Risk Factors For Revision Surgery Research Articles

Does high activity after total and unicompartmental knee arthroplasty increase the risk for aseptic revision?

It has been suggested that high activity might negatively impact implant survival following total and unicompartmental knee arthroplasty (TKA/UKA) and many surgeons advise their patients to only participate in moderate level sport activities. To date, it remains unclear whether such restraints are necessary to assure longevity of the implants. We conducted a retrospective study on 1906 knees (1745 TKA, 161 UKA) in 1636 patients aged 45-75years who underwent primary arthroplasty for primary osteoarthritis. Lower extremity activity scale (LEAS) at a two year follow-up was assessed to define the activity level. Cases were grouped in low (LEAS ≤ 6), moderate (LEAS 7-13) and high activity (LEAS ≥ 14). Cohorts were compared with Kruskal-Wallis- or Pearson-Chi2-Test. Univariate logistic regression was conducted to test for association between activity level at two years and later revisions. Odds ratio was reported and converted to predicted probability. A Kaplan-Meier curve was plotted to predict implant survival. The predicted implant survival for UKA was 100.0% at twoyears and 98.1% at fiveyears. The predicted implant survival for TKA was 99.8% at twoyears, 98.1% at fiveyears. The difference was not significant (p = 0.410). 2.5% of the UKA underwent revision, one knee in the low and threeknees in the moderate activity group, differences between the moderate and high activity group were not significant (p = 0.292). The revision rate in the high activity TKA group was lower than in the low and moderate activity groups (p = 0.008). A higher LEAS twoyears after surgery was associated with a lower risk for future revision (p = 0.001). A one-point increase in LEAS twoyears after surgery lowered the odds for undergoing revision surgery by 19%. The study suggests that participating in sports activity following both UKA and TKA is safe and not a risk factor for revision surgery at a mid-term follow-up. Patients should not be prevented from an active lifestyle following knee replacement.

Predictors of residual disease following pediatric thyroglossal duct cyst excision

ObjectivesResidual thyroglossal duct cyst (TGDC) following surgical excision is not uncommon. This study aimed to search for risk factors for residual disease that either required revision surgery or were resolved with only conservative treatment and follow up. MethodsA retrospective study of consecutive children who underwent surgical excision for thyroglossal duct cysts between 2008 and 2021 at Schneider Children's Medical Center of Israel, a tertiary referral center in Israel. ResultsOut of 102 children, 54 (53 %) had an uneventful recovery, 32 (31 %) had post-operative complications which were managed without revision surgery, and 16 (16 %) underwent revision surgery. A comparison of the three groups showed that children who had early post-operative complications (up to one month) were more likely to respond to conservative treatment (57 %). In contrast children with late complications had a higher probability (59 %) of undergoing revision surgery. The presence of a pre-operative cutaneous fistula was significantly associated with revision surgery (p = 0.012). In addition, children with no prior history of neck infection were more likely to have an uneventful recovery (p = 0.005). ConclusionsTGDC disease has a wide range of clinical presentations both before and after surgery. A significant percentage of children with persistent post-operative symptoms may resolve without revision surgery. The presence of a pre-operative cutaneous fistula and late post-operative complications are the main risk factors for revision surgery.

Diagnostic and Invasive Colonoscopy Are Not Risk Factors for Revision Surgery Due to Periprosthetic Joint Infection

BackgroundColonoscopy is routinely performed for colorectal cancer screening in patients who have a preexisting unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) prostheses. However, colonoscopy is theorized to provoke transient bacteremia, providing a potential nidus for periprosthetic joint infection. This study aimed to investigate the risk of aseptic and septic revision surgery in patients who underwent diagnostic colonoscopy or invasive colonoscopy within one year following UKA, TKA, or THA. MethodsA retrospective cohort analysis was performed using a national database. Patients were identified using Current Procedural Terminology. In total, 52,891 patients underwent UKA, 1,049,218 underwent TKA, and 526,296 underwent THA. Data were analyzed with univariate analysis preceding multivariable logistic regressions to investigate outcomes of interest at 2 and 3 years from the index procedure. ResultsDiagnostic colonoscopy resulted in no increase in odds of all-cause or septic revision surgery for any prostheses. At both time points, invasive colonoscopy resulted in lower odds of all-cause revision (P < .05) for patients with UKA, decreased odds of septic revision (P < .001) for patients with TKA, and decreased odds of both all-cause and septic revision (P < .05) for patients with THA. ConclusionOur results show that diagnostic colonoscopy was not a significant risk factor for revision following UKA, TKA, or THA. Paradoxically, invasive colonoscopy was protective against revision, even with very minimal use of antibiotic prophylaxis observed. This study addresses the theory that colonoscopy procedures may threaten an existing joint prosthesis via transient bacteremia and shows no increase in revision outcomes following colonoscopy. Level of EvidenceLevel III.

