus impacted femoral neck fractures using data from multiple centers. Design: Retrospective multicenter cohort study. Five tertiary-care university hospitals. Patients aged 50 and above, treated with operative fixation of valgus impacted femoral neck fractures using multiple cannulated screws from 2003 to 2019. Complications such as fixation failure, osteonecrosis of femoral head (ONFH), and reoperation were compared between the groups (in situ fixation group and fixation after CR group). Postoperative EuroQol-5 Dimension (EQ-5D), Harris Hip Score (HHS), and Koval's grade were compared. The mean age of the 206 patients (161 in situ fixation group, 45 in fixation after CR group) who met the inclusion criteria was 68.9 ± 10.9 years (range, 50 to 95 years). There were 39 men and 167 women. Fixation failure occurred in 11.2% (6.8% of in situ fixation group vs 26.7% of fixation after CR group, p = 0.002). Reoperation was required for 10.2% (7.5% of in situ fixation group vs 20% of fixation after CR group, p = 0.023). Fixation failure and reoperation rates were significantly higher in the fixation after CR group than in the in-situ fixation group (odds ratio = 4.757, p = 0.002 and odds ratio = 3.104, p = 0.023, respectively). At the two-year follow-up, ONFH occurred in 5.8% (9 out of 161, in situ fixation group vs 3 out of 45, fixation after CR group). There was no significant difference in the occurrence of ONFH between the two groups (p = 0.727). The Koval's grade at 6 and 12 months demonstrated better results in the in-situ group (p = 0.027, 0.044, respectively). Postoperative EQ-5D and HHS scores showed no statistically significant differences between the two groups. In patients aged 50 years or older with valgus impacted femoral neck fractures, when fixation was done after reduction, the reoperation rate was higher due to fixation failure compared to in-situ fixation. There was no significant difference in the incidence of ONFH in valgus impacted femoral neck fractures regardless of whether reduction was performed. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Outcomes of porcine small intestinal submucosa mesh compared to polypropylene mesh in laparoscopic transabdominal preperitoneal inguinal hernia repair: a retrospective cohort study.

To compare the long-term outcomes of porcine small intestinal submucosa (SIS) mesh and polypropylene (PP) mesh after an laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Mesh-based surgical techniques for inguinal hernia repair are recommended in the guidelines due to the lower rate of recurrence. Biologic meshes (BMs) may have advantages in terms of chronic pain due to the different postoperative remodeling, without the disadvantages of a permanent implant. SIS mesh is the most commonly used BMs, mostly used for young male patients. Until now, the long-term efficacy of SIS mesh in laparoscopic inguinal hernia repair (LIHR) has rarely been reported and remains elusive. We retrospectively reviewed prospectively collected data from consecutive LIHR performed at Beijing Chaoyang Hospital between January 1, 2014 and December 31, 2018. Two groups of meshes were selected: SIS mesh and PP mesh. To reduce potential selection bias, patients were matched based on the logit of propensity scores through age, gender, and body mass index (BMI). Follow-up was until January 30, 2024. Long-term outcomes were analyzed, including the rate of recurrence, the rate of re-operation, and the postoperative discomfort. A total of 2,348 patients with LIHR were eligible. After exclusion criteria, a total of 1,240 unilateral hernias treated using the TAPP approach were included for statistical analysis. Of these, 143 hernias (11.5%) were operated on with SIS mesh. Applying propensity score matching resulted in 115 matched pairs for comparative analysis. The mean operative time with the SIS mesh was 63.2 ± 18.5min, which was longer than the operative time with PP mesh of 50.1 ± 17.6min (P < 0.001). The SIS mesh was used more frequently to repair indirect hernias, while the PP mesh was more often employed to direct and femoral hernias at a higher rate (P = 0.009). The mean follow-up was 84.2months and a total of seven patients (3%) were lost to follow-up. Overall, five (2.3%) patients experienced hernia recurrence postoperatively, all in the SIS group, but no statistical difference was observed between the two groups (4.4% vs. 0%; P = 0.06). All underwent a second operation, with three in TAPP approach and two in Lichtenstein approach, no recurrence was found afterward. More patients in the SIS group reported postoperative discomfort than those in the PP group (8.8% vs. 0.9%; P = 0.006), notably experiencing discomfort more frequently and to a greater degree during movement. The SIS mesh in TAPP hernia repair leads to more frequent discomfort and a higher recurrence rate (though not statistically significant) compared to PP mesh. Continued follow-up and an increased sample size are needed to analyze the effectiveness of SIS mesh and to explore risk factors for recurrence.

