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Ateschrang A, Eggensperger F, Ahrend MD, Schröter S, Stöckle U, Kraus TM. Obesity causes poorer clinical results and higher re-tear rates in rotator cuff repair. Arch Orthop Trauma Surg 2018; 138:835-842. [PMID: 29594506 DOI: 10.1007/s00402-018-2921-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this retrospective study was to report on the functional outcome after both open and arthroscopic rotator cuff (RC) repair in normal weight, pre-obese and obese patients. It was hypothesized that obesity is a negative prognostic factor for clinical outcome and failure for the RC repair. METHODS One hundred and forty-six patients who underwent either open or arthroscopic rotator cuff repair between 2006 and 2010 were included in this study. Seventy-five patients (56.7 ± 10.1 years of age) after open RC repair and 71 patients (59.0 ± 9.1 years of age) treated arthroscopically were available for evaluation. In both groups a double-row reconstruction was performed. Patients were divided in three groups according to their body-mass index. The mean follow-up was at 43 ± 16 (minimum 24) months. At follow-up, the clinical outcome was assessed by the DASH and Constant score. An ultrasound of both shoulders was performed in all patients. RESULTS The mean BMI was 28.3 ± 5.3 in the arthroscopic group and 27.7 ± 4.3 in the open group. Overall, in both groups similar clinical results were noted [Constant-Murley score 78.3 ± 18.2 arthroscopic vs. 77.0 ± 21.8 for open surgery; DASH 12.7 ± 18.2 arthroscopic vs. 15.6 ± 21.6 for open surgery (p = 0.81)]. Both the failure rate and the clinical outcome were significantly worse for obese patients (BMI > 30, p = 0.007). The failure rate was 15.8% for the normal-weight patients, 8.2% in the pre-obese group and in the obese group 28.6%. The RC repair failure occurred in 11 cases in both groups after arthroscopic or open treatment (15.0%). CONCLUSIONS Both the arthroscopic and the open approach showed equivalent clinical results and failure rates. Obesity (BMI > 30) causes less favorable results in the Constant and DASH scores and showed higher re-tear rates.
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Affiliation(s)
- A Ateschrang
- BG Trauma Center Tübingen, Eberhard-Karls-Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - F Eggensperger
- BG Trauma Center Tübingen, Eberhard-Karls-Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - M D Ahrend
- BG Trauma Center Tübingen, Eberhard-Karls-Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.,AO Research Institute, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - S Schröter
- BG Trauma Center Tübingen, Eberhard-Karls-Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - U Stöckle
- BG Trauma Center Tübingen, Eberhard-Karls-Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
| | - Tobias M Kraus
- BG Trauma Center Tübingen, Eberhard-Karls-Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
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Chalmers PN, Granger E, Nelson R, Yoo M, Tashjian RZ. Factors Affecting Cost, Outcomes, and Tendon Healing After Arthroscopic Rotator Cuff Repair. Arthroscopy 2018; 34:1393-1400. [PMID: 29371013 DOI: 10.1016/j.arthro.2017.11.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to simultaneously examine costs, functional outcomes, and tendon healing after arthroscopic rotator cuff repair. METHODS This was a retrospective, single-surgeon, single-hospital study. Pre- and postoperative Simple Shoulder Test (SST), visual analog scale (VAS) pain, and American Shoulder and Elbow Surgeons (ASES) scores, and postoperative magnetic resonance images (MRIs) were obtained. Direct costs were derived using a unique, validated tool. Costs included overall total direct cost, which included facility use costs, medication costs, supply costs, and other ancillary costs. RESULTS 85 patients had a minimum 1-year follow-up of functional outcomes (mean of 1.24 years, range 1-3.2 years) and 56 of 85 (66%) had postoperative MRI healing data at an average follow-up of 1.3 years (range 1-3.2 years). Increased direct cost was associated with ASA class III (P < .001) compared with ASA class I, procedures performed at the main operative room (P = .017) compared with those at the surgical center, single-row repair (P < .001) compared with double-row repair, medium and large tear sizes (P < .001 and P = .001) compared with small tear, and increased number of anchors (P ≤ .001 or P < .039 for each additional). Arthroscopic biceps tenodesis was associated with decreased improvement in SST, VAS-pain, and ASES scores (P < .001, .012, and .024), whereas infraspinatus atrophy and large/massive tear size was associated with decreased improvement in ASES scores (P = .03). Obesity (P = .004) and smoking (P = .034) were associated with greater improvement in VAS-pain scores as these were associated with decreased preoperative scores. Seventy percent of tears healed. CONCLUSIONS Within our study, factors that increased direct costs were outcome neutral, and factors that improved outcome were cost neutral. LEVEL OF EVIDENCE Level IV, retrospective.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A..
| | - Erin Granger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Richard Nelson
- Department of Epidemiology, University of Utah, Salt Lake City, Utah, U.S.A
| | - Minkyoung Yoo
- Economics Department, University of Utah, Salt Lake City, Utah, U.S.A
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
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Kessler KE, Robbins CB, Bedi A, Carpenter JE, Gagnier JJ, Miller BS. Does Increased Body Mass Index Influence Outcomes After Rotator Cuff Repair? Arthroscopy 2018; 34:754-761. [PMID: 29100770 DOI: 10.1016/j.arthro.2017.08.248] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the influence of pre-existing obesity (body mass index [BMI] ≥ 30) on outcomes after rotator cuff repair surgery. METHODS We collected data on adult patients who underwent surgical repair for symptomatic full-thickness rotator cuff tears confirmed by imaging between 2012 and 2015. The required follow-up was 3 years. At baseline and 6, 12, 24, and 36 months, the American Shoulder and Elbow Surgeons score, Western Ontario Rotator Cuff index, and visual analog scale pain scores were collected. Complications were assessed by a chart review. Obesity was defined as BMI ≥ 30. Chi-square analysis and Student's t-test examined differences between categorical and continuous variables at baseline. Generalized estimating equations examined the effects of fixed factors on outcome variables longitudinally from baseline to 36 months. RESULTS Thirty-nine percent of 213 subjects were obese (mean BMI = 29.2; range, 16-48; standard deviation, 5.8). There were no statistically significant differences between obese and nonobese subjects in other baseline characteristics. When controlling for covariates, obese subjects reported no differences in Western Ontario Rotator Cuff, American Shoulder and Elbow Surgeons, or visual analog scale pain scores when compared with nonobese subjects at baseline and over 3 years from surgery. Although obese patients were more likely to have inpatient surgery, there was no difference in the incidence of postoperative complications. CONCLUSIONS Contrary to our hypothesis, obese participants who underwent rotator cuff repair reported no difference in functional outcome or pain scores compared with nonobese participants over 3 years. In addition, obesity was not associated with postoperative complications in this study. However, as we hypothesized, obese participants were more likely than nonobese participants to have repair in the inpatient setting. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Katie E Kessler
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Christopher B Robbins
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - James E Carpenter
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Bruce S Miller
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A..
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Cancienne JM, Brockmeier SF, Carson EW, Werner BC. Risk Factors for Infection After Shoulder Arthroscopy in a Large Medicare Population. Am J Sports Med 2018; 46:809-814. [PMID: 29309200 DOI: 10.1177/0363546517749212] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder arthroscopy is well established as a highly effective and safe procedure for the treatment for several shoulder disorders and is associated with an exceedingly low risk of infectious complications. Few data exist regarding risk factors for infection after shoulder arthroscopy, as previous studies were not adequately powered to evaluate for infection. PURPOSE To determine patient-related risk factors for infection after shoulder arthroscopy by using a large insurance database. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The PearlDiver patient records database was used to query the 100% Medicare Standard Analytic Files from 2005 to 2014 for patients undergoing shoulder arthroscopy. Patients undergoing shoulder arthroscopy for a diagnosis of infection or with a history of prior infection were excluded. Postoperative infection within 90 days postoperatively was then assessed with International Classification of Diseases, Ninth Revision codes for a diagnosis of postoperative infection or septic shoulder arthritis or a procedure for these indications. A multivariate binomial logistic regression analysis was then utilized to evaluate the use of an intraoperative steroid injection, as well as numerous patient-related risk factors for postoperative infection. Adjusted odds ratios (ORs) and 95% CIs were calculated for each risk factor, with P < .05 considered statistically significant. RESULTS A total of 530,754 patients met all inclusion and exclusion criteria. There were 1409 infections within 90 days postoperatively (0.26%). Revision shoulder arthroscopy was the most significant risk factor for infection (OR, 3.25; 95% CI, 2.7-4.0; P < .0001). Intraoperative steroid injection was also an independent risk factor for postoperative infection (OR, 1.46; 95% CI, 1.2-1.9; P = .002). There were also numerous independent patient-related risk factors for infection, the most significant of which were chronic anemia (OR, 1.58; 95% CI, 1.4-1.8; P < .0001), malnutrition (OR, 1.42; 95% CI, 1.2-1.7; P = .001), male sex (OR, 2.71; 95% CI, 2.4-3.1; P < .0001), morbid obesity (OR, 1.41; 95% CI, 1.2-1.6; P < .0001), and depression (OR, 1.36; 95% CI, 1.2-1.5; P < .0001). CONCLUSION Intraoperative steroid injection was a significant independent risk factor for postoperative infection after shoulder arthroscopy. There were also numerous significant patient-related risk factors for postoperative infection, including revision surgery, obesity, male sex, chronic anemia, malnutrition, depression, and alcohol use, among others.