Predictive factors of revision endoscopic sinus surgery.

Despite endoscopic sinus surgery (ESS) being the standard best treatment for chronic rhinosinusitis with nasal polyps (CRSwNP), there still remains a high recurrence rate of nasal polyps after ESS. The aim of this study was to analyze the impact of ESS in the treatment of CRSwNP and identify possible predictors for revision surgery. We conducted a cross-sectional retrospective study of patients with CRSwNP submitted to ESS between the years 2013 and 2021. We analyzed 517 cases, of which 15.1% were submitted to revision ESS. The presence of hyposmia/anosmia, asthma, intolerance/allergy to non-steroid inflammatory drugs, non-steroidal anti-inflammatory drug exacerbated respiratory disease, and bilateral polyposis were more frequent in patients who needed revision surgery. Initial values of peripheral eosinophilia and Lund-Mackay scores were significantly higher in this sub-group of patients. Lund-Mackay score was the only independent risk factor for revision surgery. Factors like peripheral eosinophilia and Lund-Mackay score were associated with a higher probability of revision ESS. Applying these concepts to the clinical practice could help predict the evolution of patient's pathology in the post-operative period and identify in advance those cases that may need a multidisciplinary approach.

The Sauvé-Kapandji procedure for post-traumatic distal radio-ulnar arthrosis: Long-term results and analysis of risks factors for revision surgery

IntroductionThe Sauvé-Kapandji (SKp) procedure is a frequently used surgery for the management of post-traumatic sequelae of the distal radio-ulnar joint (DRU). Series evaluating long-term outcomes and the risk of complications are rare. The main objective was to describe the long-term clinical and radiographic results after SKp performed in a post-traumatic context. The secondary objectives were to identify postoperative complications, surgical revisions, and their risk factors for occurrence. Our hypothesis was that although SKp confers good clinical results, identifiable risk factors for complications exist. Patients and methodsThis monocentric retrospective study included all patients for whom an SKp was performed in a post-traumatic context from 2008 to 2018. Pain, satisfaction, range of motion and pre- and postoperative radiographic measurements were recorded. All complications were sought and described, as well as surgical revisions. Several variables were analysed to identify risk factors for revision surgery after SKp: age, sex, initial traumatic mechanism, initial non-surgical or surgical treatment and type of surgery, time until revision surgery with SKp after the initial trauma. ResultsThirty-seven patients were included. At a median follow-up of 9.5 years (min 7.3–max 11.5), 22 patients (60%) had a VAS of 0. Range of motion was significantly improved for all the patients (p<0.001). Seventeen (46%) patients had a complication, including 5 (13.4%) cases of ossification, 4 (10.8%) cases of discomfort related to the hardware and 4 (10.8%) painful instability at the proximal ulnar stump. Thirteen (35%) patients required revision surgery. Two risk factors for revision surgery after SKp were found: time period between initial treatment and SKp of less than 7.2 months and an age of less than 53.5 years; the combination of the two factors having a sensitivity of 97.5 and a specificity of 56.7. ConclusionSKp in a post-traumatic context significantly improved range of motion and allowed pain control at long follow-up. Revision surgery seemed more frequent in patients under 53.5 years of age and when SKp was performed less than 7.2 months after the initial trauma. Level of evidenceIV, retrospective study.

Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Adolescents Improves Outcomes and Clinical Benefit Achievement Rates at Short-Term Follow-Up: A Multicenter Analysis