The Analysis Studies of Causes and Frequencies of Reoperations after Endoprosthesis Reconstructions for Extremity Tumor Surgery: A Comprehensive Systematic Review

Introduction: Recent advancements in endoprosthetic implant designs and fixation methods have greatly enhanced the options available for reconstructing osseous defects following tumor excision. Endoprosthetic reconstruction offers multiple benefits, including versatility, improved ambulatory function, and early rehabilitation, while allowing for complete tumor resection and reducing the risk of recurrence. This systematic review aims to aggregate evidence on the complications and outcomes of primary extremity tumor endoprosthetic reconstructions to guide clinical decision-making. Methods: This review follows the PRISMA 2020 guidelines, analyzing studies published between 2004 and 2024 that address complications like infection, structural failure, and prosthesis survival in primary extremity tumor endoprosthetic reconstructions. A comprehensive search strategy across databases like PubMed, ScienceDirect, and Cochrane Library will identify eligible studies. Results: Eight studies meeting the inclusion criteria were analyzed for complications in endoprosthetic reconstructions. The studies highlighted complications such as infection, reoperation rates, and prosthesis survival. Discussion: The study discusses key articles examining complications, emphasizing factors like bone resection, implant fixation types, and tumor characteristics, which influence reoperation rates and prosthesis failure. Despite promising functional outcomes, the risk of complications, particularly infection and mechanical failure, remains significant. Surgical technique, postoperative care, and tumor characteristics are critical in optimizing outcomes. Conclusion: This review identifies key complications in primary extremity tumor endoprosthetic reconstructions, emphasizing the need for long-term follow-up, standardized reporting, and personalized surgical approaches. Further research with homogeneous cohorts is required to enhance understanding and improve patient outcomes.

Beyond traditional surgery for far lateral lumbar herniation : transforaminal full endoscopic discectomy

IntroductionThis study aimed to evaluate the clinical outcomes of transforaminal full-endoscopic lumbar discectomy (FELD) for treating lateral lumbar disc herniation. MethodsA retrospective single-center study was conducted at Centre Orthopédique Santy, Lyon, France, including 58 adult patients with foraminal or extraforaminal lumbar disc herniations who underwent surgery between October 2020 and January 2023. Inclusion criteria were patients with significant functional impairment due to unilateral radicular pain unresponsive to conservative treatment for over six weeks. Data on demographics, clinical characteristics, and outcomes were collected, evaluated preoperatively and at 12 months postoperatively using Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and Macnab criteria. ResultsThe cohort had a mean age of 56.5 years and consisted predominantly of males, with 35 men (60%). Most herniations were at the L4-L5 level (29 patients, 50%). Significant improvements were observed in lumbar VAS (mean reduction of 1.9 points, p < 0.001), radicular VAS (mean reduction of 4.9 points, p < 0.001), and ODI (mean reduction of 41.9 points, p < 0.001) scores. Patient satisfaction was high, with 91% (53 patients) reporting excellent or good outcomes. The reoperation rate was 6.9% (4 patients). Linear regression analysis indicated that longer symptom duration and higher preoperative radicular VAS scores predicted greater satisfaction. ConclusionsTransforaminal FELD is a safe and effective technique for treating lateral lumbar disc herniation, offering high patient satisfaction. Symptom duration and preoperative radicular VAS scores are key predictors of positive outcomes. Further studies with larger sample sizes and longer follow-up periods are necessary to confirm these findings.

A Retrospective Study on Subgaleal Fluid Collection After Titanium Mesh and Polyetheretherketone Cranioplasty

