Revision Status Research Articles

Travel distance can serve as an objective, behavioral measure of patient preference in health care. Endoscopic spine surgery is the least invasive surgical option for treating spinal pathology, yet access is limited due to the relatively small number of trained surgeons. This study evaluates travel patterns of patients seeking care at the Endoscopic Spine Institute of New York, a specialized center staffed by 3 fellowship-trained endoscopic spine surgeons. We conducted a retrospective analysis of the first 100 consecutive patients undergoing endoscopic spine surgery at Endoscopic Spine Institute of New York. The primary objective was to quantify patient travel distance as a behavioral proxy for preference for specialized, minimally invasive care. Secondary objectives were to characterize spinal pathology, determine revision surgery frequency, and compare travel distances by pathology type and revision status. Travel distances were calculated as straight-line distances from the patient's city of residence to the institute. Descriptive and comparative statistics were performed. The mean travel distance was 308.4 miles (SD: 494.1), with patients traveling from multiple states and internationally. Surgical interventions included cervical (20%), thoracic (18%), and lumbar (62%) pathologies. Revision surgeries accounted for 29% of cases. Travel distance was significantly greater for revision cases compared with primary cases (P < 0.05). Lumbar pathology cases were associated with slightly longer travel distances compared with cervical and thoracic cases, though differences were not statistically significant. Patients are willing to travel substantial distances to access specialized, minimally invasive spine surgery. Travel distance serves as a behavioral measure of patient preference, distinct from conventional quality metrics, providing insight into patient priorities in health care utilization and informing the centralization of specialized surgical services. Understanding how far patients will travel for endoscopic spine surgery provides insight into the growing demand for minimally invasive approaches and the regionalization of specialized spine care. This information can help guide resource allocation, referral patterns, and the develpment of centers of excellence. 4.

HighlightsWhat are the main findings?Residual adenoid tissue was detected in 61.8% of patients after conventional curettage adenoidectomy.Revision status and age ≥ 7.5 years were strong predictors of incomplete clearance.What is the implication of the main findings?Intraoperative endoscopic assessment with completion resection significantly improves surgical outcomes.Primary endoscopic adenoidectomy is recommended for children ≥ 7.5 years and for revision cases.Background/Objectives: Conventional curettage adenoidectomy is widely performed but may leave residual tissue in anatomically hidden nasopharyngeal areas. We evaluated the impact of age and revision status on residual adenoidal tissue after conventional adenoidectomy and assessed outcomes following endoscopic completion. Methods: A prospective cohort study included 178 patients undergoing conventional adenoidectomy followed by intraoperative nasal endoscopy. Residual tissue in the nasopharyngeal roof, Fossa of Rosenmüller, and around the Eustachian tube was resected using a microdebrider. Patients were categorized into four groups based on age (<9 or ≥9 years) and surgical history (primary vs. revision). Pediatric Sleep Questionnaire (PSQ) or STOP-BANG scores were collected pre- and postoperatively. Receiver operating characteristic (ROC) and logistic regression analyses were used to identify predictors of residual tissue. Results: Residual adenoid tissue was detected in 61.8% of patients after conventional adenoidectomy, highest among those ≥9 years undergoing revision (36.4%). Age ≥ 7.5 years and revision status predicted residual tissue (AUC = 0.71). Significant postoperative symptom improvement was observed (PSQ and STOP-BANG, p < 0.001). Complication rates were low (13.5%), with no recurrences reported. Conclusions: Conventional curettage often leaves residual adenoidal tissue in older and revision cases. Endoscopic completion improves outcomes. Primary endoscopic adenoidectomy is recommended for patients aged ≥7.5 years and those undergoing revision procedures.

Infectious Complications of Stereotactic Navigation in Posterior or Posterolateral Thoracic and Lumbar Spinal Fusion and Posterior Lumbar Interbody Fusion for Degenerative Spinal Disease: An ACS-NSQIP Study.

