Rate Of Secondary Surgery Research Articles

90-Day Reoperation and Wound Complication Rates in Lateral Approach to Total Ankle Replacement for Post-Traumatic Arthritis

Category: Ankle Arthritis; Ankle; Diabetes Introduction/Purpose: Total ankle replacement (TAR) has achieved relatively successful outcomes with respect to postoperative complications; however, mixed evidence exists regarding early complication rates, reoperation, and infection1-5. The largest study of TAR to date indicates a statistically significant risk of postoperative infection in tobacco users and diabetic patients6. Unlike currently established anterior approaches to arthroplasty, the lateral transfibular approach potentially avoids disruption of perfusion to the skin, possibly decreasing postoperative complications7. The lateral ankle allows surgeons to correct malunion of the fibula in post-traumatic arthritis deformity cases and achieve appropriate coronal and sagittal implant alignment to achieve similar physiological joint orientation8,9. The purpose of this study was to report 90-day reoperation and wound complication rates in lateral approach to total ankle replacement for post-traumatic arthritis (PTA). Methods: A retrospective chart review of lateral TAR cases from 2016-2022 was conducted at a single institution. Only patients undergoing TAR for post-traumatic arthritis were included in this review. A total of 49 patients (22 females and 27 males) underwent total ankle replacement with the Zimmer Biomet Trabecular MetalTM Total Ankle by a single surgeon. Patient demographics, operative data, complications, and adverse events requiring corrective surgery were recorded within 90 days of arthroplasty. Results: The patient sample included 6 active smokers, 11 diabetics, and 32 patients with hypertension with an average age of 60.7 and average BMI of 34.3 (Table 1). Three of the 49 (6.1%) patients required secondary surgery within 3 months of surgery (Table 2). Revision surgery indications included: 1 (2.0%) for removing painful hardware, 2 (4.1%) due to infection, and 1 (2.0%) for tarsal tunnel syndrome after surgery. There were 0 nonunions of the fibula at 90 days and through 1 year follow up. Of the patients requiring secondary surgery for infection, 1 was a smoker and 1 had a history of ankle fusion nonunion and avascular necrosis which was converted to a TAR (Table 4). Conclusion: This retrospective study demonstrates a comparable rate of secondary surgeries following TAR via lateral approach in the early postoperative period (6.1%) while having a slightly higher rate of infection than those previously reported (4.1%)7,8. Notwithstanding, we observed a 100% healing rate of fibula osteotomies; however, we failed to demonstrate a lower incidence of wound complications than previously reported. Surgeons should counsel patients of these risks in those with PTA undergoing lateral TAR, especially in smokers and diabetics.

Germline BRCA mutation carriers are more likely to undergo cytoreductive surgery for relapsed, platinum sensitive, ovarian cancer

ObjectiveBRCA mutations have been associated with improved outcomes in ovarian cancer patients. This study's objective was to compare the secondary cytoreduction surgery (SCS) rates among ovarian cancer patients by BRCA mutation status. MethodsThe study was retrospective and included platinum sensitive recurrent high grade serous ovarian cancer patients from one Canadian center and two Israeli centers from January 1999 to December 2018. Demographic and genetic data, tumor characteristics, patterns of recurrence and surgical and medical treatments were obtained from electronic charts. Patients were grouped according to BRCA mutation status. Logistic regression analyses were used to explore potential prognostic factors of secondary cytoreduction. Results147 patients were enrolled, including 97 from Canada and 50 from Israel. Forty-seven patients (32%) had a BRCA mutation, including 39 (26.5%) germline mutations and 8 (5.5%) somatic mutations. Thirty-one patients (21.1%) underwent SCS. The rate of SCS was 33.3% among the germline BRCA mutation carriers and 15.7% among patients without germline BRCA mutation (p = 0.026). Predictors of secondary cytoreduction included germline BRCA mutation (OR = 2.5, p = 0.03), time to recurrence (OR = 1.004 per month, p < 0.001), absence of lymphatic recurrence (OR = 3.08, p = 0.013), three or fewer lesions at recurrence (OR = 36.74, p < 0.001) and absence of ascites (OR = 9.1, p = 0.034). After adjusting for the number of lesions at recurrence, no other variable remained a significant predictor. ConclusionGermline BRCA mutation carriers are more likely to undergo secondary cytoreduction. This may be mediated in part by lower volume disease at recurrence. This observation should be considered when planning surveillance for these patients after first-line treatment.

Redislocation After Posteromedial Open Reduction in Developmental Dysplasia of the Hip: Analyzing the Risk Factors and Determining the Optimal Treatment Method.