Cranioplasty is a common neurosurgical procedure aimed at providing structural protection to cerebral tissues and enhancing neurological function. The choice of implant material, particularly polyetheretherketone (PEEK) and titanium mesh, significantly influences postoperative outcomes, including the incidence of subgaleal fluid collections (SFC). This study investigates the incidence of SFC associated with PEEK and titanium mesh in cranioplasty, identifying risk factors and implications for clinical practice. A retrospective analysis was conducted on 70 patients who underwent cranioplasty. The incidence of SFC, postoperative complications, and demographic data were collected and analyzed. Statistical comparisons were made between the two implant materials. The incidence of SFC was significantly higher in the PEEK group (46.2%) compared to the titanium mesh group (20.5%) (p=0.023). PEEK was identified as an independent risk factor for SFC. Additionally, approximately 60% of postoperative epidural hematoma (PEH) cases presented with SFC, highlighting the importance of meticulous hemostasis during surgery. The overall reoperation rate was 5.7%, consistent with existing literature. Although diabetes mellitus did not show a statistically significant association with SFC (p=0.064), its potential impact on postoperative complications warrants further investigation. The selection of implant materials in cranioplasty significantly affects postoperative outcomes, with PEEK associated with a higher incidence of SFC. Careful material selection, particularly in patients with comorbidities, and meticulous surgical techniques are essential to improve patient outcomes. Future research should focus on the biological interactions between implant materials and cranial tissues to refine guidelines for clinical practice.

Impact of Intraoperative Imaging Techniques on Surgical Margins and Recurrence Rates in Breast-Conserving Surgery

Background: Achieving clear surgical margins is critical in breast-conserving surgery (BCS) to minimize recurrence risk and reduce reoperation rates. Intraoperative imaging techniques provide real-time margin assessment, allowing surgeons to improve surgical precision and outcomes. Objectives: The aim and objectives of this study were to determine the effect of intraoperative imaging on margin clearance, reoperation rates, recurrence as well as the effect of key biomarkers influencing breast cancer including estrogen receptor (ER), progesterone receptor (PR), HER2, Ki67. Methods: 300 patients were divided into two groups, Group-A intraoperative imaging was done in 150 subjects while in Group-B was not done for 150 subjects. The correlation with surgical outcomes (margin status, reoperation rate, and recurrence rate), the biomarker analyzed were expression (ER, PR, HER2, Ki67). Logistic regression, Kaplan-Meier survival analysis whereas p values was performed by using 95% confidence interval (CI). Results: Intraoperative imaging was associated with significantly lower rates of positive margins (15% vs. 25%, p = 0.03), particularly in ER positive and Ki67 low tumors. Both imaging and reoperation rates were reduced (12% vs. 22%, p = 0.02) in the imaging group, in particular for ER positive patients. Reoperation rates were higher in patients with high Ki67 expression (p = 0.01) and recurrence rates were higher in patients with high Ki67 expression (p = 0.03). Kaplan-Meier analysis showed better recurrence-free survival in the imaging group, especially in ER-positive patients (HR: 0.55, p = 0.02). Conclusion: The intraoperative imaging improves margin clearance and reduces reoperation and recurrence for biologically less aggressive tumors (ER positive, low Ki67). Nevertheless, additional therapeutic strategies may be necessary for patients in high-risk subgroups, such as HER2 positive and high Ki67 tumors, to achieve optimal outcomes.

Learning Curves for Robotic-Assisted Ventral Hernia Repair

Although the use of robotic-assisted ventral hernia repairs has increased significantly over the last decade, the experience surgeons need to achieve comparable outcomes with more established laparoscopic and open approaches has not been well characterized. To estimate the learning curves for robotic-assisted ventral (incisional and umbilical) hernia repair. This retrospective cohort study included Medicare fee-for-service patients (≥18 years) enrolled in Medicare Part A and Part B with no managed care undergoing ventral hernia repairs between 2010 and 2020. Multivariate logistic regression was used to estimate reoperation rates for hernia recurrence, adjusting for patient demographics, comorbidities, mesh placement, and hospital characteristics. Analyses were conducted from October 2023 to July 2024. Incremental robotic-assisted hernia repair volume. Reoperation for hernia recurrence within 7 years of index hernia repair. This study comprised 160 379 Medicare patients (mean [SD] age, 69 [11] years), of whom 93 272 (58.2%) were female, 13 799 (8.6%) were Black, 3124 (2.0%) were Hispanic, and 138 311 (86.2%) were White. Among these patients, 12 609 (7.9%) underwent robotic-assisted hernia repairs, 32 337 (20.2%) laparoscopic repairs, and 115 433 (71.9%) open repairs. This study also included 23 580 surgeons, with 5074 performing robotic-assisted hernia repairs. The national reoperation rates for hernia recurrence after laparoscopic and open repairs were 12.5% (95% CI, 12.06%-12.94%) and 12.9% (95% CI, 12.70%-13.15%), respectively. Reoperation rates decreased as the number of robotic-assisted cases increased, from 14.2% (95% CI, 13.34%-14.97%) at 10 cases to 7.6% (95% CI, 6.75-8.37) at 50 cases. Surgeons needed at least 19 (95% CI, 16-22) robotic-assisted hernia repairs or 16 (95% CI, 13-19) repairs to achieve outcomes equivalent to those of laparoscopic and open procedures. Few surgeons (285 surgeons [5.7%]) performed enough robotic-assisted ventral hernia repairs to achieve necessary volume nationally to overcome the learning curve. In this cohort study of 23 580 surgeons who performed ventral hernia repairs between 2010 and 2020, increasing experience with robotic-assisted hernia repairs was associated with improved long-term reoperation rates for hernia recurrence. However, the majority of surgeons did not perform enough cases to reach reoperation rates equivalent to more established laparoscopic and open approaches.

