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Bernasconi A, Izzo A, Sgadari A, D'Agostino M, Mariconda M, Goldberg AJ. Median age of patients undergoing total ankle replacement has not significantly changed between 1999 and 2023: A systematic review of prospective studies. Foot Ankle Surg 2024:S1268-7731(24)00156-5. [PMID: 39069398 DOI: 10.1016/j.fas.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/22/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Total ankle replacement (TAR) is an effective treatment for end-stage osteoarthritis. The aim of this systematic review was to assess the age of patients undergoing TAR in prospective comparative studies. Our hypothesis is that the age reported in most recent papers might be lower than those reported in older papers. METHODS This systematic review was performed using Pubmed, Scopus, EMBASE and Cochrane databases. Only Level I and II studies dealing with TAR were included. Data regarding demographics, study design, number of cohorts in each study, year of publication and year/years in which surgery was performed were extracted. A two-fold analysis was conducted building groups of patients based on the year of publication and creating 1) two groups (before and after the median year) and 2) three groups (using tertiles) in order to compare age of patients operated in different period of times. A comparison was also performed considering the median year of surgery for patients undergoing TAR. RESULTS Overall 59 cohorts (42 studies, published between 1999 and 2023; median year of publication: 2017) were included (6397 ankles, 6317 patients, median age 63 years). The difference between the median age for 27 cohorts published until 2016 (weighted median 63 years; IQR, 62.5-64) and the median age for 32 cohorts published after 2017 (weighted median 63.2 years; IQR, 63-67.8) was not statistically significant (p = 0.09). The division in tertiles did not reveal any significant change in the weighted median age at surgery (T1 (1999-2014; 63.2 years; IQR, 62.8-64.1), T2 (2015-2018; 63 years; IQR,63-63.5) and T3 (2019-2023; 63.2 years; IQR, 62.6-67.8)) over time (p = 0.65). The median age of patients operated between 1999 and 2008 vs 2009 and 2023 (data from 48 cohorts) was not different either (p = 0.12). CONCLUSION According to this review of prospective studies published between 1999 and 2023, the median age for patients undergoing TAR over the last two decades has been 63 years, remaining steady with no significant changes over time. LEVEL OF EVIDENCE Level II - systematic review including Level I and Level II studies.
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Affiliation(s)
- Alessio Bernasconi
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Antonio Izzo
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Arianna Sgadari
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Martina D'Agostino
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
| | - Massimo Mariconda
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.
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Le YTT, Tran DNA, Nguyen BTT, Nguyen TT, Chen YP, Kuo YJ. Is smoking a risk factor for complications following total ankle arthroplasty? A meta-analysis. Foot Ankle Surg 2024:S1268-7731(24)00149-8. [PMID: 38987122 DOI: 10.1016/j.fas.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Smoking has long been recognized as a risk factor for impaired wound and bone healing, particularly in the context of ankle and foot surgery. Despite numerous studies exploring the association between smoking and complications following ankle replacement, there remains significant inconsistency in their findings. Therefore, this meta-analysis study aims to elucidate whether smoking increases the rate of complications after total ankle arthroplasty (TAA), providing valuable insights for clinical management. METHODS A comprehensive systematic search was conducted in the PubMed, Embase, and Wiley databases to identify relevant English studies on the influence of smoking on postoperative complications following ankle replacement without any restrictions on publication dates. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Random-effect models were used to calculate odds ratios (OR) and 95 % confidence intervals (CI). This study adhered to PRISMA guidelines for transparent reporting and was registered with PROSPERO. RESULTS The analysis incorporated data from 12 retrospective cohort studies, totaling 17331 subjects, 2580 of whom were smokers and 791 complications following TAA. The findings revealed a statistically significant disparity in wound-related complications (OR: 2.26; 95 % CI: 1.13-4.50; P = .02), particularly evident in current smokers with an OR of 3.30 (95 % CI: 2.12-5.14; P < .00001). However, we lacked sufficient evidence to substantiate an association between smoking and complications related to the prosthesis (OR: 1.09; 95 % CI: 0.77-1.53; P = .64) or systemic complications (OR: 1.18; 95 % CI: 0.10-14.13; P = .90) following TAA. CONCLUSIONS Smoking, especially current smoking, is associated with increased wound complication risk post-operation for total ankle arthroplasty. Despite a lack of definitive evidence on the optimal timeframe for smoking cessation before surgery, discontinuing smoking appears to be a prudent measure to mitigate these complications.