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Affiliation(s)
- Jourdan M Cancienne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Eric W Carson
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
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Hunt TJ. Editorial Commentary: Go Ahead and Repair That Shoulder Rotator Cuff Tear in Your Obese Patient: Just Be Prepared to Admit Them. Arthroscopy 2018; 34:762-763. [PMID: 29502696 DOI: 10.1016/j.arthro.2017.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 02/02/2023]
Abstract
Arthroscopic rotator cuff repair in the obese patient offers functional outcomes and rates of complications comparable to those seen in nonobese patients. Future prospective studies with better methodology, as well as including larger numbers of severely obese patients with a body mass index of 40 or greater, will help to further elucidate if obesity truly affects outcomes in rotator cuff repair. In the meantime, be sure to consider admission of your obese rotator cuff repair patients.
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Boddapati V, Fu MC, Schairer WW, Ranawat AS, Dines DM, Taylor SA, Dines JS. Increased Shoulder Arthroscopy Time Is Associated With Overnight Hospital Stay and Surgical Site Infection. Arthroscopy 2018; 34:363-368. [PMID: 28941946 DOI: 10.1016/j.arthro.2017.08.243] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to characterize the rates of short-term postoperative complications, readmissions, and overnight hospital stays as a function of shoulder arthroscopy procedure time. A secondary aim of this current study was to identify baseline patient risk factors for adverse outcomes. METHODS This study used the American College of Surgeons National Surgical Quality Improvement Program registry from 2012 to 2015. Shoulder arthroscopy cases were categorized based on operative time, either <45 minutes, between 45 and 90 minutes, or >90 minutes. The rates of 30-day postoperative complications, readmissions, and overnight hospital stays were compared with bivariate and multivariate analysis. RESULTS In total, 33,095 shoulder arthroscopy procedures were identified. Of these, 7,027 (21.2%) were <45 minutes, 16,610 (50.2%) were between 45 and 90 minutes, and 9,458 (28.6%) were >90 minutes. Multivariate analysis identified increased the risk of superficial surgical site infections (SSIs) for procedures lasting between 45 and 90 minutes (odds ratio [OR] = 3.63; P = .036) and for procedures >90 minutes (OR = 4.40; P = .019), compared with procedures <45 minutes. Furthermore, there was an increased risk of overnight hospital stay for patients who had a shoulder arthroscopy lasting between 45 and 90 minutes (OR = 1.33) and >90 minutes (OR = 2.14), compared with procedures <45 minutes. A body mass index >30 kg/m2 was an independent predictor of both overnight hospital stay and superficial SSI (P = .020). Age >60, female gender, American Society of Anesthesiologists class ≥3, and a history of diabetes mellitus, hypertension, or chronic obstructive pulmonary disease were additional predictors of overnight hospital stay (P < .001 for all comparisons, unless otherwise noted). CONCLUSIONS Increased shoulder arthroscopy procedure time is associated with adverse short-term outcomes, particularly superficial SSI and overnight hospital stay. This information may be useful for patient counseling and postoperative risk stratification, as operative time is an easily measured surrogate for surgical complexity or difficulty. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Venkat Boddapati
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A..
| | - Michael C Fu
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - William W Schairer
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - David M Dines
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - Samuel A Taylor
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
| | - Joshua S Dines
- Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York, U.S.A
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Berglund DD, Kurowicki J, Giveans MR, Horn B, Levy JC. Comorbidity effect on speed of recovery after arthroscopic rotator cuff repair. JSES OPEN ACCESS 2018; 2:60-68. [PMID: 30675569 PMCID: PMC6334868 DOI: 10.1016/j.jses.2017.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Comorbidities have been shown to affect rotator cuff healing and postoperative outcomes. The purpose of this study was to analyze the effect of comorbidities on speed of recovery (SOR) and overall outcomes after arthroscopic rotator cuff repair (RCR). Methods We identified 627 patients who underwent primary arthroscopic RCR from 2006 to 2015. Measured motion and patient-reported outcome measures for pain and function were analyzed for preoperative, 3-month, 6-month, and 1-year intervals. Subgroup analysis of overall outcome and plateau in maximum improvement was performed for diabetes, smoking, obesity, hypercholesterolemia, and age. Results Diabetic patients had worse pain (visual analog scale for pain) and functional outcome (American Shoulder and Elbow Surgeons function, Simple Shoulder Test, visual analog scale for function, and elevation) scores at 6 months and 1 year (P < .05), with an earlier plateau in recovery (6 months) for nearly all variables. Smoking had no impact on postoperative outcome scores; however, plateaus occurred earlier in smokers (6 months). Obese patients had worse American Shoulder and Elbow Surgeons function score and external rotation at 1 year (P < .05) with similar plateau points. No significant differences were observed in outcomes for patients with hypercholesterolemia; however, plateaus for Single Assessment Numeric Evaluation and motion occurred earlier (6 months). Outcome scores for patients older than 65 years were not significantly different from those for younger patients. Conclusion After arthroscopic RCR, SOR for pain outpaced that for function and motion. Diabetic patients had worse outcomes and earlier plateau points. Earlier plateaus were seen for smokers and for motion in patients with obesity or hypercholesterolemia. Obese patients showed lower functional scores and external rotation. Age did not significantly influence SOR.
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Affiliation(s)
| | - Jennifer Kurowicki
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.,Seton Hall University, School of Health and Medical Sciences, Department of Orthopaedics, South Orange, NJ, USA
| | | | - Brandon Horn
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.,Witham Orthopaedic Associates, Lebanon, IN, USA
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Saltzman BM, Kuhns BD, Basques B, Leroux T, Alter J, Mather RC, Salata MJ, Nho SJ. The Influence of Body Mass Index on Outcomes After Hip Arthroscopic Surgery With Capsular Plication for the Treatment of Femoroacetabular Impingement. Am J Sports Med 2017; 45:2303-2311. [PMID: 28520460 DOI: 10.1177/0363546517705617] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It remains unknown how variations in body mass index (BMI) influence outcomes after primary hip arthroscopic surgery with capsular plication for femoroacetabular impingement (FAI). PURPOSE To evaluate the effect that abnormal BMI (namely, overweight, obese, morbidly obese, and underweight) versus normal weight has on patient-reported clinical outcomes more than 2 years postoperatively from primary hip arthroscopic surgery with capsular plication by a single surgeon. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A clinical repository containing patients undergoing primary hip arthroscopic surgery for FAI between January 1, 2012, and January 1, 2014, with a minimum 2-year follow-up was queried. Outcome measures included the Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sports, modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain; satisfaction, and Patient Acceptable Symptomatic State (PASS) for the HOS-ADL; scores were collected preoperatively and at 3 months, 1 year, and minimum 2 years postoperatively. Included patients were segregated by preoperative BMI into the following categories: underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2), and morbidly obese (≥35.0 kg/m2). A multivariate logistic regression model controlling for patient demographics and disease severity was used to identify independent associations between BMI categories and outcomes. A Bonferroni adjustment lowered the threshold for significance to P < .01. RESULTS There were 409 hips in 381 patients appropriate for study inclusion: 7 underweight, 197 normal BMI, 130 overweight, 31 obese, and 16 morbidly obese. The mean age was 33.1 ± 12.1 years, with 232 (61%) female patients. At 2 years postoperatively, significant differences in the trend among HOS-ADL, HOS-Sports, and mHHS scores were evident, with normal BMI patients, followed by underweight patients, demonstrating greater scores than their overweight, obese, and morbidly obese counterparts. Obese patients demonstrated lower satisfaction scores than normal BMI patients. Overweight, obese, and morbidly obese patients had lower improvements in VAS pain scores compared with normal BMI patients. Increasing BMI (not subdivided into the 5 BMI categories) was associated with a higher infection risk (mean BMI for infections: 32.3 ± 9.8 kg/m2 vs mean BMI for noninfections: 25.2 ± 4.8 kg/m2; P = .0035). However, with multivariate analysis, no significant differences in patient clinical outcomes between the BMI categories met the threshold for significance. Among obese patients (BMI ≥30.0 kg/m2), no specific risk factors were found to be significantly associated with decreases in the change in VAS, HOS-ADL, HOS-Sports, mHHS, satisfaction, or PASS for the HOS-ADL scores. However, because of the small cohort sizes at the extremes of the BMI categories, this analysis may have been underpowered to identify a significant difference in underweight or morbidly obese patients. CONCLUSION In the current cohort, there were multiple potential confounding variables, and while some clinical differences were observed initially (higher HOS-ADL, HOS-Sports, and mHHS scores for normal BMI patients than overweight and obese patients at 2 years postoperatively; lower satisfaction scores for obese patients than normal BMI patients; and lower improvement in VAS pain scores for overweight, obese, and morbidly obese patients when compared with normal BMI patients), after multivariate analysis, no associations were observed between BMI and clinical outcomes after hip arthroscopic surgery with capsular plication for FAI.