Redislocation, which is one of the most serious problems in developmental dysplasia of the hip (DDH), might occur because of several reasons. Regardless of the treatment, redislocations are reported to be associated with high complication rates in the literature. Our objective was to identify the risk factors for redislocation in the patients treated for DDH and to determine the optimal treatment method for redislocations. Patients with DDH who were treated with the limited posteromedial approach in our clinic between 1993 and 2021 and followed up prospectively were examined in this single-centered study. The participants were assigned into 2 groups: a study group consisting of 25 hips of 17 patients with redislocation and a control group consisting of 502 hips of 390 patients without redislocation. To determine the risk factors for redislocation, demographic data, known risk factors for DDH, preoperative Tönnis stage, and whether the capsule was opened or not were evaluated. To determine the optimal treatment method, a subgroup analysis based on applied treatment (closed reduction and cast replacement vs. repeating open reduction) was conducted, and recurrent redislocation, complication, and secondary surgery rates were evaluated. Bilaterality and high-grade hip dislocations were found to be associated with higher odds ratio (OR) for redislocation [ P =0.007, OR=3.64, 95% confidence interval (CI), 1.3 to 8.8; and P =0.006, OR=4.52, 95% CI, 1.37 to 14.91, respectively]. Recurrent redislocation and complication rates were found to be significantly higher in redislocations treated with closed reduction and cast replacement ( P =0.007 and P =0.015, respectively). Bilaterality and higher preoperative Tönnis stage are critical risk factors for redislocation after open reduction in DDH. It should be kept in mind that closed reduction and cast replacement is associated with higher rates of recurrent redislocation and complications, and redislocation cases should be treated by repeating open reduction. Level II-therapeutic study.

Single versus dual incision approaches for dual plating of bicondylar tibial plateau fractures have comparable rates of deep infection and revision surgery

ObjectivesThe use of one midline incision versus dual medial/lateral incisions for dual plating of bicondylar tibial plateau (BTP) fractures is controversial. This study aimed to compare rates of infection and secondary surgery in patients treated with dual plating for a BTP fracture using a single versus double incisions. DesignRetrospective cohort study. SettingTwo Level-1 trauma centers. Patients/ParticipantsPatients > 18 years with a closed AO/OTA 41-C BTP fracture without compartment syndrome treated with a single midline or dual incision (lateral with medial or posteromedial) approach for dual plating. InterventionDual plating through either a single anterior incision, or dual medial/lateral incisions. Main outcome measurementsRates of deep infection and reoperation were compared using Chi-square analysis (p-value of < 0.05). Results and conclusionsIn total 636 AO/OTA 41-C BTP fractures treated between 1/1/01 and 12/31/18 were identified and assessed. After exclusions for limited follow up, other techniques, open fracture and the need for fasciotomies, 346 patients were studied. Of these 254 had been treated with a single plate / single approach technique while 92 had been dual plated, 41 through a single anterior incision while 51 had dual plating through separate lateral and medial or posteromedial incisions. For these 92 fractures, there was no significant difference in the rate of deep infection (22.0% vs 23.5%, s=0.858) or reoperation (31.7% vs 31.4%, p=0.973) between the single and dual incision groups. Injuries that had been treated with single plating via a single incision had comparably lower rates of deep infection (10.2% vs. 22.8%, p=0.003) and reoperation (12.2% vs. 31.5%, p<0.001). There were no significant differences in any demographic parameters between patients undergoing single versus dual plating. Although retrospective, not randomized and subject to single surgeon bias these data suggest that these complications are more based on injury than the approach. Level of evidenceIII

Paper 57: Labral Tear Management in Patients Aged 40 Years and Older Undergoing Primary Hip Arthroscopy: A Propensity-Matched Case-Control Study Comparing Labral Reconstruction to Labral Repair with Minimum Two-Year Follow-Up. *ACCEPTED TO AJSM*

Objectives:To report minimum two-year patient-reported outcome (PRO) scores, survivorship, and secondary surgeries, in patients aged ≥ 40 years who underwent primary hip arthroscopy with labral reconstruction compared to a propensity-matched primary labral repair group.Methods:Data were prospectively collected and retrospectively reviewed for patients who underwent a primary hip arthroscopy for femoroacetabular impingement syndrome from January 2014 to June 2018. Patients aged ≥ 40 years who underwent a labral reconstruction or a labral repair and had preoperative and minimum two-year PROs for the modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain were included. Patients with prior ipsilateral hip conditions and surgery, Tonnis grade > 1, hip dysplasia, or worker’s compensation status were excluded. Patients in the reconstruction group were propensity-matched 1:2 to patients in the repair group based on age, sex, and body mass index. Secondary surgeries and the achievement of the minimal clinically importance difference (MCID), patient acceptable symptomatic state (PASS), and maximum outcome improvement (MOI) were recorded.Results:Fifty-three and 106 hips were included in the labral reconstruction and repair groups, respectively. The average follow-up time was 37.6 months. The average age for the reconstruction and repair groups were 48.01 ± 5.4 years and 48.61 ± 6.0 years, respectively. Both groups achieved significant improvements in all PROs at minimum two-years with similar achievements of MCID, PASS, and MOI. Both groups showed comparable secondary surgeries rates.Conclusions:Patients aged 40 years and older who received primary labral repair and primary labral reconstruction, achieved similar significant improvements in all PROs, VAS pain, and patient satisfaction at minimum two-year follow-up, with comparable rates of secondary surgeries and achieving MCID, PASS, and MOI. Based on these findings, labral repair remains the gold standard treatment for viable labrum in this population group, while reconstruction is a useful alternative for irreparable labrum.