To report minimum 2-year follow-up patient-reported outcome scores (PROs) and rates of achieving the minimal clinically important difference (MCID), the patient-acceptable symptomatic state (PASS), and the maximal outcome improvement (MOI) on adolescents following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Second, to determine risk factors for revision surgery. Prospectively collected data from two high-volume hip arthroscopy centers were retrospectively reviewed on adolescents (≤19 years old) who underwent primary hip arthroscopy between November 2008 and February 2019. Adolescents with a minimum 2-year follow-up for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS) for pain were included regardless of their growth plate status. Exclusion criteria were Tönnis grade >1, lateral center edge-angle <18°, and previous ipsilateral hip surgery or conditions. Preoperative and postoperative radiographic data, MCID, PASS, MOI, secondary surgeries, and complications were reported. A multivariable survival analysis for risk factors for secondary surgery was conducted. A total of 287 hips (249 patients) were included (74.9% females). The mean values for age, body mass index, and follow-up were 16.3 ± 1.3 years, 22.3 ± 3.5, and 26.6 ± 9.4 months, respectively. Further, 88.9% underwent labral repair, 81.5% femoroplasty, and 85.4% capsular closure. Improvement for all PROs was reported (P < .001) with high patient satisfaction (8.8 ± 1.5). Achievement for the MCID was 71.7%, 83.0%, 68.1%, and 79.5% for the mHHS, NAHS, HOS-SSS, and iHOT-12, respectively. Achievement for the PASS was 68.3% for the mHHS and 73.2% for the NAHS. The MOI for mHHS, NAHS, and VAS was 58.3%, 77.0%, and 59.6%, respectively. Rates of revision hip arthroscopy, cam recurrence, and heterotopic ossification were 5.8%, 1.7%, and 5.5%, respectively. Acetabular retroversion was found to be a risk factor for revision surgery (P= .03). The results of this multi-center study demonstrated that adolescents who underwent primary hip arthroscopy for FAIS reported significant improvement in all PROs, with satisfactory achievement rates for the MCID, PASS, MOI, and high patient satisfaction at a minimum 2-year follow-up. IV, retrospective multicenter study.

Revision Rates and Associated Risk Factors after Shoulder Arthroplasty.

This study aims at answering the following questions (1) How high is the revision rate after osteoarthritis-, and rotator cuff-related compared to proximal humerus fracture (PHF)-related shoulder arthroplasty? (2) What are the associated risk factors for a revision after shoulder arthroplasty? Shoulder arthroplasty procedures occurring between 1 January 2009 and 31 December 2019 were identified from the Medicare database. First, revision rates for PHF patients and age- and sex-matched non-fracture patients, grouped into osteoarthritis-related and rotator cuff-related arthroplasty, were compared. Second, revision rates between total shoulder arthroplasty and hemiarthroplasty after PHF were compared. Semiparametric Cox regression was applied, incorporating 23 demographic, clinical, and socioeconomic covariates, to investigate risk factors for revision surgery. Between the considered time period from 2009 through 2019, a total number of 47,979 PHFs was identified. A shoulder arthroplasty procedure was performed in n = 2639 (5.5%, 95%CI: 4.8-6.1) of the cases. The five-year survivorship of the implant was 96.3 (95%CI: 93.8-97.9) after hemiarthroplasty and 96.1% (05%CI: 94.2-97.3) after total shoulder arthroplasty. To compare the revision rates, n = 14,775 patients with osteoarthritis and n = 4268 patients with rotator cuff arthropathy, who received a shoulder arthroplasty, served as a non-fracture control group. Patients receiving a rotator cuff-related arthroplasty were more likely to require a revision compared to patients treated for osteoarthritis (HR: 1.27, 95%CI: 1.04-1.44, p = 0.018). Identified significant risk factors for revision surgery after shoulder arthroplasty included age ≤ 75 years, male sex, and osteoporosis. High implant survival was found for hemiarthroplasty and total shoulder arthroplasty for the treatment of PHF in elderly patients. The risk of revision surgery was elevated in patients receiving a rotator cuff-related arthroplasty as well as in patients with osteoporosis, male patients and patients older than 75 years.

Risk factors for revision surgery in operative treatment of traumatic injuries of the olecranon and prepatellar bursa

IntroductionTraumatic lacerations of the prepatellar (PB) and olecranon bursa (OB) are common injuries. The aim of this study was to gain descriptive data and to identify risk factors associated with complications that made revision surgery after primary bursectomy necessary.Material and methodsIn this retrospective monocentric study at a level I trauma center, all patients with traumatic lacerations of the PB or OB who were treated with primary surgical bursectomy from 2015 to 2020 were analyzed.Results150 consecutive patients were included. In 44% of cases, the PB was affected (n = 66), in 56% the OB (n = 84). The reoperation rate after surgical bursectomy was 10.7% (n = 16). The main cause of reoperation was wound infection (50%; n = 8). The most common pathogen of postoperative infections was Staphylococcus aureus (87.5%). Several comorbidities have been identified as risk factors for reoperation after primary surgical bursectomy, such as heart diseases, arterial hypertension, the use of antihypertensives and anticoagulation. In contrast, surgical expertise, use of drains, postoperative immobilization, and postoperative antibiotics had no statistically significant effect. A significantly higher postoperative infection rate (17.6%) was observed in patients who were operated more than 48 h after initial trauma.ConclusionsGiven the limited recommendations for therapy of these common injuries, further investigations should focus on standardized therapeutic options for lacerations of the PB or OB. Delayed surgical interventions after trauma were associated with higher complication rates. Therefore, urgent surgery within 48 h after trauma may help to prevent revisions.Level of evidenceLevel of evidence IV.