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Affiliation(s)
- Bryan M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benjamin D Kuhns
- Department of Orthopedic Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Bryce Basques
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy Leroux
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer Alter
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard C Mather
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Taylor SA, Degen RM, White AE, McCarthy MM, Gulotta LV, O'Brien SJ, Werner BC. Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective. Am J Sports Med 2017; 45:1640-1644. [PMID: 28282498 DOI: 10.1177/0363546517691950] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Data regarding risk factors for revision surgery after superior labral anterior-posterior (SLAP) repair are limited to institutional series. PURPOSE To define risk factors for revision surgery after SLAP repair among patients in a large national database. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A national insurance database was queried for patients undergoing arthroscopic SLAP repair (Current Procedural Terminology [CPT] code 29807) for the diagnosis of a SLAP tear. Patients without a CPT modifier for laterality were excluded. Revision surgery was defined as (1) subsequent ipsilateral SLAP repair (CPT 29807), (2) ipsilateral arthroscopic debridement for the diagnosis of a SLAP tear (CPT 29822 or 29823, with diagnosis code 840.7), (3) subsequent ipsilateral arthroscopic biceps tenodesis (CPT 29828), (4) subsequent ipsilateral open biceps tenodesis (CPT 23430), and (5) subsequent biceps tenotomy (CPT 23405). Multivariable binomial logistic regression analysis was performed to identify risk factors for revision surgery after SLAP repair, including patient demographics/comorbidities, concomitant diagnoses, and concomitant procedures performed. Odds ratios (ORs), 95% CIs, and P values were calculated. The estimated financial impact of revision surgery was also calculated. RESULTS There were 4751 patients who met inclusion and exclusion criteria. Overall, 121 patients (2.5%) required revision surgery after SLAP repair. Regression analysis identified numerous risk factors for revision surgery, including age >40 years (OR, 1.5; 95% CI, 1.2-1.8; P = .045), female sex (OR, 1.5; 95% CI, 1.3-1.8; P = .010), obesity (OR, 1.8; 95% CI, 1.5-2.2; P = .001), smoking (OR, 2.0; 95% CI, 1.6-2.4; P < .0001), and diagnosis of biceps tendinitis (OR, 3.5; 95% CI, 3.0-4.2; P < .0001) or long head of the biceps tearing (OR, 5.1; 95% CI, 4.1-6.3; P < .0001) at or before the time of surgery. Concomitant rotator cuff repair and distal clavicle excision were not significant risk factors for revision surgery. The cost of revision surgery averaged almost $9000. CONCLUSION Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing. The diagnosis of biceps tendinitis (OR, 3.5) or long head of the biceps tearing (OR, 5.1) at or before the time of surgery was an especially significant risk factor for revision surgery. The high cost of revision surgery highlights the importance of appropriate indications to avoid the need for subsequent procedures.
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Affiliation(s)
| | - Ryan M Degen
- University of Western Ontario, London, Ontario, Canada
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The influence of body mass index on outcome of open arthrolysis for post-traumatic elbow stiffness. J Shoulder Elbow Surg 2017; 26:809-814. [PMID: 28162879 DOI: 10.1016/j.jse.2016.12.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/11/2016] [Accepted: 12/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Being overweight has become a serious public health concern in China. Higher body mass index has been proven to be associated with poor outcome after orthopedic surgery. The purpose of this study was to examine the effect of being overweight on functional outcomes and complications after open arthrolysis for post-traumatic elbow stiffness. METHODS We performed a retrospective study including 122 patients with post-traumatic elbow stiffness undergoing arthrolysis, including 84 in the normal weight group and 38 in the overweight group. Demographic data, surgical data, and data on preoperative and postoperative functional performance and complications were obtained. RESULTS Demographic data and disease characteristics were comparable between the 2 groups at baseline. All patients showed significant improvement after elbow arthrolysis. Postoperatively, the range of motion and Mayo Elbow Performance Score of the normal weight group were significantly better than those of the overweight group. Sixteen patients developed postoperative complications. No significant differences in complication rates between the 2 groups were found. CONCLUSIONS Most patients showed satisfactory functional outcomes after arthrolysis. The postoperative functional outcomes of the overweight group were inferior to those of the normal weight group to a certain extent. This study underlines the importance of detailed rehabilitation instructions in patients with higher body mass index.
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Mollison S, Shin JJ, Glogau A, Beavis RC. Postoperative Rehabilitation After Rotator Cuff Repair: A Web-Based Survey of AANA and AOSSM Members. Orthop J Sports Med 2017; 5:2325967116684775. [PMID: 28210654 PMCID: PMC5302103 DOI: 10.1177/2325967116684775] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Postoperative rehabilitation after arthroscopic rotator cuff repair (ARCR) remains controversial and suffers from limited high-quality evidence. Therefore, appropriate use criteria must partially depend on expert opinion. HYPOTHESIS/PURPOSE The purpose of the study was to determine and report on the standard and modified rehabilitation protocols after ARCR used by member orthopaedic surgeons of the American Orthopaedic Society for Sports Medicine (AOSSM) and the Arthroscopy Association of North America (AANA). We hypothesized that there will exist a high degree of variability among rehabilitation protocols. We also predict that surgeons will be prescribing accelerated rehabilitation. STUDY DESIGN Cross-sectional study; Level of evidence, 4. METHODS A 29-question survey in English language was sent to all 3106 associate and active members of the AOSSM and the AANA. The questionnaire consisted of 4 categories: standard postoperative protocol, modification to postoperative rehabilitation, operative technique, and surgeon demographic data. Via email, the survey was sent on September 4, 2013. RESULTS The average response rate per question was 22.7%, representing an average of 704 total responses per question. The most common immobilization device was an abduction pillow sling with the arm in neutral or slight internal rotation (70%). Surgeons tended toward later unrestricted passive shoulder range of motion at 6 to 7 weeks (35%). Strengthening exercises were most commonly prescribed between 6 weeks and 3 months (56%). Unrestricted return to activities was most commonly allowed at 5 to 6 months. The majority of the respondents agreed that they would change their protocol based on differences expressed in this survey. CONCLUSION There is tremendous variability in postoperative rehabilitation protocols after ARCR. Five of 10 questions regarding standard rehabilitation reached a consensus statement. Contrary to our hypothesis, there was a trend toward later mobilization.
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Affiliation(s)
- Scott Mollison
- Division of Sports Medicine, Department of Orthopedic Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jason J. Shin
- Division of Sports Medicine, Department of Orthopedic Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - R. Cole Beavis
- Division of Sports Medicine, Department of Orthopedic Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Saccomanno MF, Sircana G, Cazzato G, Donati F, Randelli P, Milano G. Prognostic factors influencing the outcome of rotator cuff repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016. [PMID: 26197937 DOI: 10.1007/s00167-015-3700-y] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To identify prognostic factors significantly associated with rotator cuff repair outcome and define the strength of these associations. METHODS Search was performed using electronic databases. Studies reporting prognostic factors affecting rotator cuff repair outcome were included. Primary outcomes were: structural integrity, Disabilities of the Arm, Shoulder and Hand score, American Shoulder and Elbow Surgeons score, and Constant score. Each other outcome was considered as secondary outcome. Descriptive statistics was used. When possible, meta-analyses were performed. Methodological quality was assessed using the Quality In Prognosis Studies Tool. A best evidence synthesis was performed using the Grading of Recommendations Assessment, Development and Evaluation framework adapted to prognostic studies. RESULTS Sixty-four studies were included. Methodological quality was high only for twelve studies. The overall quality of evidence was low to very low. Meta-analyses were possible only for seven studies. Older age and larger tears size were found to affect retear risk. Results were controversial for fatty infiltration, acromioclavicular joint or biceps procedures, acromiohumeral distance, delamination of tendon edges, musculotendinous junction position, number of tendons involved, and tendon length, quality and retraction. Baseline scores and workers compensation claim predicted functional outcomes. Subjective outcome was also affected by patient's expectations. CONCLUSIONS Despite the large number of outcomes and prognostic factors evaluated by a relative small number of studies, almost not prognostic in design, it was not possible to reach any definitive conclusion regarding the most relevant predictors of outcome of rotator cuff repair. Moreover, the low methodological quality of the included studies and, subsequently, the low quality of evidence, seriously affected the strength of recommendation of the present review. Based on data available, retear risk is mainly affected by older age and larger tears size. Baseline scores and work compensation claim are the most significant predictors for functional outcomes. LEVEL OF EVIDENCE Systematic review of level I-IV prognostic studies, Level IV.
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Affiliation(s)
- Maristella F Saccomanno
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Giuseppe Sircana
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Gianpiero Cazzato
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Fabrizio Donati
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy
| | - Pietro Randelli
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giuseppe Milano
- Department of Orthopaedics, Catholic University, "A. Gemelli" University Hospital, Largo A. Gemelli 8, 00168, Rome, RM, Italy.