Endoscopic Fenestration for Treating Galassi Type III Middle Cranial Fossa Arachnoid Cysts: Single- and Multiple-stoma have the Same Curative Effect.

For endoscopic fenestration of middle cranial fossa arachnoid cysts (MCFACs), the decisions on the location and number of stomas are key issues. However, research on this particular topic has been limited. Thus, this study aimed to compare single- versus multiple-stoma endoscopic fenestration for treating Galassi type III MCFACs. This retrospective study included 86 patients with Galassi type III MCFACs treated with endoscopic fenestration. Single-stoma fenestration to the basal cistern was performed in 37 cases, whereas multiple-stoma fenestration to the basal cistern and the carotid cistern was performed in 49 cases. Clinicoradiologic profiles and follow-up data were analyzed. The rate of symptom relief was 83.7% (72/86), and the rate of cyst shrinkage was 96.5% (83/86). Postoperative ipsilateral subdural effusion, which was significant (p = 0.042), and noninfectious fever were the two most common complications in the single- and multiple-stoma groups. No significant differences in intraoperative nerve injury, vascular injury, proportion of cases with cyst reduction, and symptom remission rate were observed between the two groups. The rates of cyst recurrence and secondary surgery in the single-stoma group were higher than those in the multiple-stoma group, although the difference was not significant. Endoscopic fenestration is an effective and minimally invasive approach for treating Galassi type III MCFACs. Single- and multiple-stoma endoscopic fenestrations have the same curative effect.

Reoperation rates for stress urinary incontinence and pelvic organ prolapse in women after undergoing Mid-Urethral sling with or without concomitant colporrhaphy in academic centers within the United States

In this study, the rates of reoperation for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women who underwent a mid-urethral sling (MUS) with or without concurrent colporrhaphy were evaluated. An academic faculty practice consortium database was used to identify a cohort of patients treated surgically for SUI with or without concurrent POP repair (apical, anterior, posterior, or a combination of the three) with or without hysterectomy between 2009 and 2011. A total of 20,484 patients matched the criteria. Of patients who underwent a MUS, 7.2% underwent secondary surgery, with a higher rate of 8.6% associated with those who underwent concurrent prolapse repair (Apical repair HR 1.84, p < .01; Anterior compartment repair HR 1.47, p < .01). Concurrent hysterectomy was associated with a lower hazard of secondary prolapse surgery (HR 0.48; p < .01) if the initial surgery involved a complete POP repair. Prolapse mesh repair resulted in a higher hazard of additional surgery (HR 1.43, p < .01). Medicaid insurance was also associated with an increased hazard ratio compared to commercial insurance for secondary surgery (HR 1.32, p < .01). For women undergoing MUS with complete prolapse repair, concurrent hysterectomy is associated with lower secondary surgery rates. Concurrent prolapse repair with mesh is associated with higher secondary surgery rates. Synopsis: For women undergoing MUS (mid-urethral sling) with complete prolapse repair, concurrent hysterectomy is associated with lower secondary surgery rates. Concurrent prolapse repair with mesh is associated with higher secondary surgery rates. Impact Statement What is already known on this subject? Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can present at the same time and negatively impact patients’ quality of life. There is little data regarding reoperation rates for patients who undergo both MUS and colporrhaphy in one setting. What do the results of this study add? This study found that patients who undergo concurrent MUS (mid-urethral sling) and complete POP repair with the addition of hysterectomy had a lower risk of secondary surgery. What are the implications of these findings for clinical practice and/or further research? Our data can be used by surgeons to counsel patients on the risks of re-operation for SUI for those who would like to undergo concurrent POP repair with or without hysterectomy.