Revision Surgery Due to Proximal Junctional Failure and Rod Fracture in Adult Deformity Surgery at a Single Institution in Japan.

Proximal junctional failure (PJF) and rod fracture (RF) are the primary reasons for revision surgery after a long corrective fusion for the adult spinal deformity (ASD). However, many recent studies on ASD are multicenter studies from the US and European racial characteristics may differ from those of Asians. Therefore, the risk factors for revision surgery because of PJF and RF after ASD surgery were evaluated in Japanese patients. Patients with ASD who underwent corrective surgery from the thoracic vertebrae to the ilium at the authors' institution were reviewed. Demographic, surgical, and radiographic parameters were included in the analysis. Univariate and multivariate regression models were used to analyze the risk factors for PJF and RF. Two hundred and fifty-nine patients were included in the study. A total of 73 patients (28.1%) required revision surgery because of mechanical complications and 15 patients (5.7%) required revision surgery because of PJF on average 380 days after surgery. In PJF cases, body mass index (BMI) and pelvic tilt were significantly higher (p=0.01, p=0.048, respectively). BMI was an independent risk factor for revision owing to PJF (odds ratio [OR], 1.16; p=0.013). A total of 49 patients (18.9%) required revision owing to RF on average 867 days after surgery. Three-column osteotomy (p<0.001), significant blood loss (p=0.048), number of fusion segments (p=0.023), absence of lateral lumbar interbody fusion (p<0.001), and sagittal imbalance (p=0.033) were risk factors for revision surgery owing to RF in the univariate analysis. Three-column osteotomy (OR 4.41; p<0.001) and number of fusion segments (OR 1.21; p<0.009) were independent factors for revision surgery owing to RF. PJF occurred in a relatively early phase (approximately 1 year) after surgery in patients with ASD with high BMI. Conversely, RF occurred approximately 2.5 years after surgery in three-column osteotomy and spinal fusion cases that involvedlonger fusion range.

Incidence, Timing, and Risk Factors for 5-Year Revision Surgery After Autologous Chondrocyte Implantation in 533 Patients

Background: Autologous chondrocyte implantation (ACI) can be used to treat focal, full-thickness chondral defects of the knee. However, there is limited large-sample evidence available regarding the incidence, timing, and risk factors for revision surgery after ACI. Purpose: To assess the 5-year incidence, timing, and risk factors for revision surgery after ACI in a large national cohort. Study Design: Case series; Level of evidence, 4. Methods: The 2010-2020 PearlDiver database was queried for patients aged 20 to 59 years who underwent primary ACI of the knee without previous chondral procedures or knee arthroplasty. Revision surgery was defined as subsequent revision ACI, osteochondral allograft transplantation, osteochondral autograft transfer, unicompartmental knee arthroplasty, or total knee arthroplasty within 5 years. Kaplan-Meier analysis was used to assess both incidence and timing of revision surgery. Risk factors evaluated for revision surgery included patient age, sex, body mass index (BMI), Elixhauser Comorbidity Index (ECI) score, and previous or concomitant bony realignment procedures. Results: In total, 533 patients underwent primary ACI and met inclusion criteria. The 5-year incidence of revision surgery was 10.3%, with 63% of revisions occurring in the first 2 years after surgery. Risk factors associated with revision surgery included female sex (odds ratio, 2.58; 95% CI, 1.22-5.45; P = .013) and BMI ≥35 (odds ratio, 2.24; 95% CI, 1.01-4.94; P = .047). There was no relationship between age, ECI score, or previous or concomitant bony realignment procedures and revision surgery at 5 years (P > .05). Conclusion: In an analysis of 533 patients who underwent ACI, 10.3% required a subsequent articular cartilage procedure or conversion to knee arthroplasty in the first 5 postoperative years. Revision surgery was greatest in the first 2 postoperative years. Female sex and severe obesity (BMI, ≥35) were associated with increased risk of revision surgery, while age, ECI score, and previous or concomitant bony realignment procedures were not. These findings suggest that treatment of chondral defects of the knee with ACI is associated with durable outcomes at the 5-year follow-up.

Risk factors for revision surgery due to dislocation within 1 year after 111,711 primary total hip arthroplasties from 2005 to 2019: a study from the Norwegian Arthroplasty Register.