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Sing DC, Ding DY, Aguilar TU, Luan T, Ma CB, Feeley BT, Zhang AL. The Effects of Patient Obesity on Early Postoperative Complications After Shoulder Arthroscopy. Arthroscopy 2016; 32:2212-2217.e1. [PMID: 27209623 DOI: 10.1016/j.arthro.2016.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/02/2016] [Accepted: 03/15/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE To report the prevalence of obesity in shoulder arthroscopy, determine a body mass index (BMI) threshold most predictive of complication within 30 days, and evaluate obesity as an independent risk factor for medical and surgical complications. METHODS Using the National Surgical Quality Improvement Program database, we reviewed all patients who underwent shoulder arthroscopy during 2011 to 2013. Receiver operating characteristic and Youden coefficient were calculated to find an optimal BMI cutoff to predict complications within 30 days of surgery. A case-control matched analysis was then performed by stratifying patient BMI by this cutoff and matching patients one to one according to age, sex, type of shoulder arthroscopy, American Society of Anesthesiology rating, surgical setting, and 8 comorbidities. Operating time, complications, and readmissions were also compared. RESULTS Of the 15,589 patients who underwent shoulder arthroscopy, 6,684 (43%) were classified as obese when using the optimal cutoff point of BMI = 30 according to the Youden coefficient. Obese patients had a higher risk of superficial site infection than nonobese patients (0.3% vs 0.0%; odds ratio [OR]: 6.00; 95% confidence interval [CI], 1.3 to 26.8; P = .015). Obese patients did not have significantly increased risk for overall early postoperative complication (1.2% compared with nonobese 0.8%; OR: 1.54; 95% CI, 1.0 to 2.4), readmissions (OR: 0.85; 95% CI, 0.5 to 1.5), or increased operating time (P = .068). CONCLUSIONS Up to 43% of patients undergoing shoulder arthroscopy can be classified as obese, but early perioperative complications are uncommon. Higher patient BMI is associated with increased risk of superficial site infection but not an overall risk for complication, readmission, or increased operating time. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- David C Sing
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - David Y Ding
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Thomas U Aguilar
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Tammy Luan
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A..
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Prodromo J, Rackley J, Mulcahey MK. A review of important medical and surgical considerations for obese patients undergoing arthroscopic surgery. PHYSICIAN SPORTSMED 2016; 44:231-9. [PMID: 27578242 DOI: 10.1080/00913847.2016.1221750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Obesity represents a unique challenge in orthopaedic surgery, the impact of which is seen through all phases of injury: in the development of disease, during the operative procedure, and throughout the rehabilitation period. Given the high prevalence of obesity in the United States and around the world, this patient population represents a substantial proportion of patients in need of orthopedic care. The effects of this disease constrain both medical and financial resources. For obese patients undergoing orthopedic procedures, adequate steps must be taken to minimize the risks that occur before, during, and after surgical intervention. This literature review discusses the impact of obesity on arthroscopic procedures, with a focus on procedures involving the shoulder, hip, and knee. The management of obese patients during the perioperative period should address the specific concerns relating to these patients. Obesity is a risk factor for numerous comorbidities, is associated with surgical complications, and is a predictor of poor functional outcomes following arthroscopy. Efforts to minimize the negative impact of obesity on arthroscopic procedures are crucial.
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Affiliation(s)
- John Prodromo
- a Department of Orthopaedic Surgery , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Justin Rackley
- b Drexel University College of Medicine , Philadelphia , PA , USA
| | - Mary K Mulcahey
- c Department of Orthopaedic Surgery , Hahnemann University Hospital/Drexel University College of Medicine , Philadelphia , PA , USA
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Sahni V, Narang AM. Review article: Risk factors for poor outcome following surgical treatment for rotator cuff tear. J Orthop Surg (Hong Kong) 2016; 24:265-8. [PMID: 27574276 DOI: 10.1177/1602400229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Medline database was searched using key words: 'rotator cuff', 'tear', and 'treatment'. 12 studies that involved (1) surgical treatment for rotator cuff tear, (2) measurement of pre- and post-operative pain score, functional score, and/or patient satisfaction, (3) patients that failed to improve functionally or had poor satisfaction, (4) preoperative examination of risk factors that could lead to poor outcome, and (5) a minimum follow-up of 6 months were reviewed to identify risk factors associated with poor outcome following surgical treatment for rotator cuff tear. The most common risk factor was tear size, followed by open compensation claim, age, and time from injury to surgery.
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Affiliation(s)
- V Sahni
- Southport and Formby District General Hospital, Town Lane, Kew, Southport. United Kingdom
| | - A M Narang
- Kettering General Hospital Northamptonshire, United Kingdom
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Kokmeyer D, Dube E, Millett PJ. Prognosis Driven Rehabilitation After Rotator Cuff Repair Surgery. Open Orthop J 2016; 10:339-348. [PMID: 27708736 PMCID: PMC5041202 DOI: 10.2174/1874325001610010339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/23/2015] [Accepted: 02/01/2016] [Indexed: 12/31/2022] Open
Abstract
Background: Rehabilitation after rotator cuff repair surgery has been the focus of several clinical trials in the past decade. Many illuminate new evidence with regard to the prognosis of structural and functional success after surgery. Methods: A selective literature search was performed and personal physiotherapeutic and surgical experiences are reported. Results: Post-operative rehabilitation parameters, namely the decision to delay or allow early range of motion after surgery, play a large role in the overall success after surgery. Using a prognosis driven rehabilitation program offers clinicians a means of prescribing optimal rehabilitation parameters while ensuring structural and functional success. This commentary aims to synthesize the evidence in a spectrum of prognostic factors to guide post-operative rehabilitation. Conclusion: The optimal rehabilitation program after rotator cuff repair surgery is debatable; therefore, we suggest using a spectrum of prognostic factors to determine a rehabilitation program suited to ensure structural and functional success, quickly and safely.
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Affiliation(s)
- Dirk Kokmeyer
- Maine Medical Partners, Orthopedic and Sports Medicine, South Portland, Maine, United States
| | - Eric Dube
- Howard Head Sports Medicine, Silverthorne, Colorado, United States
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Sing DC, Luan TF, Feeley BT, Zhang AL. Is Obesity a Risk Factor for Adverse Events After Knee Arthroscopy? Arthroscopy 2016; 32:1346-1353.e1. [PMID: 27013106 DOI: 10.1016/j.arthro.2016.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 10/17/2015] [Accepted: 01/08/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate how body mass index (BMI) affects rates of 30-day complication, hospital readmissions, and mortality in patients undergoing knee arthroscopy. METHODS Patients undergoing knee arthroscopy procedures between 2006 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patient demographics and preoperative risk factors including BMI were analyzed for postoperative complications within 30 days. Cochran-Armitage testing was performed to detect differences in complication rates across BMI categories according to World Health Organization classification. The independent risk of BMI was assessed using multivariate regression analysis. RESULTS Of 41,919 patients with mean age 48 years undergoing knee arthroscopy, 20% were classified as normal weight (BMI 18.5 to 24), 35% overweight (BMI 25 to 29), 24% obese class I (BMI 30 to 34), 12% class II (BMI 35 to 40), and 9% class III (BMI ≥40). Risk of complication increased significantly with increasing BMI (normal: 1.5%, overweight: 1.6%, obese class I: 1.7%, obese class II: 1.8%, obese class III: 1.9%, P = .043). On multivariate analysis, there was no increased risk of postoperative complication directly attributed to patient BMI. Independent risk factors for medical and surgical complications after knee arthroscopy included American Society of Anesthesiologists (ASA) rating (class 4 v class 1 odds ratio [OR]: 5.39 [95% confidence interval: 3.11-9.33], P < .001), functional status for activities of daily living (dependent v independent OR: 2.13 [1.42, 3.31], P < .001), history of renal comorbidity (presence v absence OR: 5.10 [2.30, 11.29], P < .001), and previously experienced history of wound infection prior to current surgery (presence v absence OR: 4.91 [2.88, 8.39], P < .001). CONCLUSIONS More than 40% of knee arthroscopy patients qualify as obese. Although univariate analysis suggests that obesity is associated with increased postoperative complications within 30 days of surgery, BMI alone does not predict complications. Independent predictors of complications include patients with high ASA classification, dependent functional status, renal comorbidities, and a recent history of wound infection. LEVEL OF EVIDENCE Level IV, prognostic case series.
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Affiliation(s)
- David C Sing
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Tammy F Luan
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A..