Combining All Available Clinical Outcomes on Cervical Disc Arthroplasty: A Systematic Review and Meta-Analysis

Background: Reviews of total disc arthroplasty (TDA) performance have focused on prospective randomized controlled trials (RCTs), excluding potentially important clinical information reported by others. The goal of the present study was to perform a comprehensive review, including both RCTs and non-randomized cohorts with more than five years of clinical outcome. We further explored the differences in outcome between prospective RCT and non-randomized, including retrospective studies. Methods: A systematic literature review was performed following PRISMA guidelines. Inclusion criteria were: clinical follow-up ≥ 5 years with quantitative clinical and radiographic outcome. All studies that met these criteria, including retrospective and non-randomized studies, were included, for a total of 62 studies. As anterior cervical discectomies and fusion (ACDF) was included as a control group in the majority of the studies, comparisons between TDA and ACDF were conducted. Results: Overall, there was a statistically significant difference between the rates of secondary surgeries reported for prospective RCTs and all other studies, with reoperation rates of 5.4% for prospective RCT studies v. 7.5% in all others (P&lt;0.01). Including all studies, the reoperation rate for TDA patients was 5.6% and for fusion patients (included as control groups), 7.8%, (P=0.06). Overall, the reported incidence of adjacent segment degeneration was 26.2% in TDA patients and 43.9% in fusion patients (P&lt;0.001). Conclusions: These findings demonstrated the need for including all available data to assess the current outcomes of cervical disc arthroplasty and account for potential biases.

Hyperfractionation versus Conventional Fractionation of Preoperative Intensity-Modulated Radiotherapy with Oral Capecitabine in Locally Advanced Mid-Low Rectal Cancer: A Propensity Score Matching Study.

Purpose In theory, the hyperfractionated radiotherapy can enhance biological effect dose against tumor and alleviate normal tissue toxicity. This study is to assess the efficacy and safety of preoperative hyperfractionated intensity-modulated radiotherapy (IMRT) with oral capecitabine in patients with locally advanced rectal cancer (LARC). Methods We retrospectively screened patients with LARC from January 2015 to June 2016. Patients that received hyperfractionated IMRT or conventional fractionated IMRT were eligible in the hyperfractionation (HF) group or conventional fractionation (CF) group, respectively. The primary outcome was the complete response rate. Secondary outcomes included toxicity, postoperative complications, anus-reservation operation rate, local recurrence and distant metastases rate, overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Results 335 patients were included in the analysis. The complete response rate for the hyperfractionated and conventional fractionated IMRT was 20.41% vs. 23.47% (P = 0.583). The anus-reservation operation rate was 68.37% vs. 65.31% (P = 0.649). There were no cases of grade 4 toxicity during radiotherapy; the rate of grade 3 toxicity and postoperative complications was both comparable between groups. However, in the CF group, more patients had a second operation due to complications (0.0% vs. 5.68%, P = 0.011). The cumulative local regional recurrence and distant metastases rates of the HF group and CF group were 5.10% vs. 9.18% (P = 0.267) and 22.45% vs. 24.49% (P = 0.736), respectively. The 5-year OS, CSS, and DFS in the HF group and CF group were 86.45% vs. 73.30% (P = 0.503), 87.34% vs. 75.23% (P = 0.634), and 70.80% vs. 68.11% (P = 0.891), respectively. Conclusions The preoperative hyperfractionated IMRT with oral capecitabine, with an acceptable toxicity and favorable response and survival, could reduce the rate of secondary surgery.

Stress fractures of the femoral neck in adults: an observational study on epidemiology, treatment, and reoperations from the Swedish Fracture Register.

Background and purposeStress fractures of the femoral neck (sFNFs) are uncommon injuries. Studies on sFNFs are rare. We describe the demographics, classification, treatment, reoperation rates, and mortality in a cohort of sFNF patients from the Swedish Fracture Register (SFR).Patients and methodsWe included 146 patients ≥ 18 years of age with an sFNF registered in the SFR between 2011 and 2020. The cohort was linked with the Swedish Arthroplasty Register and reviewed using medical records and radiographs. We assessed the presence of disorders of bone remodeling, duration of symptoms, fracture classification, treatment, reoperations, and mortality.ResultsThe mean age was 58 years (21–96), 75% were women and the median duration of symptoms was 23 days (1–266). 40% of patients had disorders of bone remodeling. 54% were undisplaced (uFNF), 30% displaced (dFNF), and 16% basicervical (bFNF). 14% of patients < 60 years were treated nonoperatively, by internal fixation (IF) in 77% and by arthroplasty in 10%. Patients ≥ 60 years were treated nonoperatively in 10%, IF in 40%, and arthroplasty in 49%. Nonoperative treatment was reserved for uFNFs or bFNFs, resulting in 35% receiving late surgery. The overall secondary or late surgery rate was 19%. Mortality was 2% at 90 days and increased to 3% at 1 year.InterpretationsFNF has a biphasic age distribution. One-third of patients presented with a displaced FNF and those managed nonoperatively for an undisplaced sFNF were at risk of late surgery. The mortality rates for patients with these injuries was low.

A systematic review and meta-analysis of the efficacy and complication rates of augmentation rhinoplasty with autologous cartilage and silicone prosthesis.

