1
|
Vardiman AB, Wallace DJ, Booher GA, Toossi N, Bucklen BS. Decreasing the Pedicle Screw Misplacement Rate in the Thoracic Spine With Robot-guided Navigation. Clin Spine Surg 2023; 36:431-437. [PMID: 37348067 PMCID: PMC10681281 DOI: 10.1097/bsd.0000000000001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
STUDY DESIGN A retrospective chart review. OBJECTIVE The aim of this study was to evaluate the screw accuracy of thoracic pedicle screws placed with a robot-guided navigation system. SUMMARY OF BACKGROUND DATA Thoracic pedicles are smaller in diameter than lumbar pedicles, making pedicle screw placement difficult. Misplaced pedicle screws may present complications including decreased construct stability, and increased risks of neurological deficits and blood vessel perforation. There is a dearth of knowledge on thoracic pedicle screw accuracy placed with a robot. MATERIALS AND METHODS A retrospective analysis of the robot-assisted placement of thoracic pedicle screws was performed. Preoperative and postoperative computed tomography (CT) scans of the implanted thoracic screws were collected to assess screw placement accuracy, pedicle breadth, and placement deviations. A CT-based Gertzbein and Robbins System was used to classify pedicle screw accuracy in 2 mm increments. A custom image overlay software was used to determine the deviations between the preoperatively planned trajectory of pedicle screws and final placement at screw entry (tail), and tip in addition to the angular deviation. RESULTS Seventy-five thoracic pedicle screws were implanted by navigated robotic guidance in 17 patients, only 1.3% (1/75) were repositioned intraoperatively. Average patient age and body mass index were 57.5 years and 25.9 kg/m 2 , respectively, with 52.9% female patients. Surgery diagnoses were degenerative disk disease (47.1%) and adjacent segment disease (17.6%). There were zero complications, with no returns to the operating room. According to the CT-based Gertzbein and Robbins pedicle screw breach classification system, 93.3% (70/75) screws were grade A or B, 6.6% (5/75) were grade C, and 0% were grade D or E. The average deviation from the preoperative plan to actual final placement was 1.8±1.3 mm for the screw tip, 1.6±0.9 mm for the tail, and 2.1±1.5 degrees of angulation. CONCLUSIONS The current investigation found a 93.3% accuracy of pedicle screw placement in the thoracic spine. Navigated robot assistance is a useful system for placing screws in the smaller pedicles of the thoracic spine. LEVEL OF EVIDENCE Level III-retrospective nonexperimental study.
Collapse
Affiliation(s)
- Arnold B. Vardiman
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - David J. Wallace
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Grant A. Booher
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Nader Toossi
- Musculoskeletal Education and Research Center (MERC), Audubon, PA
| | | |
Collapse
|
2
|
Pugely AJ, Lindsay CP, Hall J, Orness ME, Toossi N, Bucklen B. Are modular pedicle screws associated with a high complication rate following posterior spinal fixation? J Spine Surg 2023; 9:133-138. [PMID: 37435318 PMCID: PMC10331498 DOI: 10.21037/jss-22-99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/14/2023] [Indexed: 07/13/2023]
Abstract
Background Modular pedicle screws have a separate head that can be intraoperatively assembled to the inserted shank. The aim of this study was to report associated intra- and post-operative complications and reoperation rates of posterior spinal fixations with modular pedicle screws at a single center. Methods A retrospective, institutional chart review was performed on 285 patients who underwent posterior thoracolumbar spinal fusion with modular pedicle screw fixation between January 1, 2017, and December 31, 2019. The primary outcome was failure of the modular screw component. Other measures recorded were length of follow-up, other complications, and need for additional procedures. Results There were 1,872 modular pedicle screws (average 6.6 per case). There were no (0.0%) screw head dissociations at the rod screw junction. There was 20.8% overall complication rate (59/285) with 25 reoperations: 6 due to non-union and rod breakage, 5 for screw loosening, 7 for adjacent segment disease, 1 for acute postoperative radiculopathy, 1 for epidural hematoma, 2 for deep surgical-site infections, and 3 for superficial surgical-site infections. Other complications included superficial wound dehiscence [8], dural tears [6], non-unions not requiring reoperation [2], lumbar radiculopathies [3], and perioperative medical complications [5]. Conclusions This study demonstrates that modular pedicle screw fixation has reoperation rates similar to those previously reported for standard pedicle screws. There was no failure at the screw-head junction, and no increases in other complications. Modular pedicle screws present an excellent option to allow surgeons to place pedicle screws without the risk of extra complications.