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Soukup DS, MacMahon A, Burket JC, Yu JM, Ellis SJ, Deland JT. Effect of Obesity on Clinical and Radiographic Outcomes Following Reconstruction of Stage II Adult Acquired Flatfoot Deformity. Foot Ankle Int 2016; 37:245-54. [PMID: 26542162 DOI: 10.1177/1071100715614841] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obesity is a known risk factor for the development of adult acquired flatfoot deformity (AAFD), but obesity's effects on outcomes following AAFD reconstruction are unknown. We hypothesized that obesity would negatively impact outcomes following joint-preserving stage II AAFD reconstruction. METHODS This retrospective study compared the outcomes of normal-weight (18.5 kg/m(2) ≤ BMI < 25 kg/m(2)), overweight (25 kg/m(2) ≤ BMI < 30 kg/m(2)), and obese (BMI ≥ 30 kg/m(2)) patients after AAFD reconstruction. Clinical outcome measures included the Foot and Ankle Outcome Score (FAOS), Short-Form 12 (SF-12), and Numeric Rating Scale of Pain (NRS Pain) administered preoperatively and at least 1 year postoperatively. Anteroposterior and lateral radiographs were taken preoperatively and at least 6 months postoperatively. Pre- to postoperative changes in outcome measures were assessed within BMI classes. Preoperative, postoperative, and pre- to postoperative changes in outcomes were compared among BMI classes. There were 41 normal-weight patients, 39 overweight patients, and 44 obese patients with a mean age of 56 years, FAOS follow-up of 2.9 years, and radiographic follow-up of 2.1 years. Demographics and reconstructive procedures were comparable among the 3 BMI classes. RESULTS All outcomes significantly increased pre- to postoperatively in the 3 groups with the exception of the FAOS Symptoms subscale for normal-weight patients (P = .340) and SF-12 Mental Component score for all 3 BMI classes (P > .999). Preoperatively, obese patients had more symptoms than normal-weight patients, scoring 12 points lower on the FAOS Symptoms subscore (P = .008). Obese patients also scored 11 points lower preoperatively on the SF-12 Overall score (P = .028) and had 31% greater pain than normal-weight patients (P = .003). There were no differences among the 3 BMI classes in any postoperative outcomes assessed. CONCLUSION Although obese patients had significantly worse symptoms, overall health, and NRS pain scores preoperatively, the short-term clinical and radiographic outcomes of stage II AAFD reconstruction were similar for normal-weight, overweight, and obese patients. We suggest that joint-preserving reconstruction remains a viable alternative to fusion of the triple joint complex for the treatment of overweight and obese stage II AAFD patients. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Dylan S Soukup
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Aoife MacMahon
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jayme C Burket
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Jeanne M Yu
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
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Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty. Clin Orthop Relat Res 2016; 474:787-95. [PMID: 26452748 PMCID: PMC4746173 DOI: 10.1007/s11999-015-4584-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/30/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have analyzed the association between elevated BMI and complications after total shoulder arthroplasty (TSA). Previous studies have not consistently arrived at the same conclusion regarding whether obesity is associated with a greater number of postoperative complications. We used a national surgical database to compare the 30-day complication profile and hospitalization outcomes after primary TSA among patients in different BMI categories. QUESTIONS/PURPOSES We asked: (1) Is obesity associated with an increased risk of complications within 30 days of primary TSA? (2) Is obesity associated with increased operative time? METHODS The American College of Surgeons National Surgical Quality Improvement Program(®) database for 2006 to 2012 was queried to identify all patients who underwent a primary TSA for osteoarthritis of the shoulder. The ACS-NSQIP(®) database was selected for this study as it is a nationally representative database that provides prospectively collected perioperative data and a comprehensive patient medical profile. Exclusion criteria included revision TSA, infection, tumor, or fracture. We analyzed 4796 patients who underwent a primary TSA for osteoarthritis of the shoulder. Patients who underwent a TSA were divided in four BMI categories: normal (18.5-25 kg/m(2)), overweight (25-30 kg/m(2)), obesity Class 1 (30-35 kg/m(2)), and obesity Class 2 or greater (> 35 kg/m(2)). Perioperative hospitalization data and 30-day postoperative complications were compared among different BMI classes. Differences in patient demographics, preoperative laboratory values, and preexisting patient comorbidities also were analyzed among different BMI groups, and multivariate analysis was used to adjust for any potential confounding variables. RESULTS There was no association between BMI and 30-day complications after surgery (normal as reference, overweight group relative risk: 0.57 [95% CI, 0.30-1.06], p = 0.076; obesity Class 1 relative risk: 0.52 [95% CI, 0.26-1.03], p = 0.061; obesity Class 2 or greater relative risk: 0.54 [95% CI, 0.25-1.17], p = 0.117). However, greater BMI was associated with longer surgical times (for normal BMI control group: 110 minutes, SD, 42 minutes; overweight group: 115 minutes, SD, 46 minutes, mean difference to control: 5 minutes [95% CI, -1 to 10 minutes], p = 0.096; obesity Class 1: 120 minutes, SD, 43 minutes, mean difference: 10 minutes [95% CI, 5-15 minutes], p < 0.001; obesity Class 2 or greater: 122 minutes, SD, 45 minutes, mean difference: 12 minutes [95% CI, 6-18 minutes], p < 0.001). CONCLUSIONS Although the surgical time increased for patients with greater BMI, the 30-day complications and perioperative hospitalization data after TSA were not different in patients with increased BMI levels. Obesity alone should not be a contraindication for TSA, and obese patients can expect similar incidences of postoperative complications. The preoperative medical optimization plan should be consistent with that of patients who are not obese who undergo TSA. LEVEL OF EVIDENCE Level III, therapeutic study.
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Abate M, Salini V, Andia I. How Obesity Affects Tendons? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 920:167-77. [PMID: 27535258 DOI: 10.1007/978-3-319-33943-6_15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several epidemiological and clinical observations have definitely demonstrated that obesity has harmful effects on tendons. The pathogenesis of tendon damage is multi-factorial. In addition to overload, attributable to the increased body weight, which significantly affects load-bearing tendons, systemic factors play a relevant role. Several bioactive peptides (chemerin, leptin, adiponectin and others) are released by adipocytes, and influence tendon structure by means of negative activities on mesenchymal cells. The ensuing systemic state of chronic, sub-clinic, low-grade inflammation can damage tendon structure. Metabolic disorders (diabetes, impaired glucose tolerance, and dislipidemia), frequently associated with visceral adiposity, are concurrent pathogenetic factors. Indeed, high glucose levels increase the formation of Advanced Glycation End-products, which in turn form stable covalent cross-links within collagen fibers, modifying their structure and functionality.Sport activities, so useful for preventing important cardiovascular complications, may be detrimental for tendons if they are submitted to intense acute or chronic overload. Therefore, two caution rules are mandatory: first, to engage in personalized soft training program, and secondly to follow regular check-up for tendon pathology.
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Affiliation(s)
- Michele Abate
- Department of Medicine and Science of Aging, University G. d'Annunzio, Via dei Vestini 31, Chieti-Pescara, 66013, Chieti Scalo (CH), Italy.
| | - Vincenzo Salini
- Department of Medicine and Science of Aging, University G. d'Annunzio, Via dei Vestini 31, Chieti-Pescara, 66013, Chieti Scalo (CH), Italy
| | - Isabel Andia
- Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
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Abstract
The role of inflammation in tendon disorders has long been a subject of considerable debate. Developments in our understanding of the basic science of inflammation have provided further insight into its potential role in specific forms of tendon disease, and the circumstances that may potentiate this. Such circumstances include excessive mechanical stresses on tendon and the presence of systemic inflammation associated with chronic diseases. In this chapter a brief review of the basic science of inflammation is provided and the influence that it may play on tendons is discussed.
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Affiliation(s)
- Cathy Speed
- Cambridge Centre for Health and Performance, Cambridge, UK. .,Fortius Clinic, London, UK. .,University of St Mark and St John, Plymouth, UK.
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Abstract
BACKGROUND The appropriate use criteria (AUC) were developed for full-thickness rotator cuff tears to determine when it is reasonable to recommend nonoperative care, partial repair/débridement, repair, reconstruction, or arthroplasty. The goal of this report was to interpret and summarize the results of the AUC process into clinically relevant terms. METHODS Using the results of the AUC methodology, we systematically interpreted the clinical importance attributed to the various patient and pathologic variables. We then assessed the combination of considerations that would justify the various treatment options using "preference tables." RESULTS A nonoperative program was appropriate if the patient had a positive response to conservative care. However, a repair could be maybe appropriate was also accepted. Rotator cuff repair was appropriate when conservative treatment failed in symptomatic patients. Reconstructive measures were recognized primarily in those with chronic massive tears. Most found arthroplasty maybe appropriate only in healthy patients, pseudoparalysis, and chronic massive tears. Surprisingly, neither factors that decreased healing nor adversely affected outcome had a strong influence on the panel's treatment recommendations. CONCLUSIONS The AUC process accounts for clinical experience and considers individual patient and pathologic characteristics of the condition. Overall, the outcome of this exercise does support the current practice for the management of rotator cuff tears (ie, repair of symptomatic tears). However, the minimal importance given to patient and pathologic considerations, well documented to influence outcome, prompts an ongoing effort to refine this important and clinically relevant process.
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Affiliation(s)
- Christopher C Schmidt
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Bernard F Morrey
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
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Griffin JW, Werner BC, Gwathmey FW, Chhabra AB. Obesity is associated with increased postoperative complications after total elbow arthroplasty. J Shoulder Elbow Surg 2015; 24:1594-601. [PMID: 26385389 DOI: 10.1016/j.jse.2015.06.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obesity has become a significant public health concern in the United States. Few published data have examined the association between obesity and postoperative complications after total elbow arthroplasty (TEA). METHODS Patients who underwent TEA were identified using the PearlDiver database Current Procedural Terminology codes. Patients were divided into obese and nonobese cohorts using International Classification of Diseases, Ninth Revision codes. Each cohort was then assessed for major and minor complications within 90 days postoperatively. Odds ratios, 95% confidence intervals, and χ(2) tests were calculated, with P < .05 considered significant. RESULTS From 2005 to 2011, 7580 patients who underwent TEA were identified, of whom 1030 patients (14%) were coded as obese (body mass index > 30) and 611 patients (8%) were coded as morbidly obese (body mass index > 40). The obese TEA patients had increased risk of 90-day major and minor complications. The rate of postoperative venous thromboembolism differed significantly between groups, with a trend toward a higher venous thromboembolism rate in obese patients (2.2%) vs. nonobese patients (0.7%). Rate of postoperative stiffness was similar between groups. Infection rates were higher in obese patients compared with nonobese patients. Medical complications were higher in obese patients (16.7%) compared with the nonobese cohort (4.7%). A significant difference in implant removal was notable at 6 months and 1 year in morbidly obese patients compared with nonobese counterparts. CONCLUSIONS Obesity and associated medical comorbidities place patients at increased risk for complications after TEA. Obese patients and especially morbidly obese patients thinking of undergoing TEA should be appropriately counseled preoperatively about their increased risk for complications.