Long-term outcomes, satisfaction, and survival rates of a medial pivot knee design.

Cross-sectional study. This study aimed to analyze the failure patterns of expandable corpectomy cages. Expandable corpectomy cages offer significant advantages for anterior column reconstruction but introduce unique mechanical complexities. Device-specific failure patterns and their clinical implications remain poorly characterized in the literature. We analyzed 373 adverse event reports involving expandable corpectomy cages from the FDA Manufacturer and User Facility Device Experience (MAUDE) database through October 2024. Using validated AI-assisted classification, reports were categorized by failure mode, anatomical location, revision status, and contributing factors. Chi-square tests with Bonferroni correction were used to assess associations between variables. Inserter-related issues constituted the most common adverse events (34.3%), yet rarely resulted in clinical symptoms (5.4%) or revision surgery (21.9%). Conversely, less frequent mechanical failures demonstrated significantly higher revision rates: endplate subsidence (80.0%), device migration (77.8%), and structural fracture (63.8%). Failure modes showed distinct anatomical patterns, with migration predominating in the lumbar spine (31.4% vs. 2.3% cervical), while height loss occurred more frequently in cervical applications (20.5% vs. 7.8% lumbar). Among inserter issues, torque handle calibration failures (18.8%) and set screw complications (25.0%) accounted for nearly half of these events. Surgical technique was identified as the predominant contributing factor across all failure modes (28.7%), while inadequate fixation was specifically associated with device migration (35.6% of migration cases). For surgeons, the high reported prevalence of inserter complications may be a key consideration for device selection, particularly regarding set screw mechanisms, despite the apparent lesser clinical impact. Similarly, heightened vigilance may be warranted for lumbar applications of expandable corpectomy cages due to increased migration risk.

Background Patients undergoing anterior cruciate ligament reconstruction frequently present with concomitant meniscal or articular cartilage injuries. In revision anterior cruciate ligament reconstruction(ACLR), the prevalence of articular cartilage damage is higher compared to primary reconstruction. However, limited data are available regarding the extent and distribution of cartilage damage by articular surface. Objective To determine the differences in the prevalence and characteristics of meniscal tears and articular surface injuries between patients who underwent primary ACLR or ACLR revision. Methods A cross-sectional study of patients undergoing ACL surgery between 2017 and 2023. Patient characteristics and arthroscopic findings on the location and type of meniscal injury, as well as the degree of chondral lesion, were recorded by the surgeon. A chi-square test was used to determine differences between reconstruction and revision patients, and a simple logit model was used to estimate the risk of lesions. Results Around 527 surgeries were analyzed: 92.79% reconstructions and 7.21% revisions. Meniscal tear prevalence was 69.83% and was more frequent in the lateral menisci. Complex and degenerative tears were more frequent in revision patients. Overall, articular surface chondral damage prevalence was 24.48% and was affected by the meniscal condition and revision status (OR=3.53 (95% CI: 1.72‒7.28)), up to 42.72% and 66.67% in reconstruction and revision patients, respectively. Discussion Lateral and medial meniscus injuries were common, with complex tears more frequent in revisions. Chondral lesions were more often detected when both menisci were torn or when the lateral meniscus alone was affected. The medial femoral condyle emerged as the most commonly injured articular surface. Although conflicting evidence exists regarding meniscal tear incidence in revision cases, degenerative and multidirectional tears appeared to be more prevalent. Future research is needed to clarify injury patterns, improve detection of minor chondral damage, and optimize surgical timing. Conclusion Meniscal tears (up to 69.83%) and articular cartilage injuries (24.48%) are common in patients undergoing primary or revision ACL reconstructions. Revision procedures, sex, age, and meniscal tears increase injury likelihood. The medial femoral condyle is most often affected, while the lateral tibial plateau is least involved.

Validation of data capture in the Australasian shunt registry with a prospectively maintained institutional database.