Collapse
Affiliation(s)
- Andrew J. Pugely
- Department of Orthopedics and Rehabilitation, The University of Iowa Health Care, Iowa City, IA, USA
| | - Christopher P. Lindsay
- Department of Orthopedics and Rehabilitation, The University of Iowa Health Care, Iowa City, IA, USA
| | - James Hall
- Department of Orthopedics and Rehabilitation, The University of Iowa Health Care, Iowa City, IA, USA
| | - Michael E. Orness
- Department of Orthopedics and Rehabilitation, The University of Iowa Health Care, Iowa City, IA, USA
| | - Nader Toossi
- Musculoskeletal Education and Research Center (MERC), Audubon, PA, USA
| | - Brandon Bucklen
- Musculoskeletal Education and Research Center (MERC), Audubon, PA, USA
| |
Collapse
|
3
|
Kanaly CW, Backes DM, Toossi N, Bucklen B. A Retrospective Analysis of Pedicle Screw Placement Accuracy Using the ExcelsiusGPS Robotic Guidance System: Case Series. Oper Neurosurg (Hagerstown) 2023; 24:242-247. [PMID: 36454079 DOI: 10.1227/ons.0000000000000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/06/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Robotic guidance has become widespread in spine surgery. Although the intent is improved screw placement, further system-specific data are required to substantiate this intention for pedicle screws in spinal stabilization constructs. OBJECTIVE To determine the accuracy of pedicle screws placed with the aid of a robot in a cohort of patients immediately after the adoption of the robot-assisted surgery technique. METHODS A retrospective, Institutional Review Board-approved study was performed on the first 100 patients at a single facility, who had undergone spinal surgeries with the use of robotic techniques. Pedicle screw accuracy was graded using the Gertzbein-Robbins Scale based on pedicle wall breach, with grade A representing 0 mm breach and successive grades increasing breach thresholds by 2 mm increments. Preoperative and postoperative computed tomography scans were also used to assess offsets between the objective plan and true screw placements. RESULTS A total of 326 screws were analyzed among 72 patients with sufficient imaging data. Ages ranged from 21 to 84 years. The total accuracy rate based on the Gertzbein-Robbins Scale was 97.5%, and the rate for each grade is as follows: A, 82%; B, 15.5%; C, 1.5%; D, 1%; and E, 0. The average tip offset was 1.9 mm, the average tail offset was 2.0 mm, and the average angular offset was 2.6°. CONCLUSION Robotic-assisted surgery allowed for accurate implantation of pedicle screws on immediate adoption of this technique. There were no complications attributable to the robotic technique, and no hardware revisions were required.
Collapse
Affiliation(s)
- Charles W Kanaly
- Steward St. Anne's Hospital, Fall River, Massachusetts, USA
- Neurosurgery Center of Southern New England, PC, Fall River, Massachusetts, USA
| | - Danielle M Backes
- Neurosurgery Center of Southern New England, PC, Fall River, Massachusetts, USA
| | - Nader Toossi
- Musculoskeletal and Education Research Center, Clinical Research Department, Audubon, Pennsylvania, USA
| | - Brandon Bucklen
- Musculoskeletal and Education Research Center, Clinical Research Department, Audubon, Pennsylvania, USA
| |
Collapse
|
4
|
Toossi N, Vardiman AB, Benech CA, Kanaly CW, Maltenfort MG, Backes DM, Bucklen B. Factors Affecting the Accuracy of Pedicle Screw Placement in Robot-Assisted Surgery: A Multicenter Study. Spine (Phila Pa 1976) 2022; 47:1613-1619. [PMID: 36256605 PMCID: PMC9632944 DOI: 10.1097/brs.0000000000004473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/15/2022] [Accepted: 08/14/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective multicenter. OBJECTIVE The aim was to investigate the factors involved in, and their relative contributions to, the overall accuracy of robot-assisted pedicle screw placement. SUMMARY OF BACKGROUND DATA Robot-assisted surgery has reportedly resulted in greater accuracy for placement of pedicle screws than conventional methods. There are many potential factors affecting the accuracy of pedicle screws placed with a robot. No study has