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Affiliation(s)
- Justin W Griffin
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
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Chen JY, Lee MJH, Rikhraj K, Parmar S, Chong HC, Yew AKS, Koo KOT, Singh Rikhraj I. Effect of Obesity on Outcome of Hallux Valgus Surgery. Foot Ankle Int 2015; 36:1078-83. [PMID: 25881625 DOI: 10.1177/1071100715581449] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obesity is a global epidemic, but its effect on foot and ankle surgeries is not well defined. This study aimed to investigate the influence of obesity on functional outcome scores, incidence of postoperative surgical site infection (SSI), and repeat surgery after hallux valgus (HV) corrective surgery. METHODS Between January 2007 and December 2011, 452 patients who underwent HV corrective surgery at a tertiary hospital were evaluated. They were categorized into 2 groups based on their body mass index (BMI): (1) BMI less than 30 kg/m(2) (control); (2) BMI 30 kg/m(2) or more (obese). The patients were prospectively followed for 2 years. RESULTS Patients in the obese group were significantly older by 4 years (95% CI, 1-7 years) (P = .043). The preoperative American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) Scale and Physical Component Score were 6 points (95% CI, 1-11 points) and 3 points (95% CI, 1-6 points) poorer, respectively, in the obese group (P = .014 and P = .032, respectively). However, the Visual Analog Scale, AOFAS Hallux MTP-IP Scale, Physical Component Score, and Mental Component Score were comparable between the 2 groups at 6 months and 2 years of follow-up (all P > .05). Eleven patients (3%) in the control group and 1 patient in the obese group (2%) developed postoperative SSI (P = .777). Nine patients (2%) in the control group and 7 patients in the obese group (14%) required repeat surgery for complications (P < .001). CONCLUSION The authors conclude that while it is important to warn obese patients of the significantly higher risk of repeat surgery, these patients should not be excluded from undergoing HV surgery. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
| | | | - Kiran Rikhraj
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Simran Parmar
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Hwei Chi Chong
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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75
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Fermont AJ, Wolterbeek N, Wessel RN, Baeyens JP, de Bie RA. Prognostic factors for recovery after arthroscopic rotator cuff repair: a prognostic study. J Shoulder Elbow Surg 2015; 24:1249-56. [PMID: 26189806 DOI: 10.1016/j.jse.2015.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 04/09/2015] [Accepted: 04/11/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Studies concerning prognostic factors of recovery after arthroscopic rotator cuff repair mostly focus on tendon integrity or functional recovery as an outcome. Little is known about how they influence quality of life after surgery. We therefore tried to identify prognostic factors having an impact on quality of life after arthroscopic rotator cuff repair. METHODS This study included 30 patients who underwent arthroscopic rotator cuff repair. We assessed Western Ontario Rotator Cuff Index as primary outcome and RAND-36, Constant-Murley score, and a shoulder hindrance score as secondary outcomes. Patients were repeatedly measured: once preoperatively and 4 times postoperatively. Preoperative range of motion, obesity, fatty infiltration, and cuff retraction were preselected as prognostic factors. RESULTS Patients were significantly improved at 3 months and 6 months after arthroscopic rotator cuff repair. In multiple regression analysis, none of the preselected factors could be identified as a prognostic factor influencing quality of life after arthroscopic rotator cuff repair (measured with the Western Ontario Rotator Cuff Index). For the outcome variables RAND-36 (6 months, 1 year) and shoulder hindrance score (1 year), fatty infiltration Goutallier stages 1 and 2 and retraction grades II, III, and IV were significant predictors. CONCLUSION Although fatty infiltration and retraction grade predict the RAND-36 and shoulder hindrance score, this study could not support preoperative range of motion, obesity, fatty infiltration, or retraction of the cuff as a prognostic factor for quality of life after arthroscopic rotator cuff repair. This study shows that if selection of patients is done properly, these factors do not influence a successful outcome.
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Affiliation(s)
- Anouk J Fermont
- Department of Orthopaedic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands; Medicort Sports and Orthopedic Care, Utrecht, The Netherlands.
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Ronald N Wessel
- Department of Orthopaedic Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Jean-Pierre Baeyens
- Vrije Universiteit Brussel, Brussels, Belgium; University College Thim van der Laan, Landquart, Switzerland
| | - Rob A de Bie
- Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands
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Gupta A, Redmond JM, Hammarstedt JE, Stake CE, Domb BG. Does obesity affect outcomes in hip arthroscopy? A matched-pair controlled study with minimum 2-year follow-up. Am J Sports Med 2015; 43:965-71. [PMID: 25617403 DOI: 10.1177/0363546514565089] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip arthroscopy has gained popularity over the past decade, and its indications have broadened as newer techniques have been developed. However, there has been a paucity of literature evaluating the outcomes of hip arthroscopy in obese patients. PURPOSE To compare 2-year clinical outcomes of obese patients undergoing primary hip arthroscopy with matched nonobese controls. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS From February 2008 to February 2012, data were collected prospectively on all obese patients undergoing primary hip arthroscopy. A matched-pair nonobese control group was selected at a 1:2 ratio. All patients were assessed pre- and postoperatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Activities of Daily Living, and Hip Outcome Score-Sport Specific Subscale. Pain was estimated on the visual analog scale, and satisfaction was measured on a scale from 0 to 10. RESULTS Sixty-two hips (62 patients) were included in the obese group and 124 hips (124 patients) in the control group. At preoperative baseline, the obese group had significantly lower PRO scores when compared with the control group. Both groups demonstrated statistically significant postoperative improvement in all scores (P < .05). Absolute scores were significantly lower in the obese group for all PRO measures, pre- and postoperatively. However, the improvement (delta) in PRO scores from pre- to postoperative time was not significantly different between groups. The rate of conversion to total hip arthroplasty, the rate of revision, and the complication rate were not significantly different between the 2 groups; however, rates of conversion to total hip arthroplasty and revision tended to be twice as high in the obese patients, but the study was not powered for these 2 outcomes. CONCLUSION Overall, obese patients had lower absolute PRO scores preoperatively and at 2-year follow-up. Both obese and nonobese patients demonstrated significant improvement in all PRO scores, and the change in scores were similar between groups. These results indicate that while obese patients may not have similar absolute scores after hip arthroscopy, they may show similar gains in improvement when compared with baseline. Hip arthroscopy appears to be a viable treatment option in the obese patient as long as expectations are adjusted accordingly.
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Affiliation(s)
| | | | | | | | - Benjamin G Domb
- American Hip Institute, Westmont, Illinois, USA Hinsdale Orthopaedics, Westmont, Illinois, USA Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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Obesity is associated with increased postoperative complications after operative management of proximal humerus fractures. J Shoulder Elbow Surg 2015; 24:593-600. [PMID: 25440511 DOI: 10.1016/j.jse.2014.08.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obesity has become a significant public health concern in the United States. The goal of this study was to assess the effect of obesity on postoperative complications after operative management of proximal humerus fractures by use of a national database. METHODS Patients who underwent operative management of a proximal humerus fracture were identified in a national database by Current Procedural Terminology codes for procedures in patients with International Classification of Diseases, Ninth Revision (ICD-9) codes for proximal humerus fracture, including (1) open reduction and internal fixation, (2) intramedullary nailing, (3) hemiarthroplasty, and (4) total shoulder arthroplasty. These groups were then divided into obese and nonobese cohorts by use of ICD-9 codes for obesity, morbid obesity, or body mass index >30. Each cohort was then assessed for local and systemic complications within 90 days and mortality within 2 years postoperatively. Odds ratios and 95% confidence intervals were calculated. RESULTS From 2005 to 2011, 20,319 patients who underwent operative management of proximal humerus fractures were identified, including 14,833 (73.0%) open reduction and internal fixation, 1368 (9.2%) intramedullary nail, 3391 (16.7%) hemiarthroplasty, and 727 (3.6%) shoulder arthroplasty. Overall, 3794 patients (18.7%) were coded as obese, morbidly obese, or body mass index >30. In each operative group, obesity was associated with a substantial increase in local and systemic complications. CONCLUSIONS Obesity and its resultant medical comorbidities are associated with increased rates of postoperative complications after operative management of proximal humerus fractures. Obese patients for whom operative management of proximal humerus fractures is planned should be counseled preoperatively about their increased risk for postoperative complications.
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Mochizuki Y, Ochi M. Clinical results of arthroscopic polyglycolic acid sheet patch graft for irreparable rotator cuff tears. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2015; 2:31-35. [PMID: 29264237 PMCID: PMC5730641 DOI: 10.1016/j.asmart.2014.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/28/2014] [Accepted: 11/24/2014] [Indexed: 01/08/2023]
Abstract
The high retear rates after surgery for irreparable rotator cuff tears can be explained by the healing capacity potential of tendons and the native rotator cuff enthesis characterised by complex morphological structures, called direct insertion. Many experimental researches have focused on biologically augmenting the rotator cuff reconstruction and improving tendon–bone healing of the rotator cuff. The results of the experimental study showed that the polyglycolic acid sheet scaffold material allows for the regeneration of not only tendon-to-tendon, but also tendon-to-bone interface in an animal model. We performed a clinical study of the arthroscopic polyglycolic acid sheet patch graft used for the repair of irreparable rotator cuff tears. One-year clinical results of the repair of irreparable rotator cuff tears by arthroscopic patch graft with a polyglycolic acid sheet demonstrated improved shoulder function and a significantly lower retear rate, compared with patients treated with a fascia lata patch.