Should We Operate on Octogenarians with Cervical Myelopathy or Radiculopathy?

Retrospective Cohort. Investigate the disparities between octogenarians and non-octogenarians undergoing cervical spine surgery regarding perioperative, and postoperative outcomes. As the population ages, the demand for elective cervical spine surgery among older, more active adults increases. However, concerns remain regarding the optimal management of older patients undergoing cervical surgery, given the potential complexities associated with advanced age, comorbidities, and physiological decline. While the safety and efficacy of cervical spine surgery in younger cohorts have been extensively studied, there is a paucity of literature specifically addressing outcomes in octogenarians. Octogenarians undergoing elective cervical spine surgery were propensity matched 3:1 to patients <80 years old by baseline neck and arm pain, surgical approach, and total instrumented levels. Primary outcomes of interest were postoperative complications, unexpected 90-day hospital readmissions and 12-month reoperation. Secondary outcomes were 12-month patient satisfaction and patient reported outcome measures (PROMs) at 3 and 12 months, including EuroQol-5D, modified Japanese Orthopaedic Association, neck disability index, and visual analog scale for neck and arm pain. There were 29 octogenarians and 87 nonoctogenarians identified. The mean age in each cohort was 82.4±2.2 vs. 59.1±11.1 years, respectively. There was no difference in postoperative complications (10.3% vs. 6.9%, P=0.548), 90-day readmission (10.3% vs. 6.9%, P=0.548), and 12-month reoperation (3.4% vs. 2.3%, P=0.736) between octogenarians and non-octogenarians. Similarly, octogenarians and nonoctogenarians experienced comparable 12-month patient satisfaction (65.2% vs. 55.3%, P=0.393), improvement in 3- and 12- month PROMs and MCID achievement. Postoperative complications, readmission, reoperation rate, patient satisfaction, and PROMs did not significantly differ between octogenarians and non-octogenarians undergoing cervical spine surgery. These findings suggest that age alone should not be a determining factor in surgical decision-making for elective cervical spine procedures, as octogenarians can achieve comparable outcomes to their younger counterparts.

Intrawound vancomycin powder in primary total knee arthroplasty: Does it reduce early postoperative infection?

BackgroundThe purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate prosthetic joint infection (PJI) within 90-days following primary total knee arthroplasty (TKA). MethodsFrom October 2021-September 2022, a prospective quality control project was undertaken in which 10 high-volume arthroplasty surgeons alternated between using IVP and not using IVP each month. Patients who received IVP were compared to those who did not. The primary outcome was culture positive PJI within 90-days following primary total knee arthroplasty. Secondary outcomes included overall reoperation rate, wound complications, and readmission within 90-days post-operatively. ResultsA total of 1,317 primary TKA patients were identified for analysis. Fifty-six and seven tenths percent (n = 747) of patients were included in the IVP group and 43.3% (n = 570) patients were included in the non-IVP group. The overall PJI rate was 0.5%. There was no difference in 90-day culture positive PJI rates between the groups (0.7% vs. 0.2%, p = 0.24). The overall reoperation rate did not differ between the IVP and non-IVP group (6.4% vs. 4.6%, p = 0.15). Reoperation for suspected infection was not statistically different by IVP administration (1.2% vs. 0.5%, p = 0.25). Additionally, there were no differences in the incidence of wound complications (p = 0.80) or readmissions (p = 0.15). ConclusionsThe overall infection rate for this cohort was low. IVP was not associated with decreased culture positive PJI, wound complications, reoperation or readmission rates. Further analysis of IVP use in TKA should be undertaken to fully determine its efficacy and safety profile.