investigated these factors in a robust way. MATERIALS AND METHODS Radiographic and clinical data of three centers were pooled. Preoperative and postoperative computerized tomographies were obtained by all three centers to assess the accuracy of the placed screws. The primary outcome measured was accuracy of pedicle screws placed with the robot. The authors performed a multivariate regression analysis to determine the significant patient-related and screw-related variables and their relative contribution to the overall accuracy. In addition, an ordinal regression analysis was conducted to investigate the effects of different variables on accuracy of robot-placed screws graded by Gertzbein-Robbins grading system (GRS). RESULTS The total contribution of all studied variables to overall accuracy variation as measured by offsets between the placed and planned screws was only 18%. Obesity, long constructs, female gender, surgeon, and vertebral levels were among the factors that had small contributions to the different screw offsets. For GRS grades, significant variables were gender (Log odds: 0.62, 95% CI: 0.38-0.85), age (Log odds: 0.02, 95% CI: 0.01-0.03), length of constructs (Log odds: 0.07, 95% CI: 0.02-0.11), screw diameter (Log odds: 0.55, 95% CI: 0.39-0.71), and length of the screws (Log odds: 0.03, 95% CI: 0.01-0.05). However, these variables too, regardless of their significant association with the accuracy of placed screws, had little contribution to overall variability of accuracy itself (only about 7%). CONCLUSION The accuracy of screws placed with robotic assistance, as graded by GRS or measured offsets between planned and placed screw trajectories, is minimally affected by different patient-related or screw-related variables due to the robustness of the robotic navigation system used in this study. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Nader Toossi
- Musculoskeletal Education and Research Center (MERC), Audubon, PA
| | | | - Carlo A. Benech
- Department of Neurology and Clinical Neurophysiology, Fornaca Clinic, Turin, Italy
| | | | | | | | - Brandon Bucklen
- Musculoskeletal Education and Research Center (MERC), Audubon, PA
| |
Collapse
|
5
|
Abar O, Toossi N, Johanson N. Cost and determinants of acute kidney injury after elective primary total joint arthroplasty. Arthroplast Today 2018; 4:335-339. [PMID: 30186917 PMCID: PMC6123230 DOI: 10.1016/j.artd.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 01/07/2023] Open
Abstract
Background Acute kidney injury (AKI) is a serious complication after major surgery, which may lead to increased morbidity and mortality. The aim of this study was to identify cost and determinants of AKI after total joint arthroplasty. Methods A retrospective case-controlled study was conducted with 1719 primary elective total hip or knee replacements performed from January 2004 through September 2015 at an urban teaching hospital. Patients who developed AKI were matched in a 1:3 ratio with those in a control group who did not develop AKI based on age, sex, race, operated joint, and comorbidities including hypertension and diabetes. Increased postoperative serum creatinine was considered indicative of AKI. Results Fifty-four patients (3.1%) had AKI that was significantly associated with increased length of hospital stay (8.07 days) compared with that of the control group (4.50 days, P < .0001) and incurred significantly higher hospital charges ($224,533) than those of the control group ($142,753, P < .0001). We identified high body mass index, undergoing bilateral surgery in one session, high estimated blood loss, and longer duration of surgery as significant risk factors for AKI in univariate analysis. Elevated preoperative creatinine, large postoperative drop in hemoglobin, and high American Society of Anesthesiologists physical status scores were significant independent predictors of AKI in multivariate analysis. Conclusions Health-care providers and patients should work together to manage risk factors and to lower the risk of morbidity and mortality, longer in-hospital stay, and high associated costs of AKI.