Background and purposeDislocation of a hip prosthesis is the 3rd most frequent cause (after loosening and infection) for hip revision in Norway. Recently there has been a shift in surgical practice including preferred head size, surgical approach, articulation, and fixation. We explored factors associated with the risk of revision due to dislocation within 1 year and analyzed the impact of changes in surgical practice.Patients and methods111,711 cases of primary total hip arthroplasty (THA) from the Norwegian Arthroplasty Register were included (2005–2019) after primary THA with either 28 mm, 32 mm, or 36 mm femoral heads, or dual-mobility articulations. A flexible parametric survival model was used to calculate hazard ratios for risk factors. Kaplan–Meier survival rates were calculated.ResultsThere was an increased risk of revision due to dislocation with 28 mm femoral heads (HR 2.6, 95% CI 2.0–3.3) compared with 32 mm heads. Furthermore, there was a reduced risk of cemented fixation (HR 0.6, CI 0.5–0.8) and reverse hybrid (HR 0.6, CI 0.5–0.8) compared with uncemented. Also, both anterolateral (HR 0.5, CI 0.4–0.7) and lateral (HR 0.6, CI 0.5–0.7) approaches were associated with a reduced risk compared with the posterior approach. The time-period 2010–2014 had the lowest risk of revision due to dislocation. The trend during the study period was towards using larger head sizes, a posterior approach, and uncemented fixation for primary THA.InterpretationPatients with 28 mm head size, a posterior approach, or uncemented fixation had an increased risk of revision due to dislocation within 1 year after primary THA. The shift from lateral to posterior approach and more uncemented fixation was a plausible explanation for the increased risk of revision due to dislocation observed in the most recent time-period. The increased risk of revision due to dislocation was not fully compensated for by increasing femoral head size from 28 to 32 mm.

Assessment of Outcomes After Multisurface Osteochondral Allograft Transplantations in the Knee.

Background:Treatment of multisurface articular cartilage lesions of the knee is a challenging problem.Hypothesis:Large multisurface cartilage defects in the knee can be successfully managed with transplantation of high chondrocyte viability osteochondral allografts (OCAs) to result in statistically significant improvements in patient-reported outcome measures of pain and function.Study Design:Cohort study; Level of evidence, 3.Methods:Patients were prospectively enrolled into a registry to follow outcomes after OCA transplantation. The study included patients who received OCA transplantation for multisurface unipolar defects in 1 knee and had minimum 2-year follow-up data, including patient-reported outcome measures, failures, reoperations, and complications. The OCA transplants had been stored using 2 methods: standard preservation (SP) or Missouri Osteochondral Preservation System (MOPS). Preoperative data were compared with outcomes at 1 year and final follow-up, and risk factors for revision surgery or failure (total knee arthroplasty) were analyzed.Results:The sample included 25 patients with a mean age of 37.2 years (range, 13-51 years), body mass index of 27.7 (range, 18-38), and follow-up of 45.1 months (median, 49 months; range, 24-68 months). OCAs stored using SP were transplanted into 6 patients, and those stored using MOPS were transplanted into 19 patients. The initial success rate was significantly higher for MOPS OCAs (94.7%) than SP OCAs (33.3%). There were statistically significant improvements in all patient-reported outcomes at 1 year and final follow-up in the MOPS cohort (P < .0001 for all). Revision surgery/failure was significantly associated with patients who were nonadherent to the prescribed postoperative restrictions and rehabilitation protocols (P = .038; odds ratio = 13.5) and with OCAs that had a viable chondrocyte density <70% of the established reference range mean at transplantation (P = .0037; odds ratio = 76).Conclusion:OCA transplantation for treatment of large multisurface cartilage defects in the knee resulted in a 94.7% initial success rate when grafts with high viable chondrocyte density (≥70%) were used and when patients strictly adhered to prescribed postoperative rehabilitation protocols. Successful outcomes were associated with statistically significant improvements in patient-reported outcome measures of pain and function.

Achilles Tendon Repairs: Identification of Risk Factors for and Economic Impact of Complications and Reoperation.