Background/Objectives: Long-term prosthetic stability in ossicular chain reconstruction (OCR) surgery may be affected by multiple factors, including prosthesis type. We compared audiometric outcomes including air–bone gap (ABG) and air conduction pure-tone average (AC PTA) over a multi-year period in titanium clip partial prosthetics and other titanium partial and total ossicular reconstruction prostheses. Methods: This was a retrospective study of 92 adult patients (19–74 years) receiving primary, second-look, or revision OCR at a single institution between 2017 and 2021. ABG and AC PTA at short (3–6 months) and long-term (&gt;12 months) postoperative follow-up were compared among patients receiving clip partial prosthetics, traditional PORPs, and TORPs. Results: Overall, AC PTA and ABG were significantly improved in the short term and did not significantly deteriorate in the long term. Clip partial prostheses had significantly lower AC PTAs and ABGs than TORPs in both the short and long term and no difference with PORPs. There was also no significant deterioration in audiometric outcomes in either clip partials, PORPs, or TORPs over time. Clip partials had the highest rate of short- and long-term surgical success (i.e., ABG ≤ 20 dB) with 62.2% and 54.1%, respectively. Cholesteatoma and revision status were not independent predictors of long-term ABG success. Conclusions: The clip partial prosthesis seems to demonstrate similar, and potentially increased, resilience compared to the PORP and TORPs in both the short and long term. They may have comparable effects on audiometric outcomes to PORPs, demonstrating postoperative ABG and AC PTAs that reflect the previous literature. Clip partials appear to be a safe and effective prosthetic for OCR in patients with intact stapes regardless of cholesteatoma or revision status.

INTRODUCTION: Shunt systems are central in managing adult hydrocephalus by regulating CSF and intracranial pressure (ICP). Traditional methods for adjusting shunt drainage relied on symptomatic assessments and radiological interventions, leading to high resource utilisation and radiation exposure. The advent of implantable telemetric ICP sensors (telesensors), offers non-invasive and rapid ICP monitoring, supporting clinical decision-making and potentially reducing resource utilization. METHODS: This retrospective, propensity-matched, control study included adults treated for hydrocephalus with CSF diversion incorporating an MScio/Sensor Reservoir. Controls had a non-telemetric Sprung reservoir and were matched on demographics, diagnosis, shunt-type, and revision status. Data collected included neurosurgical admissions, outpatient clinics, imaging, and further surgeries, comparing 2 years before and after shunt implantation. Cost-effectiveness analyses were conducted using local tariffs, incorporating multivariate regression and propensity score matching. RESULTS: 136 patients (73 telesensor, 63 controls) were analysed in this study. Telesensor used led to significant reduction in neurosurgical inpatient admissions and procedures, including ICP monitoring. Telesensor patients also had, on average, 3.9 fewer x-rays and 1.4 fewer CT scans than controls, translating to an average radiation dose reduction of 4.00 mSv over two years (p = 0.009). Propensity-matched analysis included 48 pairs of patients, demonstrating significant cost savings, particularly in the first-year post-implantation of $5597 (p = 0.03), and cumulatively over the two-year follow-up of $6338 (p = 0.04). This was primarily driven by reduced costs associated with neurosurgical inpatient admissions and imaging. Break-even analysis shows cost-savings were likely to be achieved within 8 months of clinical use, post-implantation. CONCLUSIONS: Telesensor implantation significantly reduced patient radiation exposure and service utilisation, as well as providing institutional net financial savings. These findings support the adoption of telesensor technology as a cost-effective option for enhancing patient care.