Collapse
Affiliation(s)
- Orchideh Abar
- Department of Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Nader Toossi
- Department of Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Norman Johanson
- Department of Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| |
Collapse
|
6
|
Sandling M, Arif N, Taherkani S, Gracely E, Toossi N, Johanson N, Dike K, Szep Z. Risk Factors Associated with Avascular Necrosis in HIV-Infected Patients in the New Antiretroviral Therapy Era. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marcus Sandling
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Nida Arif
- Division of Infectious Disease and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Sara Taherkani
- Howard County General Hospital Infectious Disease Associates, Columbia, Maryland
| | - Ed Gracely
- Drexel University, College of Medicine, Philadelphia, Pennsylvania
| | - Nader Toossi
- Drexel University, College of Medicine, Philadelphia, Pennsylvania
| | - Norman Johanson
- Drexel University, College of Medicine, Philadelphia, Pennsylvania
| | - Kimberly Dike
- Drexel University, College of Medicine, Philadelphia, Pennsylvania
| | - Zsofia Szep
- Division of Infectious Diseases and HIV Medicine, Drexel University, College of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
7
|
Meller MM, Toossi N, Gonzalez MH, Son MS, Lau EC, Johanson N. Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA. Clin Orthop Relat Res 2016; 474:2472-2481. [PMID: 27562787 PMCID: PMC5052212 DOI: 10.1007/s11999-016-5039-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/11/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with morbid obesity, defined as a BMI greater than 40 kg/m2, and super obesity, defined as a BMI greater than 50 kg/m2, increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care. Until recently, analysis of higher BMI data was limited to small cohorts from hospital-based data banks, based on BMI or height and weight only, often as part of a multivariate analysis. On October 1, 2010 the Centers for Medicare & Medicaid Services added a fifth digit to the BMI data, V85.xx, in the Medicare data bank, which allowed data mining of cases of patients with higher BMI. To our knowledge, our study is the first large retrospective Medicare data mining study, which allows us to examine BMI levels greater than 40 and 50 kg/m2 to delineate risks, complications, and costs for these patients. QUESTIONS/PURPOSES We sought to quantify (1) the surgical risk, and (2) the costs associated with complications after THA in patients who were morbidly obesity (BMI ≥ 40 kg/m2) or super obese (BMI ≥ 50 kg/m2). METHODS This is a retrospective study of patients, using Medicare hospital claims data, who underwent THA. The ICD-9 Clinical Modification (CM) diagnosis code V85.4x was used to identify patients with morbid obesity and with super obesity from October 1, 2010 through December 31, 2014. Patients without any BMI-related diagnosis codes were used as the control group. Twelve complications occurring during the 90 days after THA were analyzed using multivariate Cox models adjusting for patient demographic, comorbidities, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through the subsequent 90 days. RESULTS Patients with morbid obesity had increased postoperative complications including prosthetic joint infection (hazard ratio [HR], 3.71; 95% CI, 3.2-4.31; p < 0.001), revision (HR, 1.91; 95% CI, 1.69-2.16; p < 0.001), and wound dehiscence (HR, 3.91; 95% CI, 3.14-4.86; p < 0.001). In addition, patients with morbid obesity had increased risk of deep vein thrombosis (HR, 1.43; 95% CI, 1.14-1.79; p < 0.002), pulmonary embolism (HR, 1.57; 95% CI, 1.25-1.99; p < 0.001), implant failure (HR, 1.48; 95% CI, 1.3-1.68; p < 0.001), acute renal failure (HR, 1.68; 95% CI, 1.56-1.80; p < 0.001), and all-cause readmission (HR, 1.48; 95% CI, 1.40-1.56; p < 0.001). However, death (HR, 0.94 95% CI, 0.73-1.19 p < 0.592), acute myocardial infarction (HR, 0.94; 95% CI, 0.74-1.2 p < 0.631), and dislocation (HR 1.07; 95% CI, 0.85-1.34; p < 0.585) were not different between patients in the control and morbidly obese groups. Super obese patients had an increased risk of infection (HR, 6.48; 95% CI, 4.54-9.25; p < 0.001), wound dehiscence (HR, 9.81; 95% CI, 6.31-15.24; p < 0.001), and readmission (HR, 2.16; 95% CI, 1.84-2.54; p < 0.001) compared with patients with normal BMI. Controlling for patient and institutional factors, each THA had mean total hospital charges of USD 88,419 among patients who were super obese compared with USD 73,827 for the control group, a difference of USD 14,591. Medicare payment for the patients who were super obese also was higher, but only by USD 3631. CONCLUSIONS Patients who are super obese are at increased risk for serious complications compared with patients with morbid obesity, whose risks are elevated relative to patients whose BMI is less than 40 kg/m2. Costs of care for patients who were super obese, likewise, were increased. We present BMI outcomes to allow an objective basis for patient counseling, risk stratification, maintaining access to orthopaedic surgical care, and maintaining hospital operating margins. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- Menachem M. Meller