Rhinoplasty is one of the most common operations in plastic and aesthetic surgery. Both solid silicone material and autologous cartilage (AC) tissue have their individual advantages and disadvantages. In this meta-analysis, the efficacy, complication rate of rhinoplasty with AC and silicone material were comprehensively analyzed and compared. The databases Medline, Embase, PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang were searched by rapid matching of keywords to obtain randomized controlled trials related to AC rhinoplasty or silicone filled rhinoplasty, which were analyzed using the software Stata 16.0 after screening and quality assessment. A total of 1,233 patients undergoing rhinoplasty from 7 articles were included in the study. Meta-analysis showed that rhinoplasty with AC would gain more satisfaction [risk ratio (RR) =1.11; 95% confidence interval (CI): (1.02, 1.21); Z=2.413; P=0.016]. would reduce the complication rate [RR =0.34; 95% CI: (0.22, 0.52); Z=-5.010; P<0.0001], and resulting in less secondary surgery rate [RR =0.34; 95% CI: (0.18, 0.64); Z=-3.363; P=0.001] comparing to silicone prosthesis (SP) material. In rhinoplasty, the use of AC material gains more satisfaction, has less total complication rate, and results in less secondary surgery rate than silicone material. But based on the heterogeneity and publication bias in the studies, this topic still needs to be further explored by including more high-quality studies.

Pathologic Findings on Hip Arthroscopy in High-Level Athletes Competing in Flexibility Sports

Background: Athletes who compete in flexibility sports (FS) place unique demands on their hip joints because of the supraphysiologic range of motion required. Purpose: To compare the pathologic features, outcomes, and return-to-sports (RTS) rates of high-level athletes participating in FS who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear against a propensity score–matched cohort of high-level athletes participating in non–flexibility sports (NFS). Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed for high-level athletes who underwent primary hip arthroscopy for FAIS from April 2008 to December 2018. Patients who participated in FS such as dancing, gymnastics, martial arts, figure skating, and cheerleading were propensity score matched by body mass index, age at time of surgery, sex, sports competition level, and labral treatment to a cohort of high-level athletes participating in all other sports, such as distance running, soccer, volleyball, and softball. Baseline patient characteristics, intraoperative findings, and surgical procedures were compared. Minimum 2-year patient-reported outcome measures were compared for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain and satisfaction. Rates of secondary surgery and RTS were compared. Results: A total of 47 patients (50 hips) who participated in FS were included and propensity score matched to 130 patients (150 hips) who participated in NFS. Follow-up time was 37.5 ± 10.4 months (mean ± SD). Most patients (96.0%) were female with a mean age of 19.5 ± 7.3 years. FS athletes had significantly higher rates of femoral head cartilage lesions (Outerbridge ≥2; 12.0% vs 2.0%; P = .008) and ligamentum teres tears (48% vs 26%; P = .003). FS and NFS athletes demonstrated significant clinical improvements after surgery for all patient-reported outcome measures. Of the patients who attempted, 34 (75.6%) participating in FS were able to RTS while 11 (24.4%) were not because of ongoing hip issues. This was not significantly different than the NFS group (P = .073). Conclusion: High-level athletes who participated in FS and were treated for FAIS with hip arthroscopy exhibited higher rates of femoral head cartilage lesions and ligamentum teres tears requiring debridement when compared with a benchmark group of athletes who participated in other sports. Despite this, both groups demonstrated similar improvements in outcome scores and comparable rates of RTS at minimum 2-year follow-up.

Surgical Versus Nonsurgical Management of Acetabular Fractures With Associated Patterns in Elderly Patients: Factors Affecting Outcomes.

Introduction:Among elderly patients, anterior column posterior hemitransverse (ACPHT) and associated both column (ABC) are common acetabular fracture patterns after low-energy mechanisms. Given the paucity of outcomes data in this cohort, the goal of this study was to determine the favorability of results with surgical versus nonsurgical management. Secondarily, factors linked with poor functional outcomes were assessed.Methods:Over a 16-year period, 81 patients aged ≥60 years with 82 ACPHT and ABC acetabular fractures were evaluated. Retrospectively, patient demographics, injury details, and early and late complications were collected. Functional outcomes were assessed with the Musculoskeletal Function Assessment (MFA) after a minimum of 12 months of follow-up.Results:During the study period, 81 patients sustained 82 ACPHT (n = 35, 43%) or ABC (n = 47) fractures, most secondary to low-energy falls (71%). Patients managed surgically were younger, had higher-energy mechanisms, and more often had an associated hip dislocation or marginal impaction (all P < 0.05). Of note, 42.3% and 18.5% of patients had early and late complications, respectively, with no differences between surgical and nonsurgical groups. Posttraumatic arthrosis (PTA) was noted in 27% overall (36% surgical versus 16% nonsurgical, P = 0.10). The mean MFA score was 25.2 after 59 months. Better outcomes were associated with high-energy mechanisms, multiple injuries, and surgical management (all P < 0.05). The worst MFA outcomes were among patients with PTA (40.2) and those requiring a secondary procedure (45.7), both P < 0.05.Discussion:Nonsurgical management had a low rate of PTA. Mitigating PTA and decreasing the rate of secondary surgeries seem crucial achieving satisfactory outcomes. Higher-energy injuries benefit from open reduction and internal fixation, as indicated by better MFA scores.