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Affiliation(s)
- Yen Thi Thao Le
- The International Master Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Ophthalmology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Duy Nguyen Anh Tran
- The International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Bao Tu Thai Nguyen
- The International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Tan Thanh Nguyen
- Department of Orthopedics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Yu-Pin Chen
- Department of Orthopedics, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Henry JK, Shaffrey I, Cororaton AD, Munita JP, Cody E, O'Malley M, Deland J, Ellis S, Demetracopoulos C. Implant Choice May Reduce the Risk of Early Mechanical Failure in Total Ankle Replacement. J Bone Joint Surg Am 2024; 106:767-775. [PMID: 38442190 DOI: 10.2106/jbjs.23.00933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Total ankle replacements (TARs) have rapidly advanced in terms of volume, technique, design, and indications. However, TARs are still at risk for early mechanical failure and revision. Prior studies have investigated potential risk factors for failure, but have been limited to smaller series or older implants. This study sought to identify risk factors for early mechanical failure in modern TAR. METHODS This is a retrospective study of a single-institution registry. Five surgeons contributed cases involving patients who underwent a primary TAR with any implant. Implants were grouped on the basis of the type of fixation. The primary outcome was early mechanical failure (revision with component removal for a non-infectious etiology, that is, subsidence, aseptic loosening, and/or malalignment). Logistic regression determined the effects of age, weight, hindfoot arthrodesis, implant type, and radiographic deformity on failure. RESULTS The 731 included patients had a mean follow-up of 2.7 years. Ten percent (71 patients) had hindfoot arthrodesis. There were 33 mechanical failures (4.5%) at a mean of 1.7 years after the index surgical procedure. Our model demonstrated that hindfoot arthrodesis was associated with 2.7 times greater odds of failure (p = 0.045), every 10 kg of body weight increased the odds of tibial-sided failure by 1.29 times (p = 0.039), and implants with more extensive tibial fixation (stems or keels) lowered the odds of tibial failure by 95% (p = 0.031). CONCLUSIONS In patients with uncontrollable risk factors (hindfoot arthrodesis) or risk factors that may or may not be modifiable by the patient (weight), implants with more robust tibial fixation may be able to reduce the risk of early mechanical failure. Further research is warranted to support efforts to decrease early failure in TAR. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jensen K Henry
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
| | | | - Agnes D Cororaton
- Biostatistics Department, Hospital for Special Surgery, New York, NY
| | | | - Elizabeth Cody
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
| | - Martin O'Malley
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
| | - Jonathan Deland
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
| | - Scott Ellis
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
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Varga C, Váncsa S, Agócs G, Hegyi P, Gidró BT, Szőke G, Domos G, Rodler E, Kocsis G, Holnapy G. Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis. Foot Ankle Int 2023; 44:1305-1318. [PMID: 37902184 DOI: 10.1177/10711007231201158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA. METHODS We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups). RESULTS Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group. CONCLUSION Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis's survival.
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Affiliation(s)
- Csaba Varga
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Gergely Agócs
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | | | - György Szőke
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gyula Domos
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Endre Rodler
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - György Kocsis
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gergely Holnapy
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Bowcutt JT, Shibuya N, Jupiter DC. Preoperative Serum Albumin and Other Risk Factors Related to 30-Day Postoperative Complications in Total Ankle Arthroplasty. J Foot Ankle Surg 2023; 62:981-985. [PMID: 37549784 DOI: 10.1053/j.jfas.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/08/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
This study investigates effects of preoperative albumin on 30-day total ankle arthroplasty (TAA) outcomes. Additionally, other preoperative risk factors are addressed, including American Anesthesia Society (ASA) class, functional status, chronic obstructive pulmonary disease (COPD), diabetes, smoking status, time of operation, and age. Outcomes assessed were readmission, return to operating room, surgical site infection, wound dehiscence, and total length of stay (TLOS). Data were extracted from the National Surgical Quality Improvement Program database. Bivariate comparisons were analyzed using correlation coefficients, t tests, or chi-squared tests; multivariate comparisons used linear or logistic regression. Our data showed no significant correlation between serum albumin and patients with readmission (odds ratio -0.14, P = 0.06), return to operating room (-0.07, P = 0.61), or surgical site infection (-0.08, P = 0.56). With bivariate analysis, functional status and COPD were significant for readmission (12.67, P < 0.001 and 7.83, P < 0.001, respectively) and dehiscence (30.52, P < 0.001 and 6.74, P = 0.05, respectively), while high ASA class (0.4, P = 0.01), increased age (0.1, P < 0.001), and longer time of operation (0.19, P < 0.001) were associated with longer TLOS. With multivariate analysis, functional status showed higher odds of readmission (7.42, P = 0.02) and dehiscence (20.47, P = 0.01), while COPD showed higher odds for readmission (6.65, P < 0.001) and longer TLOS (0.31, P = 0.05). High ASA class (0.42, P < 0.001) and female sex (0.32, P < 0.001) also had higher odds for longer TLOS. In summary, low albumin was not significant for readmission, return to operating room, or surgical site infection in TAA. COPD, functional status, high ASA class, longer time of operation, increased age, and female sex were all correlated with adverse outcomes in TAA.