Mixed clinical results have been reported following the use of lateral unicompartmental knee arthroplasty (UKA) in patients with isolated lateral compartment osteoarthritis (OA) of the knee. Although this procedure may be appropriate for use in about 10% of knees needing arthroplasty, it is only used in about 1%. The aim of this study was to determine the medium-term results for the Fixed Lateral Oxford (FLO) UKA. We report the clinical results and survival for 305 consecutive FLO UKAs implanted in 279 patients between July 2015 and August 2022. A total of 283 knees (93%) satisfied the recommended surgical indications. The mean age of the patients was 70.8 years (SD 11), their mean BMI was 28.4 kg/m2 (SD 5.4), and 219 (72%) were female. Isolated lateral compartment OA was the indication for 298 operations (98%). The mean follow-up was 4.3 years (1 to 8). The Oxford Knee Score (OKS) was recorded pre- and postoperatively. The revision status of all knees was known. There were four revisions (1%): two were conversions to a total knee arthroplasty (TKA) for instability and progressive OA and two had the addition of a medial UKA for medial compartment OA. Three other UKAs required a reoperation. At the last follow-up, the mean OKS was 40.9 (SD 7.8), a mean increase of 20 points from the preoperative score. The cumulative rate of survival with any reoperation, including revision, as the endpoint, at seven years, was 96% (95% CI 91 to 100), with revision as the endpoint was 98% (95% CI 94 to 100) and with revision to a TKA as the endpoint was 99% (95% CI 96 to 100). No revisions required revision TKA components. When those who underwent surgery for indications which were outside the recommended indications were excluded, there were only two revisions, both with the addition of a medial UKA for progressive OA, resulting in a seven-year cumulative survival with revision as the endpoint of 99% (95% CI 93 to 100). This study involved the largest published cohort of fixed-bearing lateral UKAs. The good clinical outcomes and medium-term survival of the FLO UKA, particularly in patients satisfying the recommended indications, suggest that it is an excellent alternative to TKA for the treatment of patients with isolated OA of the lateral compartment of the knee.

Abstract Purpose: To compare time to achievement of clinically significant outcomes (CSOs) between patients undergoing primary and revision hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary and revision HA for FAIS with complete 6-month, 1-year, and 2-year Hip Outcome Score - Activities of Daily Living (HOS-ADL) and Sport Subscale (HOS-SS) were identified. Revision patients were propensity matched 1:4 to primary HA patients, controlling for age, sex, and body mass index (BMI). Time to achievement of Minimal Clinically Important Difference (MCID) and Substantial Clinical Benefit (SCB) were compared alongside cumulative CSO achievement at 6, 12, and 24 months. Predictors of earlier CSO achievement were identified with multivariate Cox regressions. Results: Fifty revision HA patients were matched to 200 primary HA patients. There were no differences in age (30.1±11.6 years vs. 29.7±11.4, p=0.816), sex (86% female vs. 84%, p=0.830), or BMI (25.4±3.7 kg/m2 vs. 25.9±4.1, p=0.806) between groups. Primary HA demonstrated a greater prevalence of regular, preoperative physical activity (87% vs. 59%, p&amp;lt;0.001). Significantly more primary HA patients achieved MCID for HOS-ADL by 6 months (80.7% vs. 60.0%, p=0.005) and by 12 months (87.3% vs. 76.0%, p=0.047). Primary HA patients achieved SCB for HOS-SS quicker than revision HA (p=0.036). Preoperative PRO score predicted delayed achievement of CSOs (p ≤ 0.002), alongside age, BMI, activity level, and revision status (p ≤ 0.047). Conclusions: Primary HA patients showed greater achievement of MCID for HOS-ADL at 6 and 12 months and quicker achievement of SCB for HOS-SS compared to revision HA patients. Preoperative PRO score, increased age, greater BMI, infrequent physical activity, and revision HA predicted delayed achievement of CSOs. Level of Evidence: Level III, Cohort Study Keywords: Time to Outcomes, Hip Arthroscopy, Revisions

Pediatric cochlear implantation in otitis media with effusion: Are ventilation tubes truly necessary?