Compared with nonoperative management, Achilles tendon repair is associated with increased rates of complications and increased initial healthcare cost. However, data are currently lacking on the risk factors for these complications and the added healthcare cost associated with common preoperative comorbidities. Identify the independent risk factors for complications and reoperation after acute Achilles tendon repair and calculate the added cost of care associated with having each preoperative risk factor. Retrospective cohort study. Level 3. A retrospective review of a large commercial claims database was performed to identify patients who underwent primary operative management for Achilles tendon rupture between 2007 and 2016. The primary outcome measures of the study were risk factors for (1) postoperative complications, (2) revision surgery, and (3) increased healthcare resource utilization. A total of 50,279 patients were included. The overall complication rate was 2.7%. The most common 30-day complication was venous thromboembolism (1.2%). The rate of revision surgery was 2.5% at 30 days and 4.3% at 2 years. Independent risk factors for 30-day complications in our cohort included increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Independent risk factors for revision surgery within 2 years included female sex, tobacco use, hypertension, obesity, and the presence of any postoperative complication. The average 5-year cost of operative intervention was $17,307. The need for revision surgery had the largest effect on 5-year overall cost, increasing it by $6776.40. This was followed by the presence of a postoperative complication ($3780), female sex ($3207.70), and diabetes ($3105). Achilles tendon repair is a relatively low-risk operation. Factors associated with postoperative complications include increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Factors associated with the need for revision surgery include female sex, hypertension, obesity, and the presence of any postoperative complication. Female sex, diabetes, the presence of any complication, and the need for revision surgery had the largest added costs associated with them. Surgeons can use this information for preoperative decision-making and during the informed consent process.

To Cross the Cervicothoracic Junction? Terminating Posterior Cervical Fusion Constructs Proximal to the Cervicothoracic Junction Does Not Impart Increased Risk of Reoperation in Patients With Cervical Spondylotic Myelopathy.

Retrospective cohort study. To evaluate the effect of caudal instrumentation level on revision rates following posterior cervical laminectomy and fusion. A retrospective review of a prospectively collected database was performed. Minimum follow-up was one year. Patients were divided into two groups based on the caudal level of their index fusion construct (Group 1-cervical and Group 2- thoracic). Reoperation rates were compared between the two groups, and preoperative demographics and radiographic parameters were compared between patients who required revision and those who did not. Multivariate binomial regression analysis was performed to determine independent risk factors for revision surgery. One hundred thirty-seven (137/204) patients received fusion constructs that terminated at C7 (Group 1), while 67 (67/204) received fusion constructs that terminated at T1 or T2 (Group 2). The revision rate was 8.33% in the combined cohort, 7.3% in Group 1, and 10.4% in Group 2. There was no significant difference in revision rates between the 2 groups (P = .43). Multivariate regression analysis did not identify any independent risk factors for revision surgery. This study shows no evidence of increased risk of revision in patients with fusion constructs terminating in the cervical spine when compared to patients with constructs crossing the cervicothoracic junction. These findings support terminating the fusion construct proximal to the cervicothoracic junction when indicated. III.

Artificial Neural Networks Can Predict Early Failure of Cementless Total Hip Arthroplasty in Patients With Osteoporosis.

Total hip arthroplasty (THA) done in the aging population is associated with osteoporosis-related complications. The altered bone density in osteoporotic patients is a risk factor for revision surgery. This study aimed to develop and validate machine learning (ML) models to predict revision surgery in patients with osteoporosis after primary noncemented THA. We retrospectively reviewed a consecutive series of 350 patients with osteoporosis (T-score less than or equal to -2.5) who underwent primary noncemented THA at a tertiary referral center. All patients had a minimum 2-year follow-up (range: 2.1 to 5.6). Four ML algorithms were developed to predict the probability of revision surgery, and these were assessed by discrimination, calibration, and decision curve analysis. The overall incidence of revision surgery was 5.2% at a mean follow-up of 3.7 years after primary noncemented THA in osteoporotic patients. Revision THA was done because of periprosthetic fracture in nine patients (50%), aseptic loosening/subsidence in five patients (28%), periprosthetic joint infection in two patients (11%) and dislocation in two patients (11%). The strongest predictors for revision surgery in patients after primary noncemented THA were female sex, BMI (>35 kg/m2), age (>70 years), American Society of Anesthesiology score (≥3), and T-score. All four ML models demonstrated good model performance across discrimination (AUC range: 0.78 to 0.81), calibration, and decision curve analysis. The ML models presented in this study demonstrated high accuracy for the prediction of revision surgery in osteoporotic patients after primary noncemented THA. The presented ML models have the potential to be used by orthopaedic surgeons for preoperative patient counseling and optimization to improve the outcomes of primary noncemented THA in osteoporotic patients.