The Clinical Significance of Infolded Limbus on Postreduction Arthrogram in Developmental Dysplasia of the Hip.

The purpose of this study was to investigate whether presence of an infolded limbus on hip arthrogram at index closed reduction was associated with increased residual dysplasia or secondary surgery. We retrospectively reviewed all patients who underwent closed reduction for dysplasia of the hip with a minimum 2-year follow-up between 1980 and 2016. Demographic data was obtained including the age at reduction and severity of dislocation based on the International Hip Dysplasia Institute (IHDI) classification. Arthrograms performed at time of closed reduction were separately reviewed by 3 fellowship-trained pediatric orthopaedic surgeons to evaluate for an infolded limbus. The primary radiographic outcome was acetabular indices at 2 and 4 years postreduction. We also assessed the presence of avascular necrosis and rate of secondary reconstructive surgery for residual dysplasia. A total of 182 hips in 165 patients underwent closed reduction at a mean age of 9.8±4.5 mo and were followed a mean of 9.0±4.9 y. An infolded limbus was identified in 20.3% (37/182) hips with substantial agreement among the 3 graders (Fleiss κ=0.75). The frequency of labral infolding increased with the severity of dislocation (8.8%% of IHDI II, 26.7% IHDI III, and 25.0% of IHDI IV hips; P=0.03). Hips with infolded limbus were older at reduction (12.4±5.3 vs. 9.2±5.8 mo, P=0.001). The mean acetabular index was higher in hips with infolded limbus than hips without at 2 years postreduction (34.8±4.8 vs. 32.6±5.8 degrees, respectively; P=0.04). However, multivariate analysis revealed that only the severity of dislocation predicted dysplasia at 2 years postreduction. No significant difference in acetabular index was seen at 4 years postreduction (27.2±7.4 vs. 25.4±6.5 degrees, P=0.24). There was no difference in avascular necrosis between groups (P=0.74). There was no difference in rate of secondary surgery between hips with labral infolding and those without (35% vs. 30%, respectively; P=0.52). An infolded limbus was more common in older patients with more severe dislocations. However, it is not associated with increased residual dysplasia or secondary surgery and may have limited utility in decision-making during closed reduction. Level II-prognostic study.

Ten-Year Outcomes of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion in Patients With Single-Level Lumbar Spondylolisthesis.

A retrospective observational study. This study investigated the clinical and radiological results of minimally invasive (MI) versus open transforaminal lumbar interbody fusion (TLIF) in patients with single-level lumbar spondylolisthesis over a 10-year period. Few studies have compared 10-year follow-up outcomes between MI-TLIF and open TLIF. We retrospectively collected the outcome data of patients with single-level lumbar spondylolisthesis who underwent TLIF procedures using an MI (n = 108) or open (n = 53) approach. Fifty-two (48%) and 31 (58%) patients in the MI-TLIF and open TLIF groups, respectively, completed the 10-year follow-up. A primary clinical outcome included the Oswestry Disability Index (ODI) as well as visual analog scale (VAS) scores for back and leg pain at baseline and at 2, 5, and 10 years postoperatively. The radiographic fusion rate and incidence of secondary surgery due to adjacent segment disease were assessed at 2, 5, and 10 years postoperatively. Intraoperative blood loss and length of hospitalization were significantly lower in the MI-TLIF group than in the open TLIF group. At 2 years postoperatively, the ODI and VAS scores for back and leg pain were significantly lower in the MI-TLIF group than in the open TLIF group. No significant differences were found in VAS scores for back and leg pain or ODI scores between the two groups at 10 years postoperatively. Radiographic fusion rates and prevalence of secondary surgery for adjacent segment disease were not significantly different between the groups at 10 years postoperatively. Efficacy of MI-TLIF for patients with single-level lumbar spondylolisthesis is comparable to that of open TLIF over 10-years. However, MI-TLIF may have superior perioperative recovery and 2-year postoperative functional outcomes than open TLIF.Level of Evidence: 3.

Effect of Cigarette Smoking on Outcomes in Patients Undergoing Primary Hip Arthroscopy and Labral Reconstruction: A Propensity-Matched Controlled Study With Minimum 2-Year Follow-up.