ObjectiveTo determine which ear environment risk factors impact ossiculoplasty hearing outcomes and to generate a statistically‐valid grading system for ossiculoplasty outcome reporting.Study TypeRetrospective case series.MethodsA multi‐institutional database was generated from cases performed between 2011 and 2019. Preoperative and postoperative hearing thresholds were recorded alongside potential ear environment risk factors. Multiple variable linear regression statistical analyses of risk factors were applied to determine independent association with postoperative pure tone average air‐bone gap (PTA‐ABG). Significant factors were used to generate a statistically‐weighted grading scale of Ear Environment Risk (EER).Results1679 cases had a mean follow‐up time of 33.6 months (SD 36.3) and a mean postoperative PTA‐ABG of 21.2 (SD 12.8). Multiple revision status (p < 0.001), presence of canal wall down mastoidectomy cavity (p = 0.020), absent malleus (p < 0.001), absent stapes superstructure (p = 0.016), frequent otorrhea (p = 0.008), pediatric age (p < 0.001), and blunted/lateralized tympanic membrane (p = 0.003) were independently correlated with PTA‐ABG. These factors were incorporated into an EER Scoring System with four distinct risk groups wherein each risk group was significantly correlated with PTA‐ABG, and this grading system was better correlated with PTA‐ABG (Kendall's τ = 0.193) than other existing published grading scales.ConclusionGrading environment risk according to a novel EER scoring system generates meaningful risk groupings that correlate with ossiculoplasty postoperative PTA‐ABG, and this holds potential to frame reporting of hearing outcomes for future ossiculoplasty research.Level of Evidence3 Laryngoscope, 135:S1–S11, 2025

The restoration of sufficient overall lumbar lordosis (LL) and segmental LL (SL) is associated with achieving optimal sagittal balance, decreasing back pain, and enhancing functional outcomes for patients. Expandable cages were developed in hopes of improving radiographic parameters and clinical outcomes, although current clinical evidence is inconclusive. Here, the authors aimed to evaluate the clinical and radiographic outcomes in patients undergoing one- or two-level open transforaminal lumbar interbody fusion (TLIF) with expandable versus static cage placement, using propensity-matched cohorts. An institutional retrospective cohort of patients who underwent one- or two-level open TLIF with either expandable cage or static cage placement was identified. Using relevant preoperative covariates, including age, primary versus revision operation, number of cages implanted, and surgical level implanted, the authors built propensity-matched cohorts. They identified clinical outcomes in both cohorts, including operative characteristics and complication rates, along with pain, weakness, and sensory deficits over follow-up. Furthermore, they extracted and examined preoperative, postoperative, and last follow-up radiographic parameters. A total of 148 patients were included, and they were followed for a mean of 1.7 years (range 0.5-4.3 years). Propensity matching was used to create cohorts of patients who were similar with respect to age, surgical indication, revision status, number of cages implanted, surgical level implanted, and length of follow-up. Patients in both groups had similar preoperative radiographic parameters. Patients with expandable cages saw larger increases in SL, both postoperatively (5.3° ± 7.5° vs 1.6° ± 5.6°, p = 0.006) and at last follow-up (5.7° ± 7.4° vs 1.0° ± 6.1°, p = 0.003). They also saw significant improvements in pelvic incidence minus LL mismatch at last follow-up (-4.4° ± 13.2° vs 5.8° ± 13.8°, p = 0.009). No differences in intraoperative or perioperative complications were found, but patients with expandable cages were less likely to require readmission, develop adjacent-segment disease, or require revision surgery. They were also more likely to be symptom free at 1 month after surgery and at last follow-up. Expandable cages lead to better restoration of radiographic features, including SL and improvements in clinical outcomes, compared with static cages in propensity-matched cohorts in patients undergoing one- or two-level open TLIFs.