- Department of Orthopaedic Surgery, Mercy Philadelphia Hospital, 501 South 54th Street, Philadelphia, PA 19143 USA
| | - Nader Toossi
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA USA
| | - Mark H. Gonzalez
- Department of Orthopedic Surgery, University of Illinois College of Medicine, Chicago, IL USA
| | | | | | - Norman Johanson
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA USA
| |
Collapse
|
8
|
Toossi N, Johanson NA. Is BMI an Independent Risk Factor for Unfavorable Outcomes Following Total Hip Arthroplasty? Commentary on an article by Eric R. Wagner, MD, et al.: "Effect of Body Mass Index on Complications and Reoperations After Total Hip Arthroplasty". J Bone Joint Surg Am 2016; 98:e11. [PMID: 26842416 DOI: 10.2106/jbjs.o.01098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Norman A Johanson
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
9
|
Toossi N, Johanson NA. Some Points to Make About an Original Article. J Arthroplasty 2016; 31:553. [PMID: 26286819 DOI: 10.1016/j.arth.2015.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/14/2015] [Indexed: 02/01/2023] Open
Affiliation(s)
- Nader Toossi
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Norman A Johanson
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| |
Collapse
|
10
|
Lau EC, Son MS, Mossad D, Toossi N, Johanson NA, Gonzalez MH, Meller MM. The Validity of Administrative BMI Data in Total Joint Arthroplasty. J Arthroplasty 2015; 30:1683-7. [PMID: 26088396 DOI: 10.1016/j.arth.2015.04.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/28/2015] [Indexed: 02/01/2023] Open
Abstract
Identifying BMI via administrative data is a useful way to evaluate outcomes in total joint arthroplasty (TJA) for varying degrees of obesity. The purpose of this study was to evaluate the concordance between BMI coding in administrative claims data and actual clinical BMI measurements in the medical record for patients undergoing TJA. Clinical BMI value was shown to be a significant determinant of whether ICD-9 codes were used to report the patient's obesity status (P<0.01). Although a higher clinical BMI strongly increased the likelihood of having either of the ICD-9 diagnosis codes used to identify obesity status, only the accuracy of the V85 code increased with increasing levels of BMI.
Collapse
Affiliation(s)
| | | | - David Mossad
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Nader Toossi
- Institute at Hahnemann, University Orthopaedic, Philadelphia, Pennsylvania
| | - Norman A Johanson
- Institute at Hahnemann, University Orthopaedic, Philadelphia, Pennsylvania
| | - Mark H Gonzalez
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Menachem M Meller
- Department of Orthopedic Surgery, Mercy Health System, Philadelphia, Pennsylvania
| |
Collapse
|
11
|
Abstract
BACKGROUND AND PURPOSE Although plating is considered to be the treatment of choice in distal tibia fractures, controversies abound regarding the type of plating for optimal fixation. We conducted a systematic review to evaluate and compare the outcomes of locked plating and non-locked plating in treatment of distal tibia fractures. PATIENTS AND METHODS A systematic review was conducted using PubMed to identify articles on the outcomes of plating in distal tibia fractures that were published up to June 2012. We included English language articles involving a minimum of 10 adult cases with acute fractures treated using single-plate, minimally invasive techniques. Study-level binomial regression on the pooled data was conducted to determine the effect of locking status on different outcomes, adjusted for age, sex, and other independent variables. RESULTS 27 studies met the inclusion criteria and were included in the final analysis of 764 cases (499 locking, 265 non-locking). Based on descriptive analysis only, delayed union was reported in 6% of cases with locked plating and in 4% of cases with non-locked plating. Non-union was reported in 2% of cases with locked plating and 3% of cases with non-locked plating. Comparing locked and non-locked plating, the odds ratio (OR) for reoperation was 0.13 (95% CI: 0.03-0.57) and for malalignment it was 0.10 (95% CI: 0.02-0.42). Both values were statistically significant. INTERPRETATION This study showed that locked plating reduces the odds of reoperation and malalignment after treatment for acute distal tibia fracture. Future studies should accurately assess causality and the clinical and economic impact of these findings.