Arthrodesis Versus Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Joint Arthritis: A Systematic Review and Meta-Analysis.

Arthrodesis and ligament reconstruction and tendon interposition (LRTI) are commonly performed procedures for treatment of thumb carpometacarpal (CMC) osteoarthritis. Although LRTI is the most common surgical treatment, CMC arthrodesis has been performed because of its reported advantages. This systematic review and meta-analysis compared the differences between CMC arthrodesis and LRTI to better inform surgeons and patients when they are making treatment decisions. We searched MEDLINE, Embase, and the Cochrane Library for studies published up to 27 August 2023 that directly compared arthrodesis with LRTI for thumb CMC joint arthritis. The pooled analysis compared the visual analog scale; Quick Disabilities of the Arm, Shoulder, and Hand scores; grip strength; key pinch strength; reoperation rates; and postoperative complication rates. Six studies describing 285 thumbs, including 141 and 155 thumbs that underwent arthrodesis and LRTI, respectively, were included. Visual analog scale (standard mean difference [SMD],-0.05; 95% CI,-0.40 to 0.30; P= .78), Quick Disabilities of the Arm, Shoulder, and Hand score (SMD, 0.53; 95% CI,-1.12 to 2.17; P= .53), and grip strength (SMD,-0.67; 95% CI,-1.85 to 0.51; P= .27) showed no difference between the two groups. The arthrodesis group showed significantly higher key pinch strength (SMD, 0.61; 95% CI, 0.32-0.90), reoperation rate (odds ratio, 8.02; 95% CI, 2.00-32.16), and postoperative complication rate (odds ratio, 2.08; 95% CI, 1.11-3.91; I2= 0%) compared with the LRTI group. Carpometacarpal arthrodesis is associated with a better key pinch strength than LRTI. Nevertheless, no significant differences were observed in functional scores and grip strength. Patients who undergo arthrodesis have higher reoperation rates and incidence of postoperative complications than those who undergo LRTI. Thus, although arthrodesis may be a better operation for patients who require high pinch strength, surgeons should also consider the higher complication compared with LRTI. Therapeutic II.

Day-case knee and hip replacement.

Day-case knee and hip replacement, in which patients are discharged on the day of surgery, has been gaining popularity during the last two decades, and particularly since the COVID-19 pandemic. This systematic review presents the evidence comparing day-case to inpatient-stay surgery. A systematic literature search was performed of MEDLINE, Embase, and grey literature databases to include all studies which compare day-case with inpatient knee and hip replacement. Meta-analyses were performed where appropriate using a random effects model. The protocol was registered prospectively (PROSPERO CRD42023392811). A total of 38 studies were included, with a total of 83,888 day-case procedures. The studies were predominantly from the USA and Canada, observational, and with a high risk of bias. Day-case patients were a mean of 2.08 years younger (95% CI 1.05 to 3.12), were more likely to be male (odds ratio (OR) 1.3 (95% CI 1.19 to 1.41)), and had a lower mean BMI and American Society of Anesthesiologists grades compared with inpatients. Overall, day-case surgery was associated with significantly lower odds of readmission (OR 0.83 (95% CI 0.73 to 0.96); p = 0.009), subsequent emergency department attendance (OR 0.62 (95% CI 0.48 to 0.79); p < 0.001), and complications (OR 0.7 (95% CI 0.55 to 0.89) p = 0.004), than inpatient surgery. There were no significant differences in the rates of reoperation or mortality. The overall rate of successful same-day discharge for day-case surgery was 85% (95% CI 81 to 88). Patient-reported outcome measures and cost-effectiveness were either equal or favoured day-case. Within the limitations of the literature, in particular the substantial risk of selection bias, the outcomes following day-case knee and hip replacement appear not to be inferior to those following an inpatient stay. The evidence is more robust for unicompartmental knee replacement (UKR) than for total knee replacement (TKR) or total hip replacement (THR). The rate of successful same-day discharge is highest in UKR, followed by TKR and comparatively lower in THR.