Some patients treated surgically for grade 1 spondylolisthesis require revision surgery. Outcomes after revision surgery are not well studied. The objective of this study was to determine how revision surgery impacts patient-reported outcomes (PROs) in patients undergoing decompression only or decompression and fusion (D+F) for grade 1 spondylolisthesis within 5 years of the index surgery. Patients in the 12 highest Quality Outcomes Database (QOD) enrolling sites with a diagnosis of grade 1 spondylolisthesis were identified and the incidence of revision surgery between the decompression-only and D+F patients were compared. PROs were compared between cohorts requiring revision surgery versus a single index procedure. Of 608 patients enrolled, 409 had complete 5-year data available for this study. Eleven (13.3%) of 83 patients underwent revision in the decompression-only group as well as 32 (9.8%) of 326 in the D+F group. For the entire cohort, patients requiring revision had significantly worse PROs at 5 years: Oswestry Disability Index (ODI) 27.4 versus 19.4, p = 0.008; numeric rating scale for back pain (NRS-BP) 4.1 versus 3.0, p = 0.013; and NRS for leg pain (NRS-LP) 3.4 versus 2.1, p = 0.029. In the decompression-only group, the change in 5-year PROs was not impacted by revision status: ODI 31.9 versus 24.2, p = 0.287; NRS-BP 1.9 versus 2.9, p = 0.325; and NRS-LP 6.2 versus 3.7, p = 0.011. In the D+F group, the change in 5-year PROs was diminished if patients required revision: ODI 19.1 versus 29.1, p = 0.001; NRS-BP 3.0 versus 4.0, p = 0.170; and NRS-LP 2.3 versus 4.6, p = 0.001. The most common reasons for reoperation within 5 years in the decompression-only group were repeat decompression and instability, whereas in the D+F group the most common reason was adjacent-segment disease. The need for revision resulted in modestly diminished benefit compared with patients with no revisions. These differences were greater in the fusion cohort compared with the decompression-only cohort. The mean PRO improvement still far exceeded minimal clinically important difference thresholds for all measures for patients who underwent a revision surgery.

Primary Hip Arthroscopy Is Associated With Earlier Achievement of Substantial Clinical Benefit Compared With Revision Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Background: Although hip arthroscopy has been shown to have beneficial outcomes, there is a paucity of literature examining predictive factors of 10-year clinical outcomes. Purpose: (1) To identify predictive factors of 10-year outcomes of hip arthroscopy and (2) to compare these factors with those found in 2-year and 5-year studies. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing hip arthroscopy between February 2008 and June 2012. Patients were included if they had a minimum 10-year follow-up on 2 patient-reported outcome measures: Nonarthritic Hip Score (NAHS) and modified Harris Hip Score. Exclusion criteria included previous ipsilateral hip conditions. Using bivariate and multivariate analyses, that authors analyzed the effects of 37 pre- and intraoperative variables on the NAHS, modified Harris Hip Score, and conversion to total hip arthroplasty. Results: Of the 883 patients who met the inclusion criteria, 734 (83.1%) had follow-up data. The mean follow-up time was 124.4 months (range, 120.0-153.1 months). Six variables were significant predictors of NAHS in both multivariate and bivariate analyses: revision status, body mass index (BMI), duration of symptoms, preoperative NAHS, age at onset of symptoms, and need for acetabular microfracture. Positive predictors of 10-year survivorship included acute injury and gluteus medius repair, while negative predictors included revision arthroscopy, Tönnis grade, acetabular inclination, iliopsoas fractional lengthening, and notchplasty Conclusion: Multiple predictive factors including age, BMI, revision status, and preoperative outcome scores were identified for long-term survivorship and functional outcomes. These may prove useful to clinicians in refining indications and guiding patients on expected outcomes of hip arthroscopy.

Workflow for cortical bone trajectory (CBT) screws includes tapping line-to-line or under tapping by 1mm. We describe a non-tapping, two-step workflow for CBT screw placement, and compare the safety profile and time savings to the Tap (three-step) workflow. Patients undergoing robotic assisted 1-3 level posterior fusion with CBT screws for degenerative conditions were identified and separated into either a No-Tap or Tap workflow. Number of total screws, screw-related complications, estimated blood loss, operative time, robotic time, and return to the operating room were collected and analyzed. There were 91 cases (458 screws) in the No-Tap and 88 cases (466 screws) in the Tap groups, with no difference in demographics, revision status, ASA grade, approach, number of levels fused or diagnosis between cohorts. Total robotic time was lower in the No-Tap (26.7min) versus the Tap group (30.3min, p = 0.053). There was no difference in the number of malpositioned screws identified intraoperatively (10 vs 6, p = 0.427), screws converted to freehand (3 vs 3, p = 0.699), or screws abandoned (3 vs 2, p = 1.000). No pedicle/pars fracture or fixation failure was seen in the No-Tap cohort and one in the Tap cohort (p = 1.00). No patients in either cohort were returned to OR for malpositioned screws. This study showed that the No-Tap screw insertion workflow for robot-assisted CBT reduces robotic time without increasing complications.