Identifying Risk Factors for Recurrence After Cubital Tunnel Release

This study investigated specific risk factors for recurrent surgery of ulnar nerve entrapment (ie, ipsilateral clinical symptoms within 5 years after initial cubital tunnel release [CuTR]) in a large cohort. We hypothesized that recurrence is associated with lifestyle variables (eg, smoking, drinking alcohol, a high body mass index [BMI]) or comorbidities). A retrospective cohort study was performed using the Current Procedural Terminology codes for all patients who underwent CuTR between January 2012 and November 2018. Demographic data, including sex, age, weight, height, BMI, comorbidities, smoking, and alcohol consumption, were collected. The primary outcome was the need for revision surgery after initial CuTR. Univariate and multivariate analyses were performed to identify potential risk factors for revision surgery. Of the 678 patients who underwent CuTR, 120 patients (18%) needed revision surgery within 5 years. Sixty-six patients required subfascial transposition (55%) and 47 patients (39%) received in situ releases. Also, sex, BMI, smoking, alcohol consumption, and comorbidities (except for spinal disc herniation) were similar between the primary and revision subgroup. Age at first occurrence was significantly lower in the revision group (48 years for revision vs 52 years for primary surgery). Moreover, cervical spinal disc herniation was associated with revision surgery (13% vs 6% in the primary group). Age and medical history of cervical spinal disc herniation are associated with an increased risk of revision surgery. More importantly, BMI, smoking, alcohol consumption, and other comorbidities are not associated with increased risk of revision surgery within our sample. Prognostic IV.

Surgical treatment and outcome of posterior fossa arachnoid cysts in infants.

The aim of this cohort study was to describe and analyze the surgical treatment and outcome of posterior fossa arachnoid cysts (PFACs) in infants. Patients presenting with a PFAC at infancy or prenatally, between the years 2000 and 2019, and who were surgically treated before the age of 2 years, were included in this study. Patient data were retrospectively collected including baseline characteristics and surgical variables. Factors related to revision surgery were analyzed through uni- and multivariate analysis. Thirty-five patients, of whom 54.3% were male, were included. The cyst was diagnosed prenatally in 23 patients (65.7%). Surgery was typically recommended after a mean cyst follow-up of 3.4 ± 3.9 months, with a mean age at surgery of 6.1 ± 5.1 months. In 54.3% of patients (n = 19), surgery was performed before the age of 6 months. The PFAC was treated purely neuroendoscopically in 57.1% of patients (n = 20), while 28.6% of patients underwent open cyst procedures (n = 10), 5.7% (n = 2) were treated with a shunt, and 8.6% (n = 3) underwent a combined procedure. Additional surgery was required in 31.4% of patients (n = 11; mean 2.36 ± 2.11 surgeries per patient). At the last follow-up (61.40 ± 55.33 months), no mortality or permanent morbidity was seen; radiological improvement was apparent in 83.9% of the patients. Those patients treated before the age of 6 months (p = 0.09) and who presented before surgery with a stable cyst size that was maintained throughout preoperative monitoring (p = 0.08) showed a trend toward higher revision rates after surgical treatment. PFACs in infancy may require surgical treatment before the age of 6 months. Navigated endoscopy was a valid surgical option. Overall mortality or permanent morbidity was rare. Additional surgery was required in up to 30% of the patients; younger age and a preoperatively stable cyst might be risk factors for revision surgery.

Unicompartmental Knee Arthroplasty: Survivorship and Risk Factors for Revision: A Population-Based Cohort Study with Minimum 10-Year Follow-up.

Operative management for end-stage knee osteoarthritis (OA) primarily consists of arthroplasty. Total knee arthroplasty (TKA) is the so-called gold standard for multicompartmental OA. In selected patients, specifically those with unicompartmental OA and no definite contraindications, realignment osteotomies and unicompartmental knee arthroplasty (UKA) are viable options. UKA offers several advantages over TKA, including preservation of both cruciate ligaments, faster recovery, and less osseous resection. The purpose of this study was to determine the survivorship of UKAs and risk factors for all-cause revision surgery in patients with a minimum follow-up of 10 years in a large population-based database. We performed a population-based cohort study using linked administrative databases in Ontario, Canada. We identified all UKAs performed from January 2002 through December 2006. All patients had a minimum 10-year follow-up. Demographic data and outcomes were summarized using descriptive statistics. We used a Cox proportional hazards model with the Fine and Gray method accounting for competing risks such as death to analyze the effect of surgical and patient factors on the risk of revision of UKA. A total of 4,385 patients were identified as having undergone primary UKA from 2002 through 2006 in Ontario. Of these patients, 779 underwent revision surgery, for a cumulative risk for all-cause revision of 16.5% at 10 years (95% confidence interval [CI]: 15.4% to 17.7%). Mechanical loosening was the reason for 83.4% of all revisions. Male sex, diabetes, an age younger than 50 years, and cementless implants were significant risk factors for revision surgery. Residence in a rural or urban setting, income quintile, discharge destination, and type of OA were not associated with the risk of revision. Survivorship at 1, 5, 10, and 15 years was 97.2%, 90.5%, 83.5%, and 81.9%, respectively. This study demonstrated a >80% long-term survivorship for UKA based on a large administrative database sample and identified important risk factors for failure including male sex, younger age, diabetes, and cementless fixation. This study found rates of survivorship similar to those previously reported in the literature, while identifying key risk factors for failure. Patient selection has always been identified as a key factor in ensuring successful UKA, and the risk factors identified in this study may help guide decision-making for surgeons and patients dealing with unicompartmental knee OA. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Fifteen-Year Experience with the Ghent Technique of Penile Inversion Vaginoplasty.