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Affiliation(s)
- Yu Mochizuki
- Hiroshima Prefectural Hospital, Ujina-Knada, Minami-Ku, Hiroshima, Japan
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79
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Correlation of obesity with patient-reported outcomes and complications after hip arthroscopy. Arthroscopy 2015; 31:57-62. [PMID: 25218005 DOI: 10.1016/j.arthro.2014.07.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE This study aimed to evaluate patient-reported outcomes and complications after hip arthroscopy in an obese population compared with a matched nonobese control group with a minimum 2-year follow-up, using the Modified Harris Hip Score (MHHS) and Nonarthritic Hip Score (NAHS). METHODS Data were analyzed from 21 consecutive obese patients (body mass index [BMI] ≥ 30) and 18 nonobese patients (BMI < 25) who underwent hip arthroscopy between 2009 and 2012 with a minimum follow-up of 2 years. Data collected included MHHS, NAHS, traction and intraoperative times, and postoperative complications. RESULTS Traction times were similar between obese and nonobese patients at 48 and 45 minutes (P = .51), respectively. Operative times were also similar at 54 and 51 minutes (P = .79), respectively. Each group had a statistically significant improvement in MHHS from baseline to final follow-up: 45 to 79 (P < .001) in the obese group and 49 to 81 (P < .001) in the nonobese cohort. Similarly, the NAHS showed significant improvement in each group from baseline to final follow-up: 43 to 75 (P < .001) in the obese cohort and 45 to 83 (P < .001) in the nonobese group. There was no difference between groups in MHHS or NAHS data. There were 8 complications in the obese group, most commonly deep vein thrombosis (DVT) and worsened pain, whereas the nonobese cohort had one complication (an instance of heterotopic ossification [HO]). Overall, obese patients had 11.1 times the risk of a complication developing than did nonobese patients (95% confidence interval, 1.2 to 99.7). CONCLUSIONS Hip arthroscopy in the obese patient population leads to improved short- to mid-term patient-reported outcomes similar to those seen in nonobese patients. Obese patients, however, are at a significantly increased risk of postoperative complications such as DVTs and worsened hip pain. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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80
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81
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The impact of obesity on complications of elbow, forearm, and hand surgeries. J Hand Surg Am 2014; 39:1578-84. [PMID: 24975260 PMCID: PMC4116465 DOI: 10.1016/j.jhsa.2014.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/30/2014] [Accepted: 05/01/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the rates of postoperative complications in obese and nonobese patients following elbow, forearm, and hand surgeries. METHODS This case-control study examined 436 patients whose body mass index (BMI) was over 35 and who underwent hand, wrist, forearm, or elbow surgery between 2009 and 2013. Controls were patients (n = 433) with a BMI less than 30 who had similar surgeries over the same period, and who were frequency-matched by type of surgery (ie, bony, soft tissue, or nerve), age, and sex. Postoperative complications were defined as infection requiring antibiotic or reoperation, delayed incision healing, nerve dysfunction, wound dehiscence, hematoma, and other reoperation. Medical comorbidities (e.g., hypertension, diabetes, stroke, vascular disease, kidney disease, and liver disease) were recorded. Chi-square analyses were performed to explore the association between obesity and postoperative complications. Similar analyses were performed stratified by surgery type and BMI classification. Logisticregression modeling was performed to identify predictors of postoperative complications accounting for surgery type, BMI, the presence of comorbidities, patient age, and patient sex. This same model was also run separately for case and control patients. RESULTS The overall complication rate was 8.7% with similar rates between obese and nonobese patients (8.5% vs. 9.0%). Bony procedures resulted in the greatest risk of complication in both groups (15% each group). Multivariate analysis confirmed surgery type as the only significant predictor of complications for nonobese patients. However, among obese patients, both bony surgery and increasing BMI were associated with greater complication rates. CONCLUSIONS Not all obese patients appear to be at any higher risk for complications after elbow, forearm, and hand surgery compared with nonobese patients. However, there appears to be a dose-dependent effect of BMI among obese patients such that increasing obesity heightens the risk of complications, especially for those with a BMI greater than 45. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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82
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Kluczynski MA, Bisson LJ, Marzo JM. Does body mass index affect outcomes of ambulatory knee and shoulder surgery? Arthroscopy 2014; 30:856-65. [PMID: 24731386 DOI: 10.1016/j.arthro.2014.02.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/24/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Obesity is highly prevalent among patients with knee and shoulder injuries and is associated with greater odds of surgical treatment for these injuries. The purpose of this systematic review was to summarize the literature that has examined the association between body mass index (BMI) and outcomes of ambulatory knee and shoulder surgery. METHODS A literature search of PubMed and Medline was conducted up to December 2013. Studies that examined the association between BMI and outcomes after ambulatory knee and shoulder surgery (arthroscopy, repairs, and reconstructions) were included. Outcomes included postoperative functional scores, clinical scores, and complications. RESULTS Eighteen studies were included in this review; 13 involved knee surgery and 5 involved shoulder surgery. Seven knee studies and 2 shoulder studies found increased BMI to be associated with worse postoperative outcomes, whereas the remaining 9 studies did not find an association. Increased BMI was associated with worse clinical scores and less patient satisfaction after arthroscopic meniscectomy or debridement, and with worse clinical scores and lower activity levels after anterior cruciate ligament (ACL) reconstruction. It was also associated with worse clinical scores and a longer hospital stay after rotator cuff repair and with longer time to return to work after subacromial decompression. Six studies examined the association between BMI and complications, but all reported null findings. CONCLUSIONS There is a lack of consensus in the literature regarding the association between BMI and ambulatory knee and shoulder surgery. Several factors may have contributed to contradictory findings, including variation in measuring and classifying anthropometry, postoperative outcomes, and follow-up time. LEVEL OF EVIDENCE Level IV, systematic review of Level I, III, and IV studies.
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Affiliation(s)
- Melissa A Kluczynski
- School of Medicine and Biomedical Sciences, UBMD Orthopaedics and Sports Medicine, University at Buffalo, State University of New York at Buffalo, Buffalo, New York, U.S.A
| | - Leslie J Bisson
- School of Medicine and Biomedical Sciences, UBMD Orthopaedics and Sports Medicine, University at Buffalo, State University of New York at Buffalo, Buffalo, New York, U.S.A..
| | - John M Marzo
- School of Medicine and Biomedical Sciences, UBMD Orthopaedics and Sports Medicine, University at Buffalo, State University of New York at Buffalo, Buffalo, New York, U.S.A
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Ciampi P, Scotti C, Nonis A, Vitali M, Di Serio C, Peretti GM, Fraschini G. The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study. Am J Sports Med 2014; 42:1169-75. [PMID: 24634447 DOI: 10.1177/0363546514525592] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff repair typically results in a satisfactory, although variable, clinical outcome. However, anatomic failure of the repaired tendon often occurs. HYPOTHESIS Patch augmentation can improve the results of open rotator cuff repair by supporting the healing process, protecting the suture, and reducing friction in the subacromial space. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 152 patients with a posterosuperior massive rotator cuff tear were treated by open repair only (control group; n = 51; mean age, 67.06 ± 4.42 years), open repair together with collagen patch augmentation (collagen group; n = 49; mean age, 66.53 ± 5.17 years), or open repair together with polypropylene patch augmentation (polypropylene group; n = 52; mean age, 66.17 ± 5.44 years) and were retrospectively studied. Patients were evaluated preoperatively and after 36 months with a visual analog scale (VAS) and the University of California, Los Angeles (UCLA) shoulder rating scale and by measuring elevation of the scapular plane and strength with a dynamometer. The VAS and UCLA scores were also obtained 2 months postoperatively. Tendon integrity was assessed after 1 year by ultrasound. Patients were homogeneous as per the preoperative assessment. RESULTS After 2 months, results (mean ± standard deviation) for the control, collagen, and polypropylene groups, respectively, were as follows: VAS scores were 6.96 ± 1.11, 6.46 ± 1.02, and 4.92 ± 0.90, while UCLA scores were 11.29 ± 1.46, 11.40 ± 1.51, and 19.15 ± 1.99. After 36 months, the mean scores for the respective groups were 3.66 ± 1.05, 4.06 ± 1.02, and 3.28 ± 1.10 for the VAS and 14.88 ± 1.98, 14.69 ± 1.99, and 24.61 ± 3.22 for the UCLA scale. In addition, after 36 months, elevation on the scapular plane was 140.68° ± 9.84°, 140.61° ± 12.48°, and 174.71° ± 8.18°, and abduction strength was 8.73 ± 0.54 kg, 9.03 ± 0.60 kg, and 13.79 ± 0.64 kg for the control, collagen, and polypropylene groups, respectively. The retear rate after 12 months was 41% (21/51) for the control group, 51% (25/49) for the collagen group, and 17% (9/52) for the polypropylene group. In particular, the reduced 12-month retear rate and the increased UCLA scores, abduction strength, and elevation at 3-year follow-up were statistically significant for patients treated with a polypropylene patch compared with those treated with repair only or with a collagen patch. CONCLUSION Polypropylene patch augmentation of rotator cuff repair was demonstrated to significantly improve the 36-month outcome in terms of function, strength, and retear rate.