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Affiliation(s)
- Jeffrey T Bowcutt
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Naohiro Shibuya
- The University of Texas Rio Grande Valley, School of Podiatric Medicine, Edinburg, TX
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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Henry JK, Shaffrey I, Wishman M, Palma Munita J, Zhu J, Cody E, Ellis S, Deland J, Demetracopoulos C. Early outcomes of the Exactech Vantage fixed-bearing total ankle replacement. Bone Joint J 2023; 105-B:1099-1107. [PMID: 37777206 DOI: 10.1302/0301-620x.105b10.bjj-2023-0173.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Aims The Vantage Total Ankle System is a fourth-generation low-profile fixed-bearing implant that has been available since 2016. We aimed to describe our early experience with this implant. Methods This is a single-centre retrospective review of patients who underwent primary total ankle arthroplasty (TAA) with a Vantage implant between November 2017 and February 2020, with a minimum of two years' follow-up. Four surgeons contributed patients. The primary outcome was reoperation and revision rate of the Vantage implant at two years. Secondary outcomes included radiological alignment, peri-implant complications, and pre- and postoperative patient-reported outcomes. Results There were 168 patients (171 ankles) included with a mean follow-up of 2.81 years (2 to 4.6) and mean age of 63.0 years (SD 9.4). Of the ten ankles with implant failure (5.8%), six had loosening of the tibial component. In the remaining four failed implants, one was due to periprosthetic joint infection (PJI), one was due to loosening of the talar component, and two were due to loosening of both the tibial and talar components. Seven patients underwent reoperation: irrigation and debridement for superficial infection (n = 4); bone grafting for cysts (n = 2); and open reduction internal fixation (n = 1). Asymptomatic peri-implant lucency/subsidence occurred in 20.1% of ankles, with the majority involving the tibial component (n = 25). There were statistically significant improvements in PROMs in all domains. Conclusion Short-term results of this implant demonstrate early survival comparable to the reported survivorship of similar low-profile, non-stemmed implants. Radiological lucency occurred more commonly at the tibial component, and revisions occurred primarily due to loosening of the tibial component. Further research is needed to evaluate longer-term survivorship.
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Affiliation(s)
- Jensen K Henry
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Isabel Shaffrey
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Mark Wishman
- Weill Cornell Medical College, New York, New York, USA
| | - Joaquín Palma Munita
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Hospital Sótero del Río, Santiago, Brazil
| | - Jiaqi Zhu
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Elizabeth Cody
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Scott Ellis
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan Deland
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
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Togher CJ, Thompson JM, Perkins JM, Berlet GC, Hyer CF. A Study of Tibial Cyst Formation in Modular Stemmed Total Ankle Arthroplasty: Exploring a Possible Relationship to Smooth and Porous Coating on the Stem Segments. J Foot Ankle Surg 2023; 62:756-763. [PMID: 37100341 DOI: 10.1053/j.jfas.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/01/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
Vertical fixation through stemmed components has been a successful strategy in total ankle arthroplasty. Research in hip replacement surgery has demonstrated increased rates of stress shielding, aseptic loosening, thigh pain, and cystic formation around stemmed femoral implants extensively coated with porous surfaces. While some ankle prostheses have integrated porous coating technology with stemmed tibial implants, there is little to no research investigating the potential negative effects of bone bonding to the tibial stems and possible impact on tibial cyst formation. We performed a retrospective cohort study comparing the incidence of periprosthetic tibial cyst formation in smooth versus fully porous-coated stemmed tibial implants after undergoing total ankle implant arthroplasty. Radiographs were compared for postoperative rates of tibial cyst formation and bone bonding to the tibial stems. Relative risk for reoperation between the smooth and porous-coated implants was investigated. The smooth-stem group showed no incidence of tibial cyst formation nor signs of significant bone bonding to the tibial stems; however, the follow-up matched porous-coated group showed a rate of 63% of cystic formation with associated evidence of bone bonding on final radiographic follow-up (p < .01). Relative risk for reoperation was 0.74. Despite a higher incidence of tibial cyst formation in the stemmed ankle arthroplasty groups with porous coating, reoperation rates were similar. We theorize that the proximal bonding to the porous stem surface could impact the distal stems and result in the observed increase in cyst formation.
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Affiliation(s)
- Cody J Togher
- Fellow, Orthopedic Foot & Ankle Center, Worthington, OH.