Demand for male-to-female gender-affirmation surgery is rising. Creation of a vaginal vault and a feminine vulva remains challenging, especially in circumcised patients. The authors present the 15-year results of the technique developed by the senior author (S.M.). A retrospective case review was performed of all penile inversion vaginoplasties carried out by the senior author between 2003 and 2017. Age, hormonal therapy time, body mass index, smoking, diabetes, circumcision, and the need for full-thickness skin grafts to lengthen the vaginal vault were investigated as potential risk factors for postoperative complications. A total of 384 penile inversion vaginoplasties were retained, with 85.7 percent of patients requiring a full-thickness skin graft to lengthen the vaginal vault. Rectum perforation occurred in six patients (1.6 percent). Early revisions were necessary in 8.4 percent of patients and late revision surgery was performed in 37.1 percent of cases. There was no independent risk factor for early complications. Diabetes was an independent risk factor for late revision surgery. After vaginoplasty, 97.2 percent of patients reported being able to engage in penetrative intercourse, and 83.4 percent of patients reported having orgasms. Vaginoplasty is possible in all trans women, with most patients being able to engage in penetrative intercourse and reach an orgasm. To reach the desired depth of 14 cm, the neovaginal vault is usually lined with full-thickness skin grafts from the scrotum and/or abdomen. Diabetes was the only independent risk factor for revision surgery. Rectal tears are a rare complication and can usually be managed conservatively. Therapeutic, IV.

Revision Surgery and Progression to Total Hip Arthroplasty After Surgical Correction of Femoroacetabular Impingement: A Systematic Review

Background: Femoroacetabular impingement (FAI) is a major cause of hip pain in young adults and athletes. Surgical treatment of FAI is recommended in cases of failed nonoperative treatment that have the typical clinical and radiographic findings. At present, the role of risk factors for revision surgery and progression to total hip arthroplasty (THA) in patients with FAI is still unclear. Purpose: To investigate the possible association between (1) rate of revision and progression to THA and (2) patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores. Study Design: Systematic review; Level of evidence, 4. Methods: The present systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In October 2020, the main online databases were accessed. All articles concerning surgical correction for selected patients with FAI were accessed. Patient characteristics, type of intervention, radiographic parameters, physical examination, and pre- and postoperative scores were assessed. The outcomes of interest were the possible association between these variables and the rate of revision and subsequent progression to THA using a multivariate analysis through the Pearson product-moment correlation coefficient. Results: Data from 99 studies (9357 procedures) were collected. The median follow-up was 30.9 months (interquartile range, 24.0-45.0). The mean ± SD age was 33.4 ± 9.3 years; mean body mass index (BMI), 24.8 ± 4.8; percentage right side, 55.8% ± 8.0%; and percentage female sex, 47.5% ± 20.4%. The overall rate of revision was 5.29% (351 of 6641 patients), while the rate of subsequent progression to THA was 3.78% (263 of 6966 patients). Labral debridement (P < .0001), preoperative acetabular index (P = .01), and BMI (P = .03) all showed evidence of a statistically positive association with increased rates of THA. No other statistically significant associations were found between patient characteristics, type of lesion, family history of hip disease, type of intervention, radiographic parameters, physical examination, or pre- and postoperative scores and the rate of revision and/or progression to THA. Conclusion: Although surgical procedures to treat FAI led to satisfactory outcomes, there was a revision rate of 5.29% in the 9357 procedures in the present systematic review. The rate of progression to THA after a median follow-up of 30 months was 3.78%. Patients who have a higher BMI and/or have a pathologic acetabular index and/or undergo labral debridement during correction of FAI are more at risk for a subsequent THA. We advocate additional education of this patient population in terms of expected outcomes and suggest surgical labral repair instead of debridement if needed.