Arthroscopic Superior Capsular Reconstruction with Acellular Human Dermal Allograft for Irreparable Rotator Cuff Tears: Outcomes, Complications, and Reoperations at 2-Year Minimum Follow-up

BackgroundManagement of posterosuperior irreparable rotator cuff tears (IRCTs) remains challenging without clear consensus amongst shoulder surgeons. Arthroscopic superior capsular reconstruction (SCR) with dermal allograft has been proposed as a promising treatment option. However, current investigations are limited to short term studies and recent data has suggested variable clinical outcomes. Therefore, the purpose of this investigation was to report intermediate-term clinical outcomes in patients who underwent arthroscopic SCR with a dermal allograft for IRCTs. MethodsOver a four-year period (2016 to 2020), all patients who underwent an arthroscopic dermal allograft SCR with a minimum two-year follow-up period were identified. SCR with dermal allograft was performed for patients with an IRCT utilizing a 3mm acellular dermal allograft. Collected clinical outcomes included range of motion (ROM), strength, Numeric Rating Scale (NRS) for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE) score, complications, and reoperations. ResultsThe final cohort included 41 dermal allograft SCR performed in 40 patients (one bilateral) with a majority male cohort (n = 29; 72%), a mean age of 67 ± 7 years, BMI of 28.4 ± 5.0, and follow-up of 5.3 ± 1.4 years. Clinically, there was a significant improvement in pre- and post-operative NRS pain scores from 5.0 to 1.8 (P < .001), but no differences in pre- and post-operative forward flexion (P = .268), abduction (P = .822), external rotation (P = .323), or internal rotation (P = .995). The final post-operative ASES and SANE scores were 66 ± 28 and 59 ± 30, respectively. There were 8 (19.5%) complications, which consisted primarily of symptomatic graft failure in 6 (14.6%) shoulders and progression of rotator cuff arthropathy in 2 (4.9%) shoulders. Reoperations occurred in 6 (14.3%) shoulders: 4 (9.8%) were conversion to rTSA and 2 (4.9%) were arthroscopic revision dermal allograft SCR with partial repair and reattachment of the torn graft. ConclusionAt a cohort mean of five years after arthroscopic superior capsular reconstruction with dermal allograft for irreparable rotator cuff tears, patients experienced sustained pain relief but no significant improvement in shoulder function. Additionally, 20% sustained a postoperative complication with a 14% reoperation rate. These findings should be considered when counseling patients about the challenges of managing IRCTs and the possible outcomes of utilizing dermal allograft SCR as a surgical modality.

Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Descriptive Study With Minimum 10-Year Follow-up

Background: Anterior cruciate ligament (ACL) reconstruction is increasingly being performed in patients &gt;50 years old; however, the long-term outcomes are unclear. Purpose: To analyze the functional results, osteoarthritic progression, reoperation rate, and failure rate at minimum 10-year follow-up in patients &gt;50 years old who have undergone primary ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were patients &gt;50 years old who underwent primary ACL reconstruction and had at least 10 years of follow-up data. All patients had instability with limitation of their activities, indicating the necessity of surgical intervention. Patients with revision surgeries, ACL repairs, and nonoperative treatment were excluded. Failure was defined as the presence of revision, high-grade Lachman, positive pivot shift (2+), or subjective instability. The Knee injury and Osteoarthritis Outcome Score (KOOS), subjective and objective functional scores, and osteoarthritic progression were analyzed at final follow-up. Results: A total of 38 patients were identified. The mean age at surgery was 56.8 ± 5.7 years (range, 50.6-70 years). The mean clinical follow-up was 16.2 ± 4.3 years (range, 10.9-23.3 years). The failure rate was 10.5% (4/38): 1 of the 4 patients had a recurrence of instability at 13 years postoperatively and underwent revision with a modified Lemaire extra-articular tenodesis, 1 patient had a positive pivot shift (2+) without subjective instability, and 2 patients underwent total knee arthroplasty. The overall KOOS was 74.2 ± 22.2, and 91.4% of patients were satisfied or very satisfied with the results of the procedure. Radiographic osteoarthritis was identified in 88.5% of patients at final follow-up; however, there was no statistical significance on clinical outcomes ( P &gt; .05). Concomitant partial medial meniscectomy ( P &lt; .01) and meniscal repair ( P &lt; .01) were associated with the presence of Ahlbäck grade 3 or 4 osteoarthritic manifestations. Conclusion: In patients over the age of 50 years who underwent primary ACL reconstruction, there was a low long-term failure rate and a high level of patient satisfaction, despite osteoarthritic progression in 88.5% of cases. Concomitant meniscal procedures were associated with more severe osteoarthritic progression.