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Chao M, Manz WJ, Fink J, Coleman MM, Kadakia RJ, Bariteau JT. Body Mass Index (BMI) Cutoffs and Racial, Ethnic, Sex, or Age Disparities in Patients Treated With Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231184189. [PMID: 37484537 PMCID: PMC10359662 DOI: 10.1177/24730114231184189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background The rising prevalence of obesity among American adults has disproportionately affected Black adults and women. Furthermore, body mass index (BMI) has historically been used as a relative contraindication to many total joint arthroplasty (TJA) procedures, including total ankle arthroplasty. The purpose of this study was to investigate potential disparities in patient eligibility for total ankle arthroplasty based on race, ethnicity, sex, and age by applying commonly used BMI cutoffs to the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Methods Patients in the ACS-NSQIP database who underwent TAA from 2011 to 2020 were retrospectively reviewed in a cross-sectional analysis. BMI cutoffs of <50, <45, <40, and <35 were then applied. The eligibility rate for TAA was examined for each BMI cutoff, and findings were stratified by race, ethnicity, sex, and age. Independent t tests, chi-squared tests, and Fisher exact tests were performed to compare differences at an α = 0.05. Results A total of 1215 of 1865 TAA patients (65.1%) were included after applying the exclusion criteria. Black patients had disproportionately lower rates of eligibility at the most stringent BMI cutoff of <35 (P = .004). Hispanic patients had generally lower rates of eligibility across all BMI cutoffs. In contrast, Asian American and Pacific Islander patients had higher rates of eligibility at the BMI cutoffs of <35 (P = .033) and <40 (P = .039), and White non-Hispanic patients had higher rates of eligibility across all BMI cutoffs. Females had lower eligibility rates across all BMI cutoffs. Ineligible patients were also younger compared to eligible patients across all BMI cutoffs. Conclusion Stringent BMI cutoffs may disproportionately disqualify Black, female, and younger patients from receiving total ankle arthroplasty. Level of Evidence Level III, retrospective cross-sectional study.
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Affiliation(s)
- Myra Chao
- Emory University School of Medicine, Atlanta, GA, USA
| | - Wesley J. Manz
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Juliet Fink
- Emory University School of Medicine, Atlanta, GA, USA
| | - Michelle M. Coleman
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rishin J. Kadakia
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason T. Bariteau
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Overweight increases perioperative spinal surgery complications: a single-center retrospective study. BMC Musculoskelet Disord 2023; 24:98. [PMID: 36740675 PMCID: PMC9900974 DOI: 10.1186/s12891-023-06217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/01/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) defines a person with a body mass index (BMI) greater than or equal to 25 kg/m2 as overweight. Being overweight is a lifestyle-related disease; however, little is known about the impact of overweight on the perioperative complications of orthopedic surgery. This study aimed to define the effect of overweight on the perioperative complications of spinal surgery. METHODS This retrospective case series study reviewed 269 consecutive patients who underwent spinal surgery. These patients were divided into the overweight (OW) and non-overweight (NOW) groups. Age, BMI, surgical time, blood loss, and perioperative complications were evaluated and compared between the groups. RESULTS There were 117 patients (43%) in the OW group and 152 (57%) in the NOW group. Cervical surgery was performed in 72 cases, thoracic surgery in 34, and lumbosacral surgery in 159. The surgical time was significantly longer in the OW group than in the NOW group (204.6 ± 98 min vs. 175 ± 75 min; p = 0.01). Blood loss was greater in the OW group than in the NOW group (446.8 ± 447.9 mL vs. 279 ± 296.5 mL; p = 0.00). Durotomy was more frequent in the OW group than in the NOW group (10 vs. 3 cases; p = 0.02). There was no difference in complications other than durotomy. CONCLUSIONS OW patients had longer surgical time, more blood loss, and more frequent durotomy than NOW patients. These findings indicate that overweight increases perioperative complications of spinal surgery.
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Early Failure of Total Ankle Arthroplasty in a Patient with Ipsilateral Varus Knee Deformity. Case Rep Orthop 2021; 2021:5245396. [PMID: 34608422 PMCID: PMC8487397 DOI: 10.1155/2021/5245396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Multiple risk factors such as age, body mass index (BMI), preoperative diagnosis, smoking, diabetes mellitus, malalignment of an implant, and presence of ipsilateral hindfoot fusion have been shown to contribute to failure of total ankle arthroplasty (TAA). However, the exact causes of TAA failure remain uncertain, and various causes can lead to a need for revision surgery. We report a case of early aseptic loosening of the implant following TAA in a patient with severe varus deformity of the ipsilateral knee.
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