Collapse
Affiliation(s)
- Amrit S Khalsa
- Department of Orthopedic Surgery, Drexel University College of Medicine
| | - Nader Toossi
- Department of Orthopedic Surgery, Drexel University College of Medicine
| | - Loni P Tabb
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA
| | - Nirav H Amin
- Cleveland Clinic Sports Health Center, Garfield Heights, OH, USA
| | - Kenneth W Donohue
- Department of Orthopedic Surgery, Drexel University College of Medicine
| | - Douglas L Cerynik
- Department of Orthopedic Surgery, Drexel University College of Medicine
| |
Collapse
|
12
|
Chakravarty R, Toossi N, Katsman A, Cerynik DL, Harding SP, Johanson NA. Percutaneous column fixation and total hip arthroplasty for the treatment of acute acetabular fracture in the elderly. J Arthroplasty 2014; 29:817-21. [PMID: 24075241 DOI: 10.1016/j.arth.2013.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 02/01/2023] Open
Abstract
We used our database of primary total hip arthroplasties to identify those patients who had acetabular fractures fixed with percutaneous screws under the same anesthesia as for the arthroplasty procedure. There were 19 patients with the average follow-up of 22 months. Fourteen patients sustained the fracture secondary to a low-energy trauma, while the remaining patients were involved in a high-energy trauma accident. The mean survival time was calculated to be 2.5 ± 0.6 years for the low-energy group and 4 ± 1.4 years for the high-energy group. We believe that this unique treatment of acetabular fractures has a role in carefully selected patients and provides the necessary reduction and immediate stability of the fracture needed to ensure adequate fit for the acetabular cup in the subsequent THA.
Collapse
Affiliation(s)
- Rajit Chakravarty
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Nader Toossi
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Anna Katsman
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Douglas L Cerynik
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Susan P Harding
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Norman A Johanson
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
13
|
Amin NH, Chakravarty R, Jakoi A, Cerynik DL, Toossi N, Harding SP. Placing femoral intramedullary nails in severely bowed femurs. Orthopedics 2014; 37:179-82. [PMID: 24762145 DOI: 10.3928/01477447-20140225-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 09/05/2013] [Indexed: 02/03/2023]
Abstract
The authors describe a novel technique of anterograde femoral intramedullary nail fixation for hip fracture using the starting guide pin as a blocking screw. This cost-effective technique uses fluoroscopic radiography to ensure the guidewire is within the posterior aspect of the femur on a lateral view, thereby minimizing the risk of anterior cortical femoral fractures.
Collapse
|
14
|
Fedorka CJ, Cerynik DL, Tauberg B, Toossi N, Johanson NA. The relationship between knee arthroscopy and arthroplasty in patients under 65 years of age. J Arthroplasty 2014; 29:335-8. [PMID: 23809706 DOI: 10.1016/j.arth.2013.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/20/2013] [Indexed: 02/01/2023] Open
Abstract
A private payer database was used to examine the incidence and rates of knee arthroscopy in patients less than 65 years of age and the subsequent risk of knee arthroplasty. Time to event analysis was performed using the Kaplan-Meier method; also, Cox regression analysis was used to evaluate the relative risk of subsequent knee arthroplasty for arthroscopic patients. Overall, 247,034 knee arthroscopies, done for injury or arthropathy, were identified between 2004 and 2009. Within 1-year of arthroscopy, 2.2% of arthropathy patients and 0.9% of injury patients underwent a knee arthroplasty. These increased to 5.2% and 2.4% at 5-years, respectively. The risk of arthroplasty following arthroscopy increased significantly with age. Further study is warranted to examine the benefit of arthroscopy in younger patients with OA.
Collapse
Affiliation(s)
- Catherine J Fedorka
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Douglas L Cerynik
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Brandon Tauberg
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Nader Toossi
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Norman A Johanson
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
15
|
Amin NH, Old AB, Tabb LP, Garg R, Toossi N, Cerynik DL. Performance outcomes after repair of complete achilles tendon ruptures in national basketball association players. Am J Sports Med 2013; 41:1864-8. [PMID: 23733634 DOI: 10.1177/0363546513490659] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A complete rupture of the Achilles tendon is a devastating injury. Variables affecting return to competition and performance changes for National Basketball Association (NBA) players are not readily evident. HYPOTHESIS Players in the NBA who ruptured their Achilles tendons and who underwent surgical repair would have more experience in the league, and the performance of those who were able to return to competition would be decreased when compared with their performance before injury and with their control-matched peers. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data for 18 basketball players with Achilles tendon repair over a 23-year period (1988-2011) were obtained from injury reports, press releases, and player profiles. Variables included age, body mass index (BMI), player position, and number of years playing in the league. Individual season statistics were obtained, and the NBA player efficiency rating (PER) was calculated for 2 seasons before and after injury. Controls were matched by playing position, number of seasons played, and performance statistics. Univariate and multivariate analyses were performed to assess the effect of each factor. RESULTS At the time of injury, the average age was 29.7 years, average BMI was 25.6, and average playing experience was 7.6 years. Seven players never returned to play an NBA game, whereas 11 players returned to play 1 season, with 8 of those players returning for ≥2 seasons. Players who returned missed an average of 55.9 games. The PER was reduced by 4.57 (P = .003) in the first season and by 4.38 (P = .010) in the second season. When compared with controls, players demonstrated a significant decline in the PER the first season (P = .038) and second season (P = .081) after their return. CONCLUSION The NBA players who returned to play after repair of complete Achilles tendon ruptures showed a significant decrease in playing time and performance. Thirty-nine percent of players never returned to play.