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Affiliation(s)
- Pietro Ciampi
- Giuseppe M. Peretti, Department of Biomedical Sciences for Health, University of Milan, Via R. Galeazzi 4, 20161 Milan, Italy. and Gianfranco Fraschini, Department of Orthopaedics and Traumatology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy (e-mail: )
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84
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Prognostic factors for successful recovery after arthroscopic rotator cuff repair: a systematic literature review. J Orthop Sports Phys Ther 2014; 44:153-63. [PMID: 24450368 DOI: 10.2519/jospt.2014.4832] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVES To perform a systematic review of the literature on prognostic factors for successful recovery after arthroscopic rotator cuff repair. BACKGROUND Rotator cuff lesion is a common shoulder disorder, with a prevalence ranging from 13% in people over 50 years of age to more than 50% in people over 80 years of age. Several factors can affect the extent to which a person will recover after the surgical repair of a rotator cuff tear. More knowledge about these prognostic factors may lead to a better understanding of why the recovery process is successful in some patients but not in others. METHODS A systematic literature search from 1995 to November 2013 was performed to identify studies reporting prognostic factors for successful recovery after arthroscopic rotator cuff repair. RESULTS A total of 455 studies were initially identified, 10 of which were included in the review. For all included studies, the percentage of patients with complete tendon healing at final assessment ranged from 60% to 88%. Twelve prognostic factors, which could be divided into 4 categories, were identified as being associated with better recovery: demographic factors (younger age, male gender), clinical factors (higher bone mineral density, absence of diabetes mellitus, higher level of sports activity, greater preoperative range of motion, absence of obesity), factors related to cuff integrity (smaller sagittal size of the cuff lesion, less retraction of the cuff, less fatty infiltration, no multiple tendon involvement), and factors related to the surgical procedure (no concomitant biceps or acromioclavicular joint procedures). CONCLUSION Knowledge and understanding of prognostic factors should be used in the decision-making process concerning arthroscopic rotator cuff repair to offer better care to patients. LEVEL OF EVIDENCE Prognosis, level 2a-.
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85
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Obesity in orthopedics and trauma surgery. Orthop Traumatol Surg Res 2014; 100:S91-7. [PMID: 24461910 DOI: 10.1016/j.otsr.2013.11.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/25/2013] [Accepted: 11/08/2013] [Indexed: 02/02/2023]
Abstract
In 2012, 32.3% of the French population over 18 years of age was considered overweight (25 ≤ BMI<30 kg/m(2)) and 15% obese (BMI ≥ 30 kg/m(2)). Worldwide, 2.8 million people die every year from the complications of obesity. In 2008, the prevalence of obesity was almost double that of 1980. Obesity is a genuine concern for the orthopedic surgeon, as it affects bones and soft tissues on the biomechanical and biochemical level. In traumatology, low-energy trauma is more frequent in obese patients and induces complex comminutive fractures of the extremities. In orthopedics, obesity is an independent risk factor for osteoarthritis, particularly for the knee joint. The goals of this review are to describe specific aspects of the care of obese patients in trauma and orthopedics surgery during the pre-, intra- and postoperative periods, as well as the risk-benefit ratio related to the treatment of the obese patients.
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86
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Erdil M, Bilsel K, Sungur M, Dikmen G, Tuncer N, Polat G, Elmadag NM, Tuncay I, Asik M. Does obesity negatively affect the functional results of arthroscopic partial meniscectomy? A retrospective cohort study. Arthroscopy 2013; 29:232-7. [PMID: 23270789 DOI: 10.1016/j.arthro.2012.08.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 07/01/2012] [Accepted: 08/09/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of body mass index (BMI) on early functional results of patients who undergo isolated partial meniscectomy. METHODS The functional results for 1,090 patients who underwent partial meniscectomy, in 2 different orthopaedic clinics, were evaluated retrospectively. The study includes cases with arthroscopic partial meniscectomy for isolated meniscal tears; patients with concomitant knee pathology were excluded. Three hundred forty-one (31%) patients with isolated lateral meniscal tears, 628 (58%) patients with isolated medial meniscal tears, and 121 (11%) patients with both medial and lateral meniscal tears underwent arthroscopic partial meniscectomy. We divided these patients into 3 subgroups on the basis of their BMI; <26, between 26 and 30, ≥30. Preoperative functional results were compared with 1-year postoperative follow-up results using the International Knee Documentation Committee (IKDC),(26) Lysholm Knee Scale,(27) and Oxford Scoring System(28) scores. RESULTS According to all 3 knee scales, age, side of lesion, and tear type had no effect on functional outcome. When compared with the group with BMI <26, the patients with BMI between 26 and 30 and the patients with BMI ≥30 had significantly worse outcomes as measured by the IKDC, Oxford Scoring System, and Lysholm Knee Scale scores. Patients with BMI between 26 and 30 and ≥30 did not have significantly different functional outcomes. CONCLUSIONS Short-term outcomes after arthroscopic partial menisectomy reflect significant improvement in subjective outcome. However, patients with moderate or significant obesity (BMI >26) have inferior short-term outcomes compared with nonobese patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Mehmet Erdil
- Department of Orthopedics and Traumatology, Medical Faculty, Bezmialem Vakif University, Turkey.
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87
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Abate M, Schiavone C, Salini V, Andia I. Occurrence of tendon pathologies in metabolic disorders. Rheumatology (Oxford) 2013; 52:599-608. [PMID: 23315787 DOI: 10.1093/rheumatology/kes395] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This article reviews the pathogenetic role of metabolic disorders, which are of paramount relevance to the progression of tendon damage. In diabetes, the prevalence of rheumatological diseases is high, mainly because of the deleterious effects of advanced glycation end products that deteriorate the biological and mechanical functions of tendons and ligaments. In heterozygous familial hypercholesterolaemia, most patients develop Achilles xanthomatosis, a marker of high risk for cardiovascular disease caused by cholesterol deposition in the tendons. Tendon degeneration has also been observed in non-familial hypercholesterolaemia. Monosodium urate crystal deposition in soft tissues is a hallmark of chronic gouty arthritis. In this group of diseases, the mobilization of cholesterol and uric acid crystals is presumably followed by low-grade inflammation, which is responsible for tendon degeneration. Adiposity may contribute to tendon disorders via two different mechanisms: increased weight on the load-bearing tendons and systemic dysmetabolic factors that trigger subclinical persistent inflammation. Finally, tendon abnormalities have been observed in some rare congenital metabolism disorders such as alkaptonuria.
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Affiliation(s)
- Michele Abate
- Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Chieti Scalo (CH), Italy.
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Arthroscopic repair of large rotator cuff tears using the double-row technique: an analysis of surgeon experience on efficiency and outcomes. J Shoulder Elbow Surg 2013; 22:26-31. [PMID: 22652062 DOI: 10.1016/j.jse.2012.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/24/2012] [Accepted: 03/05/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic rotator cuff repair is one of the most commonly performed procedures in the orthopaedic specialty. The goal of this study was to evaluate the effect(s) of surgical experience on efficiency and patient outcomes after double-row rotator cuff repair. METHODS A retrospective review of 69 consecutive patients with large rotator cuff tears who underwent double-row arthroscopic rotator cuff repair by 1 surgeon from the start of practice was conducted. We divided the patients into 2 cohorts: group 1, early (first 18 months of study period) (n = 35), and group 2, recent (final 12 months of study period) (n = 34). Outcome measures including American Shoulder and Elbow Surgeons score, Penn Shoulder Score, and range of motion were assessed preoperatively and at final follow-up. In addition, we compared the operative times between the groups. RESULTS At a mean follow-up of 13.25 months, both cohorts showed significant improvement (P < .001) in American Shoulder and Elbow Surgeons scores (from 47.9 to 76.5 and from 43.6 to 79.4 in groups 1 and 2, respectively) and Penn Shoulder Scores (from 45.8 to 80 and from 38.7 to 79.6 in groups 1 and 2, respectively) postoperatively. The magnitude of change and final scores were similar between the groups. Similar improvements in range of motion were noted in both groups. Patients in group 1 had a statistically significantly longer mean operative time than those in group 2 (116 minutes vs 99.7 minutes, P = .036). CONCLUSION Double-row rotator cuff repair provides predictable improvement in pain and function. It can be performed effectively early in a surgeon's career. However, with experience, efficiency is improved.
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Mulligan EP, Devanna RR, Huang M, Middleton EF, Khazzam M. Factors that impact rehabilitation strategies after rotator cuff repair. PHYSICIAN SPORTSMED 2012; 40:102-14. [PMID: 23306420 DOI: 10.3810/psm.2012.11.1993] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Multiple factors influence rehabilitation strategies after rotator cuff repair. These variables may also impact the overall success of the surgical intervention. Physicians and rehabilitation specialists should be aware of prognostic indicators that can provide therapeutic guidance and offer insights into eventual clinical outcomes. The success of surgical and rehabilitative interventions is often evaluated in terms of patient-reported outcome measures, return to activity, and pain. Although these factors are somewhat interdependent, each of them independently influences the final result. This article presents a comprehensive overview of the recent literature in this area to provide insight as to the short- and long-term outcomes that patients should expect based on their unique presentations. This article examines both intrinsic and extrinsic patient factors to help therapists develop customized rehabilitation programs that optimize surgical outcomes.
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Affiliation(s)
- Edward P Mulligan
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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