Background:There is a paucity of literature evaluating the effect of cigarette smoking on outcomes in patients undergoing hip arthroscopy and labral reconstruction.Purpose:(1) To report minimum 2-year patient-reported outcome (PRO) scores for patients who smoke cigarettes and underwent primary hip arthroscopic labral reconstruction and (2) to compare these results with those of a propensity-matched control group of patients who have never smoked.Study Design:Cohort study; Level of evidence, 3.Methods:Data were collected for all patients who underwent primary hip arthroscopy for labral reconstruction between January 2011 and January 2019. Patients were eligible for the study if they indicated that they smoked cigarettes within 1 month of surgery and had minimum 2-year postoperative outcome scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the visual analog scale (VAS) for pain. The percentage of patients achieving the minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) was recorded. Rates of revision surgery were also documented. These patients were then propensity matched in a 1:3 ratio to patients who had never smoked (controls) for comparison.Results:A total of 20 patients (20 hips) were included with a mean follow-up of 39.9 ± 13.0 months and mean age of 41.4 ± 10.4 years. These patients demonstrated significant improvement from preoperatively to the minimum 2-year follow-up for mHHS, NAHS, and VAS (P < .05). They also achieved MCID for mHHS and VAS at acceptable rates, 70% for both. When outcomes were compared with those of 60 control patients (60 hips), patients who smoke demonstrated lower preoperative PRO scores but similar minimum 2-year postoperative PRO scores for mHHS and NAHS. Patients who smoke demonstrated lower rates of achieving PASS for mHHS (55% vs 75%) and NAHS (40% vs 61.7%) compared with controls; however, these findings were not statistically significant. Rates of secondary surgery were statistically significantly higher in the smoking group compared with controls (25% vs 5%; P = .031). Survivorship for the smoking patients was 80% and 98.3% for the control group. At the two-year mark survivorship was 90% for the smoking group and 100% for the control group (P = .06)Conclusion:While smokers can still derive significant improvement from hip arthroscopy, their ultimate functional outcome and rate of secondary surgeries are inferior to those of nonsmokers. As smoking is a significant and modifiable risk factor, we should continue to counsel smokers on smoking cessation prior to and after surgery

Poor Outcomes After Anterior Impaction Pilon Fractures.

Pilon fractures occur through high-energy axial-loading trauma and are frequently associated with complications. The goal of this study was to assess whether anterior impaction (AI) tibial pilon fractures are associated with increased rates of posttraumatic osteoarthritis (PTOA), secondary surgeries, and lower patient-reported outcomes compared with patients with non-AI pilon fractures. In this retrospective cohort study, 52 pilon fractures in 50 patients were included. The average follow-up was 25 months (range, 12 to 62 in non-AI and 12 to 66 in AI). The Kellgren and Lawrence (KL) score for PTOA, tibiotalar ratio for anterior-posterior talar subluxation, coronal tibiotalar angle, Patient-Reported Outcomes Measurement Information System score, and rates of secondary surgeries and infection were assessed. The AI group showed radiographic evidence of more advanced PTOA at the final follow-up (KL score 3.1 vs. 2.5, P = 0.021) and a higher rate of implant removal for pain (39% vs. 13%, P = 0.030). AI also had greater anterior talar subluxation on preoperative (P < 0.001) and final follow-up radiographs (P = 0.026). A higher KL score was associated with greater anterior talar displacement on preoperative (r = -0.421, P = 0.003) and final follow-up radiographs (r = -0.359, P < 0.009). No differences were seen in 1-year Patient-Reported Outcomes Measurement Information System scores. AI pilon fractures are associated with recurrent anterior talar subluxation, more severe PTOA, and a higher rate of implant removal for pain compared with non-AI fractures.

Comparing Traditional Lapidus to Newer Triplane Methods for Correction of Hallux Valgus

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Correction of hallux valgus is a common procedure for foot and ankle specialists. Advances in the understanding of this deformity has shifted surgical correction back to the first tarsometatarsal joint. Traditional Lapidus methods had a low recurrence rate and 10% nonunion rate. Recent developments in the correction of hallux valgus have centered on triplane correction utilizing proprietary systems. These systems are effective at obtaining, and maintaining, correction. However, they are expensive and there is a paucity of unbiased literature comparing it to traditional methods. This study aims to evaluate radiographic outcomes and complications of patients undergoing traditional Lapidus fixation to triplane corrective procedures. Our hypothesis is that overall correction will be obtained and maintained at a similar rate, with no difference in overall complications.Methods:After IRB approval, a total of 275 patients over the age of 18 were identified who underwent a total of 294 procedures for first tarsometatarsal joint fusion for hallux valgus correction between February 2010 to August 2020. A retrospective chart review was then performed dividing patients into two groups: traditional Lapidus fixation and triplane correction methods. A total of 191 patients underwent traditional Lapidus, and 103 underwent triplane correction. Charts were evaluated for complications that required a return to the operating room, specifically nonunion, loss of correction, infection, and hardware removal. AP foot radiographs were then reviewed from the patient's preoperative visit, immediate postoperative, and final follow up. On each film, the first intermetatarsal angle (IMA) was then measured by two independent observers. Each IMA was recorded and overall surgical correction, final correction angle, and maintenance of correction were calculated.Results:Comparing triplane correction to traditional Lapidus cohorts, there was no difference in age (50.6 vs 48.9 years, p=0.39), initial deformity (14.66 vs 15.61 degrees, p=0.05), or x-ray follow up (229 vs 393 days, p=0.23). When comparing IMA correction, there was no difference in initial amount of correction (11.2 vs 11.4 degrees, p=0.58) or final correction angle (5.22 vs 5.66 degrees, p=0.05). Comparing complications, there was no difference in secondary surgery rates (9/103, 8.7% vs 11/191, 5.76%, p=0.34), especially nonunions/loss of correction (4.85% vs 2.62%, p=0.32). Comparing number of cases that experienced an increased IMA of more than 5 degrees from post-op to final, there was no difference (10/103, 9.71% vs 12/191, 6.29%, p=0.35). Finally, there was no difference in infection (p=0.13) or implant removal (p=0.43).Conclusion:When comparing radiographic correction of IMA, maintenance of correction, and secondary surgery rates, there appears to be no difference between triplane correction methods and traditional Lapidus procedures. Recent evidence in the literature supports correction of hallux valgus through the TMT joint, with a subsequent increase in proprietary reduction and fusion methods. These proprietary methods are expensive, and according to this study, offer no improvement over traditional, less expensive methods in terms of IMA correction and need for secondary surgery. Further study is needed to assess patient reported outcomes for each and potential radiographic findings that may suggest risk of recurrence.