Collapse
Affiliation(s)
- Nirav H Amin
- Drexel University College of Medicine, Department of Orthopaedic Surgery, 245 N 15th Street, Philadelphia, PA 19102, USA
| | | | | | | | | | | |
Collapse
|
16
|
Toossi N, Adeli B, Timperley AJ, Haddad FS, Maltenfort M, Parvizi J. Acetabular components in total hip arthroplasty: is there evidence that cementless fixation is better? J Bone Joint Surg Am 2013; 95:168-74. [PMID: 23324965 DOI: 10.2106/jbjs.k.01652] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of cementless acetabular components in total hip arthroplasty has gained popularity over the past decade. Most total hip arthroplasties being performed in North America currently use cementless acetabular components. The objective of this systematic review and meta-analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty. METHODS A primary literature search in PubMed identified 3488 articles, of which 3407 did not meet the inclusion criteria and were excluded. Only English-language articles on either the survivorship or revision rate of primary total hip arthroplasty at a minimum of ten years of follow-up were included. The present study analyzed forty-five articles reporting the long-term outcome of cementless acetabular components, twenty-nine reporting the outcome of cemented acetabular components, and seven comparing cemented and cementless acetabular components. Meta-analysis (with a random-effects model) was performed on the data from the seven comparative studies, and study-level logistic regression analysis (with a quasibinomial model) was performed on the pooled data on the eighty-one included articles to determine a consensus. The studies were weighted according to the number of total hip arthroplasties performed. RESULTS The meta-analysis did not reveal any effect of the type of acetabular component fixation on either survivorship or revision rate. The regression analysis revealed the estimated odds ratio for survivorship of a cemented acetabular component to be 1.60 (95% confidence interval, 1.32 to 2.40; p = 0.002) when adjustments for factors including age, sex, and mean duration of follow-up were made. CONCLUSIONS The preference for cementless acetabular components on the basis of improved survivorship is not supported by the published evidence. Although concerns regarding aseptic loosening of cemented acetabular components may have led North American surgeons toward the nearly exclusive use of cementless acetabular components, the available literature suggests that the fixation of cemented acetabular components is more reliable than that of cementless components beyond the first postoperative decade.
Collapse
Affiliation(s)
- Nader Toossi
- Rothman Institute of Orthopedics, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Toossi N, Adeli B, Rasouli MR, Huang R, Parvizi J. Serum white blood cell count and differential do not have a role in the diagnosis of periprosthetic joint infection. J Arthroplasty 2012; 27:51-4.e1. [PMID: 22608690 DOI: 10.1016/j.arth.2012.03.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 03/13/2012] [Indexed: 02/01/2023] Open
Abstract
Serum white blood cell (WBC) count and neutrophil differential are frequently ordered during preoperative workup of suspected cases of periprosthetic joint infection (PJI). However, their roles in diagnosis of PJI have remained unclear despite previous studies. In this study, preoperative serum WBC and neutrophil percentages were retrieved from hospital charts. The diagnostic cutoff point determined by receiver operating characteristic curve analysis was 7800 cells/μL with 55% sensitivity and 66% specificity for WBC count, whereas the cutoff value for neutrophil percentage was 68% with 52% sensitivity and 75% specificity. Our study confirms the long-held belief that serum WBC count and differential has minimal role in routine workup of patients with suspected PJI.
Collapse
Affiliation(s)
- Nader Toossi
- Department of Orthopedics, Rothman Institute of Orthopedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
| | | | | | | | | |
Collapse
|