OBJECTIVES/GOALS: To examine the individual and combined association between preoperative sleep disturbance (SD) and depression and 12-month disability, back pain, and leg pain after lumbar spine surgery (LSS). METHODS/STUDY POPULATION: We analyzed prospectively collected multi-center registry data from 700 patients undergoing LSS (mean age=60.9 years, 37% female, 89% white). Preoperative SD and depression were assessed with PROMIS measures. Established thresholds defined patients with moderate/severe symptoms. Disability (Oswestry Disability Index) and back and leg pain (Numeric Rating Scales) were assessed preoperatively and at 12 months. We conducted separate regressions to examine the influence of SD and depression on each outcome. Regressions examined each factor with and without accounting for the other and in combination as a 4-level variable. Covariates included age, sex, race, education, insurance, body mass index, smoking status, preoperative opioid use, fusion status, revision status, and preoperative outcome score. RESULTS/ANTICIPATED RESULTS: One hundred thirteen (17%) patients reported moderate/severe SD alone, 70 (10%) reported moderate/severe depression alone, and 57 (8%) reported both moderate/severe SD and depression. In independent models, preoperative SD and depression were significantly associated with 12-month outcomes (all p’s<0.05). After accounting for depression, preoperative SD was only associated with disability, while preoperative depression adjusting for SD remained associated with all outcomes (all p’s<0.05). Patients reporting both moderate/severe SD and moderate/severe depression had 12.6 points higher disability (95%CI=7.4 to 17.8) and 1.5 points higher back (95%CI=0.8 to 2.3) and leg pain (95%CI=0.7 to 2.3) compared to patients with no/mild SD and no/mild depression. DISCUSSION/SIGNIFICANCE: Preoperative SD and depression are independent predictors of 12-month disability and pain when considered in isolation. The combination of SD and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe SD and depression could benefit from targeted treatment strategies.

Patients actively smoking at the time of primary hip or knee arthroplasty are at increased risk of direct perioperative complications. We investigated the association between smoking status and risk of revision and mortality within 2 years following hip or knee arthroplasty. We used prospectively collected data from the Dutch Arthroplasty Register. All primary total hip arthroplasties (THAs), total knee arthroplasties (TKAs), and unicondylar knee arthroplasties (UKAs) with > 2 years' follow-up were included (THA: n = 140,336; TKA: n = 117,497; UKA: n = 14,807). We performed multivariable Cox regression analyses to calculate hazard risks for differences between smokers and non-smokers, while adjusting for confounders (aHR). The smoking group had higher risk of revision (THA: aHR 1.3, 95% confidence interval [CI] 1.1-1.4 and TKA: aHR 1.4, CI 1.3-1.6) and risk of mortality (THA: aHR 1.4, CI 1.3-1.6 and TKA: aHR 1.4, CI 1.2-1.6). Following UKA, smokers had a higher risk of mortality (aHR 1.7, CI 1.0-2.8), but no differences in risk of revision were observed. The smoking group had a higher risk of revision for infection following TKA (aHR 1.3, CI 1.0-1.6), but not following THA (aHR 1.0, CI 0.8-1.2). This study showed that the risk of revision and mortality is higher for smokers than for non-smokers in the first 2 years following THA and TKA. Smoking could contribute to complications following primary hip or knee arthroplasty.