Factors Influencing the Nonunion Rate Following First Metatarsophalangeal Joint Arthrodesis

Category:Midfoot/ForefootIntroduction/Purpose:The choice of fixation, biomechanical stability, and hardware density might influence the union after the first metatarsophalangeal (MTP) arthrodesis. This study aimed to assess the influencing factors on the union rate and fixation failure after MTP-1 arthrodesis.Methods:In this retrospective cohort study, we included 359 patients with 378 feet from the practice of two foot and ankle surgeons. The surgical technique was identical. The providers randomized patients to receive either the locking plate or cross screws, which comprised 187 (50%) plate fixation and 191 (50%) cross screw fixation. Radiographic union was assessed at three months and the final follow-up and was further categorized as symptomatic versus asymptomatic nonunion.Results:Accounting for potential interaction between variables using multivariable logistic analysis, plate fixation (P=0.018), and diabetes (P=0.044) were significantly associated with a higher nonunion rate. At three month follow-up, 15 (8.3%) patients in the locking plate group and 5 (2.5%) patients in the cross screws group showed nonunion. Of 15 nonunion with plate fixation, 6 (40%) underwent a second surgery because of device failure, while none of the screw fixations required a second surgery (P<0.001). In comparison to asymptomatic nonunion, remaining symptomatic at three months follow-up was a significant risk factor for developing a nonunion with possible device failure at the final follow-up requiring intervention.Conclusion:Cross screw fixation is significantly associated with a lower nonunion, device failure, and secondary surgery rate than plate fixation, which might be related to contact surfaces and biomechanical stability. Besides, the cost saving is more with the cross screws than plate and screws. Diabetic patients should be counseled about the higher nonunion rate.

Delayed Surgery for Ankle Fractures is Associated with Poor Patient Reported Outcome

Category:Trauma; AnkleIntroduction/Purpose:Several studies discuss the relation between prolonged time to surgery and postoperative complications in ankle fractures, but little is known about how a longer wait affects clinical outcomes. The present study, therefore, aims to assess the association between time from injury to surgery and patient-reported outcomes after operative treatment of severe ankle fractures.Methods:Patients treated operatively for low-energy ankle fractures which also involve the posterior malleolus from 2014 to 2016 were included. Patient charts were reviewed for patient demographics, type of trauma, fracture characteristics, treatment given, and complications. Ankle function was evaluated on a follow-up visit by clinical examination, radiographs and patient- reported outcome measures (SEFAS, RAND-36, VAS of Pain, VAS of Satisfaction). For analyses, patients were stratified based on time from injury to definitive surgery; Group 1: within the same day, Group 2: 1 to 7 days after injury, and Group 3: later than 7 days after injury.Results:Follow-up visits of 130 patients were performed at median 25 (Interquartile range (IQR), 19-34) months after surgery. Patient demographics and fracture characteristics were similar between groups. Median SEFAS was 40 in Group 1 (IQR 33-43), 41 (IQR 33-44) in Group 2, and 33 (IQR 27-42) in Group 3. The difference between Group 1 and 3 (p =.03), and between Group 2 and 3 (p =.04) was statistically significant. Group 1 had the highest rate of mechanical irritation and secondary surgery following malreduced fractures or missing syndesmotic fixation. Patients operated later than seven days from injury reported more pain than those treated earlier (p =.03).Conclusion:Time from injury to final surgery influenced clinical outcomes after these severe ankle fractures. Patients who waited more than seven days until definitive surgery had poorer clinical outcomes and more pain compared to those who had surgery within a week.